by Manda Scott
‘I want you there.’ She slid off the desk. ‘Will you come?’
‘Let me phone Nina. I’ll follow you up.’
There are so many different reasons to die. So many different ways. Sometime, somehow, I have rationalised this. I have grown to believe that there is a right time to die and that my job is to be there, back-to-front midwife, holding, containing, supporting. There are times when I believe this is right. There are other times, like now, when I know beyond all knowing that the whole of life is a travesty, that the only reality is pain and that the only thing that truly matters is dignity and speed in the process of dying.
Claire Hendon’s death was not dignified, nor was it swift. The mass of the tumour had not completely blocked her airway and she had a space left—the diameter, maybe, of a straw—through which she could still draw breath. You can’t live for long breathing through a straw, but the body takes over and fights for each molecule of oxygen however much the heart and soul may want to let go. It is agonising to watch. In a normal ward, we would call in the anaesthetist and place an artificial airway. If necessary, we would pass tubes down into the distal bronchi, hook them up to a ventilator and let technology take over the process of breathing. But in this place, the anaesthetist had a signed statement from her patient, taken in the presence of two other independent medical professionals, to say that she wanted no intervention. In this place, this is the kind of decision that matters. And so we sat for that night at the bedside—me, Dee, Claire’s mother and Claire’s father—and we watched a young woman of twenty-three struggle to let go of her life.
She was still breathing at dawn. Long, ragged, hard-drawn breaths, harder to breathe in than to breathe out but neither way easy. Dee sat on one side of the bed, holding her hand, talking her through each cycle. Her parents sat beside her, silent and white. They had said all they could say in the dark spaces of the night, talked themselves to a standstill and beyond. They were not old, but they were lined, then, as if each hour of the night had added a decade beyond the ones they already carried. Dee was the only one who still talked, the melodic rhythm of rich, rolling Irish flowing over us all, binding us all in place. I sat at the far side of the bed and I listened to the music of it, not the lyrics. I didn’t think anyone was really listening, not even Claire, until I looked up and found Dee was looking at me and she said it again, the sentence I hadn’t quite heard. ‘Set up the morphine, Kellen.’
‘But she said she didn’t want …’
‘She’s changed her mind.’
‘Dee, you can’t …’
‘Yes I can.’ Her eyes burned bright and red-rimmed across the white of the sheets. ‘It’s what she wants, Kellen. You can go or you can help. Just don’t argue with me now.’ And then the girl on the bed, more awake, more aware than any of us, turned her head to me and pushed a long-fought breath, ragged and faint, into the whisper: ‘Do it,’ she said, ‘just do it. Please.’
And so we did.
You can’t pretend that it’s efficient, morphine, but it’s the best we’ve got. Potassium is sudden and successful but impossible to defend in court. We might have done it in the past but we couldn’t do it now. Morphine is allowed, up to a point, because morphine stops the pain and only when there is no more pain does it stop the breathing. Unless the pain comes from the breathing, in which case all things stop together. Eventually. It is not perfect, but it has dignity and almost anything is better than the lingering battle of asphyxiation.
It took five minutes, maybe a little less. Claire held the control to begin with and I removed all the limits on the pump. Soon, when she had no strength left to push, Dee sat on the edge of the bed, folded the fine-boned hand in hers and then two thumbs pressed on the button, holding it down until the last drops were running in. At the end, I leaned over and joined them, a third hand, a second offender, because these things are better shared. It was not legal. I make no pretence that it was legal. But I learned a long time ago that when the law and my own conscience speak differently, there is only one of them that is ever talking sense. This is not the first time. It will not be the last, for me or for anyone else in the Unit.
There are things that you do when it’s over. Open the windows to let out the spirit. Bring in flowers from outside to lie on the bed. Leave the family alone with the body so that they can remember her as she was, lying at peace, with the lines of tension and pain gone from her face. I followed Dee down the corridor, walking with no sense of direction. We stopped, eventually, at the door of the office.
‘You should go home.’
‘Later. I need to run.’
‘Could I use your shower?’
‘Are you not going back to the farm?’
‘There’s no point. It’s too late. I’ll get caught up in the traffic coming back.’
‘Go ahead. You know the way. I’ll be back in an hour.’
‘Take the dog with you, huh? She needs to go out.’
‘Fine.’
The water is clear and hot and it strips my skin. Steam clouds the room. I am alone in the fog, insulated from the outside world. I am safe, enclosed, encircled, blind. Time has no structure. Space has no form. I have no past, no present, no future. Life ends in a moment. There is such liberation in this. For the first time since the night of Joey Duncan’s death, I have no headache.
‘Good shower?’
‘Very. Good run?’
‘Very. Your dog’s in the car.’
‘You don’t have to come back into work, Dee. We’ll live without you for a day.’
‘I’ll think about it.’
‘You should sleep.’
‘Am I the only one?’
‘Maybe not.’ We sit at her kitchen table and drink coffee together, hot, bitter espresso made in the machine by the window. Slowly, the colours of the morning pull back into focus. The mumbling exhaustion of the night gives way to a hollow, light-headed detachment. I can think now, which is more than I could do an hour ago. The night moves into some kind of perspective. What I remember, what I will always remember, is the soft, singing melody of her voice, moving unbroken right through to the end. I listened to the music. I didn’t listen to the words.
‘I’m sorry,’ I say, eventually.
‘What for?’
‘We could have done something sooner. She didn’t have to go on so long.’
‘She went when she was ready to go. We could do nothing without her asking. You know that.’ The run has done its job. She is hot and damp and the anger is less than it was. Her hair is dark, pasted down to her head in places where she has pushed her fingers through it. Her skin is flushed and there are wet streaks beneath her eyes that might be more than the sweat. She moves about the room, restless, carrying her mug in both hands. Her voice is different now, showing the strains of the night. I remember her face, grey with fatigue, before the worst of it started. Of all of us, she has been here before.
‘Was it like that for Beth?’ I ask it with care, treading gently past raw nerves. ‘Was there someone there for her at the end?’
‘Eventually, yes.’ She stops pacing, her mind somewhere else. ‘They took longer about it than we did but, then, she was in a general oncology ward. The place was alive with nurses. They had to be careful.’
‘I’m sorry.’
‘So am I.’ She moves over to the sink and turns her back so that I can’t see her face. Her head is framed by the window. Outside, the sun is losing the battle with the cloud. The patches of blue are far less than the blankets of grey. I remember a candle, lit in the dark of a room, and a lover, not letting go.
‘Nicco Gallianno’s here, did you know?’ She asks it suddenly, with no preamble, as if the pattern of my thinking has carried across the room.
‘Yes. I saw him last night.’
‘He’s turned down a liver transplant.’
‘I know.’ But he’s not one of those who will go out on a sea of morphine. His lover didn’t want it; he will not want it either. ‘He knows what he
’s doing.’
‘He’s following Paul.’
‘I know. He told me.’ There are ghosts, now, in this room, soft and sibilant. They make their own music. I listen, this time, to the words. ‘Nicco hasn’t chosen to go into medicine.’
‘We didn’t fuck up over Paul.’
‘True.’ With Guillain-Barré fucking up is not an option. All one can ever do is wait and monitor progress. Recovery happens, or not, at the whim of the gods. Cervical cancer is not like that. Ask Claire Hendon. Ask Beth.
I move over and stand beside her, shoulder to shoulder, touching but not holding. The ghosts crowd close, pushing questions, needing answers.
‘Would you have followed Beth if what happened to her had been more … straightforward?’
‘God, yes.’ Her voice is quiet. Only this close can I hear it. ‘It would have been so easy. And I wanted to so very badly.’
‘So why not?’
‘I had a promise to keep.’ Her face is still. She stares out past the clouds to the space beyond. ‘I thought it mattered.’
‘Does it not still matter?’
‘I don’t know. It used to. A lot. Now …’ She turns round so I can see her, so she can see me. ‘What do you do when the promise is over, Kellen?’
I promised I’d become one of them without ever becoming one of them. That I’d stop it and not be a part of it …
‘That promise is never over.’
‘I think it might be. I can’t go on with this much longer.’
No. Now, I can see that. ‘Then you let go and get on with living your own life.’
‘You may have to remind me of that.’
‘Just keep asking.’
‘Thank you. I will.’
We made breakfast after that, toast and scrambled eggs and ageing tomatoes from the back of the fridge. She treats food, at times, like I do: a tedious necessity, easily forgotten. Sitting at the table, in the flat light of the morning, she looked younger, as if the night had loaned her back some lost years. She leant forwards and speared a lone tomato from my plate. ‘How’s Lee?’ she asked. It came quietly, slipped in between one mouthful and the next, as if that way I might not think too hard on the answer.
‘She’s still alive. I think that’s about as far as it goes. I got the impression she’s not expecting to stay that way for much longer.’
‘Hell.’ She reached back to the counter and poured hot water straight from the kettle into her mug. The coffee was still pitch black. ‘Has she heard from Sarah?’
‘I don’t know. I’m not sure she’d tell me at the moment. She wasn’t at her most communicative.’
‘But she was downloading Med-line files by the yard.’
‘How do you know that?’
‘Why else would you be sitting in the office at midnight when you could be home in bed?’
‘Thanks.’ It is not any comfort to be so easily read.
‘You’re welcome.’ She abandoned the coffee, stood up and poured the stuff down the sink and ran herself a mugful of cold water from the tap instead. Then she sat down on the floor, hugging the mug to her chest. She thought for a while. ‘Are you sure the two of you are asking the same questions, Kellen? You’re trying to find out what she knows that you don’t. She may be looking for something else entirely. You could go round in circles like that for eternity.’
‘I know. But I’ve got nothing else to go on.’
‘Except memory.’ She raised a brow. ‘Who else was there, Kellen? Of the people around then, who is there still left who knew all of them, one way or another? Who shared ward round and drinking rounds? Who climbed walls and rocks and electricity pylons and took the piss out of Hillary Murdoch?’
‘Apart from me?’
‘Not apart from you.’
The morning was very still. Outside, the rain started, slow and soft, rinsing the dust from the pavements. I looked at her. She looked at me, long and steady. ‘If Lee knows something then you know it too.’ She leant over and knocked a knuckle against my forehead. ‘You don’t need to waste time searching papers on Med-line. It’s in there if it’s anywhere.’
‘You think I haven’t thought of that?’
‘I think you haven’t let yourself think too deeply about anything. You’ve been progressively less coherent since you brought Eric back to the mortuary. You need to stop feeling and start thinking while you still remember how.’
‘Will it help?’
‘It probably won’t make a blind bit of difference to Lee but it might make you feel less like you’re over your head in the slurry pit and sinking deeper with every breath.’
‘Thanks.’
‘Any time.’ She smiled. ‘You don’t come here to be cosseted. You can get that at home. If you can remember where that is.’
‘Just about.’
‘Then I suggest you take the dog and go. They don’t need either of us in at work today. We wouldn’t be doing anybody any favours. Get some sleep while you can. You’ll not make much sense of anything without.’
She stood up and walked me to the door. We parted on the landing and my final memory of the morning is of her leaning against her own door-post, her skin translucent from lack of sleep, her eyes warm with the candour of the night. We hugged briefly, chastely, in the hallway.
‘Kells … ?’
‘Yes?’
‘Thank you for being there last night.’
‘You’re welcome. I’m glad I could do it.’
‘Get some sleep, huh?’
‘I’ll do my best.’
The day is heavy, overcast and overwarm, waiting for rain that doesn’t come. The bedroom is airless, the windows pegged wide for nothing. I lie awake and unclothed, on top of the duvet, drifting between the worlds. Sleep blends with no-sleep. Past blurs into present. Then into now.
Now, I am home at the farm listening to the world at work. Outside, the Galbraiths are cutting silage on the hill above the village. Three hired tractors run relays from the fields to the silage clamp, three hundred horse power, racing the rain. The noise comes in where the wind does not. I have nothing else to go on. Except memory. It is impossible to sleep.
Then, I am at home in another place on another close, airless day. I lie unclothed on another bed after yet another night on duty, too tired to sleep. The ceiling here is higher and has no beams and the walls are new-paint white, the smell of it still hanging in the air. The windows are open on other versions of the world at work: the endless commuter cars on Great Western Road; the Underground; the self-conscious laughter of students queuing for morning lectures—all of it carried in on a gagging mix of pizza and curry and the dregs of last night’s beer. A morning like any other morning, after a night like any other night. I lie awake and know that I should call Bridget and can’t be bothered to make the effort and lift the phone.
And then, this morning of all mornings, there is something else, not part of the pattern. Feet run up the stairs at a time when I should not be having company. The front door slams open and then shut on the end of a kick. The footsteps come closer, a knuckle taps on the door and a voice, barely heard, asks if I am asleep before she comes in anyway and sits on the edge of my bed. It is Lee, of course, but not the Lee I have known. This one is white to match the walls, whiter still at the flared edge of her nostrils and the tight line of her lips. Her eyes are black because her eyes are always black but never before with such a depth of anger. She is shaking, a fine, vibrating shudder, the same way she was shaking when she held Eric dead on a cliff-top, but this time, the first time, she is shaking with anger and not with grief.
She is shaking too much to hold a full mug of tea and so I get out of bed and make two mugs and then pour half of hers down the sink to make it safe. I come back to the bed and sit on top of the duvet with my mug between my palms and I listen while she spins me a story of the night and the day and the night before spent without sleep on the ward. A story of a patient dying slowly and begging for something faster. A patient who ma
ttered, one for whom it was worth taking risks. A patient who held her hand and said thank you in the brief five minutes when the housemen and the nurses were looking the other way and the woman who had trained for half her life to be a doctor drew up the morphine and spiked it with potassium and injected it all into the drip line for a final release into death.
I sit on the bed in silence then, because it is almost a year since I came to this and I have always known that for Lee, in her world of absolutes, it will be a harder bridge to cross. I lose myself in a world of remembered deaths and their meanings and I don’t listen, particularly, to what comes next: to the clinical history of a patient who should not have been a patient, to the clinical trials that should never have been run, to the details of the war to end all wars that she has declared on Randolph Duncan. I don’t listen because I’ve heard often enough before the sordid details of surgical politics, which are no different, really, to medical politics, and I’ve had my lifetime’s fill of that, by now. So I don’t even read, at first, the wording of the letter she holds out to me, typed in haste by his secretary, which tells her of the Professor’s belief that, in view of the opinions recently expressed, she is no longer able to fulfil the terms of her contract. It is with great regret, therefore, that he is forced to relieve her of her position, with effect from the morning shift. And so slowly, too slowly, the unreal becomes real.
She is no longer his surgeon.
She is no longer anyone’s surgeon.
Lee Adams has just lost her job, her life, her future, her soul.
I sit behind her on the bed and wrap my arms around her and I know that the world has ended.
But now I am here, not there, and so the world did not end and the ancient, long-dead pain is overlaid with the screaming fury of the colt, kicking up hell in the hawthorn field, a delinquent adolescent banished from the family fold because one of the new-foaled mares is in season and he hasn’t learned yet to control his hormones. On another day, Sandy would go up and spend time with his child, but today Sandy has a new love. The last of the foaling mares bedded down last night and the old man sat up with her, watching.