Cruel to Be Kind

by Cathy Glass

  All three children were the quietest they’d been all summer as we entered the surgery – Max had Adrian’s and Paula’s sympathy. But the dentist, a young Australian woman, had a lovely child-friendly manner. I explained to her who I was and that Max was staying with me for the time being, then I helped him clamber onto the couch. Adrian and Paula stood to one side, still very subdued, as the dentist began examining Max’s teeth. With the stainless-steel probe she gently went round his mouth and called out her findings to the nurse, who wrote them down. They were dental terms, but sadly some of what she said was all too obvious, for example, ‘lower right two missing’.

  The dentist paused partway through the examination and looked at me. ‘I’m guessing you’ve changed his diet and he’s not eating as many sweet foods?’

  ‘That’s right,’ I said.

  ‘Excellent, and his oral hygiene has improved too.’

  ‘Can you tell that?’ I asked.

  ‘Yes, there isn’t the same build-up of plaque.’

  ‘Fantastic,’ I said, relieved.

  I was delighted when she came to the end of the examination and said that there was no new decay in Max’s teeth. She said she’d monitor the teeth that were already decayed – and might need to be extracted – but if they didn’t deteriorate further or cause him pain then she’d leave them to come out naturally when his second teeth came through. It’s a traumatic experience for a child to have teeth extracted under anaesthetic. As I helped Max from the couch she told him he was doing well and emphasized the importance of continuing to clean his teeth thoroughly morning and night and not eat sugary foods. The dental nurse gave Max a well-done sticker and the dentist said I should have one too for the part I’d played, so we both left sporting stickers of big molars with happy, smiling faces.

  That afternoon Max had contact and I had no hesitation in telling Caz the good news about his teeth. She knew he had a dental appointment – she’d given me the details and had asked me to take him. She was already in the Family Centre sitting on the couch in Red Room with her feet up, but when I told her the result of the dental check-up she just nodded vaguely and seemed very distant and not herself.

  ‘Are you OK?’ I asked her.

  ‘Not really.’ She shifted uncomfortably. ‘I’ve had to take strong painkillers for my foot and they make me woozy.’

  ‘Oh dear. I’m sorry to hear that. Have you seen a doctor?’ I asked, glancing at the girls.

  ‘No, I must,’ she said lethargically.

  ‘The nurse told her to see the doctor the last time she came,’ Kelly said.

  ‘It’s difficult to fit it all in, having to come here as well,’ Caz explained.

  ‘I’m sure contact could be rescheduled so you can see the doctor,’ I said.

  She nodded and rested her head back. I was concerned. She’d been complaining of her foot hurting for some time – not the one that had been operated on but the other one – and it seemed to be getting worse, not better.

  ‘Perhaps Kelly could make the doctor’s appointment and then phone Lorraine?’ I suggested, for it seemed that Caz was finding it all too much, and Kelly was the oldest.

  ‘I’ll phone when we get home,’ Kelly said.

  Caz nodded again and closed her eyes. Max, recognizing his mother wanted to rest, went over to find a game to play with the girls.

  ‘See you later then,’ I said to them all.

  ‘Yes, bye,’ the supervisor called.

  Outside, Adrian and Paula, who’d waited by the door and had seen Caz, were worried too. ‘What’s the matter with Max’s mother?’ Adrian asked.

  ‘Her foot is hurting so she’s going to see a doctor,’ I said. ‘Don’t worry, the doctor will make her better.’ How naive those words would seem later.

  We went to the park, but the carer I’d bumped into the previous week wasn’t there, as Monday contact for her child was in the morning. The weather was still fine in late August and it was lovely to be outside. We’d had an excellent summer, but once we were into September the afternoon air would begin to chill, heralding autumn and then winter. How long Max would be with me I didn’t know – it would depend on the social services assessment, which I guessed had been slowed due to Jo being off work sick. Lorraine, as her manager, would cover the essentials, but I doubted she’d have time to complete an assessment. Hopefully Jo would recover and return to work soon or, if not, an agency social worker is sometimes used to cover absence.

  We returned to Red Room for 3.30 p.m. and as soon as I stepped in I noticed a pungent smell, despite the windows being open. I assumed it was the result of hot bodies being together in one room with the sun shining in. The room felt hot and Caz looked particularly flushed. She was still on the sofa but was now lying with her feet up. The girls and Max had packed away the games in preparation for the end of contact. The atmosphere had changed and seemed more sombre. As I went further into the room I thought the smell seemed to be coming from Caz’s direction, then Kelly said, ‘It’s Mum’s foot that smells. She missed her appointment with the nurse to have the dressing change.’

  I glanced at the supervisor, who was also looking concerned. ‘We’ve telephoned Caz’s doctor and got her an appointment for this evening,’ she said. ‘The manager here has told her she shouldn’t have missed a medical appointment and contact could have been rearranged.’

  I looked at Caz as she began to manoeuvre herself into a sitting position, gingerly lifting one leg and then the other to the floor and then righting herself. She grimaced, clearly in a lot of pain. Sweat glistened on her forehead and her cheeks were crimson.

  ‘Caz, you must look after yourself,’ I said. She nodded. ‘We’ll phone you tomorrow.’

  She gave another desultory nod. The girls were looking very serious and worried. There was nothing I could do, so I said I hoped all went well at the doctors and, saying goodbye, we left. What I didn’t know at the time was that the girls recognized these warning signs, having seen them before, and were desperately hoping they were wrong.

  That night I reassured Max (and Adrian and Paula) that the doctor would make his mother better, and then the following morning Jill arrived at eleven o’clock for one of her statutory visits. We were in the living room and I was updating her in respect of Max. She’d seen and spoken to the children as she was supposed to do at each visit, and they were now playing in the garden. The phone rang and I picked up the handset from the corner table. It was Lorraine, Jo’s manager. ‘I have some bad news, I’m afraid,’ she said, her voice tight. ‘Caz was admitted to hospital last night. She has gangrene in two of her toes and is at risk of septicaemia.’

  ‘Oh no!’ I said, shocked and aware of the seriousness of this condition. ‘How is she?’

  ‘They’re giving her antibiotics through a drip and they’ll operate as soon as she is stable to remove the infected toes. But she’s very poorly.’

  ‘She wasn’t well at contact yesterday,’ I said.

  ‘So I understand. She should have sought medical help sooner. Could you tell Max his mummy is in hospital, please?’

  ‘Yes, of course.’

  ‘We think it’s best if he doesn’t see her until she’s a bit better. We’ll take it a day at a time.’

  ‘What about the girls? How are they managing?’

  ‘They’re at home and Caz’s friend, Bet, is there. They might go to the hospital this afternoon to see Caz, but they won’t stay for long.’

  ‘Perhaps I could phone them later when they’ve been, to see how she is.’

  ‘Yes. That should be all right.’

  ‘I am sorry,’ I said. ‘I’ll tell Max.’

  ‘Thank you.’

  Jill was watching me intently as I said goodbye and replaced the handset. She knew from my expression it wasn’t good news.

  ‘Caz is in hospital,’ I said. ‘She has gangrene in her toes and possible septicaemia. They’re going to operate to remove the infected toes as soon as she is stable.’ It was then I realized
the full significance of the smell at contact. It was the gangrene from her rotting flesh. No wonder she was in pain. I told Jill.

  ‘The poor woman,’ she exclaimed, as shocked as I was. ‘She hasn’t properly got over her last operation and now this.’

  ‘I need to tell Max something. He won’t be seeing her for a while.’

  ‘Do you want me to stay while you tell him?’ she asked.

  Jill had a lot of experience in dealing with traumatic news, so I thought her support would be useful. ‘Yes, please.’

  I stood and went into the garden. ‘Max, can you come inside for a moment, please?’ I said.

  He seemed to be expecting bad news. ‘Is it Mum?’ he asked, coming over.

  ‘Yes, love. She’s in hospital.’

  Once we were indoors and sitting together on the sofa, I explained to him that his mummy was in hospital and was being well looked after by the doctors and nurses. But that she would need another operation soon, similar to the last one.

  ‘Will we visit her in hospital like we did before?’ he asked.

  ‘Yes, but not just yet. She’s very tired. When she’s feeling a little better and has had her operation we’ll go.’

  ‘And we’ll buy her some sweets and fruit to make her feel better.’

  Jill threw me a knowing look. ‘We’ll certainly take her some fruit,’ I said. I balked at the idea of taking her more sweets. The amputation of her toes – first from one foot and then the other – was a result of the complications of type 2 diabetes, from obesity and a high-sugar diet. I wasn’t going to be responsible for contributing further to what was already a chronic and life-threatening condition.

  ‘OK then?’ Jill asked Max. ‘So you understand that Mummy is being looked after in hospital. Do you have any questions?’

  He shook his head.

  ‘If you think of any, you can ask Cathy.’

  ‘I will,’ he said. ‘Can I go in the garden now?’

  ‘Yes, love,’ I said.

  Outwardly, therefore, Max had taken this news as he did most bad news – in his stride – and Jill hadn’t had to say much, although it had been reassuring to have her present. Possibly for Max, having his mother in hospital facing another operation wasn’t the shock it might have been to another child, as he’d already had experience of it. Maybe at age six he didn’t fully appreciate just how serious her condition was. But I knew Max better than that, so I wasn’t surprised when, later that day, after Jill had left, he came to me and asked, ‘My mummy won’t die, will she?’

  The short and brutal answer was yes, if not from this then a related condition if she didn’t make radical changes to her diet and lifestyle. But that’s not what you tell a young child who needs reassuring. If her condition deteriorated then I’d talk to him further, but for now I said, ‘The nurses and doctors are looking after your mummy really well. I’m sure she will be feeling well enough for us to visit before too long.’

  Which he accepted, as it was what he wanted to hear.

  When Lorraine had telephoned she’d said that Max’s sisters were visiting that afternoon, so early evening I telephoned Max’s home. Paula was in bed and the boys were playing cards in the living room. I made the call in the hall, out of earshot. Paris answered.

  ‘It’s Cathy. I was wondering how your mum was. Lorraine said you were planning on visiting her this afternoon.’

  ‘Yes, we all went. She was asleep most of the time so we didn’t stay long. Her temperature has come down, which is good. Bet spoke to the nurse in charge and she said the antibiotics were starting to work and should stop the infection spreading further.’

  ‘That’s good news.’

  ‘I guess, although she’s still got to have at least two toes off. Is Max there?’ I recognized that she didn’t want to talk about it any more.

  ‘He is, I’ll put him on. So you’re all managing?’ I said, and called Max. ‘You’ve had some dinner?’

  ‘Yes, Bet cooked it for us.’

  ‘Good. All I’ve told Max is that his mummy is in hospital. I haven’t gone into the details.’

  ‘No, I won’t tell him about her toes, although he probably knows. Mum says he’s got built-in antenna that picks up everything going on around him.’

  I smiled. ‘Yes, I know what she means.’ Max didn’t miss much, because he looked, listened and intuited.

  Max came to the phone and spoke to all three of his sisters in turn. When he’d finished he hung up and returned to play cards with Adrian.

  The following day and for the rest of the week I kept him busy with a mixture of outings and playing at home. Every evening I telephoned Max’s sisters to find out how their mother was and he spoke to them. They and Bet visited Caz briefly each afternoon and her operation took place on Thursday. That evening, when I telephoned, Summer told me that Bet had phoned the hospital to see how Caz was and was told the operation had gone well and she was ‘comfortable’. They didn’t visit as the nurse had said she was still very sleepy from the anaesthetic. They visited on Friday and when I telephoned in the evening Kelly said their mother was awake and doing OK. The surgeon had told her he was satisfied that by amputating two toes he’d removed all the gangrene and had saved her foot. Apparently, the poor woman had been told before the operation that, depending on what the surgeon found, he might have to amputate her foot to stop the gangrene spreading further. He’d also told her that if she’d left it much longer before seeking medical help, her foot would certainly have had to come off. She asked the girls to find out when I could take Max in to see her. Paula and Adrian were out with their father the following day, Saturday, so I suggested I took him that afternoon.

  Saturday morning, all the children were excited to be seeing a parent; Adrian and Paula their father, and Max his mother. I made us a cooked breakfast of scrambled egg, grilled bacon and tomatoes, and saw that Adrian and Paula were ready for when their father collected them at 10.30 a.m. Once I’d seen them off I suggested to Max that we walk to our local shop so he could choose some fruit for his mother. I would have liked to take her flowers as well, but most hospitals don’t allow them in the wards for fear they might spread germs and aggravate allergies. Max no longer complained when I said we’d walk rather than use the car. The store was just a twenty-minute walk away and it would be the only exercise he’d have that day, as we’d need to take the car to the hospital – it was too far to comfortably walk.

  In the shop Max chose a double punnet containing blueberries and cherries for his mother, but was interested in the display of pomegranates. He said he’d never had one before so I bought some. They’re rather a strange fruit and personally I’m not a big fan – they seem hard work for very little reward. The last time Adrian and Paula had tried them they’d had immense fun spitting out the seeds with some force (onto the plates I’d provided). I (unwisely) shared this with Max on the way home and he said he’d save his pomegranate for when Adrian and Paula returned home and they could ‘all spit seeds together’.

  After lunch we set off for the hospital and as I drove, I warned Max that his mother would probably look quite poorly. It can be upsetting for a child to see a parent ill in a hospital bed, but of course Max had seen his mother like that before and took it in his stride. She was propped up in bed on a mound of pillows with a blanket support cage over her legs and feet, and a drip in her arm. She looked paler than she usually did and her hair was flattened from lying in bed, but considering what she’d been through she didn’t look too bad. She managed a weak smile when she saw us.

  ‘No girls?’ I asked as Max presented her with the fruit and kissed her cheek.

  ‘No, they’re coming later. Thanks for this,’ she said, referring to the fruit.

  ‘You’re welcome. I’ve washed them. How are you feeling?’

  ‘Could be worse,’ she said, putting on a brave face. She and Max began eating the fruit.

  ‘I’ll leave the two of you then and come back later.’

  ‘Stay unless y
ou’ve got stuff to do,’ she said amicably. ‘I wouldn’t mind a bit of company.’ How different this was from the reception I used to receive when she was in hospital the last time.

  ‘I can stay. I haven’t got Adrian and Paula with me,’ I said, and sat in the chair. Max stood by the bed, eating the blueberries with his mother.

  ‘Is there anything you need?’ I asked her after a few moments. ‘There’s a small shop downstairs.’

  ‘No, thanks, the girls are bringing in what I need when they come later. Nice of you to ask, though.’

  As we talked they quickly finished the blueberries and then Caz passed the box to me. ‘Put those on the cabinet, will you? I’ll save the cherries for later. I can’t be running to the bathroom.’

  I did as she asked. ‘Have you been out of bed?’

  ‘Oh yes, they make you. It’s painful and I can’t manage with a walking frame yet so they bring a wheelchair. Hopefully I won’t have the complications I had last time.’ She then talked to Max about school. ‘I expect you’re looking forward to going back to school on Monday. Are you all ready?’

  ‘Yes,’ Max said. ‘I’ve got new school shoes and a new uniform.’

  ‘I know. You told me on the phone,’ she said convivially. ‘It’s a size smaller, so that’s good.’

  I was pleased she’d mentioned this, as it allowed me neatly to raise the matter of breakfast club. ‘I was thinking of not enrolling Max for breakfast club next term,’ I said. ‘He has breakfast before we leave. What do you think?’

  ‘Whatever Max wants,’ she said easily. Which was awkward, because children of Max’s age don’t always know what’s best for them and have to be directed by a parent.