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Tuesday, 25 January 2011

Hannelore

She never wanted to talk about what had happened. If pressed, all she would say was that it was “an accident,” or “a stupid thing.” Even years later, I believe, she still found it too embarrassing for words. We had heard from other sources that it had been a failed suicide attempt, but we had no written records of what exactly had happened. Whatever it was, it had basically left her paralysed from the neck downwards.

When she came to us, the event in question was already nearly a decade in the past. She had lived for years in a nursing home in Cologne but over the course of time her strength had gradually deteriorated. She contracted a serious chest infection and after it had been finally treated she was no longer able to breathe continually on her own and had to be put on a respirator. The nursing home wasn’t equipped to deal with this kind of continuous intensive care so she moved to the house our company runs in Remscheid – long-term intensive care, particularly of people with artificial respirators, is our area of specialisation.

She was not your typical suicide; she was too strong-willed, too much the fighter for that. I always believed that it had been a spur of the moment thing, that she had been deeply offended in her vanity and had acted spontaneously. I suspect that there was an unhappy love affair in the mix and that she had been pretty drunk at the time. The forties can be a dangerous decade for fun-loving, single women who have never met Mr. Right, or for whom Mr. Right has turned out to be Mr. Seriously Wrong. They proved to be very dangerous for Hannelore at any rate.

Her first couple of months with us were extremely stressful for everybody. Much of her strength of will expressed itself in a monumental inflexibility, which made developing the intense nursing relationship and routine necessary to care for her very difficult. She could exhibit a stubbornness which was so extreme that it defied any rational attempts to find solutions to conflicts. The fact that she was daily swallowing enough medication, most of them psycho-pharmaceutics, to knock out a middling sized ox with little apparent effect (despite a body weight of less than 45 kg.) didn’t make things easier. Getting her off most of the pills would have been impossible anyway; she’d been on them for so long that she was, effectively, a junkie. The prospect of her going cold turkey was so horrifying it didn’t bear thinking about.

But slowly, gradually, we learned to work with her, and she with us. The very intensity of the care she needed helped actually, because if she was your patient then you necessarily spent literally hours with her when you were on duty. For one thing, she had deep extensive pressure sores on the back of both thighs which would have been excruciatingly painful if she had been able to feel any sensation. Sometimes paralysis can be a mercy – though the lack of sensation had probably contributed to development of the sores in the first place. They were a challenge to our nursing professionalism – she had brought them with her, I hasten to add, for such wounds are generally seen as a sign of bad nursing – and over the course of five years we tried just about everything possible to try to heal them. All we succeeded in was in keeping them from progressing further. But changing the dressings daily (sometimes more often, as she was incontinent) and carrying out the various attempts at treatment took a lot of time and effort and was difficult for her.

She could move her arms somewhat, but she had little strength and no fine control so she was no longer able to eat or drink on her own and had to be fed. I actually came to enjoy the mealtimes I spent with her. They took time – if she had ordered a salad, lots of time – for she chewed every mouthful extensively, but it was time I used to get to know her. In the early years she was with us she could spend long periods daily without the respirator and during these periods she was able to talk. She had a keen intelligence and a sophisticated (sometimes deliciously dirty) sense of humour. She told of her work – she had been a secretary in a large company in Cologne – and of the holidays she had had (she had particularly loved Kenya) and the books she had read. She had moved from Northern Germany to Cologne as a young woman and had no family living except for a brother with whom she had fought a long time ago and with whom she no longer wished to have any contacts. Over the years he sent her a couple of letters but she refused to have them opened and read to her. That stubbornness again. As we got to know each other better, I trusted myself increasingly to fight with her about such things, but on this subject I had no success, the lady was not for turning.

She had one good friend whom she had got to know after her “accident” and he faithfully took care of her few affairs. A visit from him was always a high point, a break in her monotonous routine. Though much of this monotony was entirely her own doing, something self-chosen. She developed an iron-clad daily and weekly schedule, alterations to which were very unwillingly accepted. She watched TV, for example, every afternoon till about five thirty; always the same channel, usually mindless, sensational talk shows. When asked why she never switched channels, or had the TV turned on at other times to see something she might find interesting, she explained that she needed the stringent routine to help her assure herself that she “was not going mad.”

There was one exception to that routine, which became a routine of itself; Formula 1. She loved to watch motor racing and was well informed about all the drivers and teams so every second Sunday during the season when there was a race on she would watch it. She and I were united by a cordial dislike for Michael Schumacher – something very uncommon in Germany(!) – and if he lost we would share our jubilation with civilised, understated satisfaction. If he won, which unfortunately happened quite frequently, she dismissed him as an uncouth rowdy.

She was subject to panic attacks which could last for hours, frequently for a whole night. Those nights were hell – for all concerned. She could not use an ordinary bell to summon help but because she was on a respirator our standards demanded that her vital signs, pulse and blood oxygen satiation, be continually monitored. To summon a nurse, all she had to do was remove the finger-clip (something she could do) so that the signal to the monitor was interrupted and an alarm was triggered. Doped to the eyeballs and dead tired, her panic still prevented her from sleeping and she was capable of summoning us every five minutes – just for reassurance. And you always had to go, because there was always the slight chance that the alarm from the monitor actually meant something “serious.” I spent more nights than I care to remember with her in such situations. She knew perfectly well that her panic was irrational but she was powerless against it. And she possessed the genuine magnanimity to sincerely apologise for her behaviour the following day; something which (at least for me) made the whole thing easier to bear. The night-long aggravation transformed itself in retrospect into a difficult battle we had fought together which somehow served to fortify our mutual respect and liking.

Three mornings a week she visited our day-care department, for which I was responsible for two years up to last summer. She enjoyed those visits enormously, as did we. As much as she was an intensive-care patient while she was in bed; when she had been cared for, dressed in clothes she had chosen herself, lipstick applied and transferred to her wheelchair, she became a lady, in the best sense of the word. Amid old people, most of whom suffered from dementia and/or depression, she was like a breath of fresh air for those of us who worked there, her keen sense of observation and humour, as well as her intelligence giving rise to wry, clever and pertinent comments. Or simply gestures or a curl of the lip or flash in the eye as her ability to communicate verbally slowly disappeared.

For she was weakening. Like a cunning, wily, old general, trying to defend his territory with troops too few and too undependable, she fought long delaying actions and strategic battles with her traitorous body, having to surrender a little more territory each time. The time she was able to spend without the respirator daily gradually shrank and even when she was breathing independently she no longer had the strength for the strenuous effort of speaking through a tracheotomy tube. Various crises led to her spending intervals in hospital and from one of these she returned with an MRSA infection. It took my colleagues over half a year to get that cleared up (I was with the day-care group at that stage), during which she had to be confined to her room. Apart from the frustration at the enforced quarantine, that battle also took most of her remaining strength. The MRSA finally defeated, she returned once more to the day-care centre. It was like a triumph for us all, another battle won, against great odds. But she came ever more rarely; she had simply become too weak and it was slowly dawning on us all that her time was running out.

Shortly before the day-care centre closed for good, she had to be hospitalised again. She never returned. But, being the fighter she was, even unconscious most of the time, she went on struggling for life, beyond all borders of reason or strength. Immersed as I was in new, difficult, challenging, time-consuming work, I could only hear of her last battle from a distance. The ethics committee in the hospital had to be consulted. Typical, I thought, her stubbornness and strength of will was always her greatest asset – and, at the same time, her greatest foe. She was never good at bending like a reed; instead, like a proud oak, she stood against the storm until finally the winds brought her to a fall.

I couldn’t go to her funeral in August; I was working that day and couldn’t get off. I decided instead to write this – though I’ve needed quite some time to do it. It is not all that often that a nurse makes genuine friendship with a patient but over the five years we knew each other Hannelore and I became friends. A formal, reserved friendship it is true, I never used her first names nor did we move from the formal German Sie to the familiar du, but a genuine friendship nevertheless. Which is why in writing this now I refer to her by her first name, because somehow, after her death, it’s how I think of her. And, as a friend, I miss her – while at the same time being glad for her that her purgatory is over.

More than anything else, perhaps, Hannelore taught me a very deep lesson about the nature of human dignity. Hearing a description of her condition; her paralysis and bed sores, the tubes going into her and the tubes coming out of her, her absolute dependence on others for all the simplest and most basic and most private of human actions, one tends to recoil in horror, to ask, “What kind of life is that?” Yet through all this Hannelore retained her personal dignity; more she radiated it to all who came into her orbit. She could drive you mad, but you could never fail to take her less than seriously or even consider treating her without respect; she was possessed of too much raw presence for even the most ignorant to dare it. From her I learned – no, more, I experienced daily – that dignity is, finally, not something that is defined or determined by extraneous factors but rather something intrinsic, something definitive about being human. It is something we can perhaps give up (I have a suspicion that this is a lot of what despair is about) but it is nothing that events or other people can take from us without our own assent.

Hannelore retained her dignity to the end and through that she enriched my life and that of all the others who encountered her. And for that I can rejoice in her memory and feel honoured to have known her.

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