‘Weeks or months?’
‘No one can say. It depends on so many things.’
‘Then I will continue to act as though it is weeks, and I have work to do. You could oblige me by helping me to my feet, Sister.’
I helped him to stand up, and watched with sorrow and admiration as he straightened his back, gritting his teeth as he did so.
People with abdominal pain find it eases them to bend over slightly. But not Mr Anderson – he was determined to stand straight, and he walked firmly to the door and along the corridor towards his broom cupboard.
It is generally assumed that doctors know all there is to know about death, and that, if a patient is to be told that his condition is incurable, it is the doctor’s prerogative. In my experience, this idea is overstated, because most of the time doctors are not on the wards, whereas nurses and carers are.
During the time when I was a probationer student nurse in Reading, I was working on a male medical ward. I carried out simple duties such as washing the locker tops, and was at the bedside of a man who was very ill. He grabbed my wrist, and with fierce intensity barked: ‘Have I got a growth, Nurse?’
Startled I said, ‘Yes.’
‘Thank you,’ he croaked. ‘No one would tell me. Am I going to die?’
‘I don’t know,’ I said truthfully.
‘But what do you think?’
‘I honestly don’t know. No one knows.’
‘Thank you, Nurse.’
He sank back on the pillows and sighed. It might have been a sigh of relief or despair. One could not tell.
I did not dwell on the incident, and it certainly did not occur to me that I had done anything wrong, until a few days later when Sister called me to her office.
‘Did you tell Mr S that he has a growth?’
I probably looked blank, but said, ‘Well, he asked me, so I said yes.’
‘Nurse, you are still in your probationary period. I must report this to Matron.’
The same morning I was called to Matron Aldwinkle’s office. The conversation I had had with the ward sister was repeated, but I added, ‘Well, what could I say if he asked me? I couldn’t say “no, you haven’t got a growth” when I knew that he had.’
‘You should have told him to speak to the doctor.’
‘But he had seen the consultant and the other doctors that morning. It was just after the ward round.’
‘Nurse, we do not tell a patient directly that he has a malignancy. Most patients cannot accept it.’
‘But what are we to do if we are asked?’
Matron struggled to find the right words.
‘I know it can be very difficult, but you have to think quickly. Something like “I don’t know” or “it has not yet been diagnosed” would be suitable.’
‘But it had been diagnosed. And I did know.’
‘You have to understand, Nurse, that we cannot simply blurt out the truth.’
‘If I had told a lie, I’m sure he would have seen it in my face. I’m no good at lying. I’ve tried it before, and my face always gives me away.’
Matron appeared to be slightly exasperated. ‘You have to learn to be more sensitive to a patient’s needs. Well, I am going to move you to another ward. I do not think you should continue on Victoria Ward at present. I have confidence that you will learn, and improve. You may go, Nurse.’
It would probably surprise many doctors to know how frequently very junior nurses are confronted with a dilemma such as the one described. It occurs because nurses are so much closer to patients than doctors are, a situation that doctors have cultivated, creating a barrier between themselves and their patients. Often, most hospital patients are in awe of doctors, especially consultants, and feel they cannot engage in a conversation with one of these superior beings. But they are not in awe of nurses, who are with them all the time, and therefore more accessible. Indeed, since the changes in the nursing profession, requiring nurses to be college-trained rather than ward-trained as my generation was, patients don’t have much contact with student nurses. So when a frightened patient asks, ‘Have I got a growth?’, the person most likely to be approached is a care assistant or an auxiliary, one of the many people who do the most basic and intimate of nursing duties for helpless patients. Someone close to them is what people need, someone who is on their own level, not too high-and-mighty, but approachable. And carers are nearly always women. On the whole, they are kindly, compassionate and humble. They work for the lowest of low wages, and are completely taken for granted by hospital managers. But they are the women to whom fear-ridden patients will often turn, for assurance, consolation and comfort at the time of death.
On that day, Mr Anderson returned to the ward a couple of hours later than usual, and sank into bed, exhausted. I was furious that he had over-stretched himself in that silly office, and resolved to have a word with the Chief.
Throughout the afternoon Mr Anderson slept, sometimes wincing in pain – we could see him curling up his body in an attempt to ease it – but still he slept on. He stirred as we were doing the six o’clock drug round, and sat up looking refreshed. Suppers were served at seven o’clock, and he ate without nausea or discomfort. I began to revise my opinion about the office work he was doing.
After supper is usually a good time to talk to people. The ward is quiet, the day’s activities are stilled, the light is changing, and the human heart and mind seem to change with it. Mr Anderson was sitting up in bed, watching the sun sink behind the trees. It was a reddish sunset, with bands of fluffy pink clouds. Mr Anderson appeared relaxed, and I thought, with a leap of the heart, that perhaps the radium might effect a complete cure. Spontaneous recovery from cancer is possible, and whilst no one can explain what happens, I have seen it.
It can be a bit awkward talking to someone in the middle of a hospital ward. You have to sit close, and talk very softly. It is no good asking a patient to come to the office; that is too formal, and very often the person is tongue-tied in such a situation. No, the bedside is usually the right place, and the right moment can only be judged by intuition. I pulled the curtains around his bed and sat on the edge. He moved his legs over so that I could sit more comfortably, which was encouraging, because it indicated that I was welcome.
‘It’s a lovely evening,’ I said, ‘a lovely sunset.’
‘Beautiful. I would like to go on to the balcony to see it better, but I can’t be bothered to make the effort just now.’
‘I could help you.’
He smiled. ‘No, it’s not worth it. The sun will be gone by the time we get there.’
‘You are looking very much brighter this evening.’
‘Well, I did a good morning’s work. Excellent, in fact.’
‘It obviously does you good. I thought it had tired you too much, but I was wrong.’
‘I have always needed to exert myself – it’s just the way I’m made. If I could get rid of this damned cancer by sheer will power and exertion, I would do so.’
‘You are having radium treatment, that will limit the growth. And a positive outlook, such as yours, will help a great deal. We don’t think you will be able to go trekking in the Himalayas, but Wales, or the Wye Valley, as the Chief suggested, could be possible.’
‘That’s encouraging. I will hold on to that one, Sister. The Wye – a bit of rough canoeing, wonderful, and some climbing – oh, I’d love that.’
‘Perhaps you should cancel your Himalayan trek and concentrate your thoughts on the Wye Valley.’
‘Why not? I will get my secretary to order the maps from Stanford’s tomorrow.’
His eyes sparkled with eagerness, and as I looked at the wasted muscles that could not find the energy to step on to the balcony to see the sunset, I pondered the phenomenon of hope.