In the Midst of Life by Jennifer Worth
‘If I had told a lie, I’m sure he would have seen it in my face. I’m no good at lying. I’ve tried it before, and my face always gives me away.’
Matron appeared to be slightly exasperated. ‘You have to learn to be more sensitive to a patient’s needs. Well, I am going to move you to another ward. I do not think you should continue on Victoria Ward at present. I have confidence that you will learn, and improve. You may go, Nurse.’
It would probably surprise many doctors to know how frequently very junior nurses are confronted with a dilemma such as the one described. It occurs because nurses are so much closer to patients than doctors are, a situation that doctors have cultivated, creating a barrier between themselves and their patients. Often, most hospital patients are in awe of doctors, especially consultants, and feel they cannot engage in a conversation with one of these superior beings. But they are not in awe of nurses, who are with them all the time, and therefore more accessible. Indeed, since the changes in the nursing profession, requiring nurses to be college-trained rather than ward-trained as my generation was, patients don’t have much contact with student nurses. So when a frightened patient asks, ‘Have I got a growth?’, the person most likely to be approached is a care assistant or an auxiliary, one of the many people who do the most basic and intimate of nursing duties for helpless patients. Someone close to them is what people need, someone who is on their own level, not too high-and-mighty, but approachable. And carers are nearly always women. On the whole, they are kindly, compassionate and humble. They work for the lowest of low wages, and are completely taken for granted by hospital managers. But they are the women to whom fear-ridden patients will often turn, for assurance, consolation and comfort at the time of death.
On that day, Mr Anderson returned to the ward a couple of hours later than usual, and sank into bed, exhausted. I was furious that he had over-stretched himself in that silly office, and resolved to have a word with the Chief.
Throughout the afternoon Mr Anderson slept, sometimes wincing in pain – we could see him curling up his body in an attempt to ease it – but still he slept on. He stirred as we were doing the six o’clock drug round, and sat up looking refreshed. Suppers were served at seven o’clock, and he ate without nausea or discomfort. I began to revise my opinion about the office work he was doing.
After supper is usually a good time to talk to people. The ward is quiet, the day’s activities are stilled, the light is changing, and the human heart and mind seem to change with it. Mr Anderson was sitting up in bed, watching the sun sink behind the trees. It was a reddish sunset, with bands of fluffy pink clouds. Mr Anderson appeared relaxed, and I thought, with a leap of the heart, that perhaps the radium might effect a complete cure. Spontaneous recovery from cancer is possible, and whilst no one can explain what happens, I have seen it.
It can be a bit awkward talking to someone in the middle of a hospital ward. You have to sit close, and talk very softly. It is no good asking a patient to come to the office; that is too formal, and very often the person is tongue-tied in such a situation. No, the bedside is usually the right place, and the right moment can only be judged by intuition. I pulled the curtains around his bed and sat on the edge. He moved his legs over so that I could sit more comfortably, which was encouraging, because it indicated that I was welcome.
‘It’s a lovely evening,’ I said, ‘a lovely sunset.’
‘Beautiful. I would like to go on to the balcony to see it better, but I can’t be bothered to make the effort just now.’
‘I could help you.’
He smiled. ‘No, it’s not worth it. The sun will be gone by the time we get there.’
‘You are looking very much brighter this evening.’
‘Well, I did a good morning’s work. Excellent, in fact.’
‘It obviously does you good. I thought it had tired you too much, but I was wrong.’
‘I have always needed to exert myself – it’s just the way I’m made. If I could get rid of this damned cancer by sheer will power and exertion, I would do so.’
‘You are having radium treatment, that will limit the growth. And a positive outlook, such as yours, will help a great deal. We don’t think you will be able to go trekking in the Himalayas, but Wales, or the Wye Valley, as the Chief suggested, could be possible.’
‘That’s encouraging. I will hold on to that one, Sister. The Wye – a bit of rough canoeing, wonderful, and some climbing – oh, I’d love that.’
‘Perhaps you should cancel your Himalayan trek and concentrate your thoughts on the Wye Valley.’
‘Why not? I will get my secretary to order the maps from Stanford’s tomorrow.’
His eyes sparkled with eagerness, and as I looked at the wasted muscles that could not find the energy to step on to the balcony to see the sunset, I pondered the phenomenon of hope.
Hope is the one thing that people never lose, and even though they may know that they are dying, hope never deserts them. Most people hope for a new breakthrough in medical research, a new drug, a new treatment, a miracle cure, and we have to encourage this, however unrealistic it may be. But hope does not preclude an acceptance of death, and it can come in many forms.
Most doctors believe that they must never allow a patient to give up hope of a cure. The implication of this is that the medical profession is the single source of hope. This is too narrow a definition. Hope is an abstract concept, and is by no means confined to physical cure. Hope means something different to each one of us. Hope to see a daughter married, or a grandchild born, can keep life buoyant and content for weeks, or even months, beyond the realistic expectations of a medical prognosis. Many people, knowing they have cancer, have done the most extraordinary things: run marathons, cycled halfway round the globe, written books, taken degrees. Hope, directed towards an achievement, is the driving spirit, and makes the future endurable. Belief in an afterlife is also hope.
‘The Wye Valley will be lovely in a few weeks’ time with the spring coming,’ said Mr Anderson dreamily. ‘You know, when I first suspected I had cancer, I simply did not believe it. They’ve got it wrong, I thought. I had always been healthy, and led a healthy life. I couldn’t have cancer, not at my age. I thought it must be a misdiagnosis and I was furious with the doctors.’
‘Did anyone tell you?’
‘No. Lies, half lies, evasions, silences – that’s all I ever got. It’s an insult to one’s intelligence.’
‘How did you discover?’
‘When I came here – I knew what radium treatment is for.’
I was silent. It was so obvious, so irrefutable.
‘And no one has talked to you about it until now?’
‘No. Far from dispelling my fears, the lies and evasions only added to my certainty.’
‘How did you react?’
‘When I saw the fearful condition of some of the other men in the ward, I decided that I must kill myself. I never want to get to that stage. Never.’
‘Suicide is not easy.’ I said.
‘No, it’s not. And you know something? I don’t think I have the guts. There is a window upstairs, thirty feet up, with concrete underneath. For many days I thought “I could do it today, there’s no one around. A quick jump and it will all be over.” But each day I hesitated – “Not now. This afternoon perhaps, or tomorrow.” And then I realised I just didn’t have the guts.’
‘It’s not a question of guts,’ I said, ‘most suicides are associated with mental illness, and you don’t strike me as being mentally ill. You’re a realist.’
‘I like to think so. But I cannot face the reality of the last stages of this pitiless disease. If I get to that stage I will want someone to polish me off.’
I didn’t say that nobody realises they are getting to that stage, because by that time they are incapable of recognising it. Instead I said:
‘You are having radium now. The side effects can be very severe, which is why you feel so ill and exhausted. But you must believe m
‘I do believe you. That’s what keeps me going. I feel ghastly, but I have a mental picture of the cancer cells being bombarded with radium and giving up. It’s a battle. Them or me. And I intend to win.’
‘That’s the spirit,’ I said, enthusiastically.
‘It’s a fight to the death and I am a realist – you said that yourself. I have always had to fight, from my early childhood, and I always win.’
Some people are like that – failure is never a possibility – but I said, ‘You would make it easier for yourself if you rested more.’
‘I don’t want anything to be “easier”,’ he said scornfully. ‘Life is not easy – never has been. I don’t go for the easy option.’
The night nurses were coming on duty. I had to go. He squeezed my hand.
‘I’m glad we had this talk. I feel better for it.’
‘And I’m glad too. I must tell the Chief about it when I see him.’
I slipped off the edge of the bed.
‘I hope you have a good night. What about some sleeping tablets?’
He shook his head.
*
The following morning, when I came on duty at eight o’clock, he was up and dressed in his suit. He looked very thin, but smart. He had taken no breakfast, but had asked for strong coffee. I was not happy about this, and questioned him.
‘Don’t fuss me,’ he said. ‘I have work to do, and I must keep my head clear.’
It was the same response he always gave to the idea of analgesics, and was the changeless resolve of a very determined man.
Mr Anderson spent longer each day in his broom cupboard. The pattern became regular, and how he found the strength to work as he did we never knew. His nights were not restful because of the pain, but he always rose at 6 a.m., bathed and shaved and dressed, although the effort required was enormous. He went to his office at about 7 a.m. and returned to the ward at two, looking half dead with exhaustion. We did not know what he was doing, but something seemed to have taken possession of him, and was driving him on.
I told the Chief about our conversation, and he was not really surprised. He talked with Mr Anderson, who was nearing the sixth week of his treatment, and they agreed that he should then take a holiday and return to the Marie Curie for check-ups two or three months later.
The day of his discharge was quite emotional. We had all grown to respect him so much that his rather aloof ways did not matter; they were just part of his character. He tied up the loose ends in his office and asked Matron if it could be left undisturbed, because he might need it later, to which request she readily agreed. We knew that he was going walking and climbing, but from the way he looked, that would require a miracle. He was so painfully thin, his legs and shoulders had no muscle at all, and his face looked haggard.
‘Do look after yourself, you might fall or something,’ a nurse said as he was leaving. He gave her a roguish grin, irresistible to women.
‘Now what have I got to lose?’ he replied. ‘Tell me that.’
She couldn’t reply, but said: ‘We are going to miss you.’
‘You’re a sweet girl. You all are, and I have grown very fond of you.’
He kissed a couple of the girls, and then turned to Matron. He hesitated for a fraction of a second – the navy blue uniform, the silver buckle, the high collar, the white cuffs, the frilly cap, were a touch intimidating for any man. Would he, wouldn’t he? He did. Cheered on by the nurses he kissed Matron, who blushed as pink as a peony.
Mr Anderson returned looking a lot better. He was tanned from the fresh air and sunshine, and although he had not noticeably gained weight, his muscles were stronger. He told us that he had started his walking with a paltry five miles a day, which was exhausting, but day by day he improved on this until he could manage twenty miles without too much fatigue.
‘And what about the rough canoeing?’ I enquired.
‘That also. It was a great help, having lost so much weight. You need to be light to shoot the rapids of the Wye.’
‘Wasn’t it dangerous?’ asked a nurse.
Yes, but that’s half the fun. And if you’ve got nothing to lose but a life that’s on borrowed time, you can do anything. I took far more risks than anyone else. It was great.’
He laughed in a devil-may-care way. ‘Now I’ve got to get back to work. There is a good deal to be completed still.’
Blood and serum tests were taken, and a series of X-rays. The Chief was so impressed by the apparent reduction in the size of the growth, and especially in the improvement in the patient’s general health, that he thought we could risk a further series of radium treatments. Normally, one has to limit the radiation because the effects on the body are so debilitating.
Mr Anderson was re-admitted, and his previous working pattern resumed. The effects of the radium were quickly evident, and the poor man became very weak and ill, but still he carried on going to his broom cupboard. It was pathetic, yet inspiring. There was no point in telling him to rest more; he took no notice.
The Chief had decided on a ten-week course of radium, which was longer than is usually ordered, and could easily kill a person, but they had discussed it, and Mr Anderson had declared that, by sheer strength of will, he would overcome the side effects. He was determined to go fell running in Cumbria, and the Chief felt sure he could manage this, although it is notoriously difficult and dangerous.
During the next two years Mr Anderson worked like a man possessed, in his city office during the months after he had been discharged, and in the broom cupboard when he was in hospital. He never let up. Work was punctuated by strenuous holidays – he walked the 190 miles of the Pennines in seven days; he climbed the Welsh mountains, including Mount Snowdon; he went frequently to Scotland, determined to climb each of the Munros and the Cairngorms. He did more in two years than the majority of us will do in a lifetime.
And it was not the cancer that killed Mr Anderson. It was the Cairngorms. In the mountain ranges, the weather can change from sunshine to blizzards in a few hours. Mysterious things can happen on those remote heights; perhaps he saw a beckoning hand, or heard a beguiling voice, luring him towards danger. ‘There’s nothing to lose,’ was always his spur. He had flirted with Death for so long that he almost loved Her. As he fell in the snow, and his body temperature dropped, his senses would have become numb and easeful rest would have seduced him to a sleep from which he did not waken. He had not wanted to die in a hospital bed, and the cold and the snow had saved him …
The mystery of what had been going on in the broom cupboard was later revealed. Through a combination of hard work, speculation and professional expertise Mr Anderson had accumulated millions of pounds. Every penny of it was left to Cancer Research.
POOR VAN GOGH
What poor Van Gogh needed
was a little pill,
or perhaps not that pill
but a different little pill,
or perhaps a different one again
for a month, for a year, for life,
or perhaps a combination
of little pills, try this one, try that one,
try that one and another together,
lots of little pills perhaps he needed,
a thousand pounds’ worth,
ten thousand pounds’ worth,
half a million pounds’ worth
given the research costs
and the cost of Public Relations
and the expectations of shareholders,
then poor Vincent could have
given up painting masterpieces
and vanished without trace
into old age.
— David Hart
From Running Out (Five Seasons Press, 2006)
SOCIAL ATTITUDES TO DEATH
Most people die in hospitals and not at home any more. This seems to be largely expected, and it feeds our fear. We shy away from closeness to a dying person, and from seeing the body, a
Yet basic, primitive and stark, hidden behind a curtain, death remains, and human imagination cannot resist it. We need to take a little peek now and then, and so we lift a corner of the curtain to get that frisson mingled with fear. The media know this and feed our desire by showing violent death in all its detail. The producers seem determined to show the most horrifying and bloody pictures. And this is as much as most people see, or want to see, of death.
Some producers have tried to show, realistically, on television how people die, and, on a couple of occasions, have actually filmed a man whilst he is dying. I am not sure whether this is helpful or not. It certainly shows that dying is not a time of physical pain or mental distress, but of peace and quietness. This is probably reassuring to some people. But, on the other hand, it is only a ‘virtual reality’. But perhaps that is what people want. The idea of filming a man dying quietly in his bed so that viewers can get an impression of what goes on is no doubt praiseworthy, but, of reality, they will see virtually nothing.
Only those who have been close to the dying and seen death in all its awesome mystery can get a glimpse of what it is about – and even then only a glimpse. The whole picture includes a spiritual dimension. God is not in the churches, or the mosques or synagogues. He resides not in temples and minarets. God is not the possession of priests or rabbis or mullahs. God is at the deathbed, tenderly drawing the living soul from the dying body. God is in the grief and suffering of those who are left behind, who catch a glimpse, perhaps for a few fleeting seconds, of what life and death are all about.
Reality is not to be found in a television screen. The closeness to real death means, inevitably, closeness to our mortality and questions about the divine. Perhaps this is too much to take. If we can find no spirituality in life, death is an uncomfortable reminder of a missing dimension.