Each morning when I came on duty I expected to find the side ward empty, but for two mornings he was still there. How extraordinary is life, that one can hang on in that condition, neither alive nor dead? But on the third morning the room was empty, and the night nurse reported that the flickerings of life had given way to the smothering curtain of death.
FAMILY INVOLVEMENT
Mr Elias Roberts had an enormous family, which seemed to expand with each passing day. They were Jamaican and had immigrated to England in the early 1950s, seeking a better life, better education, and better prospects for their children. They had stepped off the boats in their Sunday best, raw and hopeful, into an exhausted and war-torn England. A better time was a long way off. Jobs were plentiful because rebuilding Britain was a priority, but finding somewhere to live was near impossible. Mr Roberts had eventually found a single room at the top of a derelict house for himself, his wife and their two youngest daughters, but the older boys and girls had had to make their own way.
Mr Roberts was admitted to the Marie Curie Hospital suffering from prostate cancer, which had been treated by prostatectomy in the Royal Free Hospital. He had come to us for radium treatment but the widespread metastasis in the bones was clear evidence that the treatment had come too late.
When I was a young girl, I was told that men who had difficulty urinating carried a catheter coiled in their hatbands. When they needed to pass water, they catheterised themselves. At first, they would inevitably develop an infection, but the body’s immune system is built to fight that, and once these men had got over the initial bouts of infection, the body became immune to the germs lurking in the hatband.
Testing for cancer was not routine. Some men went to a doctor, but the treatment was fairly rudimentary – diuretics, potassium citrate, no alcohol, barley water – none of which was effective. Later, in the 1940s, the female hormones oestrogen and progesterone were prescribed in the hope of reducing the enlargement, but it is doubtful if these treatments did much good. Consequently, a great many men developed such massively distended bladders, filled with retained urine, impossible to pass normally or by catheter, that abdominal entry was necessary and a supra-pubic catheter had to be inserted to drain the fluid. I was in theatre once as the ‘runner’ - the lowliest member of the team - when a man was wheeled in with a massive lump in his lower abdomen; it was his bladder. He had not been able to pass urine for weeks. It was impossible, even under anaesthetic, to get a catheter past the enlarged prostate, so a supra-pubic insertion was made and more than a gallon of urine was drained off. The man died from surgical shock.
That was an extreme case, and the worst I have seen, but a great many men had to endure weeks in bed with indwelling catheters, twenty-four-hour drainage, daily bladder irrigation, uraemia, antiseptics and antibiotics before a prostatectomy could be attempted. Sometimes I felt that the catheter in the hatband would have been the better option.
This was all embarrassing and unpleasant for a sensitive man because there were very few male nurses in the profession; so young girls almost always performed such tasks. Incidentally, nursing procedures were comparatively basic. The following is taken from Wilson Harlow’s Modern Surgery for Nurses (1956):
There are various means of retaining an indwelling catheter in the male urethra. A common method is to attach four pipe cleaners, or two pieces of tape, to the catheter. The ends, which should be 4—6 inches long, are then brought up and fixed to the penis by a piece of Elastoplast or bandage. A similar retainer can be constructed out of a piece of sheet rubber fitted with holes and collar studs to fasten it to the penis and catheter.
I do not know what humiliations Mr Roberts had been subjected to before or after the prostatectomy, but when he came into the Marie Curie, the cancer was widespread, and there was no hope of cure. Nonetheless, the Chief decided on six doses of radiotherapy to try to control the spread, and eight if the results were favourable.
Mr Roberts’ wife and two of their eldest sons came with him. She was an unexceptional woman, apart from two trusting brown eyes that forced the word ‘integrity’ into your heart. She said that they would prefer to look after her husband at home, but they had only one room and had to climb sixty-four stairs to reach it. The Chief said that we would look after him well, and that they could visit any time, day or night. Doctors, I have found, make these rash comments without the slightest thought to the practicalities involved!
Mr Roberts said, ‘My days are numbered, so I thank you, kind doctor. My family will continue my life that is running away from me.’ He squeezed his wife’s hand and said ‘The Lord giveth and the Lord taketh away. Blessed be the name of the Lord.’ His wife whispered, ‘Blessed be God in his wisdom.’ The two boys said ‘Hallelujah’ and then one of them let out a howl. His mother said: ‘Abraham, you stop your noise right now. The good sister no want your noise in her nice quiet ward, you hear me?’ From such a small woman the effect was surprising and instantaneous.
The Chief smiled and left, saying, ‘I leave it in your capable hands, Sister.’ The wife left also, as the two youngest girls were due home from school, but the two young men said they were doing the night shift at a nearby warehouse, and could stay. As it was close to visiting hour, I agreed.
In those days, visiting hours were very strict. Too strict, I felt, but hospital discipline had to be maintained. I was glad to relax the rules when I could, but the Chief’s comment about unlimited visiting day or night was going a bit too far. Three o’clock came, and the visitors who had gathered outside were admitted. One or two wanted to see me, but mostly I was left in peace to check the drugs and equipment and to complete what little paper work there was to be done. At four o’clock I asked a nurse to ring the bell to inform people that visiting hour was over; almost simultaneously the clip, clip of high-heeled shoes was heard in the corridor, and three women walked straight into the ward. The eldest one was smartly dressed in a suit, and the two younger women wore pretty dresses. They all had hats and white lace gloves. I called to them, and they turned.
‘We come to see our daddy,’ one of the girls said.
‘But visiting time is over,’ I replied, ineffectually.
‘We come any time, day or night. The doctor, he say.’
‘Yes, but—’
The older woman stepped forward and folded her arms.
‘No but! Who are you, anyway?’
‘I am the ward sister,’ I said, hoping I sounded confident.
‘You!’ she said scornfully. ‘You too young to be ward sister. In Kingston, ward sister is a big, strong mamma, fifty years of age, a woman who know how to handle men. Not skinny girl like you, no way.’
I was completely squashed.
Visitors were beginning to leave and we were blocking the doorway. I stepped aside and the three women took it as a sign that they should proceed to Mr Roberts’ bed. The two men stood up. One of them kissed the two younger girls, calling them sister Faith and sister Mercy, and the other said to the older woman, ‘Well, well, Aunt Adoration, what you doin’ here? Long time no see,’ and he shifted on his feet with a smooth, boneless motion.