Here was someone opening the front door. Pink cheeks, a yellow V-neck stretched over an expansive stomach. The man filled the doorway, his balding head grazing the top of it, the edges of his torso spreading nearly to its sides. Oh yes, it was her son. Close to retirement himself.
‘Dr Newell,’ said this man, Mr Hanworth, as he must probably be called. He walked welcomingly backwards through the narrow corridor of the hallway. Philip stepped in, occupying the space progressively as it was vacated. The trick with a home visit, as always with being a doctor really, was to be mild, attentive, very much the professional. Put your personality on the back burner so they didn’t have the sense of being visited by you as an individual, but by a medical presence. Which diminished this awkwardness of greeting – and the greater awkwardness of barging into people’s homes, their private places.
Mr Hanworth had backed into the sitting room. ‘The nurse,’ he started to say through the doorway to Philip who was still in the hall, ‘has gone out for a bit. I said she might as well have some time off. She’ll be back at 6.’
‘That’s fine.’ Philip passed his case from his right to his left hand and let it rest on the second-from-bottom stair. ‘How has she been?’
‘You mean my mother?’
‘Mm.’
‘I suppose,’ Mr Hanworth said, his head turning to one side and down, his face seeming to sag, ‘much the same.’ Then his face lifted back up and he looked at Philip frankly, beleaguered, bravely: ‘By which I mean she has carried on on the same downward slope. Weaker. Spends more time in bed. She doesn’t come downstairs now but then I think that was already the case last week.’
There was a breathiness in his speech; you noticed him pausing for breath between each statement. Probably COPD. You could see he must have smoked when he was younger – perhaps the weight came on with stopping. Funny the signs of illness in someone who was talking about illness. Sad.
‘With some of these things’ – Mr Hanworth was carrying on – ‘you can’t tell whether it’s that she can’t, or that she doesn’t want to.’
‘Often it goes together.’
‘For instance, she used to like sitting in her chair in the window upstairs, looking out at the street. Or watching the trees, birds, you know, whatever was going on outside. She could rest her head and she seemed’ – he hesitated, looking for the right word before choosing: ‘comfortable there. Sometimes I’d go up and she’d have gone off to sleep. Or be just sitting there, eyes open, completely’ – again the hesitation – ‘vacant. Which seemed – you know, nice. But now even that has come to be too much. She just doesn’t want to do it. And I don’t know’ – he pressed on, working back around towards his point – ‘whether it’s because it’s become physically painful to sit there or because she’s lost interest.’
‘Does she say she is in more pain?’
‘No’ – he lengthened the word amusedly, pooh-poohing the idea. ‘You probably know what she’s like. That’s not the sort of thing she very much wants to admit.’
‘No. But I think, as time goes on, she may well do so more, I mean she may well find she needs increased pain relief. When that happens it’s very easy to adjust the dose.’
‘Yes,’ the man said, a serious expression coming back into his face. ‘Received and understood.’
‘And she’s been taking her medication regularly?’ Which was to say, 20mg zomorph twice a day, with oramorph top-up as required; metoclopramide 10mg 8-hourly, docusate sodium 5ml 8-hourly: really the minimum conceivable.
‘Yes absolutely. The nurse has been most efficient.’
‘No side effects?’
‘No, or, well . . .’ he said awkardly, sidling closer, lowering his voice: ‘She had – an episode of incontinence a couple of days ago. The nurse was very good about it. Now we’ve got a rubber sheet underneath. But since then she’s stopped eating more or less completely and I’m worried that that might be why. Because it’s obviously not very dignified and no one would want to . . . Do you see what I mean? If she’s lost her appetite, that’s one thing. But I wouldn’t want her to feel she had to stop herself eating. You know, deprive herself.’ He looked at Dr Newell in supplication.
‘Was it’ – Philip said calmly – ‘wee or pooh?’ God these stupid baby words.
‘Number two,’ the fat man said briskly.
‘How about her drinking, is she still taking liquids?’ If you keep the voice gentle and concerned, your expression kind and thoughtful, then these questions don’t sound so much like an interrogation.
‘Yes, I think so. Or maybe’ – the man’s eyes turned, looked past Philip to the corner of the room – ‘not so much. I confess I haven’t really been keeping very strict track of it.’
Well the nurse certainly ought to have done. ‘OK – but you should now,’ said Philip. ‘Drinking is more important than eating. If she doesn’t stay hydrated it’ll cause her some distress. But going back to that episode the other day . . .’ It was really a bit awkward, this consultation going on in the hallway, or half in the hallway. Philip kept his voice low so that it wouldn’t reach upstairs to where Grace Hanworth was. ‘It may help if we reduce the docusate, you know the laxative, to just once in the morning and once in the evening. I mean, she needs to keep taking it to counteract the effect of the morphine which – well, it has a tendency to just block up the gut completely, which can be very uncomfortable. Especially, obviously with the kind of cancer that she has. But we can take the dose down a little bit. And the other thing’ – this was stating the obvious – ‘is to be sure she is confident about how to go to the loo.’
‘Oh, she can still get to the loo.’
‘Yes but she may be finding it harder, especially if, as you said, she’s not getting up to sit in a chair any more.’
The man took this consideration on board.
‘The nurse is the person who will be able to help with this. As Mrs Hanworth finds she wants to spend more time in bed, and eventually . . . not get out of bed at all . . . she’ll need a commode, and eventually perhaps an adult diaper. But the nurse will be able to talk this process through with you.’
‘I’d be obliged,’ the fat man said throatily, ‘if you didn’t mention this to mother.’
‘No.’
‘She wouldn’t want to talk about it.’
‘No.’
‘Or to know that I had mentioned it to you.’
‘Of course.’
There was a moment of reflection. Had everything been gone through?
‘Oh, and about her eating,’ Philip remembered. ‘It’s important not to feel she has to keep eating. Not to be upset’ – he looked into the man’s wobbling eyes – ‘when her appetite declines. Because that is part of what happens in the process of . . . in the last days of life. There is a . . . a quietening, if you like, of the body and of the spirit both at the same time. A settling down. A getting ready to withdraw. All we can do, Mr Hanworth’ – Philip ventured the name and found it was the right one – ‘is . . . well, what I mean is that, as a doctor’ – he was about to speak more decisively, to share the view he had arrived at really mainly as a result of observing Grace Hanworth over the last few months: ‘I understand what is going on medically. But holistically, by which I mean thinking about the whole person, it is a mystery. It really is amazing to me how, very often, everything declines, no in fact’ – he saw that Mr Hanworth was listening gratefully – ‘“declines” does not feel like the right word. Everything develops in such a way that a death feels like the conclusion of a life. And when that happens . . . when we are in the presence of that mystery, it really is OK to trust your feelings. Your intuitions. So if you feel your mother is in discomfort, she probably is. And probably, by trusting your feelings, you can see how to help her even if she’s not saying anything – by raising her a bit in the bed, or drawing the curtain to make some shadow, or maybe to let in more light. But, equally, if you feel that she is peaceful, then she probably is that too. And it’s OK, th
en, to relax, and maybe just sit, and spend some time with her.’
Bit of a sermon. But it seemed to have gone over alright.
‘That’s very true,’ Mr Hanworth was saying. ‘Thank you. Let’s go on up.’
At which, as Philip followed Mr Hanworth up the stairs, Charlotte, 53.5 miles away, was saying: ‘How about Tahrir Square?’
‘That,’ said Sue encouragingly, ‘is a very interesting idea.’ Because it would make the leap to actual politics. Although . . .
‘Because that is life, isn’t it, if anything is,’ said Charlotte: ‘That is flaring up. Better than a flood. Better than grass. And if what we’re doing with our video-streams is connecting the observer to all sorts of pressure points round the planet, making them think about how their nerve system can extend to lots of places that are kind of out of their control or beyond their knowledge, then . . .’
‘No, you’re right,’ said Sue. ‘It’s a great idea.’ Because actually to have something mainstream. Because, actually, given that the other images were all going to be of nowhere-places, or mainly; of ordinary places that you couldn’t immediately identify. Because, given that, it would be good to have something iconic as a contrast, or rather to make people think: what are these other places? I know what that one is so what are these? I know that that one is really important so how are these ones important? No, it would be good. ‘It really is. Do you think we can get it?’
‘Oh, I’m sure. I mean they had it on the news so there must be . . . actually I think I, don’t exactly know someone . . .’
‘Like with Elton Barfitt?’
Charlotte looked startled. Then she smiled. Then she said in soaring tones, ‘No seriously!’
‘But also if we can’t we could try other squares, Bahrain, Tunisia, because in a way it’s not that square itself but that kind of square.’
But Charlotte was standing now, stretching: ‘Agreed.’
Philip was standing in Grace Hanworth’s bedroom. There was a single bed sticking out into the middle of the space. How strange it looked: monastic. Mrs Hanworth’s feet, beneath a sheet beneath a blanket beneath a pale pink tufted cotton bedspread, pointed towards a bay window from which light came pouring down upon them. Upon her. There was a pile of pillows, four or five of them, with her upper body propped against them. Its boniness showed through the ivory, shirt-like top of her nightdress. Her head lay back. It was the colour of amber. Her sparse, silvery hair had been neatly trimmed and brushed. No obvious danger signs.
The floorboards creaked as Mr Hanworth went round to the other side of the bed. He was leaning over her. His hands were on his bent knees, propping his bulk. He looked up at Philip. ‘Shall we wake her?’
‘I think she may wake gently in a minute anyway. The slight disturbance of our being here.’
‘OK I’ll – damn.’ It was the telephone. ‘I’d probably better . . .’
Philip moved closer to the bed to let Mr Hanworth squeeze past behind him.
Philip stayed standing by the bed. He listened for her breath. It was strange, the process of listening, how the sound seemed to get louder when you found it. There was the out-breath, strong. A pause. The in-breath, weaker. Rhythm a bit off kilter but no sign of difficulty. He concentrated his mind on the sound once more. No, no congestion. No hint of a gurgle.
He looked around the airy room which he had been in several times but only seen glancingly because he had always been concentrating on Mrs Hanworth. The rectangular bay window, the armchair where she liked to sit. The swirly bluey-greenish Morris-pattern wallpaper. Gnarled leaves like arthritic hands reaching out, fat buds like . . . well, like something. Like sea anemones.
Really at this stage it was just about seeing how she felt. He knew and she knew what was happening. No doubt about that. So it was all about keeping her comfortable. Or in fact in the particular case of Mrs Hanworth – he smiled to himself, half-exasperated, half-admiring – making a compromise between her wish to experience the progress of her disease and the blunt fact that if she was left just to feel it, at this stage, to really feel what it was doing to her, the pain and also other causes of discomfort, for instance, nausea, would be overwhelming.
The chair was oldish, elegant. Square and sturdy and upright. Upholstered in faded, velvety green. There was a table in front of it, wooden, rectangular. Practical. You could sit at the chair and have a meal on it – perhaps Grace had been doing that. Though in the middle of it was a little metal bust of someone. But obviously that could easily be moved.
Feeling awkward just standing there he took the few steps over to the window and turned the chair towards the bed. He would sit and watch Mrs Hanworth and listen to her breathing. For once in his life there was no rush. It was Saturday; and Sue was away until at least the evening, maybe tomorrow. If Mrs Hanworth didn’t wake he would ask Mr Hanworth to rouse her gently when he came back from the phone.
The mirror over the fireplace had an interesting wooden frame. It had narrow columns going up on either side, supporting little shelves and hooks. Keys dangled there, and other things. Philip could see the key-thing for bleeding radiators, and a Swiss-army penknife. On one shelf was a pile of what appeared to be old postcards. He wanted to get up and take a closer look but didn’t feel he should.
Because basically he agreed with a lot of what she had been saying to him. Because basically you did want people to be more self-reliant. You wanted them not to come running along to the doctor at the first sneeze. And then you wanted to be able to have a sensible discussion. You didn’t want them to put themselves at your mercy like lumps of meat, as if it were none of their business what was wrong with them and what was done about it. Throwing all the responsibility onto him. With all the pressure that put on him, and frankly also this was the state of mind that bred litigation.
But the fact remained that, as things were, people weren’t. On the whole they weren’t self-reliant. They wanted diagnosing and they wanted to be told what to do. However much he tried to, for instance, outline alternatives. Almost always it was: you know best, doc: whatever you think is best.
Except when they got it into their heads they absolutely had to have a particular medicine, for instance antibiotics, which might be wholly inappropriate. But, in fact, that sort of pig-headedness was just a different version of the same thing. This, well, this basically turning away from themselves. This not wanting to look at themselves as whole creatures, i.e. including their bodies – or in fact primarily their bodies – and really understand what was going on.
So: what could you do when people were so much like that? Not just abandon them. Not kick them out. The problem with Grace Hanworth’s point of view was that it ignored these people. It was all about what people should be like and not at all about how they were.
Still, it was definitely interesting to talk to someone who had been there right back at the creation of the NHS, and involved with it. He really hadn’t known there had been such a strong movement back then to take power away from doctors and put the emphasis on prevention. ‘But Bevan’ – he heard again the shock in Grace’s voice – ‘simply lay down on his back and let the British Medical Association march over him. We were left with the same old oppressive structure where ordinary people weren’t allowed to understand anything for themselves. The idea was: they would be left to live their lives unhealthily, fall ill, and then hand themselves over to an expert to be cured. Or maybe not cured. Either way, there were still to be experts on the one hand, and plebs on the other, and no uncertainty as to which was which. Because daddy,’ – she finished sarcastically, ‘knows best.’ It really was . . . well, it was very her, these harsh denunciations coming out of the careful, tidy body, the slim, alert face. He saw her again sitting on the orange chair in the practice, energised by the effort of making it in to see him, when she had still been able to. And probably irritated by the people in the waiting room: too many of them, not ill enough. When she started speaking she was genteel and clipped, just the way that
you’d expect from how she looked. But as she went on this sort of roar came through from underneath.
It was strange to have her voice in his mind while what his ears were hearing was her breathing. The strong, contemptuous breath out. The pause. A bit too long, that pause. And then the little uphill inhalation. A limping breath. As though she wanted it out of her more than she wanted it in.
Was it time . . . but something had changed. The sound of the breathing had dropped away and the head was stirring. Philip saw the eyelids open as the head was still laid on its side.
‘Hello Mrs Hanworth,’ he said. It might feel threatening if he got up and moved into her field of vision before she was fully awake so he would wait for her to turn her eyes to him.
She lay still, looking at . . . probably looking at nothing, to be honest, just registering the light.
He was about to say again, ‘Mrs . . .’ but now the head had rolled around and the eyes were looking at him. The head lifted itself upright. Mrs Hanworth was doing something with her arms, pushing herself into the pillows. Should he go to help? – no; she seemed OK, seemed comfortable. Still strong enough to manage that.
He leaned forward in the chair ready to converse. He could stand and move closer once she had properly grasped that he was there. Awkward that Mr Hanworth was still downstairs.
Ah, she had seen him. She was focusing on him, about to speak.
Loudly she said: ‘Gordon, you know how uneasy it makes me feel.’
The World Was All Before Them Page 17