by Robin Byron
‘What’s the story?’
Mills shrugged. ‘As you probably know, the NHS won’t touch AD, nor will private sector hospitals, so it’s all in the hands of the specialist AD clinics. What we’ve found is stuff like heavy commercial pressure from management to maximise “throughput”; staff bonuses linked to secret targets; evidence from one clinic that has never turned away a single applicant; and aggressive marketing to NHS trusts. There’s also this,’ she said, handing him a sheet of paper with a passage highlighted.
Jake began to read. ‘Shit, I see what you mean. The clinics are paying commission back to the NHS hospitals and GPs. That’s shocking.’
‘Is it?’
Jake turned and saw that Charlie had come into the room. ‘More interested in our research than your own,’ Charlie added, ‘or are you flirting with Mills?’
‘No chance,’ said Mills. ‘He’s only got eyes for his young cousin…’
‘Hey, that’s not…’
‘Come over here,’ said Charlie as he walked to his own screen.
‘What is it?’
‘Just read,’ and he pointed to his screen. ‘DEATH PATHWAY. TRUSTS PAID MILLIONS.’ Jake read on: ‘The majority of hospitals in England are being given financial rewards for placing terminally ill patients on a “pathway” to death, it can be disclosed. Almost two thirds of NHS trusts using the Liverpool Care Pathway have received pay-outs totalling millions of pounds for reaching targets related to its use…’ Jake looked at the date – November 2012.
‘Twenty-one years ago,’ said Charlie. ‘You can find a lot of articles around that time on a similar theme.’
‘Yes, but surely that was completely different?’ said Jake. ‘I mean, the Liverpool Pathway… wasn’t that considered good clinical practice for those who were shortly about to die in any event? It wasn’t medically assisted suicide.’
‘Theoretically that’s true, but if you read the contemporary material you will see that there was an element of hastening the end, denial of water and so on, and this was linked to specific financial incentives to NHS hospital trusts.’
‘So, you don’t think there is a problem?’ asked Jake.
‘Oh yes, there are abuses in the way that AD operates today and we are going to expose them. But there are also deficiencies in the present law – it doesn’t work for dementia sufferers – which is why some patients are rushing to the clinics at the first hint of Alzheimer’s. All I’m saying is that managing death has never been easy. Now I suggest you get on with your own work. I’m expecting that investigation of yours to be wrapped up in the next week.’
23
Marianne heard a door close and she knew it must be Dorrie using the front-door key she had given her. Dorrie greeted her warmly but with a quizzical look.
‘Well? Tell me how it went,’ she said, sitting across the kitchen table and measuring a small amount of milk into her tea.
‘It was entirely predictable,’ Marianne replied.
‘Well, what you may have been able to predict is not within the range of my more limited powers, so you’re just going to have to tell me.’
Marianne shrugged. ‘OK, I’ll tell you – but after that I don’t want to talk about it anymore today.’
‘OK, fine.’
So Marianne told Dorrie how it had gone at the clinic. Rather to her surprise, she found it a relief to have someone she could share the experience with and to have a laugh about the absurdities of the process. She tried to inject a little irony into the description and she thought she might have succeeded because Dorrie acknowledged the humorous side.
‘Hard to know whether to laugh or cry; but seriously, Marianne, you’re not going to go on with this, are you?’
‘Yes, I am.’
‘But why now? That’s what I don’t understand.’
Marianne sighed. ‘I don’t know whether you remember how things were in England before the law was changed, when people went off to that awful blue chalet in Switzerland?’
‘I remember.’
‘Well, what was most tragic about those cases was the fact that the patients were going off far too early, but they didn’t dare leave it any longer in case they found it was too late and were no longer able to travel.’
‘And so…?’
‘AD is still only possible if you are deemed to be of sound mind. If I had a stroke tomorrow which left me mentally disabled, then even if I still had the wit to ask for an assisted death the chances are that it would be refused.’
‘Maybe, but I had the impression they were fairly flexible on that now. I’ve known some friends who were pretty gaga but they were still accepted for AD.’
‘If they were, then the law was being broken; it’s not a risk I am prepared to take.’
Dorrie got up from the kitchen table and went over to the window. It was almost dark and the East Anglian wind was blowing small streaks of rain onto the glass panes. She pulled down the blind and turned back towards Marianne. ‘Morally – doesn’t it trouble you…?’
‘In what way?’
‘It’s curious – I’ve never been religious but to me there is something fundamentally wrong with ending your life early, unless you really are in extremis. But you had a Catholic upbringing – and I know that some traces still remain. Yet committing suicide doesn’t seem to bother you?’
Marianne thought about the question. What was left of her Catholicism was largely emotional: a sense of the transcendent when she entered an ancient cathedral; a well-developed capacity to feel guilt; and in the past – but less now – an instinctive prayer in a moment of crisis. Yet somewhere inside her there remained a need for absolution. Not the kind a priest could give, but something she had to achieve for herself; the only sacrifice she had left to make, a means to atone finally for what she had done wrong in her life.
‘Seems now I look only for utility,’ she said, ‘and here I am confident the balance favours what I’m doing.’
Dorrie sat down at the table and poured herself some more tea. ‘The Hindus have a concept called Prayopavesa – where an old person is permitted to starve themselves to death when they have no desire or ambition left, and no responsibilities remaining in life – is that how you see yourself?’
Marianne pondered for a moment. She still had ambitions but it was too late now to fulfil them; as for responsibilities, hers all lay the other way. ‘Well, I don’t fancy starving myself,’ she said. ‘I prefer to get on with it. Anyway, we weren’t going to talk about it anymore.’
‘That’s fine, but only if you promise me another opportunity to try to dissuade you.’
Marianne duly made her promise to Dorrie; she was relieved to put the whole subject to one side and talk about something else.
‘It’s good to see you’ve got those old wartime diaries of your mother out; that was the big project you were working on.’
‘It has been, but it’s all too much for me now.’ Marianne gazed at her desk with its pile of notebooks and her pages of typescript, and wondered again what she would do with all the material. It was to have been her last project, only it had come to her too late. She had started with enthusiasm – it made her feel her life had a purpose again – and she had expected to complete the project within a year; but bouts of ill health, combined with a certain slothfulness that seemed to have overtaken her in the last year, meant that it remained unfinished. Now she must type up her remaining notes and leave the material in a state where someone could take over the task. It seemed that person would have to be Claire, though she doubted Claire would have the interest or energy to do much with it.
‘No more surprises – like your father?’
Marianne shook her head.
‘Has it bothered you much in life – about who your real father was?’
‘Not at all. My mother told me when I was very young – before I was old enoug
h to understand. I just shut the knowledge away in a little box inside me. When I was older – well, I had always known, so it didn’t seem so important. My father wanted the world to think he was my natural parent and that was fine with me – I didn’t want any ghost coming between me and my papa. Personally, I’ve never set too much store on the whole blood thing – the idea that you don’t know who you are unless you know your natural parents.’
Marianne continued her explanations to Dorrie, repeating the answers she had spent a lifetime giving. But as they talked, she sensed a growing tension in Dorrie – a suppression of what she wanted to say but had agreed not to. Finally, when Dorrie got up to leave she looked Marianne in the eye. ‘You’ve got to stop this nonsense. I am going to speak to Callum.’
Marianne sighed. ‘I don’t think that’s necessary.’
‘Well I am sure that it is necessary. Indeed, it’s vital. There’s nothing wrong with you, Marianne. Snap out of it. Sometimes a child has to stop a parent doing something stupid, just as parents do for their children, and there is something stubborn and – dare I say it? – almost childish in your desire to end your life prematurely.’
‘Prematurely – at nearly ninety…?’
‘Age isn’t the test; it can’t be. Legally, age is irrelevant. You are eighty-eight…’
‘Eighty-nine in January…’
‘… and fundamentally you are quite healthy. Stacks of people are living to a hundred now and you have more to live for than most.’
Marianne said nothing, only shaking her head.
‘Stupid and selfish – that’s the only way I can describe it.’
‘Selfish? It’s the complete…’
‘… I shall speak to Callum – and I shall be waiting your call to say that you’ve come to your senses.’
‘Callum understands…’
‘If he thinks he understands, he’s badly mistaken.’
‘He has promised…’
‘Wake up, Marianne! Wake up and see how wrong this is. Stupid, selfish and wrong… I’ll let myself out,’ she added, as she stomped from the room.
Marianne moved from the kitchen to the living room and slumped into her chair. She hated quarrelling with Dorrie. But how could it be otherwise? She wrapped herself in her cashmere blanket, dimmed the light and tried to force herself to sleep.
The air is damp and misty, the sky heavy with yellow clouds and the light more like dusk than mid-morning. She stares over the top of the white picket fence to where the small boy is trying to repair a snowman, now dissolving fast in the morning drizzle. She finds Pony and pushes the toy horse up against the fence. Holding onto the wooden struts, she stands on Pony’s back and puts her stomach onto the pointed fence top; it’s not comfortable but her winter jacket cushions the pain and she brings up her legs and rolls forward, landing sideways onto the soggy ground. Getting up, she walks over to where the boy is digging slush with a plastic spade from around what is left of the snowman, as if trying to rescue a sandcastle with wet sand from the remorseless approach of the tide.
For a few minutes she tries to help him with her bare hands, then, getting bored, she starts to wander down towards the pond at the bottom of the garden. A few seconds later the boy runs past her and they are both now staring out at the ice through the high wire fencing. She is still peering through the wire when she sees that the boy has moved to where a bush is growing up against the fence and is on his knees scrabbling at the bottom of the wire. Now she is beside him and they are both digging like chipmunks, scraping away the last of the snow and exposing a strip of wire which doesn’t quite reach the ground.
When they are both under the fence they stand together looking at the frozen surface of the pond. A thin layer of melting snow covers the ice which has trapped various twigs and small branches, fallen from the overhanging trees. ‘I can slide,’ says the boy, as he steps out onto the ice. Groaning and creaking noises come from the surface but the ice holds. The boy pushes off and slides a couple of feet; smiling, he turns back towards her as if seeking her approval. Cautiously, she tries to slide herself and then they are both sliding and laughing and clinging to each other and trying to use each other to push off as they move further towards the centre of the pond. Is it her foot, or is it his, which catches on a twig protruding from the surface of the ice? Whichever it is, they reach for each other and together they fall heavily onto the ice which breaks all around them. Both her arms go down into the icy water. She tries to stand up but there is nothing solid under her. The water grips her legs, then her stomach, now up to her shoulders as her arms flail at the broken ice, trying to find something to grip onto. Beside her the boy is also struggling, but this is not helping her. The water is gripping her around the neck, now swilling against her face and in her mouth and nose. She coughs violently; she needs to do something. She reaches out a hand to the boy’s shoulder and as she does so she sees his face – surprised, frightened, the blue eyes questioning her. For a moment she hesitates – caught in the grip of his pleading eyes – then she pushes down with one hand while with the other she desperately tries to dig her nails into a rough part of the ice. The movement helps lift her body and now her knee is on something soft and yielding and as she pushes again her stomach is on the surface of the ice and one hand has found some purchase on a piece of wood. Something is clinging to her leg, pulling her back down, but with a final kick she frees herself and is out of the water and lying on the surface of the pond.
She lies there motionless for a few seconds, then she sits up and looks back at the hole in the ice. Broken pieces float on the surface. There is no sign of the boy. She knows something terrible has happened. But what should she do? ‘Ryan?’ she calls quietly. ‘Ryan?’ Then she starts to scream and her arms are thrashing but something is obstructing her. She tries to throw it off and then she is sitting up in her chair with her blanket on the floor.
Marianne lay back in the chair, breathing hard with her heart pounding in her ears. I remember everything. I have remembered for years. I started my life by drowning that poor boy. And I didn’t even run for help. I pretended to myself and to the world that it hadn’t happened. As if pretending could make it so.
24
The rattle of a passing train temporarily drowned their conversation as Jake and Leah walked across the Jubilee Bridge towards Charing Cross. So much water, Jake marvelled, great streams of gushing grey water flowing each side of the pillars; why was it that, when walking over a bridge, the Thames always seemed so much wider than he remembered? Was it merely the greyness of the afternoon, with sky and water competing for the same place on the artist’s palette, or was it the way the river curved around to St Paul’s and the City which made it seem especially wide at this point? A sharp wind was blowing down the river and Jake turned his gaze to the east where Wren’s masterpiece lay like a recumbent empress surrounded by her praetorian guard of glass and steel towers.
Jake was surprised to find that he was holding Leah’s hand; he did not recall making any conscious decision to do so. Yet somehow her hand had come into his, and he found himself remembering how powerfully intimate this simple act could be. A thousand nerve endings gently caressing each other, speaking in their own silent language of sensation, while the controlling minds danced a more cautious minuet with words.
‘So you haven’t told me yet what we are going to do,’ said Leah.
‘You said you wanted a surprise.’
‘Yeah, but now is the time to surprise me.’
‘OK – we are going to the theatre.’
‘Cool, so what are we going to see?’
‘It’s a revival. Arcadia, by Tom Stoppard, have you heard of it?’
‘Yeah… Stoppard… yeah, I remember, didn’t he write the script for Shakespeare in Love? We saw it at school.’
‘Yes, I think he did.’
‘Yeah, I remember something else. Mrs Duckworth,
our English teacher, talked about Stoppard – I think she approved of him.’
‘Well, that’s a relief!’ said Jake.
‘Hey!’ said Leah, giving Jake’s hand a squeeze. ‘Don’t mock my Mrs D – she was a brilliant teacher. What’s Arcadia about?’
‘Well, it happens in different time zones – you move back and forth from early nineteenth century to late twentieth century, with overlapping themes. To tell you the truth, the only production I’ve ever seen was about five years ago at university, so it’s all a bit hazy, but I’m looking forward to seeing it again. I seem to remember there’s lots of maths in it.’
‘Maths! Is it going to be entertainment or hard work?’
‘I think you’ll enjoy it.’
‘OK, and hey, thank you, this is a real treat for me, you know.’
Jake turned and smiled at his companion; this definitely has the feeling of a date, he thought, noticing again that Leah’s familiar jeans had given way to a skirt – short, but not ostentatiously so, over which a black woollen coat had replaced the normal grey jacket, and a new emerald green scarf which looked like cashmere was wound tightly around her neck. A modest amount of makeup – which he had never seen on her before – completed the transformation.
Jake was looking forward to seeing the play again, but ten minutes into the production, as details of the plot and characters came flooding back to him, he began to wonder whether he had made a wise choice. She’s never going to believe me if I tell her I couldn’t remember that it featured a young teenage girl and her tutor. She’s going to see all sorts of parallels which I did not intend and which I could really do without. His expectations were fulfilled as soon as the interval arrived.
‘Are you trying to tell me something?’ Leah asked as soon as the applause had died down and they had begun to move slowly from their seats towards the bar. ‘Do you think of me as Thomasina? I’m not thirteen, you know, and I think I can just about get the meaning of “carnal embrace”.’