by Nancy Peach
Tess, meanwhile, thanked the physio and crouched down to Mrs Russell’s eye level. “Mary, is this pain new? Would you like me to see if we’ve got a bed free for a few hours, somewhere you can wait quietly while we look at your medication?”
Mrs Russell nodded, her face contorted in a grimace. “Yes,” she breathed. “That would. Be good.”
Tess consulted with Dr Fielding and managed to find Mrs Russell a side room and some diamorphine. As the medication coursed through her system Mary’s breathing eased and the colour returned to her cheeks. Edward bustled about the room, trying and failing to be useful. Eventually he slumped into a chair by the window and put his head in his hands. Seeing his mother was now sleeping peacefully, he looked over to where Tess was altering the drug chart to allow her patient better pain control. She was focussing all her attention on getting the calculation right and her eyebrows were screwed together in concentration. A lone strand of hair had worked its way loose from her ponytail and was dangling in front of her face despite repeated subconscious attempts to tuck it behind her ear. The sky beyond the window was darkening with cloud and she had turned on a lamp in the corner to avoid the stark phosphorescent glare of the overhead lights while she worked. Edward, sitting in the corner, could see the warm glow glinting off Tess’s skin, her dark hair a halo of fiery brunette. Her features were soft in the lamplight, a frown of concentration smoothed by golden shadow, the curve of her lips outlined as she brought her pen to rest there while ratios and dilutions danced through her head. The hypnotic sound of opiate-induced breathing – a soft inhalation followed by longer whispered exhalations – coming from the bed, somehow added to the intimate atmosphere.
Edward cleared his throat, breaking the spell. “She’s had a dose of radiotherapy to try and shrink some of the tumour. Do you, I mean, in your experience, does that help, usually?” His tone was casual but it was clear that he wanted her approval. It was quite endearing.
“Sometimes it can do.” Tess nodded.
He moved forward in the chair and his face emerged from the shadows, his expression betraying a need for further reassurance. She wished she could give him more and almost reached out to touch his hand but stopped herself just in time.
“It’s often a good option,” she said instead, keeping her voice level and practical. “Worth considering for symptom relief, certainly.” There was a pause before she spoke again, “What’s the response to the chemotherapy been like?”
Edward exhaled, the sigh a mixture of despair and weary resignation. “It’s been bloody awful, to be honest, but we’re hoping to see some good results. Dr Hamilton-Jones, you remember? He thinks she’s got a chance. I mean, he really seems to think that there’s a possibility it might cure her entirely.”
“Really?” She tried and failed to keep the surprise out of her voice and Edward acknowledged it with a defensive look. Tess could almost see the barriers coming up, battle lines being drawn. While his mother’s condition was stable he had been able to relax and perhaps persuade himself that something miraculous was going to happen. Clearly, the state of Mary’s health was inextricably linked to his emotional wellbeing, and now it seemed she might be deteriorating again. This didn’t bode well.
“It’s a long shot,” he said. “I know that. I’m not an idiot.”
“I’m not for one minute implying—”
“But if there’s any chance at all, no matter how remote, we’ve got to try.” He looked across at his mum’s now peaceful face, her frail shoulders cradled by the pillows. “I feel bad for…” He sighed. “I know she finds it hard, but we have to keep trying.”
Chapter Nine
Tess was crossing the foyer from room four, where she had just been checking on a patient’s syringe driver. It was mid-afternoon and the May sunshine was filtering through the skylights, forming bright patches on the linoleum. Vases of flowers stood on the reception desk, their heady scent filling the room. Janice, the receptionist, took it upon herself to ensure that the flowers were always fresh, arguing that the last place for the depressing sight of dying blooms was a hospice. Many of the bouquets were donated by families inundated with funeral flowers or gifts from well-wishers, and Janice often had a lot to work with. Tess suspected that the ability to indulge her aptitude for floristry was what kept Janice at St Martin’s, because her customer service skills were questionable. Still, she had been busy this week, because the foyer smelt like a boudoir and looked like the hothouse at Kew Gardens.
Dave was wheeling a large trolley of rattling mugs through from the industrial dishwasher to the café and narrowly avoided colliding with Edward Russell as he hurried through the main entrance. Edward caught sight of Tess standing in a patch of sunlight as she turned to see the source of the commotion. She waved and made her way to the nurses’ station to begin writing up her notes as he went through to check on his mum. Mary Russell had been for another dose of radiotherapy to her lower spine yesterday but had opted to come back to the hospice rather than stay on the private ward at the hospital. Tess continued to write up her notes, leaning back in the swivel chair every now and again to catch the rays of sunlight that continued to glint through from the top windows. It was a glorious day. One of those English spring afternoons, perfect for a wedding or a fete if you could predict with any certainty that the weather would last, which of course you never could. She thought fondly of her friend Golda’s wedding a few weeks ago, when the heavens had opened, depositing their April showers, and Golda had spent the majority of the day with a muddy hem and damp confetti down her cleavage. It hadn’t reduced the radiance of her smile though; she had been a beautiful bride, and her husband Tom had looked as though he couldn’t believe his luck.
Over the edge of the desk she could see Janice working on reception trimming stems and stepping back to admire her latest creation whilst she answered phone calls and directed porters to their designated sites. After a while, Tess became aware of raised voices coming from Mrs Russell’s room. She startled as the door was flung open and Edward stalked out in a thunderous mood. He seemed unsure of what to do with himself; his teeth were gritted and his hands were balled up in fists as he paced over to the nurses’ station and slammed his palms down on the raised countertop right at Tess’s eye level. She pushed her seat back in surprise.
“Can you speak to her?” The volume of his voice jarred in the quiet foyer. “The next round of chemo begins tomorrow and she’s saying she won’t go. I’ve told her that it’s just this last course and then it’s done – but if she won’t go, well then it definitely won’t work, and what’s the point in having started it at all, and… Bloody hell! What is she thinking?”
Tess tried her best to be placatory. “Okay. I will talk to her – and see what she wants to do…”
The visible tension in Edward’s jaw eased and his shoulders began to drop. “Good,” he said. “She’ll listen to you.”
“But,” Tess said quickly, “it is up to her.”
“Yes, of course it is, but she’s not thinking straight at the moment. You’ll be able to put her right.”
Tess hesitated. “Mr Russell, your mum has the capacity to make these decisions, and if she doesn’t want to go ahead with any course of treatment then I am not going to be able to change her mind…” She waited again before adding more quietly. “And neither would I want to.”
There was a loaded pause and she could virtually see the red mist descending over Edward’s face.
“Right,” he said. “I see.”
“I just wouldn’t want her to feel forced into—”
“Forced into being cured! Of course, you wouldn’t,” he slammed his hands down on the desk again. “What kind of bloody doctor are you? What’s the point in going to medical school and doing all that training if you’re just going to preside over death all day? Surely you’re supposed to preserve life! Not just let it trickle away without a whimper. That’s this place all over, isn’t it? Why bother trying to actually cure anyone? Just give
them some bloody morphine and let. Them. Die!”
Tess tried to remain calm, but the shouting was now starting to attract attention. Dave had come back out of the kitchen with a tea towel in his hands and was keeping a wary eye on proceedings as he dried a plate. Janice had paused midway through her gerbera arrangement and was looking as much like a coiled spring as it is possible for an overweight receptionist holding a pair of secateurs to look. What was worse, the new lady in room three had also poked her head round the door and was regarding the outburst with obvious distress.
“May. I. Remind. You”—Tess pulled herself up to her full height and placed her hands on the desktop in front of him—“that there are sick patients here.” Her cheeks were flushed and her volume was now starting to increase to match his, “And that this is completely inappropriate behaviour.” She cut across his protestations, “I understand that you are finding this difficult, Mr Russell, but if you carry on upsetting our staff and patients like this I will have to ask you to leave.” She could feel her nostrils flaring and her arms were rigid on the desk as she held her ground. Edward removed his hands from the raised platform, conceding territory but still glowering at Tess.
“Oh, don’t worry,” he said. “I’m off! Sooner I get out of this bloody mausoleum the better.” And with a turn on his heel and a few angry strides he was out of the door.
Tess sat back down on the chair, her hands shaking slightly as she tried to steady her breathing. Dave sauntered over from the direction of the café, tea towel still in hand. “Well done, love,” he said. “You handled that just right. Got to nip that sort of chat in the bud pronto.” Tess looked up, grateful for his words.
“He’ll be kicking himself now, mind. Always a nice polite fella that one. Loves his mum.” Dave continued drying the plate despite the fact that there was clearly no water residue left anywhere on its surface. “Quite keen on you an’ all, I shouldn’t wonder. Blown it now though, ain’t he?” He wandered off again, taking his plate with him.
Janice had also moved across from reception with surprising speed. Once Dave had said his piece she came around to the back of the nurses’ station and wrapped her arms around Tess in an enormous matronly hug.
“No need for that sort of behaviour. I’ll give him a piece of my mind if he tries that again, honest to God I will.”
Tess allowed herself to be comforted for a few moments before taking a deep breath and pasting a watery smile to her face.
“I’m okay, Janice,” she said. “Honestly, it could have been worse. I’m sure he didn’t mean to be so… well, so bloody rude.”
She looked back down at the notes she had been writing and saw where her biro had scrawled off the paper when she had pushed her chair back so fast. Ripping out the page, she scrunched it into a ball and pulled a fresh sheet onto the desk, putting her energies into producing a neat cursive script. She thought Jane Austen might have the good grace at this point to comment on her fortitude in adversity, or at the very least the beauty of her impeccable handwriting given the circumstances, but that particular voice was ominously silent.
Instead, the television host tutted slowly. “Oh dear, oh dear, oh dear. What a nasty little scene. And how exactly did that make you feel, Tess? A bit low? A bit… hurt?”
She carried on writing.
“Still,” he said. “I know just the thing to make you feel better…”
Edward was as good as his word, and no matter how many times the click and slide of the main doors caused Tess to turn her head towards them that afternoon, it was never him. On the way back home that evening she stopped in at the corner shop and began her soothing ritual: freezer cabinet for the ice cream, grocery shelf for the biscuits, and chocolate bars in their usual place next to the cashier.
Accompanied by her bag of therapy, she returned to an empty house, the television host’s voice in her ear, the studio audience loudly munching on their popcorn, and not a peep out of Jane Austen.
Chapter Ten
In an attempt to regain a professional focus on the situation, Tess decided to try and establish what Mary Russell really wanted. After all, maybe she had got it wrong and Mary did want more treatment. There was no point in stoking up a family confrontation if it didn’t exist so she went to see her straight after the ward round the following morning.
Mary smiled as she looked up and saw Tess but faltered at the serious expression on her face.
“Oh dear,” she said. “You look like someone has died.”
“Well, it is a hospice.” Tess closed the door behind her. “Sorry, that’s not remotely amusing. No, I didn’t mean to look so preoccupied. I just wanted to get to the bottom of what happened yesterday. It all seemed to get a bit heated?” She moved her chair alongside the bed where Mary was resting against her pillows, her face drawn with fatigue. “If you don’t want to talk about it, it’s fine. I’m a terrible one for expecting people to overshare. Some call it nosiness; I prefer to call it ‘being interested in people’s lives’.”
“That can’t be considered a bad thing, surely?”
“You’re right, but my housemate, Kath, suggested that asking somebody, ‘How do you feel about this situation?’ until they burst into tears is not necessarily an approach that works for everyone, so do just let me know if you want me to leave you in peace.”
Mary laughed and looked down at her hands which were resting on top of the starched hospice linen.
“I would welcome having someone to talk to about it,” she said after a while. “Someone who is not directly involved. It’s hard to have a rational discussion with friends and family because they are all so affected by the outcome. And I know you care about what happens to me, but it’s a different type of care, a professional one.”
“Absolutely.”
“So that does make it a bit more straightforward, to perhaps say things to you that I wouldn’t say to others. It’s just… it’s difficult to know where to start. Edward is finding this all so hard. He doesn’t mean to get angry and I… I just don’t know what to do for the best.”
She looked so anguished. Tess started to feel the indignation that Edward’s outburst had roused in her yesterday coming to the fore again, but Jane Austen’s voice in her ear cautioned her to remain detached and professional.
“How about we avoid talking specifically about this round of chemotherapy for a moment and just maybe focus on the more general stuff,” she said, and Mary nodded. “I know your main concern is your son and I get that. But this isn’t about him. Not really. This is about you and what you want. And I can understand why you might want to stop treatment if it’s making you feel dreadful.”
There was a pause before Mary started to speak. Her voice was soft but she had the same authoritative tone as Edward, albeit with a gentler edge.
“The thing is, Dr Carter, it’s all well and good to say that this discussion isn’t about my son, but that’s not strictly true when you’re a mother. I take it you’re not?” Tess shook her head. “I’m sorry, I didn’t mean to be presumptuous. It’s just that I need to think about what this scenario means for my children. If I do stop treatment, then my chances of dying sooner are probably increased, although I know it’s impossible to predict. Yes?”
“Possibly. Okay, probably.”
“So, let’s say I stop the chemotherapy because I want to feel a bit better in these last few months. I’m still making an active decision to end things more quickly, aren’t I?”
“Ye-es.”
“Okay, so I’ve made that choice and it’s over for me. But the problem is that Edward and Madeleine will still be here, dealing with the consequences for the rest of their lives. Do you see? It’s not over for them. I need to think about what happens after I’ve gone.”
“But surely neither of your children would want you to have treatment that is making you feel worse, just through some misguided attempt to keep them happy?”
Mary interrupted her: “I’m sorry, doctor, it’s not misguided.” H
er voice was firmer now. “Edward doesn’t need to know that I am doing this for him. He sees I’m struggling at the moment, that I’m finding the therapy difficult, and he doesn’t perceive it as a weakness. He just can’t understand why I wouldn’t want to do everything I possibly could to stay alive. There is a part of him that feels let down even by the notion that I might give up. Subconsciously I think it is causing him to question his value: would I try harder if he was a better son? You see? I’m sorry… I just need a moment…”
She dabbed her eyes and Tess reached out to hold her hand.
“But Mary, if you told him, if you said exactly what you’ve said to me, that you’re fed up of it all and that the treatment is making you feel unwell, then surely he’d understand? He wouldn’t think it was a reflection on him? I mean, would he? Obviously, he’s your son. You know him, but…”
Mary was considering Tess’s words. “I think on a rational level, yes, of course he’d listen to what I had to say – although he’s doing a spectacular job of turning a deaf ear to it currently – but yes, I could really force the issue and he would presumably see the logic. What I’m more worried about is how he feels deep down, and of course he’s absolutely hopeless at sharing that with anyone.”
“I can imagine,” said Tess.
Mary’s forehead was wrinkled in a frown. “I’m worried that in the long run Edward might blame himself. Maybe what I need to do is just pull myself together, continue the treatment, and show him that I want to survive at all costs. That he is someone worth fighting to be alive for?” She leant back into her pillows with a groan, “Ugh, I hate this battle talk in the context of illness. I can’t believe I’m resorting to it myself. The notion that people who die from cancer haven’t fought hard enough. It’s so unhelpful.”
A tear trickled out of the corner of Mary’s eye and she looked exhausted. She obviously didn’t want to have any more treatment, and Tess was just going to have to nudge her into making the right decision.