Their visit lasted a slow, agonizing thirty minutes. After that it was clear that all he wanted to do was sleep.
Out in the car park, darkness had already descended and the sleet had turned to rain. They had to pay three pounds to get out through the automatic barrier.
‘I can remember when parking in hospital car parks was free,’ was all that Gran said. It was all that any of them said.
*
Rachel and her mother decided to spend Christmas in Beverley. Gran did not want to come to Leeds: she wanted to stay as near to the hospice as possible, and to visit Grandad every day, however little pleasure he seemed to derive from it. Christmas day was quiet, just the three of them. Rachel’s brother Nick was abroad somewhere: Copenhagen, they thought, with his current girlfriend, who was apparently Danish. On Christmas afternoon they visited Grandad in his ward and took him a box of chocolates and more fruit. He said that he didn’t want either. They gave the chocolates to the ward sister, who put them with two other, similar boxes beneath the Christmas tree in the entrance hall. The lights on the tree winked on and off fitfully, and the nurse behind the reception desk had brought in a CD player which played a party disc of carols and Christmas pop songs from a time before Rachel was born. The place had never seemed more cheerless.
This time, being in her grandparents’ house was proving a strange experience for Rachel. She could not believe how small it seemed. At the Gunns’ house in Turngreet Road, she had grown accustomed to high ceilings and airy, spacious rooms. Now she felt like Gulliver returning from Brobdingnag and trying to get used to normal human proportions again. The days seemed absurdly short. Darkness would have enveloped the garden by three thirty and at that point, having paid their daily visit to the hospice, they would draw the curtains, have a quick tea of eggs or beans or sardines on toast, then try to find something distracting to watch on the television. The Gunns, Rachel believed, were in the Caribbean somewhere. She imagined Grace and Sophia splashing and laughing in a turquoise lagoon while Madiana lay on a sunbed beneath the shade of a coconut tree, sipping cocktails.
She sent regular texts to Jamie. He was with his parents in Somerset. Livia had gone back to Bucharest. The days passed slowly, the hours dragged. They allowed New Year’s Eve to pass without notice, let alone celebration.
It took more than two weeks to arrange a meeting with her grandfather’s oncologist. Finally she was able to see him on the morning of the first Monday of January. He was a brusque, not to say inscrutable, consultant in his early forties: he received her not unkindly, but without letting her feel that the meeting was anything other than an unpleasant duty. He knew all about the drug she was talking about, and the first thing he said to her was:
‘Of course you know that cetuximab is an extremely expensive therapy.’
For some reason this aspect of the question had not occurred to Rachel.
‘Is it not available on the NHS, then?’
‘In certain circumstances it is, yes. But we’d have to apply for it through the Cancer Drugs Fund.’
‘Can you do that?’
‘I’m not sure I could make out a very strong case in your grandfather’s circumstances.’
‘Well, how much money are we talking about?’
The doctor consulted some notes on his desk. ‘Cetuximab is reckoned to give an ICER of £121,367 per QALY gained.’
‘Can you repeat that in English, please?’ Rachel said, after a shocked pause.
‘An ICER,’ said the doctor, ‘is the incremental cost-effectiveness ratio of a therapy. A QALY is a quality-adjusted life-year. A service like the NHS has to keep a very close eye on its costs. To put it bluntly, not every year of human life is valued as highly as every other. You have to take quality of life into account. Whatever therapy is given to him, I’m afraid your grandfather will have a low quality of life from now on.’
‘How do you work that out?’ asked Rachel.
‘Well, he’ll be bedridden, for instance.’
‘So?’
‘And he’s old.’
‘So’s my friend. The lady I know who’s taking the drug. What difference does that make?’
‘Do you know this person well?’
‘No,’ said Rachel, and then felt she had to admit: ‘I don’t know her at all, in fact. I know the person who walks her dog for her.’
‘Ah. Is she quite well-off, by any chance?’
‘Yes, she is. So what?’
‘Well, it’s possible that she paid for the treatment herself, that’s all.’ He did his best to give her an encouraging smile. ‘Look, I’ll put in the application. Of course, it will take a few weeks. These things always do. But we’ll see what gives.’
11
When she returned to Chelsea in the New Year, Rachel found that the house in Turngreet Road was much changed. Work on the basement conversion had been resumed, and the site both to the front and rear of the house was full of noise and activity.
Noise in particular. The piling rig in what used to be the back garden was working again, and all day long Rachel had to listen to its ceaseless, reverberant boom-boom-boom. She could even feel the ground shake with every impact. Also, from the window of her bedroom she now had a view of the pit, which lay open to the world (or at least to the neighbouring houses) like an inflamed, gaping wound in the landscape. It was, to her eyes, unthinkably deep. As well as a number of ladders fixed to its sides, there was an industrial hoist with a steel cage to take men and equipment down into the abyss and back up again. Miniature diggers had been lowered into the pit as well, and were presumably beavering away down there, with the spoil being carried back up along a huge conveyor, then along the belt through the front garden and out into the skips waiting in the street.
From the hoardings at the front of the house, Rachel learned that the building contractor had changed: Grierson Basements had been replaced by Nation Lloyd Sunken Interiors. The crew was now Romanian instead of Polish. The site manager, Dumitru, was a taciturn figure who nodded politely at Rachel whenever their paths crossed but otherwise had nothing to say to her. Like everybody else involved with the project, he wore a permanently anxious expression. Nobody, however, looked more anxious than the new project manager, Tony Blake, who spent most of every day locked up in his temporary site office, poring over the plans while still wearing his hard hat, occasionally emerging to have a nervous, conspiratorial word with Dumitru or to ring the front door bell in the hope of a meeting with Madiana to clarify some new element in her ever-changing, ever-expanding plans.
Despite the stress and inconvenience the works were causing her and everyone in the vicinity, Rachel could not help feeling sorry for Mr Blake. On the rare occasions he emerged from his office, he always looked so harassed, so terrified: she was constantly afraid that he was on the verge of having a nervous breakdown. One morning when she came back from the shops she found him at the front of the house, pacing up and down between the hoarding and the front steps and visibly shaking.
‘Would you like me to get you a cup of tea, Mr Blake?’ she asked him.
He took his hands away from his ears, which they had been covering in an attempt to block out the relentless noise of the piledriver.