Return: A Prologue
Ghada Karmi and Ellen Siegel, 1973
By Ghada Karmi in Return: A Palestinian Memoir
As I sat at my father’s bedside, listening to his irregular breathing and the sound of the pulse monitor attached to his finger, I thought how frightening it was to be brought up sharp against the awareness of one’s own mortality. I feared death equally as much as I knew my father did. He was a very old man, but age had not dimmed his ardour for life and I imagined I would be the same. Like most people, I did not like to contemplate my dying and avoided thinking about it, but it was always there, waiting in the background to be attended to. An elderly doctor I knew once told me, ‘I believe that people must prepare for death. Avoidance and denial are foolish. If we face up fair and square to the inevitability of death it will lose its terrors.’
I stroked my father’s hand but his eyes remained closed and he made no motion to indicate he was aware of my presence. The male nurses checked him over and then left us alone. I stood and went to open the window of his room, not seeing out but thinking about his approaching death. It was not a time for reckonings and resentments, but I had a memory of how affectionate and indulgent he had been when I was very young and of how he changed later. I was never sure if that memory had been idealised by hindsight and wishful think- ing. But that early childhood experience was never repeated, for when we went to England he changed into a stranger who never showed any emotion towards me except a keen interest in my academic progress. His view of me as a studious, clever daughter, whose sole ambition in life was to gain professional success coloured my view of myself. I grew up uncertain of my femininity and wondering if I should model myself on him, to the detriment of many an emotional encounter I had sub- sequently. I never forgave him for that, nor for many other things, although I never said so.
Looking at his skeletal state now, pyjama jacket unbuttoned to show his bony ribcage, his sad hollow stomach with its overlying empty folds of skin, I put away those bitter thoughts. Whatever my disappointments about his personal relationship with me, I passionately did not want him to die, not just for who he was but for what. His final days would be drawn-out, overshadowed by family squabbles, as happens at such times. But hanging over that period was the haunting knowledge that an era, not just for his family, but for Palestinian history, was drawing to a close. My father was born in Palestine at the time of the Ottoman Empire, lived through its demise and its replacement by the British Mandate that ruled Palestine, endured the establishment of the State of Israel thereafter and was forced into exile. His life encompassed a century of conflict, a period of Palestinian history that demolished everything he knew and overturned the old order forever.
He had fallen ill a month before with what was diagnosed as pneumonia, malnutrition and severe anaemia and taken to the Palestine Hospital nearby. My sister Siham, who was living with him at the time, phoned me in London to say she thought he was dying. In the 1960s, when I was a medical student in England, we were taught to think of pneumonia as ‘the old man’s friend’, a painless exit from this life which no one offi- ciously strove to prevent. But in the late twentieth century and by the time my father fell ill, medical practice had changed. No one was allowed to die without energetic intervention, antibiotics, ventilators, intravenous fluids, even surgery. When I arrived I found my father in the hospital’s intensive care unit, on antibiotics, a drip in his arm, being closely monitored. He was conscious and frightened. What rest he was afforded was constantly interrupted by a ceaseless flow of visitors inquiring after his health. The nurses’ feeble efforts to stem the tide of people entering a supposedly sterile and quiet area collapsed completely after the first day. He felt constrained to respond when anyone came, and was exhausted and querulous.
When I arrived to see this situation, unheard-of in such units in Britain, I did my best to stop visitors coming in. But this was Jordan, an Arab country, where relatives, however distant, and friends who might also be accompanied by people unknown to the patient, were expected to show their concern and respect for the sick. In my father’s case, there was the additional factor of his public status as a scholar and foremost Arab savant, which drew admirers of his work to visit as well. My efforts to keep them out appeared ungracious, even offen- sive, and were in any case unsuccessful. In a while, the café area outside the wards became a meeting place for his visitors where they ran into acquaintances they had not seen for some time or met new people. The place became a focus for such gatherings, often chatty, social and light-hearted. Meanwhile, my father somehow improved enough to be returned to an ordinary hospital bed.
Ghada Karmi and Ellen Siegel, 1992
He was alert, but so weak that he needed help with every bodily function. He ate little because he could not swallow properly, and his weight kept going down. Many of our rela- tives, devout Muslims, prayed for his recovery. I would visit him with my brother’s son, Omar, who had lived with my parents as a teenager and remained close to him. One after- noon, when I was alone with him, and thinking him asleep, he sat up and gripped my arm urgently. He looked at me almost desperately and whispered in a conspiratorial voice,
‘What do you say to Omar, you and me going home now? We could just leave now, this afternoon. What do you say?’ he entreated. I could feel his urgency and desperate desire to go home. If only I could say yes, and we could all go together just as he wanted. ‘No, father,’ I shook my head gently. ‘Not yet. But soon, soon.’ He sank back and closed his eyes. This memory returns to me even now, because I know that passionate longing for normality, for life to resume as it has always been, and yet be powerless to make it happen. It took me back to an April morning long ago and to the child I was then, standing helplessly at the closed garden gates of our house in Jerusalem that I would never see again.
Two weeks later, my father returned home as he had wished, but much altered and weaker. To make this return possible my sister and I had arranged twenty-four-hour nursing for him, and a hospital bed, suitably modified for home use, was set up in his bedroom. This had been no easy task, as the quality of nursing was not generally good, and there was little training in care of the dying at home. This situation was typical of many Arab and other underdeveloped countries. Nursing, indeed all medical services other than doctoring, was regarded as second-class. It had a low status, was poorly paid, and in general, most Arab parents would not wish for their daughters to join that profession, since it would involve immodest activi- ties like nursing men, washing, dressing and undressing them. The result of this attitude was that it was hard for us to find a good nurse for my father. After trying and rejecting several candidates, we settled on two young men who seemed reasonably competent. Even so, they would take time off away from my father’s bedside to perform their prayers at the prescribed times, a devotion well beyond the call of duty, since Islam allows for a postponement of prayer in special circumstances.
I went back to London where I was based, to cancel appointments and make arrangements for my absence, returning to Amman about a week later. The sight of my father in hospital, more shrunken and even thinner than before shocked me. His doctor, an amiable, efficient, youngish man, had pressed for a gastrostomy, an opening to be made directly into his stomach to enable the entry of adequate amounts of food. Up until then he had been maintained on a nasal tube, which did not allow sufficient nutrients to pass through and frequently got blocked. It also irritated his nose and the back of his throat. Removing it and feeding him in another way seemed to me the obvious course.
But not to the rest of the family, with whom there were heated discussions over the merits of the gastrostomy. They ignored the doctor’s opinion and mine and consulted friends and relatives, including an elderly surgeon long out of practice who was against it, and decided it would be cruel to subject an old man to an operation. He had lived a long life, they said, and his time had come. Muslims believe that to each of us there is a term of life appointed by God. When the end of that term arrives, none can advance or delay it even by one hour. There is a comforting fatalism in this belief, which I had often noted and envied. I remember when a cousin of mine lost her young daughter-in-law and two small grandchildren in a fatal car crash, leaving my cousin’s eldest son suddenly widowed and alone, I went to give her my condolences. She met me with a calm, resigned face. ‘It is as God wanted,’ she said with a sigh, neither indifferent nor overly sorrowful.
As to my father, further argument with the family was useless, and he was in effect condemned to further starvation. I urged the doctor to ignore the dissenting members of the family and proceed with the gastrostomy, but he declined, afraid to become embroiled in a family feud. It angered me that I could not overrule the family decision, despite its basic wrong-headedness. Though it was but one event, that disagreement underlined for me the difficulties in our relationships with each other, our common mistrust, disrespect and shifting affections. There were reasons not of our making for this, but it did not change the outcome. And in the end it was all for nothing. After two more futile weeks spent trying to feed my father through his nasal tube, he was readmitted to hospital and had his gastrostomy after all. Only now he was even more skeletal and starved, and it is doubtful that whatever happened at that point would make much difference.
I looked at him, lying in his bed, his eyes closed, and his breathing bubbling through the fluid in his lungs. The sound of the pulse monitor, clamped over his forefinger like a clothes peg, was sometimes the only evidence that he was alive. But yet at times he was aware of those around him, though he could not speak, and a slight nod indicated that he heard and understood what was said to him. When Salma, my daughter, whom he had asked about before he was so ill, came from London to see him, he smiled and seemed to know she was there. But most of the time, he half-slept, and I wondered what went through his mind as he lay attached to tubes, hardly able to breathe and with no hope of release.
It was as if he refused to let go of even this poor existence that he had. His hold on life had always been tenacious, and as death approached it grew even more so. My mother, then deceased for sixteen years, used to say to us: ‘Mind my words, your father does not intend to die. Ever!’