‘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.