In the Midst of Life

FORGET-ME-NOTS

‘Show us your wedding ring, Sister.’

I held out my hand for the ladies in the day room to admire.

‘It’s lovely, dear. You look after it, and your man. Keep them special.’

‘What’s he like, Sister? Tell us about him.’

They crowded round, the female interest in love and marriage alive in the face of death. I had brought the photo album of our wedding for the ladies to see.

‘He looks nice,’ said one.

‘You can’t trust men,’ said another.

‘Oh, don’t be a sourpuss. There’s good and bad everywhere, and I’m sure Sister’s chosen a good one.’

‘Mine broke my arm for me.’

‘Mine could never stop. Fifteen pregnancies I had. Even on his deathbed he was after it. He’s gone now, good riddance. I’ll bet he’ll ask the angels for it.’

A burst of laughter among the women. I loved them all, and was glad to see they still retained their sense of humour. We nurses were always told that we should keep alive an interest in life, tell the patients about our days off, our interests, families, boyfriends and the dances we went to. I even encouraged nurses to flirt with the men – anything to divert their minds. Cancer patients often feel surprisingly well, in spite of the malignancy, and keeping up hope was an important part of our work.

I tried to tell them about my young husband.

‘He’s very clever. He’s a schoolmaster.’

‘Oh, fancy that. A schoolteacher, eh? That’s nice. Did you hear that, dear? Sister’s new hubby’s a school teacher.’

‘Uh?’

‘A schoolteacher, dear, Sister’s new hubby. Oh, she’s not with us, poor soul. It’s a shame.’

‘What’s he look like? Tell us.’

‘He’s tall and good looking, very distinguished,’ I said.

‘Ooh, that’s nice,’ from the cheerful one.

‘Handsome is as handsome does,’ from the sourpuss.

‘Blue eyes or dark?’

‘Blue.’

Little Mrs Merton looked up wistfully. She had not spoken, but had been twisting her wedding ring round and round her finger. She was very small, and had a childlike quality that you sometimes meet in the very old. Her eyes were particularly appealing. They revealed patience, kindness and sadness, but also humour. We knew she had a sarcoma that was consuming her bones, but she thought the pain was due to rheumatism, and we let her think this.

‘My Bert’s eyes were blue,’ she said, ‘forget-me-not blue. He was a lovely lad, my Bert, no one like him. Before he went, I gave him a little picture. It was a woodland scene of forget-me-nots growing under chestnut trees. He always said my hair was chestnut brown, so it was like a little picture of us both, you see.’

‘That’s nice.’

‘That’s pretty.’

‘What a nice idea,’ the ladies chorused.

Mrs Merton looked pleased and flattered.

‘I thought so, and so did he. He took it with him when he went off to the Great War. I’ve got his likeness here. You can look at it. I’m that proud of it.’

She took a locket from around her neck, and opened a small silver clasp.

‘That’s my Bert.’

She handed it around lovingly. Boyish features with smiling eyes looked out at us.

‘He was such a lovely lad, always laughing, always happy, proud of his uniform – oh, I can mind him now, marching off.’

She smiled as she took the locket back and hung it around her neck. ‘I’m never parted from these – my wedding ring, and the likeness of my lovely lad. He was nineteen when we were married in 1915, and two months later he marched off to the war. Oh, I can mind him still, waving and smiling, and marching off.’

‘Did he come back?’

‘No, he never came back. Smiling and waving, he was. But my lovely lad, he never came back.’

The clock ticked on the wall, and the evening sun cast long shadows through the window. Traffic could be heard in the street, but in the day room no one spoke. Fifty years of love, still burning after only two months of marriage, could be felt by all the women.

Then Mrs Merton spoke again.

‘When I got a telegram saying “missing presumed dead” I knew he was gone for ever. I cried for two years, and for ten years I ached all the time. All the time –just here.’ She put her hands up to her chest. ‘Here it was, the ache. It was terrible. Terrible it was, far worse than the rheumatics.’ She chuckled and looked around her. ‘Rheumatics is nothing compared to the pain of losing your only love. A great wound, it was, open and bleeding just here.’ She pressed her hands on her chest again. ‘I can’t explain the ache, the feeling, but it was there all the time, never went away, ten years, the ache, ten years…’ Her voice trailed away.

There were sighs of compassion among the ladies.

‘Wicked it was – half our lads gone.’

‘War’s a crime, I say.’

‘My aunt lost four sons.’

Mrs Merton spoke again, her bird-like features eager. ‘And then, after about ten years, something happened. I can’t explain it, but it did. One morning I woke up and – d’you know what?’

She looked around brightly. We shook our heads.

‘No. What?’

‘The pain was gone. Quite gone. The wound had healed over, and my Bert was there inside me.’

She hugged her chest protectively.

‘Here, inside me, my Bert with his forget-me-not eyes.’ She chuckled. And I’ve never been alone since. He’s always inside me, laughing and waving, and marching off.’

Two weeks later a tragedy occurred that nursing staff always dread, and which usually happens so quickly that nothing can be done to prevent it.

Mrs Merton never wanted to be a trouble to anyone. She was not consumed by fierce independence as some people are, but with self-effacing humility. ‘You girls have got people more sick than me with my rheumatics to look after. I can manage fine. I’ll not be bothering you,’ she would say.

I knew that it was not really safe for Mrs Merton to walk alone, but the alternative would have been to confine her to bed with cot sides around her. This was bad for a patient, both mentally and physically. It deprived them of self-respect and dignity, and was often the start of an almost infantile dependence on the nurses, which frequently hastened the end, quite apart from the fact that it usually caused acute unhappiness. I have seen patients rattling their cot sides in impotent rage and frustration, shouting or weeping, which can have a terrible effect on the morale of other patients in the ward. If the disturbance got too much, I have seen narcotics being given to quieten the patient. This is bad medicine, and bad nursing.

I decided that Mrs Merton should be at liberty to wander around as much as she wanted. In retrospect, this was the wrong clinical decision, but so often in medicine decisions have to be taken, and it is not until later that one can say if they were right or wrong.

One afternoon, Mrs Merton was going into the day room for tea when the diseased bone of her femur snapped. She fell and shattered her pelvis and was taken to the orthopaedics department at the Royal Free for surgery. The femur was pinned and plastered without too much trouble, even though the bone was riddled with cancer, but the fractured pelvis was another matter. It was diseased and shattered in several places, and bits of jagged bone threatened to penetrate her internal organs. The surgeons did what they could, but the result was that the pelvic bone did not mend, and the external wound never healed, as the stitches could not hold the muscle together. Suppuration started around the surface, but it must have been spreading beneath the muscle, because suddenly the whole wound opened up, exposing bone, tendons, ligaments, and muscle, all sticky with pus. The wound was so deep and so extensive that you could get your hand into it.

We did our best. We gave antibiotics to try to reduce the infection and the fever. We packed the wound with flavine gauze and antibiotic powders. We were able to supply one of the new electronic air beds which kept the left side of her body free from bedsores - she had to be nursed on her side all the time because the hip was shattered from the iliac crest in front to the coccyx at the base of the spine. Fortunately, the surgeons had inserted an indwelling catheter into her bladder whilst she was in theatre, so we did not have the nightmare of dealing with the normal urination of a patient in her condition.

The one thing we were able to do which really did help Mrs Merton was give her the Brompton Cocktail regularly. In spite of the seriousness of the wound, Mrs Merton was surprisingly unaware of its extent, because she could not see it. She knew that something was wrong with her hip, because nurses came at frequent intervals to change the dressings, but she could not turn her frail old body to look at it. She knew that her right leg was in plaster, and we supposed that she thought this was the full extent of her injuries. Incidentally, the plastered leg had to be adjusted, and it was one of the most unnerving things I have ever seen because the exposed bone and ligaments of the pelvis moved as we repositioned the leg. It was a job I always did myself, with the help of a nurse, and I insisted that when I was not on duty, an experienced staff nurse should do it. This was a task that could not be left to a couple of inexperienced student nurses.

What is it that we need at the end of life? Peace and love are the words that spring to mind. Weeks, or months, of gradual decline usually precede death, but then, very often, something intangible happens. It is as though body, mind and soul have been tuned differently, like tuning down a string of a violin or cello, so that the vibrations that create the inner resonances of the instrument are altered, and the quality of sound is different. I can find no other way of describing these subtle changes that occur before death takes over. A skin change, something different in the eyes, a weariness of movements, a quieting of the mind – there are many subtle alterations that can be seen, and they are very real. And then the end is usually fairly swift. ‘Let me bide, dears,’ my grandfather had said to his daughters a few days before his death. ‘I want for nothing.’ And they allowed him to die quietly. Most dying people seem to feel the same – the Angel of Death brings peace. Harassing a dying person to return to the life they have already left is a pointless exercise, and in many instances, cruel.

Love is not something that we receive in proportion to our merits; love is a gift of God. And I like to think that ensuring peace at the end of the day is an act of love on the part of the nursing staff. St Paul, in his Letter to the Corinthians, said that Faith, Hope and Love are the greatest of God’s gifts. I suspect that most doctors and nurses will say that faith does not play a great part in tranquillity at the hour of death, because few people mention religion or ask to see a priest. But who are we to judge? None of us knows what is going on in the mind of a dying man or woman, especially if that person is beyond articulate speech. Faith is a private matter, usually held deep within a person, quite impossible to recognise or understand if you have no faith yourself.

There are many reports from people who have returned from a near-death experience, and they are all remarkably similar. Testimonies come from every part of the world, and in all periods of history. Without exception they speak of a profound sense of well-being, and overwhelming feelings of peace and calm. Some people have said they felt safety and comfort, and loving arms enfolding them. A woman has said she felt as though she was drowning in a deep green sea, and the depths contained an inexpressible joy and fullness of life that pulsed more strongly than it had ever done in ordinary life. Many have likened the sensation to lying on the surface of dark, smooth waters, and of being gently supported. Some people have spoken of having no will of their own, but a feeling of weakness and trust and languorous ease. There are also many reports of an enveloping darkness in which a light is shining. Some speak of a longing to reach that light, others of being led gently towards it. One man spoke of a feeling that he was floating between a black sky and a black sea, between which a phosphorescent light shone. A long tunnel of velvety darkness, with a light shining at the end of it, seems to be the common link. There are also reports of beautiful music, often choirs or strings – but no tune that can be named.

These near-death experiences are well documented and the similarities are striking. No one has ever reported fear or horror associated with a near-death experience, and the absence of such reports is strong evidence that the beatific claims are valid.

Biochemists tell us that the feelings of well-being are due to endomorphs, a morphine-like substance secreted by the body in time of need. Areas of the brain secrete endomorph molecules that bind to nerve endings, and the effect is to alter sensory awareness. They tell us that the light is nothing more than the hypothalamus generating electrical sparks into the brain. The chemical activities in the body that induce a feeling of peace and light at the hour of death have nothing to do with God, they tell us, and everything to do with biochemistry.

I grant the integrity of scientists and the validity of their research, but I have seen enough of life and death to suspect that this is not the whole story. There must be more to the strange species we call humanity than biochemical reactions. If there is a God, then perhaps the brain was created to release endomorphs, and the hypothalamus to release light at time of death, for the peace and comfort of the dying.

We will never know what awaits us after death. But we do know, because many people have returned to tell us, that the gentle hand of love guides us through the passage that leads from life into death.

Mrs Merton’s sister was her only living relative. I wrote to her twice, but received no reply and feared that Mrs Merton would be alone when she died. I told the nurses that we must therefore give her special love and care. On the space given for next-of-kin was also the name of Lady Tarrant, a former employer. So I telephoned the number given. The response was immediate. ‘Harriet Merton, you tell me, dying? I did not even know that she was ill! I will come tomorrow, and I will inform my sons and my daughter. They will want to know.’

Had I told the nurses that Mrs Merton needed our love because she was alone in the world? I could not have been more wrong. Mrs Merton was surrounded by love.

Lady Tarrant told me that Mrs Merton had been nanny to her three children and had been given absolute charge of them when she was abroad with her husband. When the children grew up, Mrs Merton had been retained as housekeeper. The whole family loved her, and her devotion to the family had always been well beyond what was expected of a paid servant. Lady Tarrant spent about half an hour with Mrs Merton, who afterwards said, ‘My Lady has been such a support to me in life. She was always so good, so kind. I’ve been blessed.’

It wasn’t until the sons and the daughter came that we saw the extent of their love. They were distraught, especially the youngest, Jason, a man of about thirty-five who was well dressed, competent, affluent. No one would have expected him to break down in my office – but he did. Nanny Merton meant almost as much to him as his own mother. Was she really going to die? Could nothing be done? I assured him nothing would cure her – the sarcoma had been spreading slowly, and now the bones had broken, which usually caused the malignancy to spread faster through the lymph system and the bloodstream. He broke down and wept. I told him to spend as much time as he could with his childhood nanny, because she had, we estimated, only a week or two of life left, and the presence of those who loved her would be precious.

The older brother came with his wife. Mrs Merton was surrounded by pineapples, peaches and grapes, none of which she could eat. When the orchids arrived, she murmured ‘how pretty’ and drifted off to sleep again. But when their sister arrived with her children, who had picked a bunch of forget-me-nots from the garden, Mrs Merton stretched out a frail hand and briefly returned to the world of the living.

‘Forget-me-not eyes … Never forget my Bert, my lad. Smiling and waving and marching off,’ she murmured. The children didn’t understand. How could they?

Before going off duty that evening, I went into the side ward to see Mrs Merton. It was quiet in there. Time had never seemed so measureless, silence had never seemed so intense as it did while I was feeling her pulse, feeling the slow, ever slower pulse of mortality.

A nurse had put the orchids on the windowsill, and placed the forget-me-nots in a small vase on the bed table where she could see them. Mrs Merton sensed my presence and opened her eyes. ‘I will soon be going to my Bert,’ she murmured, looking at the vase. ‘He’s waiting for me, I know. Waiting, my dear lad.’

‘I’m sure he is. I have not the slightest doubt he will be there to greet you,’ I said.

Slowly she turned her eyes from the spring flowers to meet mine. ‘One thing bothers me, though,’ she said softly.

I leaned closer. ‘What is it? Surely nothing can bother you?’

She made an enormous effort to speak. ‘Sister, do you think he will know me? My hair was chestnut brown when he went marching off. He loved my hair. Now it’s all grey. Do you think he will still love me?’

Close to tears, I said very slowly, ‘Mrs Merton, nothing can change love. You know that, don’t you?’ She nodded her head. ‘He is waiting for you, and he loves you. For him, you have not changed.’

A little moan of contentment was her response, and she glanced again at the forget-me-nots. Her lips moved, but her words could not be heard. Then she closed her eyes, and did not open them again.

I telephoned the younger son, Jason, and told him that Mrs Merton would probably die that night. He arrived at about 11 o’clock and sat with her through many watchful hours, and she died as the dawn of a new day was breaking.

None of us knows whether there is life after death, but the simplicity and beauty of Mrs Merton’s faith is something I have seen many, many times. It was not necessarily a religious faith – God, the Church, Heaven, were never mentioned. Mrs Merton’s faith was grounded in love. And God, we are taught, is love.