In the Midst of Life

1968 CONGESTIVE HEART FAILURE

The year was 1968, and I was night sister of a small provincial hospital. I walked into the ward, and there he was – Dr Conrad Hyem. We recognised each other instantly, though it had been many years since the night in Poplar when we parted. No doubt we had both changed. I was a married woman in my thirties with two children. And he? Well, he was very much changed. He looked frail, sitting up in a hospital bed, breathing with difficulty a bluish tinge around his nose and lips, and an anxious look in his eyes. The ward was quiet after the daytime bustle, and peaceful. A single light glowed above the bed of the frail old man suffering from congestive heart failure. I went over to him, sat on the edge of the bed, and took his hand. He squeezed it, and a crinkle in the corners of his eyes showed his pleasure.

‘Jenny Lee,’ he whispered, ‘after all these years … I have not forgotten you. How could I? And now you come to me when I am dying. You are thrice welcome. What a happy chance.’ He sighed with contentment, and squeezed my hand again, such a weak little squeeze. ‘A happy chance.’ He looked up and smiled once more.

The effort to speak had made him breathless, and he leaned back on the pillows panting, shallow breaths, his nostrils dilated with the effort to take in more air. An oxygen cylinder was beside his bed, and I turned it on and placed the mask over his face. He breathed the life-giving gas for a few minutes, and then pushed it away. I adjusted his pillows, and he leaned back comfortably and closed his eyes. I whispered: ‘I must go round the wards and see my other patients, but I will come back; be assured of that.’ He nodded and smiled and patted my hand. ‘Jenny Lee,’ he whispered, ‘a happy chance.’

A hospital is a lovely place to work in at night. Staff is reduced to about ten per cent of the number required during the day and there are no routine admissions or discharges, no routine surgery, no moving of patients to special departments for treatment, few telephone calls. All is quiet. I refer here to the general wards of a hospital, and not accident and emergency, where day can blend into night, and night is usually more hectic than day.

I went quietly around the hospital, taking the night report from each nurse in charge, seeing a patient here or there, checking a drug, adjusting some treatment, mentally noting this or that to be checked on the next night round, and then returned to the male medical ward, where I sat in the office reading Dr Hyem’s notes. Congestive heart failure was the diagnosis. Long-term diabetes, for which condition I had treated him in the first place, had caused generalised atheroma of the arterial circulation (atheroma – from the Greek for ‘porridge’). Just as a plumber may say, ‘Your central heating won’t work because the pipes are all furred up,’ so it is with the circulation. The arteries become congested and the heart, which is the central pump, gets weaker and cannot work properly.

I paused in my reading to ponder what I knew of his past life, his moral strength, his suffering, his mental anguish, and his heart’s grief at the loss of his wife and children in the Nazi gas chambers. ‘His heart’s grief’ – can the heart grieve, or is it just a pumping mechanism to circulate blood and oxygen throughout the body? Is mankind just a series of reactions to chemical and biological stimuli, or are we more than that? Will we ever know? Perhaps it is better that we can never be sure.

I continued reading. Dr Hyem had had several warning attacks of angina pectoris, which can best be likened to cramp. It is painful but not fatal. For years he had been inhaling the fumes of amyl nitrite and taking digitalis, which is a very ancient extract of the foxglove plant, known to mediaeval monks, and cultivated in their herb gardens. At the same time, atheroma of the blood vessels caused sluggish blood flow, and his heart’s efficiency was compromised. This led to other problems.

Oxygen is the key to animal life. If every cell in our bodies does not receive sufficient oxygen, it will die. That is what had been happening to Dr Hyem for several years. Due to lack of oxygen, the functioning of his lungs, kidneys, liver, pancreas – all his organs – was affected and their efficiency seriously diminished. This is the end result of congestive heart failure.

Eventually, Dr Hyem’s labouring heart could take no more and he had collapsed in a shopping area. An ambulance was called and had brought him to hospital where we were able to treat him. In these days of high biotechnological medicine, the treatment available back then does not seem much – morphine sedation, bed rest and an oxygen tent, amyl nitrite, digitalis, heparin (an early form of clot-buster), mersaryl (an early diuretic). It may seem very little, but it was enough to pull him through, at least temporarily.

I turned to the second page of his notes, and read, ‘Next of kin – none.’ That was all. Dr Hyem, a Viennese Jew, living in the wrong place at the wrong time, had lost his entire family – murdered. At the end of life, all that could be recorded of these atrocities was ‘Next of kin – none.’

Within a few days Dr Hyem improved. His heart rhythm had stabilised and his breathing became easier. The oedema lessened somewhat, and the cyanosis all but disappeared. He was able to get up and sit in a chair. He could walk to the lavatory. He could take a bath, with a nurse’s help. He could talk without exhaustion, and even read a little. His diabetes had been thrown out of control by the attack, and the amount of insulin he had been taking for many years was no longer applicable. His urine had to be tested, and an insulin injection adjusted twice daily, otherwise he would have developed hyperglycaemia and acidosis. But, all things considered, there was a big improvement.

I was so happy to meet him again and to be able to give him my friendship and professional care. Each evening we talked, and this was when he told me a little of his personal wartime experiences. But I am sure he left much untold, things that were too painful to put into words. I expressed my surprise, once, that he was not bitter. He said: ‘We have to forgive the unforgivable. But that does not mean forget. These things should be remembered. But if we do not forgive, we will poison our lives, and the lives of others, and evil will win.’

I thought of my poor Uncle Maurice, who had spent four years in the trenches in France and Flanders in the First World War, and whose whole life had been eaten away by savage hatred and resentment. He spent forty years hating mankind. Dr Hyem’s philosophy of forgiveness was not only wiser, but kinder to himself.

We could talk only for short periods because, firstly, it tired him, and secondly, I was night sister, with a whole hospital in my charge and many duties to attend to. Nonetheless, I was grateful for the opportunity to get to know him better.

Sometimes he spoke of death, as my grandfather had. ‘My time has come and I am content. “Everything in its season”, as the prophet teaches us; “there is a time to live and a time to die”.’

On another occasion he said, ‘I have seen so much horrific death in the camps and I think about the spirits of the departed more and more as I draw closer to them.’

Little sentences or half sentences, here and there, built up a picture of his philosophy.

‘Why did I survive? I often wonder. Why did I have to bear the perpetual pain? To die would have been easier. I’m glad my time has come at last.’

On another evening, he was reading his Hebrew prayer book when I approached his bed. He looked up, with a wry smile.

‘From ancient times Jews have described death as “God’s kiss”. Wishful thinking on the part of a people who have suffered for two thousand years at the hands of cruel men, I think. Death is only a “kiss” if it comes naturally. What do you think, eh, Jenny Lee?’ (He always called me by that name.)

One evening, he said to me, ‘I know enough about the human body to know that one day, perhaps quite soon, I will have another heart attack and that will be the end of my life. I want it to be the end. I don’t want anyone messing about with me, trying to pull me back from the brink.’

‘It’s unlikely,’ I said. ‘This is a small hospital. We only have a resuscitation room with two beds, and I don’t think it is very well equipped. Anyway, you are seventy-eight and no one with any sense is going to try resuscitating a man of your age.’

‘That’s a comfort. Nonetheless, promise you won’t let them do it.’

I promised, but said he should speak to the consultant and to the ward sister about his wishes. He told me that he had already done so.

These were the last words that Dr Hyem spoke to me. I went off duty at 8 a.m. During the day he suffered a massive heart attack and was not expected to live. The onset had been sudden. He was reading the morning paper and gave a cry, clutching his chest, and collapsed unconscious. It was thought that a blood clot, which is always liable to develop if the circulation is sluggish, had probably lodged itself in one of the pulmonary arteries.

Dr Hyem was treated as an emergency, with all the drugs and equipment available at the time, and he rallied.

At 8 p.m., when I went on duty, Dr Hyem was semi-conscious, but stable. If it had not been for the drug treatment and oxygen he would have died, probably within an hour or two of the infarction. However, he was close to death. I looked at him with deepest sadness. To lose an old friend is not only sad, but always tinged with regret, regret for all the little things left unsaid or unfinished. I had planned, in my mind, that, as he seemed to be getting better, and as he lived quite close to us, he could become part of our family group. I knew that my husband, an intellectual if ever there was one, would like him and be endlessly fascinated by his conversation. Perhaps my little girls would like him, too, and see him as a grandfather; this would be a source of happiness to him in his old age. All these plans – and now it was not to be.

A nurse was taking his pulse and blood pressure when I went into the ward. I told her to stay with him, and that I would return when I had completed my first night round in order to sit with him.

I completed the night round and returned to Dr Hyem, taking with me all the hospital notes and records from my office, so that I could write them up while I was sitting there. I told each of the nurses and the night porter where I would be, if needed.

I sat behind the curtains in the dim, green-shaded light. I listened to the hushed sounds of the ward. Dr Hyem was no longer in pain. He was unconscious, or perhaps semi-conscious, and breathing slowly but deeply. His pulse was not perceptible at his wrist, but I could feel the carotid beat, very faint and irregular. His eyes were closed, and his expression peaceful.

At ten o’clock we turned him, a nurse and I, and he seemed to be faintly aware of the movement. I leaned over him and said slowly and clearly, ‘Hello, Dr Hyem. It’s Jenny Lee. I am here with you, and I won’t go away.’ He made the faintest sound to indicate that he had heard and understood. I took his hand, and his fingers moved in response. Then he sighed and drifted into sleep again, or was it unconsciousness? Where are the boundaries in these states? Later, he was beginning to feel hot, so I took a cold flannel and wiped his face, neck and chest. Again a faint sound, a sort of appreciative ‘Mmm …’ on the outward breath told me that he knew I was there, and that he wanted me there.

I have always been convinced that unconsciousness, in a dying patient, is not wholly without perception or feeling, or even thought. The dying, even to the last breath, know who is with them. Perhaps they drift in and out of awareness of this world and indifference to it. Perhaps they are entering, or perceiving, another world that we cannot see. Where does life begin, and life end? Where do two worlds meet, or is it an illusion? We will never know. Birth, life, and death are mysteries and it is fitting that we should never know.

I sat with Dr Hyem for an hour or more. A telephone call came through, and briefly I went to another ward to answer a nurse’s request to check a drug, but returned to my friend’s bedside. He looked very peaceful, and I felt sure he would slip away before morning. The darkest hour before dawn is the time when the forces of life leave the body most frequently. After the tragedies and traumas of his life, I was glad that Dr Hyem was dying peacefully and painlessly.

At about midnight, an urgent call came from the children’s ward. A baby who had been operated on for repair of a cleft palate was having breathing difficulties. I said I would come and asked a nurse to stay with Dr Hyem.

The baby was choking and turning slightly blue. The night nurse had been feeding him water, but a little must have been regurgitated into the nasal cavities, making him choke. It was alarming, but not terribly serious. Holding him head down, patting his back to encourage coughing, and sucking out the fluid, restored normal breathing fairly quickly. The baby took no harm. However, one look at the nurse told me that she was in a far worse state than the baby. She was deadly white, shaking and sobbing uncontrollably. Not long before that incident a baby had died in a nurse’s arms, and the whole ward had been sad and subdued. No doubt the girl was thinking of that. She kept saying, ‘I don’t know what happened, Sister. I don’t think I did anything wrong. Was it my fault?’ I had to reassure her and told her it could have happened to anyone. I suggested she should sit quietly, cuddling the baby, for a while, and asked another nurse to bring her a cup of cocoa.

With one thing and another, I was away from the medical ward for longer than was originally expected.