FRIDAY
DAY 11,999

‘The Sod of Death’

Níl fhios ag éinne cá bhfuil fód a bháis

There was a man who lived near here. One day he was out cutting turf near the clifftop. He was working away when he heard a voice coming from the ditch, or the sea, or somewhere. And the voice said, that sod you’re cutting is the sod of your death. The man said, no way. He cut the sod, went to the top of the cliff, and tossed it into the sea.

Twenty years later his son was on the beach and he found a huge sod of turf. It had been hardened by the sea. He brought it home and shaped it into a sort of stool, and he put it by the fire. His father sat on it, and the next thing, he keeled over and died.

It was the sod he had cut many years earlier. It came to him, in the end.

First thing on Friday morning, I phoned the hospital. The nurse said Bo had had a bad night, had been agitated.

That word again.

Why do medical professionals not say what they mean? Why do they speak in euphemisms, in vague words that are open to interpretation?

I decided I would not take my class after all, but go directly to the hospital.

Marja telephoned the hospital and asked if she could speak to the consultant. I think they said yes, she should ask for him when she came to the hospital, he would be there in the late morning.

Another glorious autumn day. The trees plated with gold. Blue sky. Not a breath of wind.

At about ten thirty we went to the ward. Bo was surrounded by doctors. The team. We were asked to stand aside for a while and we waited in the corridor at the end of the ward, while the doctors attended to Bo. I was reassured by the fact that at least doctors were attending to him, at last.

What happened over the next few hours, the rest of Friday morning, is a bit of a blur. A young doctor told me that Bo’s kidney condition had worsened. I told him he had been chesty and his breathing had weakened last night and I asked, ‘Is he about to go into heart failure?’

‘He’s in heart failure already,’ he said.

I thought: Bo went into heart failure at 12.30 last night, when he telephoned me. That was the terrible pain. And the nurse gave him more paracetamol. ‘Agitated’ can be nurse-speak for heart failure.

‘He has to get into Intensive Care’ is another thing the doctor said. ‘We’re trying to get him a bed in our Intensive Care Unit, or else in Vincent’s.’

My heart jumped. If only we could get him to Vincent’s. If only we had got him to Vincent’s on Monday night. It is not that I trust Vincent’s University Hospital much. But it is better than Loughlinstown. And the possibility of getting a bed in the private hospital might be greater – at least the two hospitals are on the same campus.

Except now that did not matter because Bo was going to go into Intensive Care.

One of the doctors told me that a person can survive with one quarter kidney function. One eighth of each kidney, he said, that is a quarter.

Hope.

Bo had 100 per cent kidney function a week ago. Now, after a week in this place, we were talking about 25 per cent.

Marja and I went over to Bo’s bed and talked to him. He was very weak and tired. I told him they were going to move him to Intensive Care, to help him. Marja asked if he’d like to hear a piece from Bombi Bitt och Jag. Bo found a passage and she read a page or so. It was the description of the market, a classic scene in this book, celebrated in Swedish literature. Bo was spreadeagled on the bed, his pyjamas open over his now quite distended stomach. Listening.

I had moved into another zone.

I knew now that a battle was on, for Bo’s life, and I knew that I would have to fight this battle – Bo always did, he was strong, brave, resilient. We were in the gap of danger.

The doctor I had seen earlier in the week told us that they were moving Bo to Intensive Care not because he was in any danger but just so they could monitor him better, and another doctor was telling us, again reassuringly, that a person could survive with one quarter of kidney function.

Several doctors spoke to me over the next hour. An argument developed between some of the them about whether Bo should be admitted to Intensive Care Unit there or not. But it emerged that the doctor who was against the idea was looking at the wrong file. There were raised voices and a slammed door.

I was looking on at all this like a small child gawping at an adult conversation.

Now I joined in. ‘It’s the wrong file! I don’t believe this.’

A nice young doctor said, ‘He will get into Intensive Care. Don’t worry.’

In the shambles that constituted the hospital, there were some people I was grateful for, people who did their best. The young doctors, probably still training. Some of the nurses. I liked the consultant when I finally met him and he did his best to save Bo. But I felt he arrived on the scene too late in the day.

Bo was moved into Intensive Care in Loughlinstown. Possibly, even at that point, if he had been moved to Vincent’s things would have turned out differently. Possibly not. Possibly it was already too late.

I, and the other family members, were moved into a tiny waiting room opposite the ICU. It is a small, poky room with a very high ceiling. Painted pea green, it is furnished with two green sofas and a chair. A small coffee table. There is a broken water dispenser in one corner, and the window looks out on another building. It is a grim, cheerless room but by Loughlinstown standards better than any other waiting room, since it has sofas, not plastic stacking chairs.

Bo was moved into Intensive Care at about lunchtime on Friday. We – our numbers were expanding – took up residence in the green waiting room. At this point, the consultant spoke to us.

‘We are going to do everything possible for your husband,’ he told me. ‘Age is not a consideration, we will try everything. If he does not respond to our treatment by three o’clock he will have to have dialysis or partial dialysis.’

I had already been told, on Bo’s first day in this hell, that partial dialysis might kick-start Bo’s kidney function again. Dialysis did not mean permanent, regular dialysis. It is a good treatment for kidney failure. It probably should have been applied much earlier – before Bo had heart failure, for example.

‘Can you do dialysis here?’

Is it the first time I have asked this question?

‘No. Not here.’

They would have to transfer Bo to another ICU, where they could do dialysis, if he did not respond to the second-best treatment they could offer.

Apparently, they do not have a dialysis machine in Loughlinstown. People have dialysis machines in their own homes, supplied to them by the HSE. But this hospital, with its geriatric ward, its A&E, doesn’t possess one. It’s unconscionable.

Quite predictably, Bo didn’t respond to whatever treatment he was offered. At three o’clock the consultant spoke to me on the corridor and told me they were going to transfer him to another hospital. They were in the process of telephoning the various hospitals, asking for a bed in ICU. Vincent’s, Tallaght, Beaumont, the Mater.

This is the second-last act of this tragic farce.

They were having no luck getting a bed.

One of the doctors flitted by – she looked tired. I wondered if she had been on duty for eighty hours? Probably.

‘That’s the trouble at weekends. They keep their beds for accident cases.’

They’re hoarding beds? A bed that could save Bo’s life?

He’s eighty-two.

In Ireland, this matters. You’re dispensable.

In Vincent’s Private, in the Beacon, in Blackrock, it is not an issue. But in an HSE public hospital, old folk move over to make room for the young. It is a question of resources, I am sure the minister would say. It is a question of resources that they do not have a dialysis machine, which my friend in Kerry has in her own garage, which every local clinic in Sweden has, in this hospital.

Finally a bed was offered in Beaumont.

Far away in Glasnevin. Is it?

I had never been to Beaumont.

But now I was going. The ambulance has been called. Bo is being prepared for the move. I am sitting in the corridor with my coat on, waiting to join him. Two ambulance men go into ICU with a trolley. I think they may be the same ones who brought Bo here on Monday.

I wait.

Minutes pass.

Then the nurse comes out.

‘The patient’s condition has changed,’ she says. ‘He cannot be moved now.’

The ambulance men come out.

‘Sorry, we don’t have the right oxygen equipment in the ambulance,’ one of them says. ‘If it was just down the N11 to Vincent’s we could do it. But over to Beaumont in Friday afternoon traffic? It’d be chaos, in the ambulance.’

They don’t have a dialysis machine. The ambulance doesn’t have the right equipment. Vincent’s is hoarding its beds for the weekend casualties. There’s the Friday afternoon traffic.

For the want of a nail the horseshoe was lost.

On their increasingly frequent visits to the green waiting room, doctors talk about transferring Bo later. It’s quite obvious that nobody believes this for one second.

In ICU, they change his oxygen supply. Now, instead of a mask which he can take off when it gets too uncomfortable, a plastic tube is inserted through his mouth, down his throat, into his lung. It is held in place with an elastic band that stretches his mouth horribly.

‘He is anaesthetised. He feels nothing. No pain,’ the nurse assures me.

How do they know?

What I know now is that Bo is going to die.

Bo told me he was not afraid of death.

‘But I am afraid of pain,’ he said.

‘Don’t worry,’ I said. ‘I won’t let you feel pain. I won’t let anyone hurt you.’

I thought, if Bo’s cancer got bad, that we could go to Switzerland, that he would die peacefully. I thought if that did not happen that he would have a comfortable bed in a lovely hospital, that he would have one of those contraptions that allows the patient to inject morphine, that he would die listening to Mozart in the arms of morphia.

But there will be none of that here.

He is trussed up like a turkey for the oven. His eyes are closed, the lids swollen. His mouth is cruelly pulled by the elastic band. I try to loosen it but am afraid I will loosen the tube that penetrates his body like a sword.