In the Midst of Life
Jennifer Worth (2010), Phoenix, London
420 pages; £7.99. ISBN: 978-0-7538-2752-9
Jennifer Worth was born in 1935 and she died of cancer, aged 75, in 2011. She had four professional careers – school secretary, nurse, musician and author. Hers is the two-million best-selling trilogy Call the Midwife, based on her experiences as a midwife in the East End of London in the 1950s, which became such a popular BBC TV series, though she never lived to see its success.
But in this, her last book, she moves from birth to the other end of life and examines dying and death. The title is taken from one of the seven 'funeral sentences' of the 1662 Book of Common Prayer, ‘Media vita in morte sumus’, ‘In the midst of life we are in death.’
The book seems like an almost random collection of stories, anecdotes, lessons in medical practice, plus some religious thoughts. The style is sometimes sappy, sometimes text bookish, yet it informs the head and it pulls at the heart. Her prime purpose is to get the reader to think about, even discuss, dying and death – our great end. And she includes chapters on her heroes, Elizabeth Kübler-Ross and Cicely Saunders together with some of the fascinating people she knew as patients, like Dr Conrad Hyem and Mr Anderson and their medical ups and downs. There is discussion of strokes, advance directives, dementia, the Brompton Cocktail, grief, family dynamics, defibrillators and a host of other relevant topics. And there is a piece, albeit brief, on euthanasia and assisted suicide. ‘This clinic, Dignitas, gives me the creeps. What sorts of people administer it?’ On that assessment, we are as one! In addition, there are three hefty Appendices by medical experts, a list of resources, a glossary and an index – what more could you want or need?
The chronology starts in 1953, when she was a first-year trainee nurse at the Royal Berkshire Hospital in Reading – next to the school I attended – and the remarkable story of Mrs Ratski. There will be no narrative spoilers here! Jennifer Lee, as she was then, was confronted with the Hospital’s well-meaning but rigid regime of treatments, operations, drugs and antibiotics for the dying, and she was not happy. Her anxieties reached the attention of Matron – the stern, wise and four-feet eleven-inches tall Miss W Aldwinkle OBE – and a conversation over a nice cup of tea ensued. Matron’s words set the theme of the entire book, ‘A nurse must obey orders. If life-saving drugs are to be given, they must be given. Nurse, you are young and passionate. You are trying to understand a subject too deep for understanding. Medical science has found hundreds of death-defying tactics. I advise you, Nurse, not to talk too freely with other people on this subject. You will not be understood. It is a dangerous subject.’
Then, at last, some 60 years later, Jennifer Worth does get to talk, or at least write, about this ‘dangerous subject’ of dying and death and the patients, healthcare professionals and treatments involved. Her thesis is quite simple. Death is inevitable – doctors can often slow its approach, but not its finality. Everyone wants a good death. Modern medicine and its practitioners can strive too earnestly. Instead of death being quiet and dignified, it can become noisy, mechanised and prolonged. Worth does not repudiate the wonderful advances of twenty-first-century medicine, but she does question the additional suffering that, for instance, aggressive courses of drug and chemotherapy or the repeated resuscitation of the terminally-ill patient can bring. Has medicine induced a state of affairs whereby the dying are unable to die? When is it not lawful for an old man to die of old age? Should not the dying man, wracked with cancer, be comforted and permitted to die after a massive heart attack rather than hooked up and cut open? Why do medical teams find it hard to say, ‘No more, this is futile’? Worth ponders that nagging question, ‘… isn’t it better to die of heart and circulatory failure, before you have to die of cancer?’ What has happened to ‘natural’ death?
These are profound questions that modern men and women ought to be facing. But we don’t. Dying and death have become distant, sanitised and embarrassing affairs. It is Amos 4:12 that roars, ‘… prepare to meet your God.’ ‘Be prepared’ I always write on the flyleaf whenever anyone asks me to sign a copy of my book, The Edge of Life. Worth is supremely shrewd and prudent in this area.
And so to the Christian content of the book. Jennifer Worth self-identifies, ‘I am a Christian; with every breath of my body, every beat of my heart, I trust and love God’ and the book is shot through with Christian thoughts, some mawkishly sentimental, and other bits of religions of all stripes. Some bold, biblical assertions would have been nice. How can a Christian discuss death without reference to verses such as Genesis 2:17 and Romans 5:12? Instead there is that annoying stuff, like, patients' recoveries described as 'miracles', a dying wife told that she will soon meet her already-deceased husband, as if Universalism rules, or the agnostic declaration that, ‘None of us knows whether there is life after death.’ This is the book's weakness, perhaps downfall. But then she was connected to the Anglican sisters of the Community of St John the Divine and perhaps that explains her religious vagaries. Even so, such shortcomings should stop no-one from reading this thought-provoking book.
From time to time, we all meet individuals like Jennifer Worth – knowledgeable, forthright and kind – who have lived lives that have counted. Lives that are happy, instructive and compassionate, within families, among friends and towards strangers. They are examples to the rest of us. But even they have to die. As the author concludes, ‘Much of this book is dark and dreadful.’ But, ‘If you cannot envisage your own death, how can you enjoy life?’ This is a book to be enjoyed, educated and moved by. In the end, death is not an abstruse, academic matter – it will come to us all. The Teacher was spot on when he wrote, 'There is ... a time to be born and a time to die' (Ecclesiastes 3:2). Death is too infrequently discussed. Maybe this book will help us open up.