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.
OPEN HEART RESUSCITATION
(also known as Direct Manual Compression)
I returned to the male medical ward to resume my vigil with Dr Conrad Hyem.
Tread softly as you draw near to the bedside of a dying man, for the space around him is holy ground. Speak in hushed tones, with awe and reverence, as you would in a cathedral. Let not the mind engage in trivial thoughts. The awesome majesty of Death can only be met in silence.
As I approached the ward, I was aware of light and commotion coming from within, and when I entered, I saw that it was coming from Dr Hyem’s bed. The curtains were drawn, but brilliant light was shining and half the men in the ward seemed to be awake.
I pulled aside the curtains and found a full-scale open-heart resuscitation being carried out by three doctors, one of whom, the registrar, had a scalpel in his hand.
Dr Hyem was lying flat on his back. His chest had been cut open on the left side, from the sternum to the lower back ribs. Blood was oozing out, and the smooth chest muscle was glistening in the bright light. Rooted to the spot, unable to breathe or make a sound of protest, I watched the registrar with a swift, easy movement slice through the pleural muscle, revealing the ribs.
‘Retractor,’ he demanded.
I found my voice. ‘No! No! What are you doing? Stop! Stop it, I say!’
He ignored me. He inserted the retractor between two of the ribs, and turned the ratchet to open the double arms of the instrument to their full potential. I heard a rib crack.
‘Stop it!’ I shouted.
Perhaps he had not heard, as he continued with the ratchet, and I heard a second rib crack.
‘Scissors,’ he demanded.
By then I was getting close to hysteria. I took a couple of steps forward.
‘What are you doing? Stop it. He’s dying – can’t you see that? Leave him alone.’
The doctor was cutting through the pericardium with surgical scissors. He muttered, ‘Who the devil are you? Get to hell out of here.’
He inserted his hand through the open chest wound and grasped Dr Hyem’s heart; then he began a series of steady, firm compressions.
There was blood all over the place, dark venous blood, black and sticky, covering the doctor’s white coat, and the sheets and pillows scattered across the floor.
‘It’s fibrillating badly, but at least there’s some movement,’ he said as he continued his compressions. ‘How long have we been at it?’
‘Two minutes twenty,’ replied one of the housemen.
‘Not bad. If we keep it up, we should win. Here. You take my place. Then you will know what to do next time.’
He withdrew his hand and stepped backwards. One of the others took his place and inserted his hand through the hole in the chest wall.
‘Can you feel the heart?’
The young man nodded.
‘The ventricles fibrillating, like a jellyfish wriggling?’
Again the houseman nodded.
‘You can? Good. Now just squeeze the lower myocardium – regular – firm – steady; one squeeze about every second. That will force the blood upwards, out of the ventricle into the upper chamber and into the circulation.’
This was obviously a teaching exercise.
The older man stood up and stretched his back. He wiped his bloody hand down his coat.
‘That was good,’ he said with satisfaction. ‘We are winning. I can feel a pulse in the jugular.’
Then something spine-chilling occurred. Dr Hyem, lying flat on his back, opened his eyes and stared into the brilliant light shining directly on him. His mouth hung open, and a rasping roar was emitted from the depths of his throat. It was a ghastly noise, like the whoop or howl of an animal in agony. The sound rose to a crescendo and then stopped abruptly, and the silence that followed was almost more dreadful than the roar.
I ran around to the other side of the bed and took Dr Hyem’s head and shoulders in my arms in a futile attempt to protect him. He looked at me, I swear he looked at me, and in his eyes was reproach. He had said, ‘When my time comes I want it to be the end. I don’t want anyone messing about with me.’ I had promised that he would die peacefully, and I had let him down.
I have lived with that look of reproach all my life.
‘I told you to get out of here, woman. Now clear off and don’t interfere,’ barked the registrar.
‘I am the night sister,’ I exclaimed, ‘and Dr Hyem is in my care!’
‘Bloody fine care you give, trying to be obstructive.’
Then to the team, ‘He’s coming round. Excellent. Ah! There’s the porter with the machine. Splendid. Bring it over here.’
He spoke to the two younger doctors. ‘Fix it up, and it can take over the massage. Now, we will want a central line through the iliac vein, and another in the subclavian, but try the iliac first, and a shot of adrenaline direct into the myocardium. Get a tracheal tube down him, and fix up the oxygen supply.’