In the Midst of Life (24 page)

Mrs Doherty’s life, for many years, had been perfect, she told all her friends and neighbours. ‘Who could ask for more at my age? I’m in good health, I am independent, I am always busy, but can go on holiday whenever I want. Above all, I see my grandchildren all the time. I miss my dear husband very much, but Jamie has been very good to me since his father died.’

James and Tessa Doherty had three children aged between six and sixteen at the time of this story. They had a large house and garden, and when Jamie’s mother was widowed, they suggested she should come and live with them; but Mrs Doherty valued her independence and did not want to relinquish it. However, a few years later, the house adjoining the bottom of their garden came on to the market and Jamie suggested that they should buy it for his mother. He pointed out that she would have complete privacy and independence, but also be close to her family as she grew older. Mrs Doherty inspected the house, and hesitated. She loved the home she had shared with her husband for forty years, in which they had brought up three children, but she knew that it was too big for one person; she was getting older and would have to move at some stage. The children ran around the empty house with her, full of excitement. ‘You’ll be coming to live near us, Granny. Lovely!’

‘I’m not so sure,’ she replied cautiously. ‘Let me think about it.’

‘Please,’ they chorused. ‘Please, Granny’

‘Don’t pressure me,’ she said.

What tipped the balance of her indecision was the remark of one of the boys:

‘Daddy can cut a hole in the fence, and make a gate, then we can come and see you whenever we want to.’

That
did it. Any woman would have been foolish to refuse. In due course her large house was sold, the new one bought, and the move accomplished. It was total success from every point of view. She had a small but comfortable home, a small garden which she valued, and complete independence. Jamie duly removed a section of fence between the two properties, and a gate was installed, which was always left open. Not only the children, but the dog, ran freely from one house to the other.

Mothers-in-law can frequently be a pain to their daughters-in-law. But Tessa had no such complaint. In fact, she valued her mother-in-law’s proximity, help and company. She was expecting her fourth baby and was feeling more tired than she had in the other pregnancies. The three children, all under ten, were a handful. The summer holidays came, and Tessa was in the last weeks of pregnancy; it was hot, and half the time she was exhausted. The fact that she could send the children down the garden to Granny was a great relief to her. ‘I don’t know how I would manage without you,’ she said. But what she valued most, she realised, was the fact that her mother-in-law never criticised and never interfered. She was helpful, but neither demanding nor domineering. Jamie was delighted. After all, the whole idea had been his in the first place. He congratulated himself on a good plan well executed.

The eldest sibling in the Doherty family, Priscilla, was a successful accountant who lived in Durham with her husband and children. She maintained a good relationship with Jamie, although they did not see each other all that often. Their sister, Maggie, was a freelance journalist for women’s magazines, and a writer of romantic short stories. She had struggled to hit the big time, but had never quite managed it. She was unmarried, but had had a succession of men, each of whom she maintained she loved, and whom her mother hoped would prove to be ‘Mr Right’. But something always happened, and the relationship broke down.

Maggie loved her mother and her brother and sister deeply. They were her anchor in life. She also loved her nephew and nieces as if they were her own and she was a great favourite with all of them, because she was fun, she was lively, and she was full of bright
ideas about interesting things to do and places to go to. They loved listening to her stories, and boasted to their school friends about their auntie who was a writer. When she was ‘between jobs’ she always went to stay with Jamie or Priscilla and enjoyed their family life. It reminded her of her own childhood.

Maggie had been her father’s favourite, and she missed him dreadfully. There was an ache in her heart that would not go away, and she knew that he had been the man of her life, and that there would probably be no one to replace him. ‘But at least I’ve got my brother and sister, and Mummy.’ she thought (though she was over forty she still clung to the childhood ‘Mummy’). And when the brittle existence of a freelancer overwhelmed her, she turned to her mother for comfort. She had been deeply unhappy when the old house was sold. With it, she felt, were sold all her associations with the past.

The Women’s Institute does not immediately conjure up pictures of fast and furious living. But it is not everyone who wants a frenetic lifestyle, and certainly not Mrs Doherty. ‘I leave that to the young,’ she would say, as she watched her sixteen-year-old granddaughter spend the entire day beautifying herself to go out with her boyfriend to a party. ‘The party doesn’t start until ten o’clock – it won’t end until the small hours of the morning. Bliss!’ sighed the girl.

‘You enjoy yourself, dear. I’ve got cakes to make for the WI jumble sale in the church hall this afternoon and I must get on.’

‘Boring,’ said her granddaughter with a pitying sigh. ‘Poor Granny!’ and she flitted off.

‘Boring? Not a bit of it,’ thought Mrs Doherty, as she sieved the flour and rubbed in the butter. Her life was as full and rich as the cake she was making. Each week she spent an afternoon at the local hospice helping with the mobile library; an afternoon at the hostel for battered women, listening to horrifying stories of violence and abuse; a morning at the primary school helping the slow readers group. She was the backbone of the flower arranging ladies at the church; second contralto in the local choir; a reader
to the blind; a collector for Christian Aid; and a tea lady for the local cricket club, not to mention a full-time grandmother to four lively children, the eldest of whom had just informed her that her life was boring.

The local branch of the WI went from strength to strength when Mrs Doherty took over the chair. She threw herself into the task and, with real flair, organised the members into doing things they had never imagined, such as a sponsored cycle ride for grandmothers, a visit to a shipbuilders, a trip in an air balloon. Day trips to cathedrals and stately homes are old hat, she thought, so what about an outing to a metal foundry, an RAF base, a lifeboat station? For three years the Women’s Institute fizzed under Mrs Doherty’s competent guidance.

The ladies were enjoying a guided tour through the sewers of London. They had to wear special clothing, boots and hats. After an explanation of the safety precautions, with some trepidation they set off. The guide related the history of the sewers, how raw sewage had been dumped directly into the Thames until the mid-Victorian era, when London was awash with effluvia. The fear of cholera breeding in stagnant cesspits was very real.

One of the ladies muttered, ‘I think I’m going to be sick.’

The guide was unsympathetic. ‘It’s the methane gas,’ he explained. ‘It’s quite a pleasant smell when you get used to it.’

The group continued on their way, the guide telling them about Bazalgette and his visionary ideas for the construction of a new sewage system for London. He was describing the struggle the engineer had to get his plans approved, when Mrs Doherty muttered, ‘I feel funny,’ and leaned heavily on the woman beside her.

‘It’s only the methane,’ called the guide. ‘Please try to keep up at the back there. We don’t want anyone to get lost.’ Mrs Doherty couldn’t keep up. She leaned more heavily. Two women tried to support her, but couldn’t. Her voice was slurred. ‘I’m so sorry. I don’t know what’s happened. I feel fu … fu … fu …’ and she slid to the ground.

Mrs Doherty had suffered a stroke.

The
difficulty of getting the unconscious woman out of the sewer was considerable. Two ladies tried to carry her, but the slippery surface of the tunnel made it impossible. Others said they would go to get help, but the guide assured them they would get lost if they tried. With great courage and strength, he hoisted Mrs Doherty across his shoulders and carried her the half mile to the exit shaft. One of the ladies was supporting her head, and several times the guide slipped and nearly went over, but not quite, and he did not drop Mrs Doherty. ‘It was a nightmare,’ the ladies said afterwards. The journey, the bumping, and the length of time taken probably added to the injury sustained after the initial stroke.

‘Stroke’ is a good word. It is much better than medical words. There is no warning, no time to prepare when a stroke brings you down. Strokes can vary in severity from mild and transient, to catastrophic with permanent injury. They are caused by one of three things: thrombosis, embolism or haemorrhage, in order of severity.

Thrombosis is caused by the hardening and narrowing of the cerebral arteries, which can give rise to both chronic and acute changes in the oxygen supply to the brain. Blockages in the tiny cerebral arteries are associated with a slow, progressive disturbance of cerebral functions, punctuated at intervals by seizures or attacks, called transient ischaemic attacks (TIA) or mini-strokes. Stroke due to thrombosis is less common, nowadays, because of the early diagnosis of high blood pressure and hardened arteries, and drug treatments available to rectify these conditions.

An embolus is something floating freely in the circulatory system. Several things such as air or fat or necrotic material from a tumour are possible emboli, but the most common is a blood clot. Our blood gets thicker, and flows more sluggishly, with an irregular pulse, as we grow older, and clots are liable to form. When an embolus reaches an artery too narrow to allow it to pass, it becomes lodged, and the tissue beyond it is no longer fed with oxygen and will die. These blockages can occur in any part of the body, but if one of the cerebral arteries is blocked, the result will be a stroke. The severity can be mild or severe, and this will depend on the position in the brain and the size of the area affected. The incidence of a stroke due to an embolus has been greatly reduced by preventive measures – drugs such as Warfarin, which thin the blood, and those which reduce high blood pressure.

A
stroke caused by haemorrhage cannot be foreseen and, therefore, cannot be prevented. It is due to the rupture of a weak spot in a cerebral artery. We all have weak patches in our blood vessels and they normally cause no trouble. But just as the strength of a chain is in its weakest link, so it is with blood vessels. Under tension, the weakest link will snap. In certain circumstances, the weak spot of an artery will burst and blood will escape into the surrounding area of the body. This can occur in any artery, in any part of the body, and the site of the haemorrhage will determine the severity of the damage. If it ruptures in the cranium, it causes a stroke. It can occur at any age and is quite unpredictable.

I was a ward sister at the Elizabeth Garrett Anderson Hospital for Women in London when Mrs Doherty was admitted. She was in a deep coma, and her skin was colourless and cold, although covered with perspiration. Her temperature, blood pressure, pulse and respiration were subnormal. We did not think she would live for long – such a severe stroke was usually terminal. The houseman who attended whilst we admitted the patient, said much the same as I had been thinking: ‘The kindest thing would be to let her die quietly. However, I must do a lumbar puncture to diagnose the cause.’ This she did, revealing abundant blood in the spinal fluid, which was diagnostic of a cerebral haemorrhage.

We contacted the next of kin. Jamie left work at once and came to the hospital, but Priscilla was in Durham, and Maggie was on an assignment. The consultant surgeon, Miss Jenner, explained to Jamie that the prognosis was uncertain, but that a craniotomy could be performed to open the skull and suck out the blood and fluids that had collected and would be causing pressure inside the cranium. It might also be possible, she said, to locate the origin of the bleeding and tie it off.

Jamie looked alarmed, and Miss Jenner explained that opening the cranium is not all that difficult, and trephining the skull had been performed since pre-Roman days, and that sucking out the blood is not a lengthy business and would certainly relieve pressure on the brain, which was essential if Mrs Doherty was to stand any chance of recovery. (Miss Jenner was a general surgeon. What she
suggested was not brain surgery, for which a specialist brain surgeon would have been required. Also, a general surgeon in the 1960s had a far wider role than today.)

Jamie was asked to give consent for the operation. He hesitated. ‘I am not sure that she would want it. She wouldn’t want to be debilitated, I am quite sure of that. She is eighty-two, she has had a full and active life, and to go, while she is still getting about and enjoying herself, is what she would want.’

His words raised an element of doubt in Miss Jenner’s mind. ‘This is always a difficult moment, probably the hardest you will ever have to face. To treat or not to treat. To leave well alone, or to intervene. But I assure you, that if we do not operate quickly your mother will die later today.’

Poor Jamie. What a situation! And the decision was on his shoulders. His instinct said ‘leave well alone’, but he couldn’t bring himself to say it. He needed help. ‘I must speak to my sister. I will ring her office; please God let her be there.’

He went and telephoned Priscilla, who was at her desk. He explained what had happened, and what the consultant had said. Priscilla was unequivocal and immediate in her response. ‘She must be operated upon. You must sign the consent form. We cannot morally, or even lawfully, as far as I know, withhold from her the chance to survive.’