Immediately after visiting hour had finished, Mrs Cunningham called me over.
‘Get the consultant,’ she demanded, ‘I must speak to him. Get him at once.’
I explained that a consultant is not on call at a moment’s notice, but that I would ask him to come as soon as he was free.
She exploded with rage, and was very insulting to me, and to the medical hierarchy in general. She was creating a scene, and this was having a bad effect on the other women in the ward. I began to think that we might have to put her in a side ward after all.
‘Well, don’t let my son or daughter in. That’s an order,’ she shouted.
The Chief came after supper, and I told him of the afternoon’s events. He sat, tapping his watch, before he spoke.
‘The Euthanasia Society has gained in influence as medical knowledge has been able to prolong life which, it must be said, is not always a good life. I will speak to her, and I would like you to be with me, as a witness, if nothing else. We cannot have this conversation in the middle of the ward, so ask her to come here, please.’
Mrs Cunningham came to the office. I could see as she walked that her son was absolutely right, and that she was a dying woman.
She confronted the Chief even before she sat down.
‘Don’t you listen to my son or my daughter. They’ll tell you not to let me have any more treatment. They hate me. They want to get rid of me, especially Evelyn.’
She blurted it out, hardly pausing for breath.
‘There’s nothing wrong with me. I’m as strong as I ever was, but they want me out of the way. Don’t you listen to them.’
She jabbed her stick in the air to emphasise her words.
The Chief said that he would always listen first to the wishes of a patient.
‘But what if I can’t express myself? Then they will sneak in and twist your mind. They are very persuasive, and not to be trusted. I don’t trust doctors; they are all as bad as each other. I’ve signed up. They will use it. That’s what you want, the whole damned lot of you. I know what you’re up to. You can’t fool me.’
She was becoming irrational. Evidently this business of an advance directive had been playing on her mind to such an extent that she couldn’t think straight.
The Chief explained that an advance directive had no legal validity whatsoever, and was certainly not binding on the medical profession; but either she did not hear him, or could not take it in.
‘The best treatment is what I demand. Forget James and Evelyn. They are ignorant, prejudiced, stupid …’ She rambled on, repeating herself, contradicting herself. We listened to her tirade, and the Chief again told her that she would have the best treatment available. Unconvinced, but unable to say more, she returned to her bed.
From then on, Mrs Cunningham’s whole existence became paralysed by fear. Her fear of death amounted almost to madness, and an overwhelming feeling of helplessness rushed in upon her. She was lost; she panicked; she prayed to a God she did not believe in; she lost control; she screamed for advanced medical treatment, and railed that treatment was being withheld because James and Evelyn had influenced the doctors. Craven fear had roused her whole mental machinery to a state of agitation that had taken away all fatigue, all possibility of sleep, all sense of self-respect. It was a distress impossible to soothe. Drugs could have helped her, but if we went near her with a syringe she screamed uncontrollably that it was all part of the plan to do her in. She was beside herself with terror, and this reduced her to a jabbering wreck, devoid of all self-control and dignity.
We had to move her to a side ward, because of the effect she was having on other patients. She shouted that she knew why we had put her there; it was because of hospital secrecy. She knew what we were up to; all doctors were rogues and nurses were hand in glove with them. She demanded to see her lawyer, the police, her Member of Parliament. Her mind was obsessed, and nothing could divert it.
The laboratory report on the blood tests returned. Widespread metastases of the cancer were evident. The radium treatment should be started, but the Chief hesitated, because with the malignancy circulating through her entire body via the venous and lymphatic systems, it would probably be ineffective and would be distressing to her for no benefit gained. But she became hysterical and screamed that we were deliberately withholding the treatment she had been promised, and which it was her right to receive. So the Chief ordered a low dose, by way of a placebo. But when she was wheeled on a trolley to the treatment rooms, her fear became uncontrollable. In those days the radium treatment was carried out in a huge machine, into which the patient was wheeled, and the machine closed. She got halfway in, and then panicked. She shouted that we were putting her into a coffin to dispatch her while she was still alive. She thrashed about, and beat the sides, screaming for release. All the radiographers could do was return her to the ward.
Poor lady. She was so weak, and she was dying, but fear possessed her and filled her failing body with an agitation that allowed her no rest, day or night. She was suspicious of everyone, and the room seemed reduced in size by her wakeful, watchful eyes. It was pitiful to see, and impossible to calm. She would take no drugs, not even sleeping pills, and then she accused us of withholding essential treatment.
Illness is a revelation; one sees things one has never seen before. We saw, in Mrs Cunningham, a manic fear of death, which was not fear of cancer, because she did not believe she had it. Her fear was that death would be forced upon her because that was what she had always said she wanted. Day by day, hour by hour, she anticipated it, and the waiting nearly drove her mad. In fact, I think it did drive her mad.
Illness can also bring a flowering of love between people. That is one of the reasons why nursing is such a wonderful profession – we see these things. But for poor Mrs Cunningham, love was denied her at the end. She was convinced that her son and daughter were going to implement the advance directive that she had signed and re-signed. The idea was nonsense, of course, everyone knew that, but you cannot reason with obsession.
Evelyn came to the hospital several times, but her mother would not see her, and told the staff to ‘drive her away’. True to his word, James did not come again, but I have memories of Evelyn’s sad face as I took her final gifts of flowers and a bed jacket, and told her that she could not be admitted. The reconciliation between mother and daughter, which would have eased Mrs Cunningham’s last days and consoled Evelyn in her bereavement, was denied them both.
Mrs Cunningham’s mind and body could not withstand so much tension. The frenzied activity wore her out. She could no longer shout and scream, but she sobbed out of a sense of injury and injustice. She called upon God and wailed for mercy. Her terrified state of mind pursued her into her sleep and dreams, for the night nurse reported that she often woke in the night with a dreadful start and wept convulsively.
Mercifully, it did not last too long. Gradually, her mind became clouded, as it usually does as death approaches. Movement, speech, perhaps even thought, required more effort than she could command. Her breathing, circulation, and metabolism slowed down. Death overtook her, and calmed her, and, at the end, she learned that there was nothing to fear.
‘Hope is not the conviction that something will turn out well, but the certainty that something makes sense, regardless of how it turns out.’
— Vaclav Havel, playwright and
President of the Czech Republic, 1993—2003