by Nancy Peach
Madeline stifled a sob, her hand twisting into the tissue and shredding fragments of it over the bed. Mary ploughed on valiantly. “The staff were very kind. And the doctor was honest, which is what I wanted. He said likely weeks. Possibly months, but more likely weeks. Which I think came as a bit of a shock. Not to me so much. But Edward… I think he was still hoping I’d been miraculously cured.”
Tess realised that Edward would have had to break the news to his sister, who hadn’t attended the appointment. He would have heard what the consultant said and had to sit through the remainder of the appointment turning the information over in his head and working out how best to frame it for the ears of his sibling. This whilst supporting his mother and dealing with his own shock. Her chest felt tight at the thought of it.
“He’s trying not to show it, but there is a part of him that really thought more chemo might cure Mum,” Madeleine said to Tess. “I did try to tell him that it seemed unlikely, but he was pinning his hopes on her carrying on with the treatment and…” She turned to her mother. “I think he blames himself for not persuading you to keep going.”
Mary sighed. “Dr Brown said there was little evidence another course of chemotherapy would have made much difference, darling, but even if it had, I wouldn’t have wanted endless months of feeling dreadful.” She reached out to take her daughter’s hand. “Far better to have had a shorter time with my family and felt well enough to enjoy it. I did try and talk to Edward about it but once he’d heard the words ‘possible cure’ it was like he couldn’t hear anything else.”
“Mummy,” said Madeleine, “to be fair to Eddie, I suspect he just didn’t feel qualified to have that conversation with you. He maybe thought he wouldn’t be able to do it justice.”
“Perhaps. But he shouldn’t get cross if there is someone else around, someone professional, who will listen and give me an honest view. He thinks I was somehow talked out of further treatment, but he has to learn that I am a grown woman, capable of making my own decisions.”
“I know, but I think he associates Dr Carter with so much of what is going on here… And he’s upset. It feels like nothing makes sense anymore.”
Madeleine had started twisting the tissue in her hand again. Tess resisted the urge to offer her another, not wanting to draw attention to her obvious distress. “How are you both feeling about the results?” she asked.
“Oh, I knew already,” said Mary. “From the moment I saw the doctor’s face, the one who drained off the fluid. He said something to his colleague about it being bloodstained and they gave each other a look and… I’ve seen that look before, on other doctors’ faces. So, no surprises for me today, I’m afraid. Much harder for you, darling.” She looked towards her daughter.
“I have to be honest.” Madeleine looked down at her hands again. “I am frightened.” She rubbed at a patch of dry skin on her wrist. “Mainly by the timescale. I mean, weeks… It seems so very short.”
She raised her eyes in silent appeal to Tess, as if she might be able to extend the prognosis, prolong the stay of execution. Tess nodded but looked away; she could offer nothing, and she didn’t want to fall into the very easy trap of providing false hope.
“I think it’s worse because we don’t know what to expect,” Madeleine carried on. “I’ve never seen somebody… I mean been with someone when they are…”
“Dying?”
Madeleine nodded, her lips pressed together in a thin white line.
“Would it help,” Tess looked back at Mary, “if I asked Dr Fielding to talk you through it? I mean, he can’t give you an exact timetabled sequence of events, but he knows an awful lot about the usual pattern.”
Mary nodded emphatically and Madeleine spoke again, “That would be really helpful. And I think it would be good for Eddie to hear too.”
“Of course. I expect he’d find it easier coming from Dr Fielding anyway. I’ll see if he’s free. Maybe sometime tomorrow?”
“I think Edward said that Clara might be popping in tomorrow as well?” Mary looked at Madeleine, who gave a derisory snort.
“Madeleine! Whilst it’s nice to see you more animated, please do be kind. It’s not easy for her either. She barely knows us, and she’s been saddled with an awful load of emotional baggage. It’s not easy for anybody, is it?” Mary looked back at Tess.
“No,” she said. “You’re right. It’s not.”
“It is hard to navigate a clear path when assailed by rumour and suspicion,” said Miss Austen as Tess pulled the door shut behind her, “but candour and truth are a promising beginning. And it was a wise choice, Tess, to involve those with greater experience and expertise; for as one observes good practice, one learns, and as one learns, one grows and—”
“I know, Jane,” Tess interrupted. “I know. But I’ve only got a few weeks left working here before I start general practice, and there seems to be a ridiculous amount of learning and growing I still need to do in that time.”
Chapter Twenty-Seven
That evening, Tess went out to the cinema with Simon. They watched an action movie, which wouldn’t have been Tess’s first choice, but it was strangely soothing to be able to switch off from everything else that was going on in her life and simply concentrate on good guys and bad guys, interspersed with weapons-grade explosives. After the film they walked out onto the riverside in the warm July air and Simon held her hand. Tess felt oddly calm. She never really spoke to Simon about work, and he had no idea of the current tensions, or indeed attachments, between her and the various members of the Russell family – just as he didn’t know about Scott, or her dad, or any of the other baggage she was currently lugging about with her. His lack of curiosity was helpful in this instance. Simon listened when she needed him to and asked no questions. He was uncomplicated. Life was easy with him: no volatility, no moods to interpret or strong opinions to grapple with, no crimson flushes of embarrassment or moments of nervous anticipation. He was a straightforward, nice, dependable guy, and if being with him wasn’t particularly exciting, well, neither was it stressful – and she had plenty of the latter on her plate already.
“How’s that pussy of yours?” he asked, turning to face her with a cheeky grin on his face.
“Morris is fine, thank you very much,” she said. It wasn’t the first time he’d made this joke, although he still thought it hilarious. “Thanks for offering to have him when I’m in France.”
“No problem, although probably best that your mum’s going to have him, thinking about it,” he said. “Especially with the litter tray and everything. The flat would never recover. I always say when I’m showing clients round places, you can tell when someone’s had a pet, even if it’s only a budgie. Never smells the same after.”
“Yeah, you’re right. Anyway, Mum loves having him. She’ll spoil him rotten. He’ll come back even fatter, if that’s possible.”
They crossed over the footbridge, navigating their way between other couples and families out enjoying the light evening.
“I’ve only got one more week at the hospice after I get back,” she said as he swung her arm back and forward in time with their walk. The action reminded her of Harvey and Annabelle swinging arms as they raced around the hospice courtyard. “From France, I mean. It’ll be weird not working there. I’m going to really miss everyone. All my patients, all the staff. They feel almost like family.”
They carried on further up the riverside walk, watching the gulls swooping down to the water and back. “And I’ve got a pretty full-on day tomorrow,” she said. “Tricky conversation to have with relatives first thing, the ward’s already really busy, Rob’s on annual leave, and we’ve got medical students coming for teaching in the afternoon.”
Simon nodded and looked to be deep in thought. She wondered if he was going to offer some insight into how to manage her current workload, or advice about how to adapt to the transition between different working environments when she left the hospice at the end of the month.
&nb
sp; “Chips or curry?” he said eventually.
“What?”
“Which d’you fancy? I’m thinking curry. I could murder a balti and a Peshwari naan.”
She nodded in agreement. “Throw in some poppadoms and you’re on,” she said, smiling as they pushed open the door to The Star of India.
“Good Morning, Dr Carter. I’m not sure whether you know Edward’s girlfriend, Clara Delaney?”
“Oh yes, thank you, Mary. Miss Delaney and I have already met, very briefly. Hello again.” Tess reached out a hand in greeting, a little embarrassed by the memory of her rudeness at their last meeting.
Clara was standing near the window with Edward. He was dressed smartly as usual, but she outdid him for sophistication, wearing an expensive tailored suit with elegant heels and clutching a designer handbag as if her life depended on it. Indeed, it seemed to take an extraordinary force of will to peel her fingers away from the clasp and return the handshake. Her skin was damp and cold, her hand bony and fragile in Tess’s grasp, and she felt a twinge of sympathy for the woman. The veneer of poise was only just masking her obvious and rising anxiety at being in a building of this type and in such close proximity to the terminally ill. She was clearly very uncomfortable in these surroundings and Tess was reminded of Edward restlessly drumming his fingers against the countertop when he had first arrived in February. For most people, the first visit to a hospice was not easy and she tried to speak kindly when she addressed Clara.
“Mrs Russell had asked to have a chat about the likely sequence of events over the coming weeks and months. Specifically, to talk about the events leading up to dying.”
She noticed both Clara and Edward flinch at the word but continued: there was no point in pretending that she or her consultant were going to be anything other than honest during today’s discussion. She owed Mary that at least.
“Dr Fielding is just finishing off a patient in clinic. Sorry, unfortunate phrasing. He’s just finishing with a patient, and then he’ll be right along.”
She paused, noticing a tiny smile at the corner of both Mary and Madeleine’s mouths and, feeling that she may start giggling herself, she turned her attention to Clara.
“I realise that this may be a tricky conversation to hear, and if anybody would be more comfortable leaving the room and maybe approaching him, or me, or indeed any of the other doctors later in the day, that would be fine.”
Clara breathed an audible sigh of relief as she moved towards the door; she appeared to be on the verge of breaking into a run.
“I’ll wait outside. I’m terribly sorry but it’s not really my thing. A bit too um… you know.”
“That’s completely understandable.” Tess held the door for her, wondering whether this woman could really not bring herself to be outside her comfort zone for a few moments in order to support her boyfriend.
“You could always take a seat in the relatives’ room? Or the café does some nice cakes and biscuits…” Tess called after her.
“Sounds delightful…” Her words were disappearing across the linoleum as she scuttled away.
Tess noticed Edward direct the tiniest of smiles to the floor. The door swung to a close and the atmosphere lifted almost immediately.
“I don’t think cakes and biscuits are really ‘Clara’s thing’ either,” said Madeleine. “Too much in the way of carbs, I suspect.”
“Madeleine!”
“Sorry Mummy. But they’re not, are they Eddie? I simply meant that she doesn’t like baked goods very much. Nothing more.”
Mary gave her daughter a warning look. Tess glanced at Edward. “Mr Russell, would you like a seat? I can get another from the desk?”
He shifted back towards the windowsill and leant against it. “No, I’ll be fine here,” he said, still unable to meet her eye. “Thank you.”
There was a knock at the door and Dr Fielding entered. He peered at the assembled crowd over the top of his glasses.
“Morning all! Tess, dear, would you like to get another chair from the relatives’ room?”
“Oh, no, it’s okay, Dr Fielding. I’ll stand.” She positioned herself in the opposite corner from Edward, focussing her attention on the bed and the people gathered round it.
“Right.” Dr Fielding pulled his chair closer to the bed. “Excellent. Mrs Russell, you’re looking well. Tess – Dr Carter – mentioned that you had a few questions, things on your mind? Is that right? She thought perhaps you might have some specific concerns, things I could help with?”
“Yes, there are questions.” Madeleine said, flipping to page one in her notebook, but Mary interrupted her.
“What I want to know, Dr Fielding, is what will actually happen. How will I die?”
Edward gave a sharp intake of breath from the other side of the room but said nothing.
“Okay,” Dr Fielding began. “I’m guessing that you haven’t been with someone who is dying of a similar condition to yours? Maybe you haven’t seen anybody die? Most people haven’t.”
“Only my husband,” Mary said. “And I wasn’t even there when it happened. He was on the coronary care unit. I’d popped out to make a phone call and the next thing I knew there was a sign on the door saying ‘Do not Enter’. He’d had the entire cardiac arrest team and two coronary care nurses trying to resuscitate him for twenty minutes. I didn’t even get a chance to say goodbye.”
Tess slid the box of tissues along the table towards Mary.
“Thank you, Dr Carter.”
Dr Fielding waited until Mary had finished dabbing her eyes.
“Well. That is not an uncommon scenario with a death in hospital. People can feel quite distanced from their loved one at the end. The doctors intervene and become the conduit for that experience, so it is not shared by those who perhaps need or want to be involved.”
“Yes, it did feel like that. But it also felt as though that was normal. As though it was best that he had died surrounded by doctors and nurses.”
“Well, in a way, it probably was. Because his death was unexpected and therefore most families want to know that everything to potentially reverse it has been tried. But with you we can plan better, try to make it as comfortable as possible for you and those around you.”
Edward’s shoes squeaked as he shifted position but Tess did not turn to look at him. She was watching Dr Fielding, trying to commit his words to memory.
“Now, people who have similar conditions to you, and who are being managed by a specialist palliative care team, do not tend to die in this traumatic way. It is often peaceful. There is rarely pain, but if that becomes an issue, we can deal with it.”
“Well, that’s a relief.”
“Yes, I know. It worries patients a lot, but the reality is that most people simply become tired, they spend more time sleeping, and as they get closer to the end they may sleep very deeply, and even lose consciousness every now and then.”
There was absolute silence in the room.
“Are you happy for me to go on?” he asked, and Mary nodded.
“So, when and if you do become unconscious, it is not painful or distressing, it’s basically just being in a coma. And if you are in a coma, we wouldn’t want to wake you up just to give you tablets or medicine, so we set up a syringe driver to allow you to have those medications through a tiny tube beneath the skin. That means we can control your pain and any other symptoms without needing to disturb you. You can choose whether you want additional sedation, or whether you want to be as alert as possible right until the end, but either way your body will need to rest and your energy will reduce… Still okay, Mrs Russell?”
“I’m completely fine with it, doctor. Thank you.”
“Everyone else, all fine for me to continue?”
Tess could see Edward look over to the consultant and nod for him to keep talking. He was chewing his lip. Dr Fielding resumed.
“So, you will be spending less and less time awake each day until eventually you will slip into a coma for the
last time. We don’t know when that will be; there are clues sometimes, patterns of breathing that alert us. Often patients seem to know themselves, but it is rarely a Hollywood-style eloquent speech that we hear. Last words are usually brief because most people in your situation have had ample opportunity to say everything they wanted to say to their loved ones in the preceding days and weeks.”
“Yes, that’s one of the advantages, I suppose.”
“Exactly. It’s not like it was with your husband. There’s time at least for people to become acclimatised. It’s still just as upsetting of course, but less sudden and dramatic.”
“Yes, okay.”
“So, you see, there’s no mystery really. People create an idea about dying based on what they see on television, or maybe things they’ve heard in the papers about violent crimes or death during war or famine, and it’s a million miles removed from the normal process that we see occurring here every day. People are frightened about losing their dignity, or being in pain, but as I’ve said, most of that can be controlled, and if you discuss your fears then we can usually address them and provide reassurance.” He peered over his glasses again and tapped his hands against his thighs. There was a momentary silence.
“Well, you’ve certainly done that,” Mary said. “I really appreciate your taking the time to explain it all.”
“Good.” He smiled. “I’m glad it was helpful. I’d better get back to clinic now, but if you have any further questions just let one of us know.”
Tess snuck a look at Edward who was still resting against the window ledge, his expression impenetrable. “Do you want me to ask Miss Delaney to come back in?” she asked. Edward nodded but did not look up. “Thank you,” he said.
Clara was perched on a wooden bench outside the main entrance, flicking through her phone. She cut an isolated figure, unable and seemingly unwilling to show solidarity with the tight little family unit currently gathered in Mary’s room. She regarded Tess warily. “Finished, are they?”
