THE BROOM CUPBOARD
The greater one’s experience of death, the more cautious one becomes in making a pronouncement. The ways in which people face death are as different as the ways in which we all live.
Perhaps I should qualify this statement. The last ten to thirty hours before death are very much the same; a semi-awareness of space and time and people takes over, leading into a different level of existence, accompanied by peace and tranquillity. If left undisturbed, death is not an agony. It is the earlier period, the weeks or months, or even years of illness or ageing that are so different.
Mr Anderson was consultant to a firm of international financiers. He was a very successful man, confident, self-contained, a person who needed very little amusement or even warmth – his work was enough, and filled most of his time and his thoughts. For relaxation he liked to go long-distance trekking in mountain ranges, sleeping in wooden huts and scrambling over rocks and riverbeds. It was a total change from his business life, and kept him fit. His private life was less successful. He had married a pretty girl whom he thought he loved, mainly because it seemed the right thing to do, but he had no idea how to handle women, and his wife soon left him for another man. He was not particularly upset, and enjoyed the freedom of a bachelor’s life.
He had never had a day’s illness, and prided himself on keeping fit through his walking, a sensible diet, no smoking and moderate alcohol intake. He had no time for some of his business colleagues who ate and drank too much, smoked like chimneys, went everywhere by car or taxi and then complained about feeling out of shape. ‘What do they expect?’ he said to himself.
When he developed stomach pains and felt sick, he was slightly offended – it shouldn’t be happening, he thought, so for a week he cut out rich meats and fats from his diet and ate only salads. Things seemed to improve, and he was satisfied that he had nipped the problem in the bud. But a week or two later the nausea returned, along with heartburn. He had heard of something called a hiatus hernia, but lots of people get hernias of one sort or another, so he was not particularly worried. He felt well in other ways, work was busy and he was planning his first trek in the foothills of the Himalayas. Life was too full and too interesting to bother about a little heartburn.
But things did not improve, and so, a month later, he went to see his doctor, who examined him, and found an unexplained lump in the upper abdomen. He said that another medical opinion should be obtained, and advised a gastro-enterologist at the Royal Free Hospital.
Mr Anderson was indignant.
‘But I’m busy! There’s a lot of work on, and I’m going to the Himalayas trekking in ten weeks’ time.’
The doctor replied that they must get him into good shape for the trip, and wrote his referral letter.
At the Royal Free, Mr Anderson was taken to theatre for a routine laparotomy with exploration, and possibly a partial gastrectomy (there were no electronic scans in those days). In theatre, the surgeon opened him up, took one horrified look at an intractable growth of carcinogenic material, involving the stomach and duodenum, and stitched him up again. He looked despairingly at the theatre staff.’ ‘How can one tell a man of forty-five that he has inoperable cancer and has only a few weeks to live?’
No one answered. Everyone knew how great was the responsibility of telling – if they decided to tell at all. Sometimes, it is better to maintain the illusion of recovery; sometimes, it is better to tell the truth. But how is one to know what is best for a particular patient? The strong-minded person who says ‘I want the absolute truth,’ can be the one who goes to pieces when told. But the truth can be received by another calmly, and in unexpected ways may bring resolution to life. One can never be sure, and usually it is better to let the patient take the lead. Only then can you get an inkling of what he or she wants to hear. Even so, you can be wrong, because people deceive themselves. A dying man rarely looks death in the face until the end. In the early stages of terminal illness, he might have a shrewd idea of what is going on, but usually, at that point, he doesn’t want to know.
Mr Anderson was not told directly that he had cancer so advanced that it was inoperable. He was simply told that six weeks of radium therapy would be beneficial. He entered the Marie Curie feeling well, and was by far the most active and alert of our patients. He appeared scornful of the other men, and complained about not having a private room.
‘It is bad enough that I have no privacy. But it is intolerable that I do not have the use of a telephone.’
I said that we had a pay phone for patients’ use.
‘Pay phone!’ he spat out in disgust. ‘You mean I will have to put pennies in every time I need to make a phone call?’
I said I would discuss the matter with Matron. At Marie Curie we had a policy of keeping our patients happy, as far as possible, especially if we knew their days were numbered. Matron frequently went to great lengths to oblige, and she discussed the matter fully with Mr Anderson. It transpired that what he really wanted was the use of an office from which he could continue to manage his business enterprises with the help of his secretary.
Matron swallowed hard. This was something quite new to her experience. A hospital is a hospital, not an office block, she might have said – but she didn’t. He was a dying man, and who could refuse such a request? There was a broom cupboard on the first floor that was little used, would he care to look at it? Together they examined it, and Mr Anderson said it would suit him if it could be cleaned out, and a desk found. Matron did not think a spare desk was available, so he said he would have one supplied, and would also pay for a telephone to be installed. It was surprising how quickly the broom cupboard was converted into a small but adequate office. The secretary, a smart young man, immaculately suited, arrived with a car load of files and folders, and within two days Mr Anderson was at work. We never knew what business he was engaged in, but it was most unusual and the nursing staff was very impressed.
Matron’s arrangement was highly beneficial to Mr Anderson, because it kept his mind occupied and his energies engaged. Sickness usually dominates the thoughts of a patient with cancer, but too much preoccupation with illness can have a destructive effect on the mind, and knowing what can happen frequently becomes self-fulfilling. Today, people who are ill will spend hours surfing the internet to find out all they can about their illness – but this isn’t always a good thing.
Although Mr Anderson had not been told of his condition, he was an intelligent and thoughtful man, and he must have known that radium was given for cancer. We anticipated that he would start asking questions. One day, during a routine ward round, he said to the Chief: ‘I am due to go trekking in the Himalayas in six weeks’ time. Do you think I will be fit by then?’
The Chief hedged. ‘That sounds pretty strenuous.’
‘Yes, it will be. But it will do me good. I need a bit of fresh air and exercise.’
‘I think you should find something less demanding – walking in the Wye Valley or the Cotswolds, for example.’
‘I see. I will think about it,’ he replied. He picked up his book again and appeared to be reading; but I knew that he was watching us as we continued the ward round.
It was not the first time I had had the feeling of being watched. Several times I had seen him observing the nurses as they went about their work, and wondered if he fancied one of them.
One day, he said abruptly: ‘I have been watching you and your nurses.’
‘Yes, I know, and I have wondered why.’
‘You don’t miss much.’
‘Nor do you, it seems. But why?’