YES, APPLY the Hippocratic Oath,” Paula Morriset said, so softly she doubted the young house surgeon, head bent over the consent form, indicating with his superior pen where she should sign, heard her. Then she took the thick silver pen and signed fluently, a good sign. Her mother, Lorna, now successfully sedated, her broken hip eased by traction, would not be disturbed in possibly her final moments by suddenly galvanized feet—how slowly they moved now, how carefully they conserved the energy needed for the long shifts—by faces bending over, shouting, the jolt of electric shock.
“Terrifying,” the house surgeon had said when he was outlining the procedure: the alarm bell and then the pounding feet, the trolley pushed in front, the downing of tools as if an air-raid siren had gone. And Paula had concurred, partly out of a longing to make contact, even for a second. She fingered the pen, as if weighing it, before handing it back.
Several times during that long day, Paula had stood at the nurses’ station, noticing how eye contact was avoided, even though the space was so small a kind of dance was required to prevent someone carrying a file from colliding with someone leaning against a bench.
Finally, since Paula did not abandon her post, someone would look up, with a hint of exasperation, and she would ask if her mother could have more pain relief.
The nurses she remembered from her two distant stays in hospital—tonsillectomy, hysterectomy—had seemed to bustle. A young male nurse (hysterectomy) had welcomed her to the ward and given her a short tour. Occasionally a nurse broke the rules and sat on the end of a tightly made bed, getting up quickly when a ward sister came in view.
The light had seemed golden, health-giving, though Paula recognized this as romance.
Not to strive officiously to keep alive, Paula wanted to say, sotto voce, but of course there was no occasion. The house surgeon, once the papers had been handed back, rose to his feet.
Throughout the day, while Paula waited by her mother’s bed, she saw him walking in the same way as the nurses. Everything was leisured and unhurried. Paula held her mother’s hand, and when a young man, groaning in the next cubicle, was told he would be brought two Panadol for his pain, she timed it. It took fifteen minutes.
Officiously, Paula said to herself as finally, at dusk, she drove home. Her mother was settled in a ward. A weight stretched her poor frail leg and held her broken hip in a bearable position. A male nurse with a ponytail had explained that part of her pain was due to her positioning. Paula had thanked him as if he were a captain on the bridge of a ship.
At home, Conor, her ten-year-old son, was feeding the cat.
“Is Nanna going to die?” he asked, looking up from scraping the tin.
“No,” Paula said. “I don’t think so. She’s got an electric bed.”
“I’d like to see it,” he replied. His bent, according to his teachers, was science.
Ten-year-olds were supremely balanced, Paula had read. Hormones, the death-wish trolley, had not yet struck, annihilating their powers of thought, their abstract and almost theological curiosity. She could say anything to Conor and receive good advice in return.
When Paula had the house and lamplight to herself, she went to her desk and looked up the word. Officiously: unnecessarily or obtrusively ready to offer advice or services. From officiosus, kindly, from officium, service. She had not thought of the kindlier implications, the readiness to offer services when she had half-whispered the words to the house surgeon who, in any case, would not regard her as a colleague, someone whose opinion would carry equal weight. It had been presumptuous of her even to mention an oath to which he was bound by training and she had simply encountered in reading. Perhaps she had hoped they might recite it together:
Thou shalt not kill; but need’st not strive, officiously, to keep alive.
What she had been seduced by was nothing more than the rhyme and the word officiously. So satisfying to say, so full of sound, like a mouth full of teeth.
Still, if the surgeon had eliminated officiously from the experiences her mother was likely to endure, there were many others to choose from: x-ray, injection, saline drip and—in the days that followed, while an operation was debated—ECG, blood transfusion, catheter, morphine shunt.
When she finally slept, Paula dreamed she was back in the x-ray suite, bending over her mother, whispering words of encouragement, “It’ll be all right, darling. Just hang on,” while plate after plate was flawed because her mother had moved at the crucial moment.
“You need to put on a lead apron,” the technician said, and Paula felt it tugging at her shoulders. Yet her feet felt light, almost as if they were dancing. In her sleep she felt the lead enter her. She hung the apron up almost reluctantly on its hanger because it had felt as if she too was enduring something.
“Either way, the prognosis for your mother is grim,” the house surgeon said to Paula the next time they met. She had timed her visit to coincide with the surgeons’ rounds. She was spooning porridge into Lorna’s mouth and solicitously wiping her chin between mouthfuls—aware of herself doing this, aware too of the posse approaching, though she kept her eyes on her mother’s face, uttered another “darling” as the faces appeared in a line.
“We’ve had to delay your mother’s surgery,” the house surgeon said, when they were back in the nurses’ station, pressed against a row of cabinets as nurses came and went.
“The blood tests show your mother has suffered a heart attack overnight. Also there is the problem of finding an anesthetist.”
At once Paula felt a rush of rage. She looked into his face and noticed he had a scar down one check, parallel to where a line might come when he was old. So he had had some experience of life.
“I’m sorry,” he was saying, looking directly at her. A practiced look: blunt facts, measured tone, eyes held to assure the message was received. “With the anesthetists we are powerless.”
Did they risk less, Paula wanted to ask? Were fine surgeons held in thrall by creatures who manipulated gases, raised the dead?
“We’ll go on trying, of course,” he was saying. “There’s a new anesthetist almost every day. In the meantime, your mother can go back on a full diet.”
Lead-hearted, Paula had gone back to her mother’s bed and held a plastic beaker with a spout to her mother’s lips. She tested the milky tea first by allowing a few drops to fall on the inside of her wrist.
During the day, as an interloan librarian, Paula went about her work zombie-fashion. She sent requests for university texts which would be unlikely to arrive in time for students from the local polytechnic who seemed unable to penetrate their own library or ask for a desk copy. But there were also requests for feng shui, how to read auras, obscure novelists, and long-forgotten diets. Sometimes the details were scarce or wildly inaccurate, but today Paula did not feel in the mood for the lateral thinking that was required.
Her thoughts were with her mother, still with her leg stretched by weights, whimpering as she was lifted or turned, needing morphine at regular intervals, and enduring periods when it wore off and the pain returned.
And she thought of Conor who, in spite of his sensible answers and his attempt to comfort her with the explanation of light from feeble (he didn’t say “dead”) stars, was probably as miserable as herself. No doubt he was taking comfort in some equation being written on the board or a science experiment in which they worked in pairs.
That evening Lorna was not in her accustomed bed—the middle of three against the left-hand wall—when Paula came through the door. The sheet was taut and flat as if a hovering soul could not reinsert itself. The young woman in the next bed, who had a strange metal contraption protruding from her foot, confirmed that her mother had been moved that morning.
Eventually Paula found her in an isolation room with a plastic apron hanging from a hook. She sat beside the bed and fed her mother her customary evening meal: a wagon wheel of puréed vegetables arranged around a mound of mashed potato with a scattering of parsley on top: orange carrot, olive-green spinach, brighter green peas. Paula made a spoonful from each, as she had as a child.
She kissed her mother and stroked the white, naturally wavy hair. On the way home she bought takeaways for herself and Conor.
Perhaps Hippocrates had been guarding against extra solicitousness, extra kindness. A person in a toga following a doctor, asking for reassurance. Perhaps it had been on one of those days, like the one she had just endured, that he had formulated his oath.
“No hope,” he might have flung over his shoulder, before striding off. Damn those who will not or are unable to confront the reality staring them in the face. Hippocrates could have had no concept of the crash trolley, the thundering feet, the hands held clear of the bed’s metal sides as the shocks were applied.
“We’ll try again, after the weekend,” the young house surgeon had said. “We have a very good American anesthetist called Bill. He’s very sympathetic.”
So when Paula had come back into the isolation room and seen the notices removed and her mother wearing a green frilled plastic cap, she had insisted on her mother’s false teeth being put in. Bill would make the decision later that morning.
Then Paula had bent over her mother’s face—she felt her head floating like a large balloon—and with words like “Darling” and “You look wonderful” and “Soon your poor leg will be fixed”—she had willed her mother to cross this next hurdle.
My face must look hideous, she thought, for she could feel the skin taut against her bones, her eyes staring in a way that was surely impolite. A sort of death’s head.
Before she left she bent over and kissed her mother’s hair, surreptitiously making the sign of the cross with her thumb.
Paula and Conor stood in the doorway of room 7 and watched Lorna Leggott breathing greedily through an oxygen mask. There were no drips, only the long coiling tube from the catheter which emptied into its bag near the foot of the bed. From time to time Conor, concerned that the flaxen-colored liquid might be moving backward, attempted to straighten one of the coils.
“I wish I could solve the problem of optimism or pessimism,” Paula remarked to Conor when they were walking toward the car park. Even the nurses were either pessimistic (mostly pessimistic) or optimistic.
One afternoon she had been summoned by a phone call from the hospital to let her know Lorna was very poorly. Yet when she arrived Paula thought her mother seemed no worse than the day before.
“I wish I could judge,” she went on, guessing Conor would not understand. “Really judge and be accurate.”
She was tired of being buoyed up and cast down, frightened each day at what she would find. The automatic doors swung open and she felt reluctant to advance.
“Why don’t you just give it up?” Conor suggested.
“But I thought you liked it,” Paula said, surprised. “You are so good at maths and science.”
“But it’s got nothing to do with judging. Unless you’re making something. A bomb. Then you’d have to get it right.”
“So you think we should just float? That nothing counts?”
She had spent part of the afternoon looking for the name of the last person executed in the Tower of London.
“Or everything counts,” Conor stated, staring out the car window at suburban houses, suburban gardens whose colors were as garish as carpets. “Every little thing, every move you make.”
Paula thought of all the layers of dust we create in a lifetime, the layers with which one generation buries another. A light layer at first, for a generation is practically nothing. But century on century? What did Hippocrates do with his nail clippings, the shavings from his beard? If she hadn’t been driving she might have slumped forward and put her head on the steering wheel.
“It’s clear on this side,” Conor said. So he was watching out for her.
The young house surgeon was talking to a pretty blonde nurse in the nurses’ station. Paula noticed his boots with their rounded toes and thick crepe soles. She thought he must have to stand for hours, never losing concentration. He raised a hand to her as she passed. And later, when she was sitting by her mother, he came and joined her.
“Thank you for the gift,” he said. “Unnecessary, but most kind.”
She had left Playing God by Glenn Colquhoun at reception, with instructions for the nurses to deliver it.
“How is she doing?” Paula asked. She had indicated she would walk a little distance along the corridor with him. They could have been colleagues, apart from the age difference. They passed open doors where pale faces slept or stared. Some with gaping mouths. The linoleum glistened like a river.
“Either way, the situation for your mother remains grave,” he said, but his words seemed softened by his tone of voice and the soft slightly sucking tread of his boots. “We have bought her a little time. Done our best.”
“That’s all anyone can hope for,” Paula responded. Once again the words came to her:
but need’st not strive
officiously to keep alive.
In the car park she rested for a few minutes, hands on the wheel. She looked up at the huge bulk of the hospital, the children’s windows on the first floor decorated with cartoon figures facing out. Mickey and Minnie Mouse, a giant rabbit with pink ears. She could faintly make out the shape of balloons and what looked like a cot railing.
Conor had been in that ward once: a tiny form in a cot whose covers were pulled as tight as the adult beds’. Paula and Guy had tried to make it homey by bringing toys and cloth books. They had refused to admit he might not recover.
But now she looked at the rearing edifice without hope. Of course Lorna would be discharged, because hospitals were not places to rest in or take sanctuary. Paula closed her eyes for a few seconds and thought of the polished corridors, the measured tread of nurses. A river with beached creatures hanging onto spars, anything they could get hold of, before the weakest were swept away.
She drove home carefully, glad it was rush hour. Twice, since her mother’s admission, she had almost had an accident. Once, shamefully, she had lightly grazed a station wagon when she was backing out of the hospital car park. She had got out to check. Rubber bumper meeting rubber bumper had left no trace.
Conor was on Google. He put in Hippocratic Oath as a keyword and read about Hippocrates. The works attributed to Hippocrates are the earliest extant Greek medical writings, but very many of them are certainly not his.
Conor’s eyes scanned down the oath. I swear by Apollo the physician and Aesculapius…to teach this art…without fee…to disciples…according to the law of medicine. I will give no deadly medicine to anyone if asked…something about pessaries and persons laboring under the stone (whatever that meant)…going into houses…not seducing females or males…keeping all that should be kept secret.
Luckily Conor had no desire to study medicine, though he could tell his mother was becoming attached to the young surgeon she frequently referred to and, by Conor’s reckoning, seemed to waylay.
“If I go now,” she would say, casually, “I may be in time for the surgeons’ early rounds.”
Conor had visited his grandmother only twice, considering it a waste of time. His grandmother seemed to feel the same way. Her eyes opened suddenly, like a china doll’s, gazed severely at him, then closed again. She had a lopsided grin, as if the blood in her face had pooled.
He couldn’t imagine what had possessed his mother to mention the Hippocratic Oath to a surgeon.
“But perhaps he didn’t hear me,” she confessed to Conor. “I hope that was the case.”
Conor hit Print, and the Hippocratic Oath eased itself out of the printer. Then he printed the modern version. I will remember…that warmth, sympathy, and understanding outweigh the surgeon’s knife or the chemist’s drug. Nowhere were the words his mother had implied: Thou shalt not kill; but need’st not strive officiously to keep alive.
“It’s quite nice, this modern version,” his mother said. I will remember I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person’s family and economic stability. But was there time on the busy wards where, if the nurses moved slowly to husband their energy, there were barely enough bodies to cover the most unrushed shifts?
Paula had been tempted to accost a nurse carrying a covered dish—obviously her meal—then thought better of it, and felt ashamed. The nurse’s walk was different as she headed to the lift. …most especially I must tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life.
“The crash trolley is very frightening for the frail elderly,” the young house surgeon had said, looking directly at her, fiddling with his silver pen. “There is the danger of cracked ribs, a very real chance of heart failure.”
It seemed a vision from hell: demons starting their work, prodding with tridents.
At night, after her daily visit, Paula was too tired to sleep. A crash trolley coming through the door of her bedroom would have been a relief. Anything seemed better than lying awake in the dark.
She was reading a book about Paris: Travelers’ Tales Paris: True Stories of Life on the Road. Unfortunately, that night she had chosen an essay entitled “Monsieur Guillotine.” The Germans had executed victims lying on their backs, their eyes taped open so they could see the great blade descend. Paula tried swiveling her eyes from side to side, imagining herself concentrating on a patch of sky, a small cloud. Perhaps some of those victims died mercifully of cardiac arrest. Eventually she fell into a restless and unrefreshing sleep.
Returned to her rest home, Lorna Leggott first turned her face to the wall, then one hand reached out to touch the wallpaper with its little flowers, pale pink against gray. But, by nightfall, she seemed comfortable again, her hips supported by pillows.
The room had been slightly rearranged to accommodate a cube chair which would enable her to be taken to the lounge every afternoon. Her lower body was swathed, and pink woolen bed socks peeped out from under a mohair rug.
In three weeks they would go to see the surgeon again, a visit Paula was dreading.
She decided she would simply be a support person, silent or acquiescing. In the meantime she held one of her mother’s hands, admiring the shocking pink nail polish one of the nurses had applied, one hand at a time, while her mother held a soft furry ball.
At home she and Conor ate in front of the TV. They watched Friends and then Joe Millionaire, a show about a construction worker who posed as a millionaire and tried to choose a partner from a group of women who accompanied him to a French chateau. That night a woman who had foolishly made a scrapbook which included a drawing of a million-dollar note earmarked for her own spending did not receive an emerald pendant and had to pack her bags.
Later Paula stood at the kitchen bench, looking out into the garden. She thought of the space that existed in the heavens, the imponderable distances, the unplumbed darkness. Then she thought of the human heart and why, if such measuring rods existed, it was consumed by such little things. She thought of the patch of soil, spoiled by slabs of broken concrete, stones and litter, by the hospital entrance where, on her daily visits, she had imagined her own grave being dug. She planned that it would be raked and leveled, that the yellow tape barring access and the sign saying We apologize for any inconvenience during alterations would be taken down.
Then she brushed these thoughts aside. After all the entrance to the rest home was very different: a curving drive, nicely planted, lamps that came on at dusk, flowers in beds designed for color and scent. She wiped her hands on a towel and took a last look at Venus blinking like an engagement ring.
It was the day of her mother’s appointment with the surgeon. An ambulance was ordered and, dressed in her best angora cardigan over her best nightdress, Lorna was loaded with infinite slowness into its interior. A plump ambulance officer, reaching out to confine her hand which was reaching to touch the wall, confided to Paula that she had had no sleep the night before. But at least the ambulance was cool. It proceeded at the same leisurely pace as the nurses in Accident and Emergency, slowing almost to a crawl as it went over the humps near Outpatients.
Paula, feeling out of step, trotted beside the two ambulance officers. Eventually her mother’s bed was parked outside the orthopedic office. People on crutches were being helped along, wheelchairs jostled for space; x-rays were being opened from large flat envelopes as surgeons walked.
She sighted the young house surgeon in the throng and, as he turned in her direction, she called out, “We’re still here.”
Remember me, had been what she had implied when she called out to the young surgeon and he had looked back, puzzled for a second, and then shaped his face into a smile. There were four nurses around him, bringing charts or rearranging files on a trolley. Even the older nurses—women in their forties and older—seemed compelled to act flirtatiously around him.
“I’ll see you’re seen next. We won’t keep your mother waiting.”
“Thank you,” Paula said. “That would be kind.” One of the nurses, with badly peroxided hair, gave Paula a slightly warmer smile.
I must not mention the Hippocratic Oath, she reminded herself when their turn came and her mother’s bed was wheeled into the examination suite. Her mother seemed to relax, and Paula suspected she had a gift for drama, for rising to the occasion, for she now lifted and flexed her leg as required and even smiled. The x-ray, showing the two silver screws that had been inserted, was pinned on the wall. The screws were so large, her mother’s bones so old.
And anyway it wasn’t the Hippocratic Oath Paula had been thinking of the first time. Conor had found it on Google by simply putting in need not officiously keep alive. It was from a poem by someone called Clough, cynically versifying the Ten Commandments.
The young surgeon, if he had taken an oath, for it was optional, had recited something quite different. I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
He seemed very pleased with the position of the silver screws. He invited Paula to feel where they lay under her mother’s pale parchment skin. He directed her hand until she felt two little knobs. She shivered slightly, and he explained that there was a slight—a very slight—danger they might erupt through the skin. But they could deal with that when it happened. It was all going extremely well.
A well-oiled oath, Paula considered as the bed was maneuvered out of the room, the ambulance summoned again and her mother transferred. Not yet, she thought, as she sat in the ambulance with the same sleepy attendant now yawning prodigiously.
If I do not violate this oath, may I enjoy life and art. She remembered that from the printout Conor had given her. The ambulance was warm and full of sunlight.