STOKE MANDEVILLE AND GERALD BUTLER

My right testicle was heavily swollen.  It was a hydrocoele that needed repairing.  My urologist, Mr Reynard, was draining it every three months or so in the spinal outpatients department of Stoke Mandeville Hospital.  The process was uncomfortable.  He had to insert a needle into the testicle and draw off the excess fluid, which occasionally measured a hundred millilitres.  Eventually he decided to deal with it permanently.  I was admitted on to St Patrick’s Ward and occupied the middle bed in a six bed unit, three on each side of the Ward.  I liked Mr Reynard.  If I were to grade the consultants working in the Spinal Unit, I would give him 100%.  The rest never even came close.

So there I was, ensconced in bed and waiting for the operation.  My testicle was the size of a large chicken’s egg.  Opposite me was a guy called Gerald Butler.  I had met Gerald before.  He was a quirky individual.  Gerald stammered, but once he got the first couple of words out the rest followed smoothly.  He invariably completed his sentences with ‘you know’.  His lips were lopsided, his hair thin and long.  From a distance his face appeared smooth but on close inspection it was a crosshatch of grooves and thin lines.  Gerald’s hands shook uncontrollably, a condition he called ‘essential tremors’.  He made me laugh when he tried to roll a cigarette, the tobacco dropping all over the place.

Some of the other patients thought he was an idiot.  I didn’t.  To me he was intelligent and interesting.  Idiosyncratic is how I would describe him.  He was rather deep.  You got the feeling there was a lot more to him than met the eye.  I’m not sure whether he had had a stroke or whether years of medication had garbled his brain but he seemed to lack a certain awareness, or the capacity to care or feel responsible for his actions.  I didn’t like to pry too much, especially with so many judgemental patients around.  I was sure that given time I would understand him a lot more.

Six months ago Gerald’s left leg was amputated at the knee.  He had been readmitted into hospital because the stump had become infected.  He was under the care of Mr Derry.  Mr Derry put up with a lot where Gerald was concerned.  He made allowances for his lack of comprehension and responsibility.  Derry had ordered Gerald to stay in bed.  “You mustn’t apply pressure to stump.  It needs to be kept elevated.”  Gerald was a smoker.  You may as well have confined him to hell.

 My hydrocoele was operated on and was recovering well.  The testicle now looked completely normal but for a gauze dressing.  Hopefully it would never again inflate with fluid.  Things were ticking along nicely when a routine blood test produced a very low sodium result.  It wasn’t unusual.  My consultant was concerned that my adrenal glands weren’t working properly, so he decided to run stress test on them.  Before eating, at around 6:30 AM, a doctor inserted a two-way cannula into my arm and injected a special drug.  Blood was then drawn off three times, at half-hour intervals and sent to the laboratory for analysis.  The results conclusively proved that my adrenal glands were working fine.  I was perhaps drinking too much, flushing the electrolytes from my body through my urine.  My consultant prescribed sodium tablets and a reduction in fluid intake.  That and low blood pressure were the only hiccups in my recovery.  In fact my blood pressure was so low I nearly fainted when I was lifted from the bed into the chair.  Patients in the six bed unit started betting on how long I would last before I collapsed.  My wife had to keep tipping my chair back, so that my legs were raised and my head lowered.  This would go on for around an hour before my blood pressure stabilised.  It felt as if I had been disembowelled, the contents of my stomach scooped out and spilled to the floor.

A week went by.  It seemed like a month.  Time seemed to stand still in hospital.  Gerald was eventually allowed up.  He was hoisted from the bed and into his electric chair.  The nurses instructed him to return to the Ward in one hour.  Three hours later and without the slightest shame or embarrassment he wheeled back in.  The nurses scolded him but it was like water off a duck’s back.  They threatened to tell Mr Derry.  Gerald didn’t seem to care.  He took it all in his stride.  He had had his cigarette and he was happy.  In fact he seemed unusually happy.  I guessed he had been outside smoking cannabis with the other patients.  They would sit under the canopy of the main entrance smoking cigarettes laced with grass or resin.  Smoking was of course banned on hospital grounds but everybody turned a blind eye to paraplegics and tetraplegics smoking dope.  Many doctors thought the drug was therapeutic.  It calmed jangled nerves and eased pain.  If it gave us wretches a bit of comfort, so what?  Who could deny a paralysed person a moment of pleasure?

Derry warned Gerald that the stump might break down if he persisted in staying up longer than was recommended.  “You’ve got to be careful.  This stump could easily become infected.  Be patient, Gerald.  Slow and easy is the key.”  Derry wanted the stump to heal thoroughly before Gerald could stay up for long periods of time.  If all went well he’d discharge him in a couple of weeks.

The next day Gerald was allowed up for another hour.  He was once again hoisted from the bed and into his electric chair.  Wheeling towards me he said, “Bye Michael … “I’m going for a smoke …”  With his body leaning at an obtuse angle, he swivelled his chair around and headed for the corridor.  The electric motors of his chair whined softly as he faded from sight.

Three hours later he came back smiling.  Again he showed no shame or embarrassment.  It was as if he had done nothing wrong.  After another verbal ear bashing from the nurses, Gerald was hoisted back into bed.  We chatted for half an hour or so and then he dropped off to sleep.

Patients denounced him as an idiot.  One of them, a judgemental young man in his twenties and occupying the bed next to me, actually called him a stupid fool.  “He’s going to fuck that stump up for sure.”  But Gerald was never going to listen to anybody.  He was impervious to criticism.  He would always do what he thought best.  Rationality never came into it.  Those diminished responsibilities of his made sure of that.  There was no reasoning with Gerald.  In a sense he was like a child: didn’t really know what was good for him.  Unlike a child, he wouldn’t be told what to do.

A BRIEF HISTORY IN HOSPITAL TIME

The afternoon passed slowly.  You marked time in hospital by various routine tasks carried out at specific moments.  Dinner at midday.  The evening meal was served at 5 o’clock.  The night staff signed in at 8 o’clock.  By 9 o’clock the tea trolley was doing the rounds.  At the same time a nurse pushed the drugs trolley along, dishing out medication to patients.  Some patients needed hoisting back into bed; others needed turning.  The main lights were switched off at 11 o’clock.  Patients tucked themselves in or were tucked in by nurses.  The staff gathered behind their desk and then silence — but for the quiet whispering of the nurses and the soft snoring patients.  The arse rakers came round at 5 o’clock in the morning, inserting suppositories into the rectums of hapless patients and tucking incontinence sheets under their buttocks.  Much farting and squelching followed, and then the stench of shit.  Patients arses were raked out at 6 o’clock — rhythmic movements of nurses fingers teasing the shit from patients’ bowels.  Can you imagine how intensely horrible this experience was?  Dehumanising, degrading and unbearably uncomfortable.  God only knows what the staff thought?  They deserved a God damned medal.  You had to be superhuman to do that job.  I thanked my lucky stars that I had a colostomy.  It was probably the best operation I have ever had.  No shit raking for me.  The staff passed me by as if my bed was marked with the blood of the Lamb.  Gradually the stench of shit dissipated from the Ward.  The lights came on at 8 o’clock.  Wakey, wakey time.  Some patients remained asleep, drugged on sleeping tablets.  Others like me and Gerald had been awake for hours.  Breakfast was served between 8 o’clock and 9 o’clock and then the whole process started all over again.

A BACK TO GERALD

It was 9:30 AM.  Gerald’s curtains were pulled around his bed.  Nurses were washing him.  I could hear him complaining, though I couldn’t understand what he was saying.  Something had upset him.  When the curtains were pulled back, I expected to see Gerald dressed and ready to get up.  But he was still in bed, and with a look of exasperation on his face.  Apparently the nursing staff had ordered him to remain in bed.  But Gerald would have none of it.  He decided — without a single doubt or concern about his health — to discharge himself. 

Word got round to Mr Derry.  Looking very stern, he strode onto the Ward.  “I’ve spent hours operating on your leg,” he said.  “It hasn’t healed yet.  Don’t do this, Gerald.”  He threatened not to treat him if the stump broke down.  But Gerald had made up his mind.  “I can look after it myself.  I’ll make sure that I keep my leg up.  The district nurses will help me.”

And so I watched Gerald as he was hoisted from the bed for the last time.  There were no jokes this time.  He was very quiet and so were the nurses.  They carefully lowered him into his chair, adjusted his clothes and got him comfortable.  Another nurse was gathering his belongings, taking things from the bedside cabinet and drawers and putting them into a large black plastic bag.  She put them on Gerald’s lap.  He manoeuvred his chair towards my bed.  “Well, Michael, I’ll be seeing you.  I’ve had enough.  The district nurses will make sure the stump is okay.”  We said goodbye to each other and I watched him wheel from the Ward, his dishevelled hair hanging down the side of his face.

Once again he was derided by the patient in the bed next to me.  “Bloody fool, ” he said.  “The guy is a complete idiot.”  I didn’t bother to comment.

Gerald and I kept in touch by telephone.  As I got to know him more, he revealed that as a young man he had been heavily addicted to drugs, injecting amphetamines and opioids and smoking a lot of weed.  I knew there was something odd about Gerald but never in a thousand years would I had thought he was a heavy drug user.  Maybe that was one of the reasons why he had diminished responsibilities?  It made no difference to me.  I’ve had a fairly colourful life myself.  Gerald is basically a good man.  He will always be my friend.

The last time he telephoned I asked him how he broke his back.  He said he had jumped from a multi-storey car park.  That was in 1989, eight years after my accident.  I wondered whether drugs or depression had driven him to commit suicide.  “Gerald, why did you do it?”  Answering my question, he said he was bipolar and was overwhelmed by a tsunami of maddening thoughts that kept repeating themselves over and over in his brain, an uncontrollable flood of disjointed and surreal imaginings.  In an hysterical bid to escape his own mind, he threw himself from the top floor of the car park.  It reminded me of a passage in the Bible: the madman who was possessed by demons and had been cured by Christ who cast the evil spirits from his body and commanded them to enter a herd of swine.  They ran frenziedly towards a cliff and lept over the edge.  The multi-storey car park was over sixty feet high.  He was lucky to have survived.

Gerald and I met up recently in Stoke Mandeville Hospital.  We had arranged the meeting by telephone.  I was there for a routine outpatient appointment, a baclofen pump refill.  He lived near the hospital and arrived by taxi.  We met in reception and wheeled round to the canteen.  There we had a cup of tea and a chat.  Once again I looked at his face: the crosshatch of lines, the oddly skewed lips, the dishevelled hair and his deadpan eyes.  Coughing a lot, he sipped his tea.  I noticed that his left hand and arm were twitching and shaking uncontrollably.  Curiously his right arm and hand were okay. 

Not long ago he told me that he had had enough.  Spinal injury, sores and illness had got the better of him.  His big toe has recently become infected.  Apparently he had a hole in the flesh between his toes.  A team of district nurses were dressing it.  They had orders to put him to bed at 6 o’clock.  Gerald liked to stay up late.  Being confined to bed so early was torturous.  As I gazed at his guileless features, I wondered how much more he could take.  A wave of compassion swept over me.  I knew I would do all I could to make the rest of his life more pleasurable.

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