Death of a Pilgrim

by David Dickinson

  ‘Please, please!’ Dr Moreland held up his hand. ‘Your offer is most kind and most generous but I do not feel this is the right time or place to raise such questions. We are concerned with one life here, a life that is, as we speak, ebbing slowly away a couple of floors beneath us.’

  Michael Delaney winced. Wealth was not going to save him here as it had saved him so often in the past.

  ‘You see, Mr Delaney,’ the younger doctor cut in, ‘we know so little. If I could draw a very imperfect example from your own world, let us suppose that you are going to build a new railway line across some difficult mountains.’ The young man did not see fit to mention it, but his father was the senior engineer on the Kansas, Topeka and Santa Fe Railroad. ‘When you come to work up your plans, you have a pool of knowledge to draw upon: surveyors who have mapped similar lines in the past, engineers who can estimate the optimum route to avoid the high places where possible, men who have designed the rolling stock and the engines to carry the trains most efficiently across the difficult terrain. Others have trod the path before you. But with James, we have nothing at all, no maps, no charts, no previous experience. We have been changing James’s treatment all the time. Nothing seems to work. Very slowly, little by little, he is becoming weaker every day.’

  There was a distant peal of thunder and a flash of lightning lit up the New York skyline for a brief second. Delaney, Matron thought, sneaking a surreptitious glance at the man in case direct eye contact should set him off again, was looking miserable, more miserable than she had yet seen him.

  Silence ruled briefly in the library. It was Dr Moreland who broke it. ‘I hope I have tried to make it clear to you, Mr Delaney, right from the beginning, how little we know. In the medical profession,’ he glanced briefly at his colleague and at Sister Dominic, ‘we wear these white coats to impress the patients and their families. Sometimes we carry medical instruments with us, hanging around our necks. The Sisters and the nurses are dressed in special uniforms to imply they too have special knowledge. At Harvard, my old university, you see the professors wearing their gowns with scarlet hoods lined with fox and ermine and their dark mortarboards to impress on the students that they too have special knowledge. I once saw a formal assembly of lawyers processing through the Royal Courts of Justice in London with wigs and robes and emblems denoting who was Master of the Rolls and so forth. Fancy dress implies fancy knowledge. I cannot speak for the lawyers or the academics, Mr Delaney, but in so many medical cases we have no claim to special knowledge. In the case of your son James we have, in fact, almost no knowledge at all.’

  ‘I’m sure that’s not true, Dr Moreland.’ said Delaney. ‘You are most distinguished in your field, the pair of you.’

  Dr Moreland brushed the interruption aside as if he were swatting a fly from his forehead. ‘Let me cut to the point,’ he said, leaning forward to look Delaney in the eye. ‘There is a choice to be made here. Only you can make it. I am not sure I would have presented you with such a choice were you not such an eminent man.’

  ‘What is the choice?’ asked Delaney very quietly as another blast of wind rattled the windows.

  ‘If we carry on with the current treatments, then I think your son will die very soon. I could be wrong. Our knowledge is so limited. We have been making things up as we go along. If we stop the treatment altogether, then again, he might die very soon. But he might recover. Our drugs may be doing him more harm than good. We just don’t know. That is the choice, Mr Delaney. Continue as we are and he may die – if you pushed me hard, I would say it is very likely. Stop them, and there is a chance, only a chance, mind you, that he might recover.’

  Father Kennedy spoke for the first time. ‘What a terrible choice. I pray that God will guide you in the right path.’ Matron threw caution to the winds and smiled at Delaney.

  The man was silent for a moment. ‘Can I ask you a couple of questions, Doctor?’ he said, sitting forward in his chair and twirling his hat in his hands. ‘Let me thank you for a start for being so honest. In your opinion, is stopping the drugs the only chance of saving James’s life? Is there any other way? And when would you start, or maybe I should say stop?’ He sent an agonized look to Dr Moreland. ‘I mean, if you did it, how soon before you would know if it was working, that James was beginning to recover? Or to put it another way, how long,’ Michael Delaney fought back the tears, ‘how long before he dies?’

  Dr Moreland answered immediately. ‘I cannot promise you anything, Mr Delaney. I cannot promise that stopping the drugs is the only way to save James’s life. There might be other ways, but we have tried all we know. As to how soon we should stop the treatment and begin to treat your son with non-treatment, as it were, I think I can give you an answer. We should do it as soon as possible. The young man grows weaker. His ability to fight the disease lessens by the day. The longer we wait, the less likely the non-treatment is to succeed.’

  ‘Do you mean’, said an aghast Delaney, ‘that you want me to make the choice now? Here, in this room?’

  ‘I do not wish to rush you in any way,’ said the doctor, leaning back and looking at Father Kennedy, as if appealing for help. ‘It is a most terrible choice. Only you can make it. But I emphasize what I said before: the sooner we start, the better our chances. Which, as I hope I have made clear, are not very good in the first place.’

  Michael Delaney rose to his feet. He walked very slowly to the window. He was still fiddling with his hat. He stared out at the rain cascading down the windows, the dark clouds racing across the sky, the busy streets of the city outside in a healthy world.

  Sister Dominic found the whole encounter had a terrible fascination. So many times she had watched families and loved ones almost literally torn apart by the doctors’ words in this room. But she had never seen a man of such wealth and power face such a situation before. She wondered what he would do. Silently she began saying Hail Marys. The younger doctor, Dr Stead, was trying, yet again, to work out how long it would take for death to happen or recovery to begin if the treatment were to stop. Father Kennedy was planning to slip away quietly after this meeting and fetch the little box from his house, the little box that would enable him to administer the last rites. He should, he told himself bitterly, have brought it earlier. Dr Moreland was running the discussion back through his mind, hoping that he had made the position clear. Delaney thought of his dead wife and what advice she would give about the life of her only son. He thought of his own parents, now long gone, who had watched young James tottering across the floor on his first faltering steps and had been in the front of St Patrick’s Cathedral as he took his first communion. Delaney’s dead remained silent. No answers came from beyond the grave.

  At last Delaney spoke. He turned back from the window and returned to his chair to face the two men who had presented him with what he mentally referred to as the Devil’s Alternative.

  ‘Very well, gentlemen,’ he said firmly, ‘I do not think I have much choice. I ask you to stop the treatment. I ask you again, how long do you think it will be before you can detect changes for better, or . . . ’ He paused for a moment. ‘Or worse?’

  ‘The next treatment was due to be administered in just over an hour’s time,’ said Dr Moreland. ‘I do not know how long it will be before we know something. Dr Stead and I will take it in turns to sit by the bedside until we have resolution one way or the other. Matron will see to whatever special nursing needs we may require. I would advise you to take a little rest just now, Mr Delaney. Any changes might start in three or four hours. It might take twenty-four hours or even more. We do not know. But we will prepare as best we can for all eventualities.’

  ‘Thank you,’ said Delaney.

  ‘From this moment on,’ said Father Kennedy, ‘we are moving outside the knowledge of these good doctors here. We are all in God’s hands now.’

  Michael Delaney returned to the hospital shortly after half past two. He brought with him a small bag containing a change of clothing and a large b
ottle of Jack Daniels. His coachman watched him turning into the main corridor of St Vincent’s. Then he took from underneath his seat a couple of European motor magazines that had recently arrived in New York. In some respects, he thought, the French and the Germans and the British might be ahead of the Americans in terms of design and engine construction. The coachman found that hard to believe.

  The death watch party, as Delaney mentally referred to them, were already in their positions in the little ward. By the left-hand side of the bed, looking at it from the door, was a nurse, one section of her rosary beads hanging out of her pocket. Just behind her sat Dr Moreland, a couple of files on his lap and a pencil in his right hand. Next to the nurse sat Matron, her rosary beads in her lap, her lips moving silently, one tress of blonde hair which had escaped from her cap lying across the top of her forehead. Opposite the nurse sat Delaney, the hat still twisting in his hands. By the window stood Father Kennedy, staring out at the storm outside and the tiny rivers running down the front of the buildings. Above the bed, in a plain frame, was a reproduction of an earlier painting of a saint, dressed in brown with a brown background, his elbows resting on a table, his hands stretched out in prayer, the fingertips touching.

  The nurse kept her head very near the bed. If you looked closely, Delaney realized, you could see faint breathing movements, slight swellings in the sheet as the boy’s chest rose and fell. Maybe the nurses had tucked him in extra tight, Delaney thought, so they could watch the movements better. He suddenly remembered telling James about the death of his mother. It had been in the drawing room of his great house, the lights burning brightly, a fire roaring in the grate and the continuous rumble of a great city on the move just audible from the street outside. Delaney had comforted the boy as best he could. Even though they both had known she was dying, it was still a terrible shock. He recalled James telling him, months after the event, how he, James, had felt numb for weeks. Sad, of course, tearful, naturally, but the most memorable feeling was numbness, a cold feeling that ran right through you as if you had swallowed some ice cold mixture. But he wouldn’t be able to tell James about this death, Delaney realized. James wouldn’t be here.

  ‘It’s all right to talk, as long as we’re quiet, Mr Delaney,’ said Dr Moreland in a voice scarcely above a whisper. ‘Some people think it might even help, that when the patients hear human voices, they know they’re still alive. Or you can take a little break with a walk in the corridor.’

  ‘How do we . . . ’ Delaney began and then paused, groping for the difficult words. ‘How do we know if James is getting better? Or worse, for that matter?’

  ‘I cannot give you precise guidance,’ said Dr Moreland. As Delaney looked closely at the doctor, he saw that the top left-hand corner of his folder was covered with tiny drawings of golf clubs. Woods, irons, putters, they were all there. Maybe this was how Dr George Moreland usually spent his Saturday afternoons, out on some green golf course by the sea, sinking his putts with the same authority that he brought to his patients in the hospital. Not, mind you, Delaney thought, looking out of the window, on an afternoon like this.

  ‘It’s the breathing, Mr Delaney, that’s one thing that can help us. If the breathing becomes shallow, or the gaps between breaths become longer, then I’m afraid that we would regard that as bad news. But often even that simple observation can be wrong.’ He sent Delaney a small, rueful smile.

  Delaney found himself hypnotized by the praying figure on the wall, hanging directly over his son’s head, the pale, ascetic face, the fingers joined in prayer. He wondered who he was. He beckoned Father Kennedy into the corridor.

  ‘That fellow on the wall,’ he said, ‘the one above James. Do you know who he is, by any chance?’

  Father Kennedy smiled. ‘That fellow, as you call him, is one of the most important saints in the Catholic firmament. He’s called St James the Greater. He was one of the disciples, one of the fishermen.’

  Delaney had investigated fishing once as a possible source of profit, and found it disappointing. There were, in his view, too many variables, bad weather, leaking boats, unreliable fishermen. Now a temporary bout of flippancy overcame him, out here in the corridor of a hospital where his son might be about to die.

  ‘Why was he called the Greater? Was there a Smaller one? A Thinner? A Fatter perhaps?’

  Father Kennedy had seen these temporary flights of fancy all too often in his long vigils by the bedsides of the dying.

  ‘I think he was called that to distinguish him from another St James, known as St James the Less. But, come, we should return. I shall tell you more about him later, if you wish.’

  The afternoon wore on. The nun and the Matron continued their prayers. Dr Moreland moved on to tennis rackets on his folder, his eyes checking on his patient every couple of seconds. Father Kennedy was composing a sermon about the workings of God’s grace in his head. Delaney found a quiet corner of the corridor where he could take occasional consolation from his bottle of Jack Daniels. Every half-hour or so he tiptoed into the chapel and lit more candles. Outside the light faded and the storm raged on. Nurses came and went, bringing hot tea and sandwiches, pausing on their way out to say a prayer for the young man in the bed underneath St James the Greater.

  The hours passed impossibly slowly. Delaney could see no change in the condition of his son. The blue eyes he knew so well were still closed. The light brown hair still lay ruffled on the pillow. His colour was still very very pale, a white that was almost the same shade as chalk. But he was still breathing. At seven o’clock Matron took Michael Delaney back to the little chapel. He had lit all the candles by now. The room was full, standing room only at the back. There must have been fifty or sixty people in there, mostly nuns with some auxiliary staff. All of them, Matron whispered, were there to pray for the life of James Delaney. Matron didn’t say that she was using all the weapons she knew of in her fight to keep the boy alive. And that if there were weapons she knew nothing of, she would use those too, if only she could find them. Delaney wondered about the power of prayer. Certainly he had never availed himself of it in his long business career. It had never occurred to him. Great business deals, he felt, depended on more mundane, possibly, in his present surroundings, more sordid factors: profit, or the possibilities of it, the cost of borrowing money, the size and potential for growth of the particular market. But Delaney closed his eyes and prayed along with all the others for the life of his son.

  Shortly before nine o’clock the storm grew ever fiercer. Brilliant flashes of lightning shot past the windows. Claps of thunder sounded from the skies. The rain still pounded on the windows. Father Kennedy, the sermon in his head on the workings of God’s grace nearly finished now, wondered if this was an omen. Was his God, Yahweh the ever living, sending a sign that James Delaney was close to death now? Were the young man’s days and nights in his wilderness of pain and suffering coming to an end? Looking out of the window at the raging tempest outside, he thought that the fanciful and the superstitious might think that the end of the world was nigh. Was James’s passing going to be marked by this display of the power of nature, and, for Father Kennedy, of the power of God? He checked that his little box with all the necessaries for performing the last rites was still at his feet.

  Dr Moreland had been replaced by the younger man, Dr Stead. He brought with him a medical journal which he read from time to time, making notes or marks in the margin with a silver pen. By eleven o’clock the storm outside showed signs of abating in its fury. James Delaney was still breathing. The doctor beckoned to the elder Delaney and to Father Kennedy and Sister Dominic to follow him to a little room off the main ward that served as a nurse’s office. Timetables, rotas and pictures of the Virgin lined the walls. He motioned them to be seated.

  ‘I thought I should bring you up to date on our thinking about this case,’ he began. Michael Delaney felt a moment of resentment. His son was more than a case. ‘James’, the doctor carried on, ‘is still with us. We do not know
how long it will take for the drugs to pass out of his system. Certainly their power is less, considerably less, than it was twelve hours ago. Our hypothesis, and it is only a hypothesis, has been that if the withdrawal was going to kill him, it would probably have done so by now.’

  ‘Does that mean, Doctor,’ said Delaney, the hat spinning ever faster in his hands, ‘that he is going to recover, that he’s getting better?’

  Dr Stead had heard this note of hope against all the odds many times before. ‘I don’t think we could say that. Not yet. Not now. At this point the absence of bad news is almost good news. That is all I can say, I’m afraid. It’s too soon for hope, for the present.’

  Delaney pressed him. ‘I understand your qualifications, of course I do. But would you say that his chances of recovery are better now? Better than they were, I mean?’

  The doctor looked down at his journal. ‘I would not wish to give you false hope. But if you pressed me, I should say that the answer is yes. Or probably yes. Our knowledge is so limited. Forgive me, but I have been looking at a recent article in my medical journal here about the process of dying. It is, if you like, a timetable of the way death comes over the body. It is concerned with diseases similar to, but obviously not the same, as James Delaney’s. It suggests to me that if he were going to pass away, he would have done so by now. I emphasize the word “suggests”. We could be wrong.’

  Delaney was still looking for comfort. ‘Should we be more hopeful now? Is the worst over?’

  The doctor shook his head. ‘I could not agree to that at this moment. The crisis is not over. It may yet be ahead of us, I don’t know. But the breathing has become slightly more regular in the last two or three hours. His colour may be fractionally better. That is good.’

  ‘And what’, Delaney went on, ‘would you have us do now? Should we stay with him through the night?’