‘You’re the child I used to know in Reading, aren’t you?’
Yes, I am,’ I said with sudden recognition.
‘A stupid girl, I remember. What are you doing here?’
‘I’m the ward sister.’
I held out my arm to assist her as she walked. She pushed it aside.
‘Leave me alone – there’s nothing wrong with me. Ward sister, you say? That doesn’t sound too good. I dare say you are as ignorant now as you were then.’
She reached the empty bed that had been kept for her.
‘What do you mean by putting me here? I expected a private room. I’m not staying here with a lot of stupid old people!’
She glared angrily around her at the other patients.
I explained that the side rooms were for people who were very sick, and that people like her, who could get about, and were improving, were always nursed in the main ward. She looked at me steadily.
‘You mean I must be improving, or I wouldn’t be here?’
‘Yes, that is correct.’
‘Tell Evelyn that.’
‘Certainly, if you wish me to.’
‘Of course I wish you to! I wouldn’t have said it if I didn’t mean it. And tell my son, James, also. I told them both I was getting better, but they wouldn’t believe me. Fools, the pair of them.’
This didn’t look good, by any standards. I had known Mrs Cunningham as an active, strong-minded woman in her early sixties, with a sharp tongue and an independent spirit, but I certainly had not expected this would develop into such venom as she grew old. In our profession we often meet people whose bewilderment and frustration in the face of illness leads to anger, but this was excessive, and I did not like to think of the effect it would have on the other women in the ward.
The Chief came to see her that afternoon, and I accompanied him. She glared at us both.
‘About time, too. I don’t like to be kept waiting. Well? What are you going to do for me?’
He did not say too much, but examined her abdomen, and the scar from the operation, which was healing well.
‘We are going to take blood for tests.’
‘That’s not going to help me. I want proper treatment.’
‘We cannot start until we have the results.’
‘And how long will that be?’
‘A few days.’
‘A few days! That’s preposterous. I want treatment at once.’
‘We will give you tablets to prepare your body for the radium treatment.’
‘That’s something, I suppose. Why am I here at all? That’s what I want to know. I had a hysterectomy. Thousands of women have hysterectomies, then they go home and get on with life. Why do I have to come to the Marie Curie Hospital for radium? It makes no sense.’
This was always the difficult, nay, impossible, question to answer. At that time everyone knew that radium was given to reduce a growth, and most people think of a growth as cancer. But this need not always be so. Many growths are benign, many are encapsulated, and even a malignant growth can be reduced to a size of no importance. The Chief explained this to her, and said that surgery had removed the growth, and that the radium, which was the most advanced medical treatment of the day, would minimise the risk of it spreading to other parts of her body. She would probably have six treatments, which might be extended to ten, depending on the response of her body, which would be determined by her physical condition and blood tests. He chose his words carefully.
‘That’s what I wanted to hear.’ Mrs Cunningham’s sunken eyes glared at the Chief. Her thin lips spat out the words, ‘Advanced medical treatment.’
‘Yes. You will get the most up-to-date treatment that is available. This hospital is at the forefront of research, and our success rate is high.’
‘You must tell my son and daughter that. A high success rate – that’s what they need to know. Fools, the pair of them. What do they know about advanced medical treatment? Nothing! Not a thing.’
She gave a contemptuous grunt, with a curl of the lips, and repeated, ‘They know nothing.’
The Chief and I returned to the office.
‘I think she is going to be a difficult patient to handle,’ he said. ‘There’s something malign eating away inside her – and I don’t mean the cancer. There is something else on her mind.’
I told him that I had known Mrs Cunningham ten years previously, and that she had struck me as a highly intelligent woman – strong minded, independent, and humorous. He made no comment.
Two days later her son James came to see her. Halfway through the visiting hours she called loudly to one of the nurses, ‘Take him away! I won’t have him here. Get him out of here.’
I was busy checking drugs received from the dispensary, and ordering more, but when I heard the angry, raised voice, I went to see what was going on. Poor James, looking embarrassed, was leaving the ward.
‘Don’t come back. And tell that interfering sister of yours I don’t want to see her, either,’ his mother’s voice shouted as he left.
‘What on earth is all this about?’ I said as he passed. ‘Please come to the office with me. Your mother has been angry and aggressive ever since she was admitted.’
We sat down.
‘Now what was said? Why this outburst?’ I enquired.
‘I simply told her that I thought she should not have any more treatment, and that the time had come when she should accept the inevitable, and die with dignity.’
Oh dear, I thought, so was this the origin of the fear and anger? ‘Please go on,’ I said.
‘Well, it’s perfectly obvious that she is dying. The cancer is spreading. She doesn’t need more treatment. She just wants an easy way out. We all do.’
‘Yes, I know. You are quite right,’ I said, encouraging him to go on.
‘I reminded her that she had signed an advance directive years ago, and had renewed it annually.’
‘That’s interesting. Please tell me more.’
‘She has been an active member of the British Humanist Society – we are all members, the whole family – and voluntary euthanasia is high on their agenda.’
‘Euthanasia is illegal,’ I reminded him.
‘Yes, I know, but an advance directive saying that no more medical treatment should be given after a certain point, is not. It is perfectly within her legal rights to refuse further treatment.’
‘It is. But at what point do we begin withholding medical treatment?’
‘Now, of course. She is not going to get better. Anyone can see that. She’s had a good life, and she’s a good old age. The time has come to lay it down.’
‘But your mother does not see herself as being at the end of life.’
‘I can’t understand it. She was always so clear-sighted, so positive in her convictions. She knows quite well that treatment beyond the point of no return can frequently cause more suffering than the original disease. But now, she won’t accept it, and gets furious with me and humiliates me in public. She had a blazing row with Evelyn on this subject a few weeks ago. Evie told me about it, but I thought it was just another mother and daughter row. They’re always getting at each other, you know. Well, I’m damned sure I’m not coming in to visit her again, only to be shouted at.’
He spoke in an aggrieved tone, and stood up to go.
I told him that his mother was angry because she was afraid, and that she would probably get over it. I expressed the hope that he and Evelyn would both visit, because everyone needs the family to be there at the end of life.