We sleep safe in our beds because rough men stand ready in the night to visit violence on those who would do us harm
December 4, 2008 10:18 PM   Subscribe

How the Poor Die My right-hand neighbour was a little red-haired cobbler with one leg shorter than the other, who used to announce the death of any other patient (this happened a number of times, and my neighbour was always the first to hear of it) by whistling to me, exclaiming "NUMÉRO 43!" (or whatever it was) and flinging his arms above his head. This man had not much wrong with him, but in most of the other beds within my angle of vision some squalid tragedy or some plain horror was being enacted. Previously

Much of George Orwell's writings can be found online, including his essays. Here are a few from the site linked in the FPP:

You and the Atomic Bomb It is a commonplace that the history of civilisation is largely the history of weapons.
Books vs. Cigarettes With prices as they now are, I am spending far more on tobacco than I do on books.
The Lion and the Unicorn As I write, highly civilized human beings are flying overhead, trying to kill me.

A highlight of the site is the Road to Wigan Pier:

Mr Brooker was a dark, small-boned, sour, Irish-looking man, and astonishingly dirty. I don't think I ever once saw his hands clean. As Mrs Brooker was now an invalid he prepared most of the food, and like all people with permanently dirty hands he had a peculiarly intimate, lingering manner of handling things. If he gave you a slice of bread-and-butter there was always a black thumb-print on it.

As I Please, his collection of wartime essays for the Tribune, can also be found in bits and pieces on the web.
posted by KokuRyu (16 comments total) 34 users marked this as a favorite
The "How the Poor Die" essay is just creepy. I could not imagine actually being in that scenario for even just a second. Then again, I don't really like most hospitals in general, even the good ones.

But really, there are a few glaring typos in that essay too, like one key off misspellings. I'm going to go ahead and guess that Orwell did not do that himself, but even if he did, they are kind of obvious what they should be.
posted by Chan at 11:51 PM on December 4, 2008

Politics and the English language should be required reading in every high school in the western world.

These days, Orwell is probably spinning in his grave at such an unprecedented velocity that his corpse should be harnessed as an alternative source of energy.
posted by Hickeystudio at 12:59 AM on December 5, 2008 [1 favorite]

Daaamn, and I've been complaing that I can't find anything but Animal Farm and 1984 in print. Thanks for the excellent links.
posted by fleetmouse at 1:23 AM on December 5, 2008

Warning: These are not safe for work, not in the scatological or sexual sense but because they are so damn good that if you start reading one you won't be getting any work done until you finish it!

Boy, could that man write.
posted by By The Grace of God at 3:56 AM on December 5, 2008 [1 favorite]

Fleetmouse: Really? I have recently-bought copies of Homage to Catalonia and The Road To Wigan Pier.....

....I had a look on amazon.com and amazon.co.uk. Looks like it's all in print in the UK but not in the States.
posted by tiny crocodile at 3:56 AM on December 5, 2008

Fantastic links, thank you so much. One of the very few pen to paper putters who can be read for the sheer beauty and elegance of his writing, no matter what form or subject matter.
posted by protorp at 4:36 AM on December 5, 2008

This, after just finishing Upton Sinclair's The Jungle is like a one-two-punch of misanthropy. I hate mankind today. Hope me?
posted by Devils Rancher at 4:37 AM on December 5, 2008

Doubleplus good. Thank you citizen.
posted by Potomac Avenue at 5:20 AM on December 5, 2008

This business of people just dying like animals, for instance, with nobody standing by, nobody interested, the death not even noticed till the morning -- this happened more than once. You certainly would not see that in England.

That was then. I don't think it would cause much surprise if it happened in an NHS hospital today.

A thing we perhaps underrate in England is the advantage we enjoy in having large numbers of well-trained and rigidly-disciplined nurses. No doubt English nurses are dumb enough, they may tell fortunes with tea-leaves, wear Union Jack badges and keep photographs of the Queen on their mantelpieces, but at least they don't let you lie unwashed and constipated on an unmade bed, out of sheer laziness.

Again: that was then. Hilary Mantel had a recent article in the London Review of Books which was almost an updated version of 'How the Poor Die'; sadly it's not available online, but here are her observations on the current state of English nursing care:

For two days in the intensive care unit the sick man is watched every minute of the day and night. He is in no pain. No one could be more attentive or competent than these nurses. I am weak from praising them. As he descends, in a few days, through the hierarchy, from intensive care to high dependency unit, from there to a surgical ward along the Green Mile, the care becomes more perfunctory, the rooms dingier, the staff more flippant and detached. Nuns used to practise something called 'custody of the eyes'. I see that modern nurses do it too, but for the nun's downcast gaze they substitute a blinkered stare. It would be natural, coming into a bay of six patients, to cast a glance around in case anybody was about to roll out of bed, or vomit, or die. But these lasses march straight to their goal, whether to perform a procedure, pick up equipment, or write up a chart. If they looked left or right, they might see something that needed doing, something extra. They never, I notice, look at a relative or visitor, but around the edges of them, or above their heads; if these outsiders were acknowledged, they might want something; they might ask a question. I see a senior doctor, alight with irritation, rip into a gaggle of nurses, thrusting papers at them: 'Who wrote this up? Who is responsible? I want to know.' The nurses turn their shoulders and simper. They won't look at him, won't speak; they just smirk, darting amused glances at each other, until he gives up and steams away.

Money won't mend this, I think: no redistribution of resources, no policy revamp. This is about people. Is it possible that the failure is not in the healthcare system, but in the education system that has turned these people out? Or is the failure deeper than that? Do the nurses despise the patients (and their relatives) for their neediness? Are they secretly revolted by their work, and taking their revenge by pettiness, by the foot-drag and the eye-roll, the shrug? All week, my struggle is this: not to redirect my anger and distress to the wrong targets. Smiling obdurate patience must, I think, get me somewhere. But what kind of nurse dumps a patient, new to a ward, like a parcel on the nearest bed, without so much as a jug of water? Who 'forgets' to give the liquid morphine prescribed, and snaps 'He's had his pill!' when told a patient is in pain? When I was growing up people used to say: 'Where there's no sense there's no feeling.' I used to think it was a harsh saying, but I see that it's true. In the last few days much of the suffering I have witnessed and experienced has been caused not by the human body as it snakes towards death on its secret self-destructive paths, but by the blithe stupidity of the individuals I have encountered.

I suppose the truth is that hospitals have always been places where people suffer and die in humiliating ways. But it does seem as though we are rapidly regressing to the situation described by Orwell, where the best medical care is very very good but the basic standard of care is barely above the acceptable minimum (and sometimes not even that). It's striking, I think, that what Orwell observes as a hospital patient in 1929 is precisely what Mantel finds so disturbing today: the way that no one will look you in the eye or take notice of you as a human being. 'Not from any one of them did you get a word of conversation or a look direct in your face' (Orwell); 'they never look at a relative or visitor, but around the edges of them or above their heads' (Mantel).
posted by verstegan at 5:22 AM on December 5, 2008 [3 favorites]

His writing is forceful bordering on violence. Awe is slowly cooking in me.
posted by krilli at 8:06 AM on December 5, 2008

I'm reading his "Collected Essays Journalism & Letters" at the moment (it's what prompted this post) and it's fantastic stuff:

My Country Right or Left
As I Please
In Front of Your Nose
posted by KokuRyu at 8:09 AM on December 5, 2008

I myself, with an exceptionally fine specimen of
a bronchial rattle, sometimes had as many as a dozen students queuing up
to listen to my chest. It was a very queer feeling--queer, I mean,
because of their intense interest in learning their job, together with a
seeming lack of any perception that the patients were human beings. It is
strange to relate, but sometimes as some young student stepped forward to
take his turn at manipulating you he would be actually tremulous with
excitement, like a boy who has at last got his hands on some expensive
piece of machinery. And then ear after ear--ears of young men, of girls,
of negroes--pressed against your back, relays of fingers solemnly but
clumsily tapping, and not from any one of them did you get a word of
conversation or a look direct in your face.

I work in a teaching hospital, so I'm familiar with this concept, but have never read anything from the patient's perspective, let alone something so masterfully written. This should be required reading for the third year med students.
posted by Halloween Jack at 8:25 AM on December 5, 2008

It's striking, I think, that what Orwell observes as a hospital patient in 1929 is precisely what Mantel finds so disturbing today: the way that no one will look you in the eye or take notice of you as a human being.

That's probably it though...you need to develop some sense of detachment to be able to walk amongst suffering, pain and death day in and day out. You'd kill yourself or develop some form of PTSD.
posted by Ziggy Zaga at 8:38 AM on December 5, 2008

"Natural" death, almost by definition, means something slow, smelly and painful.

*sigh*, yes. It's really hard to have a "good" death, although good palliative care can make a real difference.
posted by LMGM at 9:04 AM on December 5, 2008

It's striking, I think, that what Orwell observes as a hospital patient in 1929 is precisely what Mantel finds so disturbing today: the way that no one will look you in the eye or take notice of you as a human being. 'Not from any one of them did you get a word of conversation or a look direct in your face' (Orwell); 'they never look at a relative or visitor, but around the edges of them or above their heads' (Mantel).

i have had the unfortunate experience of several ER visits in the past few years, at three different hospitals. the good hospitals. the care is fine, but perfunctory. approaching the nurses station to ask where the bathroom is is met with no acknowledgement until you cross the invisible line separating patient area from employee area, and then you get a reaction, but not the one you want.

i am not Poor. i pay my $100 copay and get led back to a bed in the group ER area. but next to me, or across from me, are people who obviously do not have insurance or the ability to pay for care. they're the ones that are ignored for hours. they're the ones that staff speak to with disdain and sometimes disgust. i'm talked down to as well because i don't look like i can afford care (i apparently dress like the lower classes do?). my questions are either ignored or answered with a half-answer.

luckily, i've not been to a squalid hospital and i hope that i never have to. i realize that healthcare professionals must have a wall, a bit of detachment, for their own sanity. but that wall shouldn't get in the way of treating patients as human beings. that's what i object to the most, at least in the hospitals that i have frequented.
posted by misanthropicsarah at 2:41 PM on December 5, 2008

I read my dad's old copy of the Road to Wigan Pier. All through it he had marked passages and made notes, which he never usually does in books. My dad was a social worker in the North West in the 60's, and I realised whilst I was reading a history book, he read it to get some background on the elderly people he was working with.
posted by Helga-woo at 3:54 AM on December 6, 2008

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