Ageing is inevitable we hope, good health and a long life is one of the most universal of wishes. Some are not so lucky, they find themselves with a long life and poor health, they may even lose themselves in the process and are left in distress and decay as their physiology keeps them alive when they have long since departed.
At school we studied the poem Old Woman by Ian Crichton Smith. The words are forever ingrained in my mind as when we learnt it I was “volunteering” in a nursing home (as prospective medical students are prone to do to demonstrate their commitment to being a doctor- a frankly ridiculous idea perpetuated by mediocre state schools) and the horrors and indignities that I saw in there whilst simultaneously studying the poem cemented his words.
I hated those Wednesday mornings, I hated the nasty, fat old bags who worked in the nursing home who could see my obvious dislike for my task. They all used to ask me why I didn’t want to be a nurse, as though what we were surrounded by was something that many straight A students aspired to.
They didn’t like my ambition, my confidence that I would not be wiping arses in a nursing home and that I would be a doctor. The city I grew up in is at times the kind of city where people are encouraged to stay in their place, to dream small and not get ideas above their station, and more than 20 years ago that certainly applied to uppity 16 year old girls. I hated what they made me do: feed old people Nice biscuits and thickened tea. It used to make me retch, what a wicked little cow I was. I hated it with a passion and would retch and gag all the way back to school when I smelled Nice biscuits and tea on my fingers and hands.
I have a patient just now who makes me think of this poem. He is paralysed from a massive stroke and keeps blowing up his colon to enormous dimensions necessitating a trip to the endoscopy department every few days to suck shit and gas out of his backside. He eats his water, coffee and tea, he cannot drink it; he has thick and easy (the name is the source of lots of amusement in hospitals) added to every fluid so he doesn’t choke on it. He is fed it on a spoon. He cannot speak, he communicates by raising his eyebrows and looking distressed.
I am not imprisoned in pity and shame like ICS is in his poem, although I have found myself wishing to be away. I am too used to decrepitude to still feel shocked by it. I just feel so helpless; he’s too frail to have his colon removed or fixed and yet he keeps volving and requiring decompression.
I see the students faces sometimes when we are confronted with the naked vulnerability of patients, I see them hesitate to help lift someone’s legs, or wipe the spit from their cheeks or the faeces from their legs or a bit of sick from their hair. You see them visibly recoil from the ugly reality of the provision of care.
Maybe they should all be forced into nursing homes as school pupils. Maybe it does teach them something, because I see the same look on some of my colleagues faces as well as they wait for a nurse to come and wipe or lift or care.
Old Woman by Ian Crichton Smith.
And she being old fed from a mashed plate,
As an old mare might drop across a fence
To the dull pastures of its ignorance.
Her husband held her upright as he prayed
To God who is all forgiving to send down
Some angel somewhere who might land perhaps
In his foreign wings among the gradual crops
She munched, half dead, blindly searching the spoon.
Outside the grass was raging. There I sat
Imprisoned in my pity and my shame
That men and women having suffered time
Should sit in such a place in such a state
And wished to be away, yes to be far away
With athletes, heroes, Greeks or Roman men
Who pushed their bitter spears into a vein
And would not spend an hour with such decay.
“Pray God” he said “we ask you God” he said
The bowed head was quiet, I saw the teeth
Tighten their grip around a delicate death.
And nothing moved within the knotted head
But only a few poor veins as one might see
Vague wishless seaweed floating on a tide
Of all the salty waters where had died
Too may waves to mark two more or three.