Jennifer Worth - In the Midst of Life

Psychosomatic paralysis:paralysis caused by the unconscious mind.

Pulmonary oedema:fluid congestion in the lungs which may be caused by heart conditions.

Radiotherapy:treatment of cancer using radium.

Remedial therapy:treatment to aid recovery: it tends to be non-pharmacological in nature.

Respiratory drive:this is controlled by a part of the brain which measures how much carbon dioxide is present in the blood and controls how the person breathes.

Retractor:a surgical instrument which is used to hold back skin, muscle or bone to allow better access and vision during surgery.

Rheumatism:a condition of the joints and connective tissue.

Rigor mortis:after a certain period following death, the muscles of the body begin to stiffen.

Sarcoma:a cancer of connective tissue, i.e. bone, cartilage or muscle.

Sclera:the white part of the eyeball, which is made up of elastic fibrous tissue.

Septicaemia:infection in the blood.

Serum:the watery part of blood, which carries the red and white blood cells, and platelets.

Shock:bodily collapse or near collapse caused by inadequate delivery of oxygen to the cells from decreased heart functioning, e.g. from excessive loss of blood.

Sigmoid colon:this links the anus and rectum to the large bowel.

Sloughing:when part of the body becomes detached, usually linked with wounds and skin in humans.

Staphylococcal infection:a particular type of bacterial infection caused by the Staphylococcus bacterium.

Statins:a group of drugs used to reduce the blood cholesterol level.

Sternum:the bone that connects both sides of the rib cage at the front.

Stertorous:heavy mouth breathing, characterised by loud snoring or gasping noises.

Suppuration:the formation and production of pus.

Supra-pubic catheter:a tube placed directly into the bladder through the skin, just above the pubic bone.

Surgical shock:similar to normal shock, but caused by surgery.

Thrombosis:a blood clot occurring in a blood vessel.

Tibia and fibula:the two bones of the lower leg, between knee and ankle.

Titrated / titration:when a drug or treatment is given according to how much is needed by the patient before too many side effects, or intolerance, develops.

Total parenteral nutrition:complete nutritional diet given intravenously. It is mixed in sterile conditions according to the individual’s daily blood tests and contains all the calories, nutrients, vitamins and minerals a person needs.

Tracheostomy:a hole made in the throat wall into which a tube is placed into the bronchus, the main breathing tube into the lungs. A tracheostomy tube is placed in this man-made hole to keep it patent, e.g. a Durham’s tube.

Transient ischaemic attack (TIA):a small stroke with little or no long-term effects on the person. But a doctor should be seen urgently if one occurs because without treatment a major stroke could follow.

Trephining / trephine:when a burr hole is made through the skull, using a drill, as part of a surgical procedure.

Trocar and cannula:a cannula is a thin ‘needle’ structure often made of plastic which can be inserted into the body. The trocar is the introducer, a thin piece of stable metal, which assists its placement. The trocar is then removed.

Uraemia:high levels of urea on the blood.

Urethra:the tube that transports urine from the bladder during excretion.

Urinalysis:a simple test of the urine to look for any problems.

Urine drainage bag:used to collect urine drainage via a catheter.

Vascular dementia:dementia caused by lack of circulation of blood to various parts of the brain causing the death of those affected parts and therefore affecting mental functions.

Ventricle:the larger chambers of the heart.

Ventricular fibrillation:fibrillation of the ventricles, the two largest chambers of the heart.

Voluntary euthanasia:when someone’s life is actively ended with their agreement, and with the help of someone else using specific drugs.

Volvulus:a blockage of the bowel caused by it twisting in on itself.

Warfarin:a blood clot-dissolving drug which tends to be used prophylactically to prevent further blood clots forming.

White cell counts:white cells exist in the blood and fight infection. If a person is not producing enough white blood cells they will be immunocompromised.

My appreciation and gratitude to all the people who have helped me in writing this book.

My husband, Philip, whose love and loyalty, wisdom and humour have kept me sane throughout

Dr David Hackett, Dr Richard Lamerton, Dr Michael Boyes

Dr Robin Moffat, President of the Medico-Legal Society Susan McGann, Paul Vaughan and Susan Watt of the Royal College of Nursing

Louise Massen and Madeline Bass

Patricia Schooling, for her several readings and invaluable suggestions All those who have supported me in prayer, especially Sister Christine and the Community of St John the Divine, Birmingham; Sister Elizabeth and the Convent of Our Lady, Kettering; the Sisters of the Love of God, Oxford

The Chaplains of the Methodist Homes for the Aged, and St Francis Hospice for the Dying

Colin Rivett, Eve Griffin, Jeremy Buckman, Counsellors

Anna Powiecki, Eugenie Furniss and Claudia Webb at William Morris, Endeavour Entertainment, John Saunders, Kirsty Dunseath, Sophie Buchan and the team at Weidenfeld & Nicolson, Carole Lewis, Sue Theobald, Christoper Howe

David Hart, poet, priest and dreamer

Patricia Birch, Joanna Bruce, MBE; Sue, Jayne and Jane, my sister and nieces who are nurses and care assistants

Lydia Hart, Eleanor Hart

Shelagh and her family in Israel, and Steve and Sandy, Wendy and Philip.

— and the many people who have told me their stories but do not wish to be named.

Excerpt from Nurse on Call by Edith Cotterill, published by Ebury, Reproduced with permission of The Random House Group Ltd.

Excerpt from How We Die by Sherwin B Nuland, published by Chatto & Windus. Reproduced with permission of Random House Group Ltd.

Excerpt from ‘Do not go gentle into that good night’ by Dylan Thomas from Poems, published by JM Dent, a division of the Orion Publishing Group. Reproduced with permission from David Higham Associates.

Excerpt from Four Quartets by T.S. Eliot reproduced with permission of Faber.

Excerpt from Malone Dies by Samuel Beckett reproduced with permission of Faber.

Poems by David Hart reproduced with permission of the author and Five Seasons Press.

All efforts have been made to obtain permission for the use of the excerpt from Truman of St Helens by Shirley Rosen. Anyone with rights to this book is invited to contact the author.

1* from How We Die, Sherwin B Nuland, Alfred A. Knopf, New York, 1993

2* It is very difficult to remove a feed-peg because it is a life-maintaining device. It requires a major medical/legal decision and this is not easy to come by.

3** Ahronheim, J C, Morrison, R S, Baskin, S A, Morris, J, Meier, D E. Treatment of the dying in the acute care hospital. Advanced dementia and metastatic cancer. Archives of Internal Medicine, 1996; 156: 2094-100.