In Two Minds

by Gordon Parker

  ‘You are so kind, Sunny, but I’ve actually been saving for such a trip for a while.’

  Edina joined them for dinner two weeks later. The trip had been ‘a delight’, she said, but her voice sounded flat. She had particularly enjoyed the Milford Sound region although she had decided against any of the day treks. She looked thinner, her eyes more radiant as a consequence of her rather wan face, and she only pecked at her food. When asked, she admitted her back pain was worse, and Martin observed again how enervating real pain is. He asked if she would like him to prescribe a stronger analgesic then, catching himself, suggested that if it was no better in a week she should see a doctor. The following weekend, when he called by to pick her up, she was lying on her couch.

  ‘I’m sorry, Sunny. Still in my dressing gown. I deserve a dressing down, I’m sure.’ Her smile was wry and superficial. Martin took a history. The back pain was intermittent but had not really changed in severity. However, she had no appetite at all and had hardly eaten during the week. Her worst symptom, however, she volunteered quietly, was a sense of dread.

  Martin immediately also felt a sense of dread. As a clinician he wanted to take a full history and examine her, but she was his mother and they had always respected each other’s personal space. Despite her high level of common sense, she had no general practitioner, always denying that she had any need and could always go to the hospital if there was a problem.

  Martin judged she needed rapid assessment. He tried to speak slowly, to hide the concern he felt while smiling reassurance. ‘Let’s see how things go, Mum. I’m sure it will settle quickly but, just to be sure, I’ll get a colleague to check you out. Some time early next week, with luck.’

  He drove home in a pensive state. After briefing Sarah he rang John Baker, a gastroenterology colleague. He tried to keep his voice calm, apologising for ringing John on a weekend. Baker could see her on Tuesday, being ‘up at Dubbo’ on Monday. Martin jumped at the appointment.

  He was not able to settle over the weekend.

  Martin accompanied Edina to the assessment. Baker took a careful history and gently examined Edina’s abdomen. He ordered numerous blood tests and an abdominal CT scan. Sarah took an increasingly tired Edina to the several hospital departments. Baker convened a review meeting on the Friday. He spoke slowly and carefully.

  ‘I’m troubled, Mrs Baker, that there may be a problem in your pancreas.’

  ‘Cancer?’

  ‘Mum,’ interjected Martin, wanting to avert such directness.

  Edina turned from Baker, took Martin’s hand and smiled at him. ‘You know me, Martin. It’s best not to beat around the bush. I would appreciate a direct answer. I probably won’t take it all in but you can translate for me.’

  Martin turned to Baker in despair and confusion, aware that Baker had not cut them off with a reassuring statement of, Oh not cancer, nothing like that. Even Baker appeared tense.

  ‘Mrs Homer. We don’t know exactly at this stage but such a possibility can’t be entirely ruled out. Martin, the CT shows an ill-defined mass and some fullness of the pancreatic head. The CA nineteen–nine level is up.’

  Martin leant forwards. ‘Any nodes?’

  ‘Not that I could find.’

  Martin felt his hands trembling. He clenched them into fists. ‘Next stage, John?’

  ‘I’d suggest a laparoscopy. I’m not confident about ultrasounds at this stage.’

  Edina turned again to Martin but did not speak. Martin smiled, feeling his capacity to reassure was being tested. ‘John will get a surgeon to put a needle into the pancreas. Just to check…’ He stopped speaking. Just to check was so inadequate, but worse, revealing.

  Baker spoke quietly to Edina. ‘I’ve talked to James Holder. He’s an expert surgeon and the two of us work closely together. The procedure is pretty minimal but we will need you to be admitted. He can do it next Wednesday. Shall we proceed, Mrs Homer?’

  Edina looked at Martin. He nodded. She turned to Baker and nodded. He nodded. Then added, ‘We’ll all be doing our very best, Mrs Homer.’

  Martin drove Edina home. She asked no questions. Instead commented on how Baker was clearly competent and kindly. But he needed someone to redo his office as it was too clinical.

  Martin offered her a stay at their house but Edina preferred her own bed. Their parting hug lasted longer than usual.

  Martin asked Sarah to sit with him on the couch as he reported on the assessment. He explained it was almost certainly a pancreatic cancer and that he had missed the early symptoms. He, a doctor, a doctor who prided himself on his competence, had missed it. ‘The weight loss, the anorexia, the mood state, you know, the dread she was describing –’

  Sarah interrupted him. ‘All non-specific, Martin. Could have been due to any number of things.’

  ‘And the back pain?’

  ‘But she said it was a recurrence of the pain she’d had some years back.’

  ‘And I bought that. I didn’t think of other possibilities.’

  ‘Martin, you must stop beating up on yourself.’

  ‘Pancreatic cancer is one of the most malignant. By the time the diagnosis is made it’s nearly always too late. You need to get it early. And I missed it!’ Martin clutched at Sarah, lay his head in her lap, and sobbed.

  The next Tuesday Martin drove Edina to the hospital to book her in for the procedure. He accompanied her to her allocated bed, in a ward with six other women, their semi-privacy defined and demarcated only by a white curtain, as if it would prevent their talk being heard. The two spoke quietly to each other.

  As Martin was about to leave, Edina stopped him.

  ‘I’m aware how serious this might all be, Sunny. My will is up to date but I’m not certain if I’ve formally given you power of attorney. Perhaps you could go through the safe tonight and just check through things.’

  Martin nodded but felt uncomfortable. To agree was to collude, to share her unstated conviction that she would soon die. To dismiss would be read by her as shallow denial on his part. He kissed her on the cheek, and looked long at her, trying to communicate as much reassurance as he could. She smiled gently in return.

  That night he opened her safe. It was her ultimate private world. It contained her few valuables. A pearl necklace she had inherited from an aunt. Some other jewellery. Her passport. The deeds to her house. Insurance documents. A will, updated three years earlier and with a power of attorney document attached. In the top section of the safe was a set of papers as well as some newspaper clippings. Martin took the set out and spread the sheets of paper across the dining room table. The newspaper cuttings were about the car crash that had occurred so many years back.

  Martin read a six-page document quickly and then read it again slowly, to ensure that he entirely understood it.

  It was a coronial report on the death of his father – Inquest into the death of Robert Bolton Homer. First addressing, What were the circumstances of Mr Homer’s death, that is, was the death an accident or did Mr Homer take his own life? Second, What was the cause of Mr Homer’s death?

  When pared back, the facts were clear, but it was otherwise bewildering to Martin. The document overviewed the police investigation, statements by his mother and Robert’s general practitioner.

  The report detailed how Mr Robert Homer, his father, had had a severe endogenous depression for a number of years and which had prevented him from being able to work for periods. That he had been reluctant to seek treatment and that, in the month prior to the accident, his depression had become severe and probably progressed to a psychotic depression according to a forensic psychiatric report that had been sought by the court to assist the inquest. The report relied on evidence from Robert’s diary and from interviews with Edina. In the fortnight before his death Robert had become convinced he had brought his family to penury, that he would never be able to pay off the mortgage on the house, that he had lost the capacity to financially support Edina and Martin, that Martin would no longer
be able to continue at his private school and that Edina would quite reasonably divorce him in response. He believed the world was in a terrible state, with another world war immanent. Martin would probably be conscripted to fight in an unwinnable war that would presage Armageddon, with unspeakable horrors falling on the population. He felt a need to save his only son from such horrors.

  The coroner noted it was generally accepted that the 1938 Briginshaw Standard of proof should apply before making a finding of suicide. He considered several matters in evidence. First, it was probable that Robert was in a psychotic depressed state for a period prior to his death. Second, it appeared that Robert had deliberately set out that day to kill both himself and Martin but the coroner was unsure whether Robert had intended to do so by running his car off the road and into a tree or whether he had intended some later means. The coroner concluded that the impact of the car hitting the water had jolted Robert into a less depressed state and one of greater or even complete rationality and that his intent to kill his son was immediately cancelled and that he had then with courage of the highest order, and despite a broken leg, managed to throw his son to the bank. The coroner judged that while Robert’s death was, in effect, the end stage of a suicidal mood, his actions to save his son in the last moments of his life were rational and not evidencing suicidal or homicidal intent. And that the cause of death was the result of the combined effects of multiple injuries and drowning.

  Martin focused on the more important section. Had the coroner concluded that his father committed suicide? After a detailed argument – which Martin read slowly and carefully – the coroner had stated, Accordingly on the evidence available to me I am NOT satisfied on the balance of probabilities, let alone adhering to the Briginshaw Standard, that Mr Homer took his own life. The coroner concluded that, Nevertheless, there was a need for both greater community awareness of depression and of those at risk of suicide.

  Martin sat at the table for an extended period trying to reconcile such information with the father he had known. A father who had always been gentle and kind.

  He still remembered how tense his father had been that day. How intensely serious he had seemed. How he had hardly spoken. But that his father had seen the world in such a distorted psychotic way was almost beyond his comprehension. Martin had certainly had patients present with psychotic depression. Perhaps one or two a year. But most were so depressed as to be almost incapable of movement.

  Martin drove home slowly. Sarah was asleep and he did not wake her. He spent most of the night staring up at the ceiling, punctuated by periods of pacing around the house.

  At breakfast the next morning he simply told Sarah he would go to the hospital before Edina went to theatre and would ring her as soon as the surgeon had some information.

  Sarah noted his exhaustion and rounded shoulders. She held him in her arms several times before he left their house.

  Edina smiled weakly at Martin when he arrived at her bed. He smiled back and gave her a long hug. He resisted asking her why she hadn’t told him, although he had repeatedly asked himself that question during the night. He knew why she was effectively telling him now. She wanted him to be aware of his history and the implications.

  ‘I’m so sorry, Sunny. Family secrets are hard to divulge.’

  ‘Usually, Mum, because they involve something horrible.’

  ‘His depression became horrible.’

  ‘He had it for a long time?’

  ‘Years. It runs through his father’s side of the family. We both colluded when it stopped him being able to get to work. Certificates were always migraine. Robert suggested it was only semantics as both were pains in the head.’

  ‘You always explained it away as migraines to me.’

  ‘Family secrets develop their own narrative. Have you told Sarah?’

  ‘Not yet.’

  ‘Not sure whether it should remain a family secret?’

  ‘I suspect that’s the reason.’

  ‘You should tell Sarah.’

  ‘But what? I know so little.’

  Edina spoke solemnly, her eyes never averting as she slowly clenched and unclenched her hands. ‘It came on in his early forties. Mostly out of nowhere. He would be down for weeks but try to struggle on, to get to work, to keep on keeping on. Only when it was really severe and he had no energy would he go to bed. And it got slowly worse over the years. But he had never had a psychotic episode previously. He had lost his appointment as the church warden, losing the vote to someone who was a bit of an upstart. Such a minor position but one that meant a lot to him. He catastrophised and became so depressed I felt I didn’t know him any longer. That morning he seemed better, more at peace with himself.’

  ‘As if he’d made his mind up?’

  ‘Indeed. As he had. I can’t talk about that day, Martin. I wanted you to know about it and that’s why I wanted you to read the coronial report. So you knew exactly what happened.’

  ‘I always knew it as terrible. But you had this extra horror.’

  ‘The death of your husband is bad enough. Death by suicide is so much worse. The guilt piles up. What I might have done. Or worse, did I do something that brought about the suicide? I was torn by guilt for years. And there were the indignities. When the newspaper published the coronial findings, the minister stated in his sermon the very next day that suicide was a crime against God. Parishioners I viewed as friends turned against me.’

  Martin reached towards Edina and held her hand. He cried gently as Edina continued to provide scarifying details.

  ‘The church auditor, who had been very close to Robert, offered his support, saying he would be happy to provide ongoing financial advice. I was never good with money and I trusted him. A lot of his investments failed. It meant I had to go on working for a much longer period.’

  ‘So many things I was unaware of, Mum. What you have faced…’ Martin’s voice trailed off.

  ‘It’s ironic. Joanna was struck with cancer but was desperate to live. Robert was struck with depression and became desperate to die.’

  ‘Oh Mum, what hell you have been through.’

  ‘Remember the Beckett quote, Sunny. “I can’t go on, I’ll go on.”’

  Martin saw in this her extraordinary tenacity. He wanted to acknowledge it but Edina cut him off, smiling wryly.

  ‘It’s called life I believe, Sunny. I wonder if there is any family that doesn’t go through such enormities. But I was lucky. I had years of love from Robert. Two wonderful children. And you. So kind and so…well, sunny. So loving. You have sustained me.’

  The orderly pulled the curtains aside, wheeled the trolley next to the bed and asked Edina to slide across. How thin and vulnerable she looked. Martin gave her a quick kiss and reassured her it was a minor procedure and he would be waiting for her.

  Edina smiled her thanks and said, ‘You may have some more questions later.’

  Questions? Yes. Had his father sought treatment? He suspected not. Too proud. He would have viewed depression as a weakness. But what if he had sought help and the treatment had failed? Edina’s revelation that depression ran in the Homer family also played on his mind. A genetic condition. Bypassed him, thank God, but then…when did the risk period end?

  Baker had invited him to wait in the surgeons’ change room. As soon as Baker emerged, Martin knew the results of the laparoscopy.

  Baker looked briefly across at Martin before focusing on removing his gown.

  ‘Not good, John?’

  ‘Not good, mate. Adenocarcinoma I suspect. We’ll get the formal path report in three to four days.’

  ‘Is surgery a possibility? A Whipples?’

  Baker looked at Martin directly. He spoke firmly but softly. ‘It’s a stage three tumour, Martin. Locally advanced and not resectable. So with surgery out, I suspect chemo and radiotherapy will be the best we can offer but the team will need to case conference after the path results.’ He sighed. ‘Pancreatic cancer is a real bugger. I don’t kn
ow anything worse. I know you can inform your mother but it would be best if you let me talk to her first.’

  Martin and he shook hands.

  It was not till the middle of the afternoon that Martin felt able to join Edina. Martin ensured the curtains were fully closed and he and Edina spoke briefly and tentatively, each having difficulty finding the right words and wishing to retreat, to draw a veil over the enormity that faced them.

  Edina lived for only six more weeks. She developed severe side-effects with the chemotherapy and, after being hospitalised and requiring intravenous rehydration, she asked for it to be ceased. And she rejected radiotherapy.

  She appreciated the offer by Martin and Sarah to move to their house but stated that a palliative care facility was more appropriate. Martin would spend as many hours there each day as he could allow, usually brought short by Edina. She felt a need to talk to him, even to listen to him, but it tired her.

  There were brief periods of lightness when she offered Martin a word that had intrigued them in the past and she tested his knowledge and memory.

  ‘Malaprop?’

  ‘Mrs Malaprop from Sheridan’s The Rivals. Became malapropism, the misuse of words. You used to love catching me out on a malapropism.’

  ‘Houyhnhnms?’

  ‘Horses with human characteristics. I loved it when you read Gulliver’s Travels. But so many consonants when I loved vowels. More like someone hrumphing.’

  ‘Cheeryble brothers?’

  ‘The brothers who employed Nicholas Nickleby. Generous people who help others.’

  Edina sighed. ‘My dear cheeryble son.’

  At the funeral service Martin traced her history. He then detailed his close perspective. Of a caring, educated and steadfast woman distinguished also by high moral principles. A woman who prioritised her family but who had had to face the deaths of her only daughter and of her husband, and who had got on with things, never complaining and always wanting to ensure that she was not a burden on people. He spoke of her intelligence and how she had given him a love of language. He finished by noting that she had asked for ‘Rock of Ages’ to be played at her funeral and that he, in return, knew her as a rock that had supported him for ages.