The medical ward. A concentration of illness, anxiety, uncertainty, need and exemplary patience. Each patient, although concerned primarily for their own welfare, cannot avoid noticing and following momentous events in the lives of others. The architects of the ward designed a semblance of privacy, and the medical staff try to maintain it by pulling (literally) paper-thin curtains around the defined space that belongs to each patient. Sometimes the edges of the curtains do not meet, allowing glimpses of flesh, a trembling hand, a bent back or shuffling feet. These things are only seen if the patient opposite chooses to watch. The skill that one acquires in pressed tube trains or crammed lifts comes into its own – the ability to ignore, to pretend that it is not happening, to avoid eye contact until decency or distance has been regained. Even if the curtains do meet, the air above, below and around them is unrestricted. Sound travels. Only whispered words remain in the immediate vicinity of the patient. Doctors tend to shout rather than whisper. Perhaps it is the fact that a good proportion of their patients are deaf, and many are barely responsive. The habit of communicating declaratively and with painful deliberation, like an ignorant tourist in a tumultuous bus station somewhere in rural China, is sometimes hard to modulate.


I sit on the edge of a patient’s bed, while his wife leans forward in the chair alongside. He looks over, eyes tinged with yellow. His liver has failed, and there has been no response to medication. I am here to tell him that this failure to respond means that his chance of survival beyond six months is less than 25%. There is no point using numbers. Instead I say that the time has come to think about going home, but that other parts of his body – like the kidneys, and later the heart – may soon begin to fail in sympathy with the liver. If that happens he may become too weak to move, and will begin to die. Alternatively, a sudden emergency such as bleeding from the gut or overwhelming infection, may hasten his deterioration. We will make sure that there are nurses and carers at hand to help him remain comfortable. He is 42.


The younger doctor, who remained standing (there was no room for another chair, and the patient was too ill to come into the relatives room) reads the situation correctly. We have finished. She parts the curtains slowly, respectfully. Not briskly, as we do when the news has been good, when the discharge plan has come as a symbol of recovery or cure. She and I walk back to the notes trolley. We pick up the folder of the next patient. Another man in middle age, another partially destroyed liver. We approach, and I pull the curtain round. His illness is less advanced, but the trend in his blood tests is not encouraging. There are tears in his eyes. He looks up and says,

‘I don’t want to die.’

‘Why do you…?’ But I know why. He has heard everything.


 [As usual, the scenario described is based on historical experiences and not a single case]



New booklet, 78 pages, £2.99 – recommended for trainees, consultants, nurses involved in the acute medical care. Click picture to explore


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