"Alone (The Death of Poilu Rochard)" by Ellen N. La Motte

Born in Louisville, Kentucky, Ellen Newbold La Motte trained as  nurse at Johns Hopkins University at a time when nursing was one of the few professions open to women who wished to pursue careers and independent lives. She became an expert in caring for tuberculosis patients and published The Tuberculosis Nurse (1914). After spending the first winter of the war in Paris, in July 1915 she departed for a French military field hospital run by American heiress Mary Borden in Rousbrugge, Belgium, about six miles behind the front lines. La Motte left the hospital a year later, returning to America, where she published The Backwash of War: The Human Wreckage of the Battlefield as Witnessed by an American Hospital Nurse in December. In the summer of 1918, her book was withdrawn by the publisher under government pressure. “Truth, it appears,” La Motte later wrote, “has no place in war.”

Alone

By Ellen N. LaMotte

French Nurses Caring for Gas Patients

ROCHARD died to-day. He had gas gangrene. His thigh, from knee to buttock, was torn out by a piece of German shell. It was an interesting case, because the infection had developed so quickly. He had been placed under treatment immediately too, reaching the hospital from the trenches about six hours after  he had been wounded. To have a thigh torn off, and to reach first-class surgical care within six hours, is practically immediately. Still, gas gangrene had developed, which showed that the Germans were using very poisonous shells. .  .

[Editor's Note:  It was later discovered that gas gangrene is caused not by a chemical agent but by infection by Clostridia, a genus of anaerobic bacteria found in farm soil where there is decaying animal and vegetable matter.] 

At that field hospital there had been established a surgical school, to which young men, just graduated from medical schools, or old men, graduated long ago from medical schools, were sent to learn how to take care of the wounded. After they had received a two months’ experience in this sort of war surgery, they were to be placed in other hospitals, where they could do the work themselves. So all those young men who did not know much, and all those old men who had never known much, and had forgotten most of that, were up here at this field hospital, learning. This had to be done, because there were not enough good doctors to go round, so in order to care for the wounded at all, it was necessary to furbish up the immature and the senile. However, the Médecin Chef (Chief Doctor) in charge of the hospital and in charge of the surgical school, was a brilliant surgeon and a good administrator, so he taught the students a good deal.

Therefore, when Rochard came into the operating room, all the young students and the old students crowded round to see the case. It was all torn away, the flesh from that right thigh, from knee to buttock, down to the bone, and the stench was awful. The various students came forward and timidly pressed the upper part of the thigh, the remaining part, all that remained of it, with their fingers, and little crackling noises came forth, like bubbles. Gas gangrene. Very easy to diagnose. Also, the bacteriologist from another hospital in the region happened to be present, and he made a culture of the material discharged from that wound, and afterwards told the Médecin Chef that it was positively and absolutely gas gangrene. But the Médecin Chef had already taught the students that gas gangrene may be recognized by the crackling and the smell, and the fact that the patient, as a rule, dies pretty soon.

They could not operate on Rochard and amputate his leg, as they wanted to do. The infection was so high, into the hip, it could not be done. Moreover, Rochard had a fractured skull as well. Another piece of shell had pierced his ear, and broken into his brain, and lodged there. Either wound would have been fatal, but it was the gas gangrene in his torn-out thigh that would kill him first. The wound stank. It was foul. The Médecin Chef took a curette, a little scoop, and scooped away the dead flesh, the dead muscles, the dead nerves, the dead blood-vessels. And so many blood-vessels being dead, being scooped away by that sharp curette, how could the blood circulate in the top half of that flaccid thigh? It couldn’t. Afterwards, into the deep, yawning wound, they put many compresses of gauze, soaked in carbolic acid, which acid burned deep into the germs of the gas gangrene, and killed them, and killed much good tissue besides. Then they covered the burning, smoking gauze with absorbent cotton, then with clean, neat bandages, after which they called the stretcher bearers, and Rochard was carried from the operating table back to the ward.

The night nurse reported next morning that he had passed a night of agony.

“Cela pique! Cela brule!” (It stings! It burns!) he cried all night, and turned from side to side to find relief. Sometimes he lay on his good side; sometimes he lay on his bad side, and the night nurse turned him from side to side, according to his fancy, because she knew that on neither one side nor the other would he find relief, except such mental relief as he got by turning. She sent one of the orderlies, Fouquet, for the Médecin Chef, and the Médecin Chef came to the ward, and looked at Rochard, and ordered the night nurse to give him morphia, and again morphia, as often as she thought best. For only death could bring relief from such pain as that, and only morphia, a little in advance of death, could bring partial relief.

So the night nurse took care of Rochard all that night, and turned him and turned him, from one side to the other, and gave him morphia, as the Médecin Chef had ordered. She listened to his cries all night, for the morphia brought him no relief. Morphia gives a little relief, at times, from the pain of life, but it is only death that brings absolute relief. When the day nurse came on duty next morning, there was Rochard in agony. “Cela pique! Cela brule!” he cried. And again and again, all the time, “Cela pique! Cela brule!”, meaning the pain in his leg. And because of the piece of shell, which had penetrated his ear and lodged in his brain somewhere, his wits were wandering. No one can be fully conscious with an inch of German shell in his skull. And there was a full inch of German shell in Rochard’s skull, in his brain somewhere, for the radiographist said so. He was a wonderful radiographist and anatomist, and he worked accurately with a beautiful, expensive machine, given him, or given the field hospital, by Madame Curie.

So all night Rochard screamed in agony, and turned and twisted, first on the hip that was there, and then on the hip that was gone, and on neither side, even with many ampoules of morphia, could he find relief. Which shows that morphia, good as it is, is not as good as death. So when the day nurse came on in the morning, there was Rochard strong after a night of agony, strong after many picqures (injections) of strychnia, which kept his heart beating and his lungs breathing, strong after many picqures of morphia which did not relieve his pain. Thus the science of healing stood baffled before the science of destroying.

Rochard died slowly. He stopped struggling. He gave up trying to find relief by lying upon the hip that was there, or the hip that was gone. He ceased to cry. His brain, in which was lodged a piece of German shell, seemed to reason, to become reasonable, with break of day. The evening before, after his return from the operating room, he had been decorated with the Médaille Militaire, conferred upon him, in extremis, by the General of the region. Upon one side of the medal, which was pinned to the wall at the head of the bed, were the words:  "Valeur et Discipline". Discipline had triumphed. He was very good and quiet now, very obedient and disciplined, and no longer disturbed the ward with his moanings.

Little Rochard! Little man, gardener by trade, aged thirty-nine, widower, with one child! The piece of shell in his skull had made one eye blind. There had been a hæmorrhage into the eyeball, which was all red and sunken, and the eyelid would not close over it, so the red eye stared and stared into space. And the other eye drooped and drooped, and the white showed, and the eyelid drooped till nothing but the white showed, and that showed that he was dying. But the blind, red eye stared beyond. It stared fixedly, unwinkingly, into space. So always the nurse watched the dull, white eye, which showed the approach of death.

No one in the ward was fond of Rochard. He had been there only a few hours. He meant nothing to any one there.  He was a dying man, in a field hospital, that was all. Little stranger Rochard, with one blind, red eye that stared into Hell, the Hell he had come from. And one white, dying eye, that showed his hold on life, his brief, short hold. The nurse cared for him very gently, very conscientiously, very skilfully. The surgeon came many times to look at him, but he had done for him all that could be done, so each time he turned away with a shrug. Fouquet, the young orderly, stood at the foot of the bed, his feet far apart, his hands on his hips, and regarded Rochard, and said: “Ah! La la! La la!” And Simon, the other orderly, also stood at the foot of the bed, from time to time, and regarded Rochard, and said: “Ah! C’est triste! C’est bien triste! (It’s sad! It’s very sad!)”

So Rochard died, a stranger among strangers. And there were many people there to wait upon him, but there was no one there to love him. There was no one there to see beyond the horror of the red, blind eye, of the dull, white eye, of the vile, gangrene smell. And it seemed as if the red, staring eye was looking for something the hospital could not give. And it seemed as if the white, glazed eye was indifferent to everything the hospital could give. And all about him was the vile gangrene smell, which made an aura about him, and shut him into himself, very completely. And there was nobody to love him, to forget about that smell.

He sank into a stupor about ten o’clock in the morning, and was unconscious from then till the time the nurse went to lunch. She went to lunch reluctantly, but it is necessary to eat. She instructed Fouquet, the orderly, to watch Rochard carefully, and to call her if there was any change. After a short time she came back from lunch, and hurried to see Rochard, hurried behind the flamboyant, red, cheerful screens that shut him off from the rest of the ward. Rochard was dead.

At the other end of the ward sat the two orderlies, drinking wine.

PARIS,  15 April 1916.

Originally published in The Backwash of War: The Human Wreckage of the Battlefield as Witnessed by an American Hospital Nurse (1916). It was republished as "Alone" in the Library of America.