Hope is the one thing that people never lose, and even though they may know that they are dying, hope never deserts them. Most people hope for a new breakthrough in medical research, a new drug, a new treatment, a miracle cure, and we have to encourage this, however unrealistic it may be. But hope does not preclude an acceptance of death, and it can come in many forms.
Most doctors believe that they must never allow a patient to give up hope of a cure. The implication of this is that the medical profession is the single source of hope. This is too narrow a definition. Hope is an abstract concept, and is by no means confined to physical cure. Hope means something different to each one of us. Hope to see a daughter married, or a grandchild born, can keep life buoyant and content for weeks, or even months, beyond the realistic expectations of a medical prognosis. Many people, knowing they have cancer, have done the most extraordinary things: run marathons, cycled halfway round the globe, written books, taken degrees. Hope, directed towards an achievement, is the driving spirit, and makes the future endurable. Belief in an afterlife is also hope.
‘The Wye Valley will be lovely in a few weeks’ time with the spring coming,’ said Mr Anderson dreamily. ‘You know, when I first suspected I had cancer, I simply did not believe it. They’ve got it wrong, I thought. I had always been healthy, and led a healthy life. I couldn’t have cancer, not at my age. I thought it must be a misdiagnosis and I was furious with the doctors.’
‘Did anyone tell you?’
‘No. Lies, half lies, evasions, silences – that’s all I ever got. It’s an insult to one’s intelligence.’
‘How did you discover?’
‘When I came here – I knew what radium treatment is for.’
I was silent. It was so obvious, so irrefutable.
‘And no one has talked to you about it until now?’
‘No. Far from dispelling my fears, the lies and evasions only added to my certainty.’
‘How did you react?’
‘When I saw the fearful condition of some of the other men in the ward, I decided that I must kill myself. I never want to get to that stage. Never.’
‘Suicide is not easy.’ I said.
‘No, it’s not. And you know something? I don’t think I have the guts. There is a window upstairs, thirty feet up, with concrete underneath. For many days I thought “I could do it today, there’s no one around. A quick jump and it will all be over.” But each day I hesitated – “Not now. This afternoon perhaps, or tomorrow.” And then I realised I just didn’t have the guts.’
‘It’s not a question of guts,’ I said, ‘most suicides are associated with mental illness, and you don’t strike me as being mentally ill. You’re a realist.’
‘I like to think so. But I cannot face the reality of the last stages of this pitiless disease. If I get to that stage I will want someone to polish me off.’
I didn’t say that nobody realises they are getting to that stage, because by that time they are incapable of recognising it. Instead I said:
‘You are having radium now. The side effects can be very severe, which is why you feel so ill and exhausted. But you must believe me, it is destroying the cancer cells in your body.’
‘I do believe you. That’s what keeps me going. I feel ghastly, but I have a mental picture of the cancer cells being bombarded with radium and giving up. It’s a battle. Them or me. And I intend to win.’
‘That’s the spirit,’ I said, enthusiastically.
‘It’s a fight to the death and I am a realist – you said that yourself. I have always had to fight, from my early childhood, and I always win.’
Some people are like that – failure is never a possibility – but I said, ‘You would make it easier for yourself if you rested more.’
‘I don’t want anything to be “easier”,’ he said scornfully. ‘Life is not easy – never has been. I don’t go for the easy option.’
The night nurses were coming on duty. I had to go. He squeezed my hand.
‘I’m glad we had this talk. I feel better for it.’
‘And I’m glad too. I must tell the Chief about it when I see him.’
I slipped off the edge of the bed.
‘I hope you have a good night. What about some sleeping tablets?’
He shook his head.
The following morning, when I came on duty at eight o’clock, he was up and dressed in his suit. He looked very thin, but smart. He had taken no breakfast, but had asked for strong coffee. I was not happy about this, and questioned him.
‘Don’t fuss me,’ he said. ‘I have work to do, and I must keep my head clear.’
It was the same response he always gave to the idea of analgesics, and was the changeless resolve of a very determined man.
Mr Anderson spent longer each day in his broom cupboard. The pattern became regular, and how he found the strength to work as he did we never knew. His nights were not restful because of the pain, but he always rose at 6 a.m., bathed and shaved and dressed, although the effort required was enormous. He went to his office at about 7 a.m. and returned to the ward at two, looking half dead with exhaustion. We did not know what he was doing, but something seemed to have taken possession of him, and was driving him on.
I told the Chief about our conversation, and he was not really surprised. He talked with Mr Anderson, who was nearing the sixth week of his treatment, and they agreed that he should then take a holiday and return to the Marie Curie for check-ups two or three months later.
The day of his discharge was quite emotional. We had all grown to respect him so much that his rather aloof ways did not matter; they were just part of his character. He tied up the loose ends in his office and asked Matron if it could be left undisturbed, because he might need it later, to which request she readily agreed. We knew that he was going walking and climbing, but from the way he looked, that would require a miracle. He was so painfully thin, his legs and shoulders had no muscle at all, and his face looked haggard.
‘Do look after yourself, you might fall or something,’ a nurse said as he was leaving. He gave her a roguish grin, irresistible to women.
‘Now what have I got to lose?’ he replied. ‘Tell me that.’
She couldn’t reply, but said: ‘We are going to miss you.’
‘You’re a sweet girl. You all are, and I have grown very fond of you.’
He kissed a couple of the girls, and then turned to Matron. He hesitated for a fraction of a second – the navy blue uniform, the silver buckle, the high collar, the white cuffs, the frilly cap, were a touch intimidating for any man. Would he, wouldn’t he? He did. Cheered on by the nurses he kissed Matron, who blushed as pink as a peony.
Mr Anderson returned looking a lot better. He was tanned from the fresh air and sunshine, and although he had not noticeably gained weight, his muscles were stronger. He told us that he had started his walking with a paltry five miles a day, which was exhausting, but day by day he improved on this until he could manage twenty miles without too much fatigue.
‘And what about the rough canoeing?’ I enquired.
‘That also. It was a great help, having lost so much weight. You need to be light to shoot the rapids of the Wye.’
‘Wasn’t it dangerous?’ asked a nurse.
Yes, but that’s half the fun. And if you’ve got nothing to lose but a life that’s on borrowed time, you can do anything. I took far more risks than anyone else. It was great.’
He laughed in a devil-may-care way. ‘Now I’ve got to get back to work. There is a good deal to be completed still.’
Blood and serum tests were taken, and a series of X-rays. The Chief was so impressed by the apparent reduction in the size of the growth, and especially in the improvement in the patient’s general health, that he thought we could risk a further series of radium treatments. Normally, one has to limit the radiation because the effects on the body are so debilitating.