by Emily Dean
The hospital staff had treated us with head-bowed reverence since the cancer diagnosis. They cordoned off a two-bed area in the ward so that Rach could have privacy and Adam could stay over. Rach’s phone pinged with messages from friends who were finding out that she was in hospital but were unaware that it was anything serious. ‘How you are doing?’ ‘Hoping all ok!’ There were abundant XXXXXs on each text. I tried to imagine what it must be like to be in their place of sunny ignorance. A nasty virus. A horrid infection that laid her low.
Rach asked me to call some of them. I seized the task. I needed to be useful, to wipe out all the times I had shouted at her. To erase the memory of stealing her Sony Walkman and not telling her for three months. To purge my guilt at once refusing to drive her into the courtyard of her flats and leaving her at the roadside entrance ‘because it was too hard to reverse.’ Even though she was carrying heavy shopping. And had Mimi with her. What a shitty thing to do.
My mum talked brightly about family members who had overcome cancer, on my dad’s side. We didn’t mention Aunty Julie, who died of it when she was around Rach’s age. My mum was almost manic. She evidently couldn’t allow herself to go to a place where this might not work out.
I rang the friends one by one, as Rach looked on. They were shocked. Some offered hopeful spins, survival tales. It’s something we all do when someone is faced with bad news; we pull out a comparable experience to express empathy. Not realising that the other person’s new world can’t yet accommodate anyone else’s story. One friend rallied, ‘Cancer has so many positive outcomes now! She can have chemo?’
Over the previous hour I had discreetly Googled every variation of the words ‘liver’ and ‘cancer’. I had found articles that began, ‘Cancer that has spread to the liver has an extremely poor prognosis.’ The words ‘five-year survival rate’. I put the websites out of my mind. Frank had always advised against reading reviews, so I decided to treat the cancer info as if it were a troll, and block it.
There were positive factors. She was only forty-three, she was healthy, had never smoked, barely drank – and perhaps we had caught it in time. She had every hope of being one of those stories that people share to make others feel better.
Rach asked for more diazepam and I leapt up, marching towards the nurses’ station as my trainers squeaked briskly on the vinyl floor tiles. I swung open a thin white curtain, behind which a nurse was making notes, and I requested some more drugs.
‘I’m sorry, it’s a little soon since her last tablet,’ the nurse replied. ‘We have to monitor …’
‘She’s just been told she’s got fucking cancer. She’s got two kids. Come on, give her the drugs,’ I said in a voice that didn’t belong to me. Come on, give her the drugs. I sounded utterly ludicrous. But I didn’t care.
She looked at me sympathetically and I realised that I had just sworn at a nurse. ‘I’m sorry I swore just now.’
‘It’s not easy,’ she said sweetly. ‘It’s a difficult time for you all.’
She reached out to stroke the faux fur trim on my cardigan. I hadn’t taken it off for the previous five days. My vigil uniform. I read once that Steve Jobs wore an identical outfit every day so that he didn’t have to waste headspace on menial choices. Outliers and the terrified had a lot in common, it turned out; neither of us gave a shit about how we looked.
It was midnight. The nurses had waived the visiting hours for us but Rach looked shattered and needed to rest. We would hear the next steps tomorrow at 9.00am, once the consultant had the results of her various tests.
A calm resolve had descended on Rach by the time I prepared to leave. She used language such as ‘not letting it defeat’ her; ‘beating it’ and ‘staying positive’.
I was waving goodbye, about to draw her bed curtain, when suddenly I found myself blurting out, ‘Fucking cancer – fuck you, cancer. We’re going to kick this fucking cunt in the arse!’
The elderly lady in the bed opposite stirred. Mum and Adam laughed.
Rach broke into a grin. ‘Yeah, let’s kick it in the arse!’ She blew a kiss. And then she said softly, ‘Night, C.’
29 December
I arrived early at the hospital today, perhaps for the first time in my life. Punctuality and I had never really had the best relationship. Jane and Jonathan had developed strategies to manage ‘Emily time’. ‘The movie starts at 7.30!’ they would say, when it began at 8.00. But I needed to ingratiate myself with time now that it had decided to start making threats to my sister.
I stopped at the food court to pick up some satsumas for Rach and take a call from my godmother, Penny. She and the Phillips family, her husband John and three boys had been friends since our childhood. They acted as a comforting bridge between us and the dog-family world, their lively artsy domestic life similar to ours but underpinned by estate cars and promptly paid bills. Bon viveurs who knew when it was time to leave the party. Penny had walked this path before with her husband’s cancer diagnosis, and was throwing her fixing skills at it all, calling her contacts at the Marsden hospital. Meanwhile Jane was researching specialist centres in LA. You gravitate towards life’s decisive architects at times like this.
My stomach gurgled. I hadn’t eaten a meal since yesterday morning. Food felt oddly decadent, somehow. The nervous hunger was a new addition to my recently formed gang of unexpected companions. It joined the wrecking ball in my stomach and our crazy new pal, insomnia.
Adam, Mum and I sat nervously around Rach’s bedside, waiting for the consultant. I suggested to Rach that I record the conversation we were about to have on my phone, so that we could keep track of all the medical stuff. She nodded.
The consultant arrived. She had wiry hair and was dressed in a neat collared jumper and skirt. She looked like an Agatha Christie character – the one you never thought to suspect. I smiled at her warmly, as if charm might have the power to affect the outcome in some way.
‘I feel we have a clear idea of where we are now,’ she said to Rach. ‘I’d like to understand what you understand.’
‘Well, I’m just trying to deal with things, really,’ Rach said calmly. ‘In some ways it’s a relief to know what’s going on. Once you know …’
Rach went through the swift decline of the previous few weeks: exhaustion, feeling breathless when walking Giggle, going off her food and the endless fevers. The ‘stubborn baby weight’, which we now knew was a swollen abdomen related to the cancer. ‘I just put it all down to having had a baby earlier this year.’
‘Yes, yes I see.’ The consultant nodded, absorbing the information, weighing it up like the boss who respectfully allows you to have your say, before delivering the outcome that has already been decided.
‘Would now be a good time to tell you about the results?’ she asked. ‘Because the disease is in your liver, and there’s quite a lot of disease in your liver. We need to try and control the activity of the cancer. Steroids are a very good—’
Rach interrupted her. ‘Can I ask you something?’ she said with a calm dignity. ‘Would you say it was quite advanced?’
‘What stage is it?’ I demanded suddenly. I immediately regretted it, feeling I had overstepped the mark, crashed through the polite medical process with reckless indelicacy.
To my relief, Rach sanctioned the question.
‘Yes, what stage?’ she repeated evenly.
The consultant shifted her position, leaning forward and clasping her hands together gracefully.
‘When disease has gone to your liver and we know it’s come from somewhere else,’ she paused, ‘then the cancer is Stage Four.’
Stage Four. There was no Stage Five.
‘Oh my God. That’s bad, isn’t it,’ Rach said, shock spreading over her face. ‘So the chances aren’t good, are they?’
She looked to Adam, Mum and me for help. The wrecking ball exploded in my stomach.
Adam grasped her hand tightly and addressed the consultant with authority. ‘Look, from our point of view, w
e just want you to be as aggressive as you can in treating this. There’s no time to lose now. We can—’
‘Stage Four, guys,’ repeated Rach. ‘That’s awful.’
Adam continued. ‘I really feel that we should go full-on with chemotherapy; she’s young and we believe she can handle it—’
Rach cut through. ‘What are my chances?’
‘I’ll try and answer all of your questions,’ the consultant said in the patiently resigned tones of someone faced with a baying media scrum.
‘Is there any hope?’ asked Rach.
‘There is hope that we can try and control the disease. But if you’re asking me can we cure you …’ She trailed off.
‘How long do you think I have?’
‘Again, that’s difficult.’
‘What about a liver transplant?’ asked Adam.
‘I’m afraid a liver transplant in your case would not be a feasible option.’
‘So I’m going to die, basically,’ said Rach. ‘How long have I got?’
‘We’re going to control it,’ said Mum.
‘Is there any hope for surgery at all?’ persisted Adam.
‘How long has she got?’ I said simply.
The consultant paused. ‘Is that something you really want to hear today, Rachael?’
‘Yes.’ The word was so small. And yet so strangely apocalyptic.
‘No doctor anywhere can predict this with certainty. But based on the rate of disease,’ her voice softened, ‘we think it will now be a matter of months.’
‘I have a ten-year-old. And a baby. I can’t leave them,’ Rach said.
Adam fought back his tears, talking forcefully about treatment and transferring hospitals. My mother had disappeared behind a mask of shock and denial, producing print-outs from the internet and challenging the consultant with cancer-survival stories.
I went to the end of Rach’s bed and curled up, placing my head on her feet. I just wanted to shut out the world and stay there, forever.
Rach was absorbing this with a grace that floored me. I had known exactly what she was thinking at every moment throughout our lives. But I didn’t know how it felt to be told you wouldn’t be here in a matter of months. How was she managing to not scream or collapse, how did she remember to say please when she just asked for a glass of water? There was no right way to respond to news like this. You react how you react. But I realised that my sister wanted us to wrap her in a calm blanket – the one in which she had always enveloped her own children.
I had sensed her wanting to shield Mimi from the burden of the diagnosis, to protect her from this trauma and keep her away from the hospital. The peaceful childhood Rach wanted for her, one that needed to differ greatly from ours, couldn’t possibly accommodate this.
Rach asked me to get her some more diazepam. We’ve joked about me becoming her dealer; I’ve been doing a comedy Harlem accent to amuse her, every time I hand over the drugs. ‘Daddy’s got some sweet sugar for his girl!’ But it felt wrong today.
As I headed out to the nurses’ station I felt light-headed and nauseous. My ears started to ring. I stared down at my trainers and then suddenly my legs gave way. I connected with the cold hospital floor.
Two nurses rushed over. ‘Her sister is in bed seven,’ I heard one whisper by way of explanation.
‘I’m fine, it’s just lack of food,’ I said. I didn’t want Rach to know that I had collapsed. Noisy Em, making the moment about her, stealing focus.
They sat me down and brought me water and I attempted to wave the moment away with comedy, recalling an observation we made on the radio show once, that fainting wasn’t a real ‘thing’, it was just attention-seeking.
One of the nurses smiled. ‘Well, actually, it is very much “a thing,”’ she said, explaining patiently that shock reduces blood flow to the brain.
I just wanted to go back to that place where we had laughed about fainting. Where the idea of being physically overwhelmed by news felt like a preposterous one.
The mood behind the curtain had changed by the time I got back. The ‘Fuck cancer’ battle cries of the night before had gone, replaced by disbelief.
Rach asked to see a priest, who was brought from the hospital chapel. He was informal and gentle and sympathetic, listening mainly, asking questions about her children and her life, talking about hope and the human spirit. She looked relieved.
I had always adopted my father’s rational approach to faith. I couldn’t understand how anyone could argue against science and logic. But those dinner-party assertions about the absurdity of belief in the afterlife now seemed ridiculous. Just as the medics had become responsible for fighting to keep her here, the priest seemed to offer her a way of coping with the moment when they had to admit defeat. A sense of something greater than merely ceasing to exist. It might not be my way, or my father’s way, but who was I, who were any of us, with our complacent luxury of a future, to argue with her choice?
My dad arrived with his messenger bag slung over his body, his eyelashes wet with sorrow. He engaged the priest in a discussion about Matthew Arnold’s poem about faith, ‘Dover Beach’, steering things into a more literary, philosophical terrain. The priest looked impressed by his knowledge and my father warmed to his approval.
I felt myself instinctively reacting with rage. This is her moment. Her time to be the painting. You must be the frame now, I wanted to scream. He took the full silent weight of my own guilt. It was less painful than dealing with mine. The feeling that I had spent my whole life trampling on Rach’s kind, generous heart, blurting out unkind things. Dominating our shared space and leaving her no room to breathe. I wanted to reboot our history, take back every thoughtless remark I had ever made, every disapproving thing I had ever said. I wanted to atone for it all, and apologise.
But confessions are sometimes for ourselves, not for the people we confess to. So I decided to sit with the discomfort. Perhaps if I was helpful, pragmatic and useful enough, I could make it up to her.
30 December
I waited for my sister to shout, to scream at the injustice of it all. For the shock to subside and usher in anger. But that didn’t happen. She stayed wrapped in peaceful introspection, ‘her bubble’, as she called it. ‘I can shut out the rest of the world, and in a way it’s easier for me, Em,’ she said. ‘My bubble protects me.’
I decided that I would take indefinite leave from the radio show and my magazine job when the Christmas break ended the following week, so that I could be by Rach’s side every day. The solid defender on our dedicated team surrounding Rach. My godmother, Penny, called often and reframed our confusion with positive action, insisting that she would call her various contacts to get Rach swiftly transferred to the Royal Marsden in Chelsea. ‘It’s the best cancer hospital in the world. Rachael deserves the best,’ she said decisively.
Rach asked me to get thank-you presents for the nurses. ‘Just some little beauty products, freebies you have from the magazine, maybe?’ She spent several hours laying out all the lipsticks and mascaras and body oils on the bed, and writing cards. ‘This lipstick would suit Tiara’s skin tone, don’t you think? And this perfume is very her.’ She rearranged the cosmetics endlessly. ‘I like doing this, Em. I feel normal again, choosing presents.’
I told her that I would have to try to sneak them into their staff room. ‘I think the NHS have jobsworth rules about accepting gifts. I don’t want to be in the Sun tomorrow. “The Evil Face Of Cancer Drug Bribes!”’
‘You know,’ she said, placing mascaras and hand creams in gift bags, ‘I want you to help with Mimi’s periods and get her Tampax. And you should take her to buy a bra. It’s nice to have a woman in your life for things like that.’
She placed a bow on a bag.
It was the first time she had addressed the concept of not being here anymore. I sensed that she couldn’t allow herself to dwell in that place for too long. ‘When I’m gone’ conversations were not ones she wanted to have. And sometimes, I all
owed myself to think she would be one of those miracle stories who made it to the other side. The maverick outlier. Not like the others.
31 December
It was New Year’s Eve. I was resting on the bed that Adam often used, in our makeshift hospital camp. His mother had moved in to their place to look after Mimi and Bertie. Adam and Rach were keen to normalise things for Mimi. This illness was obviously out of the ordinary but she didn’t know the full implications.
Rach had constant fevers and was dependent on the relief of the cool fans and doses of medication. She would be starting her treatment at the Royal Marsden in a few days, which had lifted her spirits. It represented a positive new start, a place where dire prognosis was often turned round, where ‘impossible’ sometimes became ‘maybe’.
The day before she’d told me she wanted to laugh and take her mind off things, so the previous night I’d stayed up until 4.00am, manically downloading every episode of her favourite TV programme, Peep Show. I threw in her other favourites, Alan Partridge, an Alan Carr comedy special and Paul O’ Grady’s last tour. I rationalised that the more I downloaded, the more time she would have left. It was simply not possible for someone to be watching Peep Show one day and cease to exist the next.
I was immunised from the significance of New Year’s Eve in our hospital bubble but it assaulted me when I wandered out to Sainsbury’s to buy Rach some juice and fruit. A huddle of teenage girls were choosing flavoured vodka drinks and bags of Doritos, playing Rihanna on their phones, fizzing with anticipation over their plans. Couples came in clutching each other against the cold, selecting wine from the chilled cabinet to take to parties. I averted my eyes from them, aware that I was now a member of a shadowy sub-species, who had clambered into their jubilant seasonal world and was threatening to harsh their high with my foggy gloom.
