As I take my position by my mother’s nursing home bedside this is what I write in my journal; Day One of Dying.
I suspect I am thinking her death will be more drawn out than it is. How many days am I planning on?
She has spent the previous day in Fremantle Hospital. Like a scene from Hieronymus Bosch’s Hell. Full of vomiting, retching, gagging, coughing souls. Later I am told that the hospital has declared itself; Code Black. To the layman this is bursting at the seams. Patients are served up on skinny trolleys. Obtunded. Gurneys jam the space that is supposed to be a corridor. I see a man with a gourd-like belly just covered by a triangle of hospital linen. He is one of the many waiting. Patients, like cattle, stare out into the maelstrom of the central emergency area where the doctors, nurses and ancillary staff zig-zag back and forth before them. Buzzing like flies. Drawn to the smell of carcass. Maybe patients think if I stare long and hard enough someone will come. Then a scrub-suited someone places a stethscope on a chest, eyes to the ceiling, and then moves on. Someone might take a blood pressure. Find a pulse. Scribble it down. Order blood to be taken. Boot-faced nurses. Soft-shoed staff mesmerised by chest xrays on screens. Backs to patients. Speaking to relatives on the phone. Looking at the far corner of the wall, any place other than eye-contact with a patient or a pleading relative.
When I arrive in Emergency it is already late. People should be at home, in front of the telly, or in bed with hot cocoa. Instead they are wanna-be patients waiting to be called through. But their wait depends on the level of severity of their illness. Best be dying to get their attention. Some will still be sitting watching the screen when I leave many hours later. Go home I think. I see the triage nurse and say my mother is in Emergency and that they are expecting me. Indeed they are. A nurse has to show me where Mum is and I am met by a young doctor in scrubs. He seems reluctant to discuss her in the corridor and says perhaps we should go somewhere private. He leads me into a room that someone has tried to make nice, but has failed. I get the sense the room embarrasses him, but what can he do? It has a painting of scenery on the wall. It is a little wonky. I can’t recall the scene. A lake bordered by forest? There is a vinyl couch (where I am supposed to sit) and a chair opposite it. It is where doctors deliver bad news. Bad news is thick in the room. It has made a home for itself here. I think how I prefer the corridor. I have already spoken to this doctor on the phone, so I know what he is about to say. Words like critical, sepsis and no white cells seemed to stick. Others, like the importance of her blood gas result, seem to fade. I remember his stethoscope necklace and the gentle grasp of his handshake. His face is Scandinavian, soft and sincere, as he delivers the poor prognosis and I think I like him. Mum would like him too.
Then I see her. Defrocked and in a hospital gown. Her bird-like chest is barely covered. Beneath her skin, by her collar bone, is her pacemaker. Her small bundle of clothes are in a blue plastic laundry bag at the foot of the bed. I remember Dad had a similar collection of belongings following him from ward to ward, from hospital to nursing home. She is a little bit confused, but knows it is me. I take her hand. She understands she is in the hospital and that she is pretty sick. But they will heal her. She is thirsty. No wonder. It has taken several hours to examine her and conclude she is dehydrated and get her on a drip.
They move her from a curtained cubicle in Emergency to a room in the corner, with a more comfortable bed. The corner room is normally reserved for women delivering a baby. It is a closet really. As windowless as the rest of Emergency. A bunker. Do they imagine she will die here? She has multi-coloured cords recording her heart beat and its rhythm, as well as a baboon-making oxygen mask and an intravenous infusion.
I sit watching her. Listening to the electronic beeping of her machines. I watch the fluids running in, and hear the hiss of the oxygen being delivered. I think the amount of intravenous fluid they are giving her is what I might give a sick terrier. I check that urine is flowing out into the bag hanging by the bed. The urine is still more concentrated than it should be, but less cloudy than it was. It has looked worse. Infection is treatable. That is what antibiotics do. I see another doctor, a medicine registrar, this time. He is somewhat scathing of the nursing home and their level of care. He rolls his eyes when I describe her recent turn as TIA. He asks if brain scans were done. No, I answer. How was it decided that a stroke was the cause of her collapse then? It’s just what they suspected, I answer. Hmm. I see. I see. More hurling around of the word critical.
She does not look critical to me. I remember my mother doesn’t believe in death. I go home. I blurt it all out to Graham.
The hospital parking is worse in the morning and I have to park a few streets away. She is still in Emergency. Still in the closet room.
When I arrive I find her desperate for water. There are no cups by the sink used to wash your hands. I ask a nurse. They say she can’t have oral fluids. She is in danger of choking and getting an aspiration. She is on a drip. She won’t be dehydrated, they say. They leave. Still she asks me for water. I wet a paper towel and dribble water from it into her mouth. I can see how dry her tongue is. Her lips are cracked. She sucks up the little droplets. I feel good about doing this. I am mistakenly wetting her gown. I pat it with the paper towel. I keep giving her water. I stroke her forehead.
I stand out in the corridor and survey the emergency room for oncoming doctors or nurses. All that is out there are other sick people. They are searching too. Their faces are worried. Scared. They have had their clothes removed and are in hospital gowns. They haven’t their shoes on. Some don’t have any underpants. They sit or lie on beds or trolleys. Some hold oxygen masks to their faces. Some hold kidney dishes to retch into under their chins. I am wondering how it is that I am normally so fond of hospitals.
The nurses come in to check her and to fiddle with the machine. They call her sweetheart and darling but the overused word is so devoid of compassion that they could replace it with any other noun; try pot plant. It might get more water. I am not sure what they think of her or me. I am not sure they care for us and that is what is crushing in on me and making my eyes fill up with tears. I don’t want to cry in front of people who don’t care that I am crying. I ask them to bring her a pan, because she is telling me she wants to use the toilet. They mistrust that I know, or she knows, what she wants, but I assure them she knows. She is not demented, I plead. But she can’t manage to use the pan and is still uncomfortable and I can’t settle her. I wonder if the nurse is thinking; See, I told you so.
We are setting up an adversarial relationship. I don’t want it to go this way. I want them to work for us. Like us. Help us. Mum is now begging me to get her to the toilet, but I can do anything. She might have sepsis, but all she really wants to do is to have a crap.
Then we are swooped in on by her team. They stand at the end of the bed, all six or so of them, while a young, nervous doctor gives the summary of her case. The consultant is the oldest in a tweed jacket. He is Irish with a lilting accent. Despite the chaos of Emergency he has not forgotten his manners. He addresses my mother and talks to me. He takes his time examining her. He listens to her chest. He looks at her neck and the bulging of the vessels pulsating in it. He points it out to his underlings. I tell him she is thirsty and he gets the bed head raised and hands her a plastic cup of water. She drinks from it. He wants to get rid of the wires and tubes and get her off the drip. He says yes she has sepsis. She is not mounting a good response. He thinks she should recover from this episode but sepsis will get her in the end. It’s not a bad way to go, he says. Make sure you have a blue form signed. He means make sure she has a DNR. You can go home to the nursing home and be treated there if that’s what you want.
To be continued…