'In the Midst of Life'
In the Midst of Life
Published by Weidenfeld & Nicholson
'Much of this book is dark and dreadful...' This is a quote from p. 329 of Jennifer Worth's new nursing memoir/social commentary, and by rights it should perhaps appear on page one, as a fair warning to her readers. Worth is a demandingly forthright author, her principal subject here is dying and death, and much of her material is deeply harrowing. But she's also truthful and compassionate, and ultimately positive - and her examination of the issues raised by recent medical developments in the prolongation of life deserves our most urgent and serious attention. She is not at all, as she also writes on p.329, 'a miserable old stick, best avoided'.
Even as a first-year student nurse at a Reading hospital back in 1953, medically a far simpler time than today, Worth soon met cases that gave her reason to question the establishment's indiscriminate application of the latest life-prolonging techniques to patients with clearly no wish, or reason even, to continue to live. She took her problems finally to her highest authority, Matron Aldwinkle, who firmly told her, 'Nurse, you are young and passionate. You are trying to understand a subject too deep for understanding. Medical science has found hundreds of death-defying tactics and, as this century unfolds, thousands more will become available. We do not know where it will end. Perhaps we will come to a point when human beings are unable to die... I advise you, Nurse, not to talk freely with other people on this subject. It is dangerous.'
Matron Aldwinkle was depressingly prescient. Basically the rest of Worth's memoir of her subsequent twenty-five year professional nursing career recounts case after case in which medical interventions, sometimes made for the best of reasons, but often simply by default, for fear of litigation or even of prosecution, had devastating effects upon patients and their carers. And now, after another twenty-five years, the situation is still not much better, and in many ways is even worse.
Except that, happily - and thanks in large part to the pioneering 1960s work of Dr Elizabeth Kübler-Ross, to whom Worth devotes a full chapter - the silence that Matron Aldwinkle so strongly advocated is being widely broken. Death and dying, along belatedly with sex, have been allowed out into the open. And here in this book, the issues that Aldwinkle was so afraid of discussing are exposed in all their uncomfortable complexity. Worth offers no easy answers. No-one would expect it. But the penetrating questions she asks her readers are always constructive, and set in the touchingly human context of her own experience.
I don't agree with all her attitudes. In a book of this length and depth, that hardly needs saying. But in view of where this review will appear, I do think her foggy thinking on the subject of assisted suicide is worth a mention. While I sympathise with her doubts about our mantra Dignity in Dying - 'Dying is a biological process,' she points out brusquely,' and there's no dignity to it, as anyone who is familiar with death will tell you' - I'm not so happy when she comes to discuss the Swiss clinic, Dignitas. 'This clinic gives me the creeps,' she writes. 'What sorts of people administer it? I shut my mind to such thoughts.' And a few pages later, 'Its philosophy seems so logical and, in a way, humane. And yet... I have long had severe reservations about Dignitas.' Reservations, Mrs Worth? Tell us about them. Don't just leave them dangling.
Also, as a Christian, she's muddled about atheists, and tells us that since they believe 'that life is nothing more than a series of electrical impulses and biochemical reactions, presumably such thinkers see death as the worst thing that can occur, because it means the end of everything. Therefore, (logically), maintaining the continuance of physical existence, under any circumstances, is entirely justifiable.' Logically? Surely not.
Finally, though, I must celebrate the chapter, Who Cares?, in which Worth examines the changed structure of the nursing profession. When she was a student nurse, fifty-odd years ago, her training was almost entirely hands-on, three full years of basic bedside ward work. Today, with the proliferation of drugs and techniques, plus the administrative complexities of running a modern NHS hospital, nurses are necessarily required to have a sound college education in the sciences, at least to degree standard. They are technocrats, computer-savvy and pharmaceutically knowledgeable. We see them hard at it in the nurses' station whenever we visit a hospital, just as we see another level of carers, known as health care assistants, doing most of the less academically-demanding ward work. These invaluable people carry out just about all the tasks once performed by three-year-trained nurses, yet will often have received no more than a few days' training, and - revealingly - their pay is seldom above the legal national minimum, between five and six pounds an hour in 2010, with no guaranteed sick pay, holiday pay or maternity leave, and no guaranteed pension.. As a measure of how their employers (ultimately you and me) value them, such a pay scale is clearly insulting and quite scandalous.
Obviously, although these deserving people will become ever more needed as our society ages, this is no time to be campaigning for anybody to get a wage increase. All the same, as Jennifer Worth poignantly asks us, 'Would you, reader, do it? Could you? Would you advise your son or daughter to become a health care assistant?'
D G Compton