Blood and gusts, urine and rescue

Northern Ireland reminds me so much of my roots. Sitting in the waiting room in the haematology Department I get chatting to an 85-year-old fellow patient. Our conversation was triggered by a much older man nearby getting his blood taken in a treatment room. Being wheelchair bound and extremely deaf, every exchange with the staff is audible to all in the waiting room outside. His medical records indicate he was born on the 10^th of February and the nurse treating him comments that her father was also born on that day. He asks loudly, “but what year was he born?” The nurse answers with, “1933” and his response to that is, “Sure, he’s only a young one isn’t he?” Or to be more accurate what he actually said was “Ach sure e’s only a yungon ainy?”  But I shall spare all of you any more of the deadly Northern Ireland dialect.

The people in the waiting room smile in response, feeling much better about their own age. The man beside me is also a young one born in 1933 and informs me he is the youngest of a family of eight. His elder sister never married and lived until her 97^th year, a lovely kind woman he tells me.  One of his brothers was in the military and died in his 50s, this was accompanied by a sad sigh of loss despite the decades that have since passed. We talk of places and family. His name is Anderson and I also have family members called Anderson but he comes from a different area entirely in Northern Ireland called Cookstown. I told him I have a relative who ran the pharmacy in Cookstown for years and suddenly I realise the unknown person beside me in Northern Ireland is invariably either related/lives beside a relative/or went to school with a relative.

The communication goes deeper and we share our relief at the rescue of the Thai youngsters from the dark deep water-logged cave. In such moments humans show their compassion and unity in longing for their safe rescue. All of us have become invested in these young footballers. Their release is a joyous relief. Of course, we are picky about our investment of emotional attachment. Thousands drowning in the Mediterranean pluck few heartstrings but a tiny toddler face down in the surf of a beach breaks through our intellectual defences. Likewise, millions facing desperate conditions in Yemen don’t make it onto our newspapers. Instead, the infantile posturing of the self-important gets three-inch high headlines. The worst humanitarian disaster facing humanity at present is considered of little or no impact importance in this perverse world of ours.

My 85-year-old fellow patient is struggling to maintain his garden these days just like my mum. They are both suffering from the present hosepipe ban. The younger gardeners manage by using watering cans but for the over 80s they just have to watch their flowers wilt and fade while their lawns grow brown and die. He tells me he was the last child born in his family and was 18 pounds at birth*.  He’s a nice good-natured 85-year-old, well dressed and well spoken. I tell him he’s lucky to have been brought up in a big family surrounded by loved ones.

Then, he says all his brothers and sisters have since died. The last he lost was a sister 12 years ago.  He’s all alone now. No brothers or sisters, his wife gone and his only son lives abroad. I had idly thought that the lonely were usually drug addicts or alcoholics who had systematically broken or abused every family relationship until they were homeless with no one left to care. I had not factored in that death in old age is equally effective in breaking all the loving bonds that unite families.  Gradually death casts aside all the mooring lines that attach you to others. Drifting off, these individuals are unexpected alone after a lifetime of being loved and surrounded by kindness. They don’t expect it and have no time to acclimatise to this new brutal reality. They have all the social skills that life in a loving family cultivates. They’re good-natured, long-suffering, grateful for all the special souls that have shared this journey with them. But suddenly they bereft and alone facing hospital visits and treatment alone. There is no one to share the bad news with. It fills my heart with sudden sympathy. They cultivate a new kinship with those in here to get blood tests regularly and most seem to know each other. Suddenly, as the conversations develop the noise levels rise and it makes me feel Northern Irish. That characteristic chattiness and love of a good gossip binds and quickly unites us.  They’re talking about football now anticipating the big game tomorrow as one man in a wheelchair is wheeled out of a treatment room and placed beside us.  As the consultant passes back into the treatment room he points out to the nurse that “We seem to have a leak here!”  Horrified everyone notices that the man’s wheelchair is parked in a puddle of urine that has dripped from his chair.  The consultant closes this door, the nurse rushes to get cleaning material and we are all left in awkward silence.

Into the humiliating silence, people unexpectedly begin to share tales of their own humiliation. Some are really cracking tales told in commiseration for the chap in the wheelchair.  One character, Jesse, a middle-aged man in a red tracksuit says his bowels stopped working a year ago. He was given fibre gel, lactose, senna etc and growing arsenal of stuff designed to give him a good ‘pull through’ as my grandfather would call it. All to no avail in Jesse's case,” I was blocked up as if by cement!” He explained.  “They give me everything short of dynamite to get me going but all failed. After three weeks I felt my innards would explode if no relief came. I was swollen like a pregnant pup and the pain was awful. I could barely sit and standing was not much better!  Anyway, unknown to me my doc arranged for me to be hospitalised. They took me on board this ambulance for a 10-minute drive to the local hospital. I didn’t make it. Eight minutes into the trip, my bowels finally decided to get going after being on strike for three weeks. There was I, in the back of an ambulance, having the bowel movement of the century. I apologised to the wee lass with me in the back of the ambulance and the driver and the nurse who helped clean me up on the ward later. I thought I’d be mortified beyond belief! But you know what, I was rightly relieved and grateful too! It’s not until you can’t do something that you begin to appreciate the miracle of anything.” 

It was a cracking tale that had us all laughing in stitches. Even the poor guy sitting in the wheelchair in a puddle started giggling.  The nurse came back into the waiting room mop and bucket in hand. First, she sprayed some disinfectant on the floor and then carefully mopped up the urine, moving the wheelchair to get underneath.  Then she left and the humiliation was back in the room.  Everyone knew he was sitting in soaking clothes wet and uncomfortable.

We were rescued by a white-haired lady sitting opposite who shared her story of humiliation. Once she’d been a deputy head of school and had gone in to talk to the headmaster in his office. While there she felt an unexpected urge to fart. While not been able to avoid passing wind she did manage to do so silently, “silent but deadly” she informed the riveted room. After the conversation was over she left the office happy that she had got away with the unexpected gust without being noticed.  A few minutes later she realised she had left her handbag in the office and returned to the office knocking briefly before entering to retrieve her bag. There, she found the headmaster with the office window open using a large newspaper to waft out the offending smell.  She said, “I didn’t know where to look, I actually put my hands over my eyes, I was that ashamed.  I left the office without saying a word and thought suicide was my only option!”  In the silence that followed we all howled in mirth.  The room was full of riotous laughter and good humour.  There are true comedians skilled in tales to bring you back from the edge of despair.  Sharing their own humiliation turned an unmitigated disaster into something else for all of us. 

_.

* I found this almost unbelievable but then found out afterwards that the record for "heaviest birth" is currently held by Anna Bates, who gave birth to a boy weighing 22 pounds in Seville, Ohio, on January 19, 1879.

Breaks, Drunks and a distinct lack of tea

No one warns you about falling. Yet so many do exactly that. In fact for the elderly a fall is the most common entry into the hospital/residence home system. It is a sad fact of life that almost any of us who have a severely broken leg will struggle to cope. When you cannot reach things, make your own food and suddenly become dependent on others, it feels like being a helpless child again. All your plans including work of any sort is shelved. Usual routines like housework, coffee breaks, visits to friends become challenging. But however difficult for those who are middle-aged and younger, it is as nothing compare to that facing the elderly in the same situation.

Their responsibilities may well include being a caregiver for an elderly partner. Suddenly, what was a 24-hour job becomes untenable. Often a fracture in an elderly person will not just lead to their hospitalisation but also institutionalisation of the remaining partner. Added to the anguish of pain and medical procedure is is the realisation that the closest person to you has been left vulnerable and taken from your home by the social services. Confusion reigns as the elderly quickly lose a sense of where/who they are when moved out of familiar surroundings and company. Recovery from major injury can take months not weeks and always there is a very real possibility that there may be no recovery. 

In many places hospital care has been centralised. This means people are often taken far from their family, friends and neighbours.  When they most need support and care, that lifeline is severed by the long distances travelled to receive medical procedures.  Waiting time in casualties the world over are now in excess of three/four hours.  Even after you see a doctor no one tells you what has happened.  For fear of litigation or lack of staff, communication is minimised.  So the elderly are left in beds confused as to what injury they have sustained.  Not sure what will happen next and completely disorientated by this new and frightening environment.  Trained not to complain they endure in silence while others shout for attention.  I have visited relatives who have been in hospital for days and they still have not been told what their injury is. Even basic things like fluid intake are neglected.  There used to be a lovely little lady in Coleraine hospital who would come around casualty and hand out tea and toast.  In the chaos and confusion her smiling face offering hot tea and warm toast was like an angel in a war zone.  

Nowadays, she has been replaced by on duty police officers to restrain the many drunks who attack staff and other patients.  These officers are really needed. I had a young student friend, John who was in casualty for a broken arm.  While awaiting treatment for this injury a violent drunk broke his nose as well.  I must confess to losing my sympathy for such violent individuals.  It feels as if they have decided to get drunk and in that state injured themselves.  Then, when brought to casualties up and down the country they wreck havoc on staff trying to treat them and even other patients sharing the waiting room.  It tests compassion indeed when the elderly have to share such spaces with these drunks.  The injured elderly are particularly vulnerable to abuse and know it.

Regained mobility is not taken for granted by the elderly. They know like health, mobility can be gone in the crack of a bone. Who you are and how you think about yourself all can change in a single second.  The only aspiration becomes regaining what you once had and that seems an epic battle fraught with setbacks and unexpected complications. When they have wrestled and fought to regain normality they cannot easily forget this torment.

So understand when the elderly want to tell you the details of their illness even after they recover. It is a form of post-traumatic stress and having fought on a battlefield filled with pain, sleepless nights and vulnerability they need to retell their suffering. Talk through the trauma and understand their life’s journey has changed. All can play an important role in helping them, take ownership of themselves and their path in this world by just listening. With each retelling the experience becomes more of their past and less of the present. They gain perspective on what has happened to them. Your listening ear provides a recognition of what they have been through. But don't be afraid after listening, to move the conversation on. Your insights and interests are exactly the world of outside hospitals they need to rediscover. It's just for many the hospital corridors have been long and agony filled.  It takes time for them to mentally navigate and find their exit. 

Parallel universes exist in this earth. There is the life inside hospital and life outside. Two completely different worlds.

Slaves Revolt - Malta

Picture shows underwater statues in memory of slaves lost at sea near Grenada slaves thrown overboard

In 1749 there was a famous slave revolt that took place in Malta.  In the history of Malta it is betrayed as a terrible conspiracy where slaves were planning to slaughter the local inhabitants.  The slaves are portrayed as a violent murderers willing to slaughter their masters to gain freedom.   Here is a typical account of the event.

“A plot of the most dangerous character, and one that threatened the direst disaster to the Christian inhabitants of the island, was, however, discovered on the 6th June 1749. At the head of this conspiracy was the Pascha Mustafa, Governor of Rhodes, then a prisoner of war in Malta. This dignitary, while on his way to Rhodes, had been captured by the Christian slaves who manned his galley. The mutineers, after having murdered their officers and become masters of the vessel, made for Malta, where they arrived on the 2nd February 1748. 

The Pascha, instead of being looked upon as an ordinary prisoner of war, was treated by the Order with every mark of respect. From the moment of his arrival Mustafa devised the detestable plot of massacring the whole Christian population of Malta with the assistance of the Turkish slaves in the island, who at the time numbered about 1,500, and then annexing Malta to the Ottoman Empire. Continual promises of support from Constantinople emboldened the conspirators, and the 29th June, the festival of St. Peter and St. Paul was selected as the date on which their atrocious designs were to be carried out. As on that day the city would be practically deserted the majority of the inhabitants being away at the festivities at Notabile. Had it not been for an accidental quarrel that led to the betrayal of the plot, a wholesale massacre would have most undoubtedly ensued. 

The quarrel originated in a tavern where two of the conspirators had gone to endeavour to enlist as a confederate a young Maltese soldier of Pinto's bodyguard. Enraged by his continual refusals to join their ranks, they attempted to stab him. He would have been torn to pieces had it not been for the timely interference of the innkeeper, who, on learning the motive of the quarrel, lost no time in revealing this dangerous plot to the Grand Master himself. Several of the conspirators were at once seized and subjected to torture, under the extreme agonies of which a complete confession was extorted and some sixty of the ringleaders were put to death. The honest innkeeper, Cohen, was handsomely rewarded, and the faithful young soldier, Cassar, for his unflinching devotedness to his colours, was promoted from the ranks and given the command of Pinto's bodyguard, known as the " Guardia Urbana." On the anniversary of the discovery of the plot, the Knights of Malta regularly held a thanksgiving service in the church of St. John in commemoration of this providential escape from massacre."

However, if you examine the life of slaves in the world at that time there were many changes happening.  In the Caribbean on the island of Saint John in 1733 there was an uprising of the slaves to try and obtain freedom.  In South Carolina in 1739 there was also a slave revolt.  In 1747 Africans rose up on the Rhode Island ship (Captain Beers) which was off the Cape Coast in Ghana.  It is important to remember that off the millions transported to America in slavery, over a period of 300 years almost 40% died on that journey.  Many fortunes were made, it was seen as a strictly economic endeavour with the human beings simply a product to be sold.  Many aristocratic estates all over the world, many of our rich today gained fortunes on the back of slavery.  

But the tide on slavery was beginning to turn and many people were speaking out against this trade.  Legislation was soon to be in place that would gradually make it illegal in various parts of the world.  It is unfortunate that long after the African American slavery route was halted, African European slavery continued.  So, it is important to understand what conditions were like for slaves in Malta at that time.  The seaborne crusade demanded a largely unarmed and coerced labour force. The Knights of St John needed captives. They needed them as oarsmen in the galleys and labourers in the docks. Whether they were prisoners of war, victims of shipwreck or persons kidnapped, they were a vital resource.  There were simply not enough crew or convicts to man the ships that the knights needed without slaves.  Ottoman cities remained multi religious while most of western Christendom was purged of its Jews and Muslims. After the Reformation it was also purged of even if its Christian dissenters.  While Catholic merchants and consuls who lived in Istanbul Alexandra or Tripoli could practice their faith and find a small community of practising Catholics, supported by Rome, there were no such parallel infrastructures for Moslems in Christendom.  In fact between 1609 and the late 19th century no free community of Muslims, including those converted to Christianity, resided within Western Europe.  The Knights of St John Malta would target all non-Catholics, Orthodox Christians, Muslims and Jews alike and enslave them. They would seize the cargo of Jews, even those with permits and passports, and send them to the slave market in Valletta.  Within the Mediterranean, the numbers of east and sub Sahara African inhabitants sold into bondage outnumbered the numbers of either Western Christians or Mediterranean Muslims.  As long as galley fleets were used for transport slavery persisted. It was only when wind powered vessels came into being that the need for slaves on board was reduced somewhat.

Being condemned to the galleys was a dreadful form of punishment for even the convicts. What was supposed to be a short-term at sea, for them, could become a death sentence. Many men would maim themselves rather than face the ordeal. After a few weeks of confinement on ships the stench of human sweat and excrement was overwhelming. The oarsman who were chained to the benches could not change their clothing or even move to relieve themselves. For weeks they might have only brief sleep periods. Many slaves died on these ships; the plague of 1720 carried off one fifth of France’s rowing force. A small amount of galley slaves survived for decades some remaining at the oars into their 60s and 70s. They were not permitted to marry .  Given its role as one of the chief traffickers of non-Catholic slaves within the Mediterranean, Maltese cities held more than 1000 Muslims in slavery at the end of the 18th century.  In battle or if the boat foundered the slaves chained to the benches, not the captain, would go down with the ship.  At the end of the sailing season Muslims slaves would be pressed into the construction of public works such as bridges and walls in the Maltese cities of Valetta and Senglea. In the mid 18 century, 639 of the 782 men at the oars were enslaved Muslims.  Muslim slaves in Malta complained that unlike the practices in Istanbul or North African ports they were not allowed to eat or drink their purchases of food inside shops or taverns were forced to eat outside on the street.  Their heads were shaved except for a distinctive pigtail, they wore a roughly woven woollen cape with a hood. Converted slaves and Muslims alike carried a 1 to 2 pound lock around the ankle.   

With this knowledge, it is not hard to see that many desired freedom. If they could arrange for relatives, back home, to provide a ransom then there was a hope freedom could be purchased.  However, for many poor slaves this was not an option. It is important to note that slavery was common place at this time across the world and practised by most nations.  With the advantage of hindsight we can observe the whole machinery of enslavement through horrified eyes.  The loss of lives was heavy, the mistreatment and torture of human beings intolerable.  Perhaps, it is a salutary lesson of the past that all it took was a different religion/sect or race to enable us to feel righteous and noble in enslaving them.  

There are perhaps parallels in today’s world where we will allow people to starve to death, drown in our seas, fester in refuge camps and still manage to feel disengaged from their suffering.  The slave trade was ultimately economically driven, so too we must ensure that economic considerations are not driving nations into despair,destitution and a new modern form of slavery.

Worth a read - puts the topic in perspective today

A Persistent Evil: The Global Problem of Slavery, a report published by the Harvard International Review in 2002, Richard Re suggested: "Conservative estimates indicate that at least 27 million people, in places as diverse as Nigeria, Indonesia, and Brazil, live in conditions of forced bondage"