More than anything else a dying person needs to have someone with them. This used to be recognised in hospitals, and when I trained, no one ever died alone. However busy the wards, or however short of staff, a nurse was always assigned to sit with a dying person to hold their hand, stroke their forehead, whisper a few words. Peace and quietness, even reverence for the dying, were expected and assured.
I disagree wholly with the notion that there is no point in staying with an unconscious patient because he or she does not know you are there. I am perfectly certain, through years of experience and observation, that unconsciousness, as we define it, is not a state of unknowing. Rather, it is a state of knowing and understanding on a different level that is beyond our immediate experience.
Peggy was aware of this and, in ways that neither she nor anyone could explain, she entered into Frank’s mental state in the last few weeks and days of his life.
One day, as I was leaving, she said, “It won’t be long now. I shall be glad for us both when it’s all over.” She did not look unhappy. In fact she looked as serene and as confident as ever. But all pretence was gone.
I asked her, “How long have you known that he was going to die?”
“How long? Well, I can’t say exactly. A long time, anyway. From the time the doctor first said he should go into hospital for tests, I suppose.”
“So you’ve known all the time, and never let on?”
She did not reply, but stood on the doorstep, smiling.
“How did you guess?” I asked, intrigued.
“It wasn’t a question of guessing. I just knew, quite suddenly, as though someone had told me. I’ve had so much happiness in life with Frank, more happiness than anyone can expect. We’re more than brother and sister, more than husband and wife. How could I fail to know that he was going to die?”
She smiled, and waved to a neighbour who was passing, and replied to her enquiry, “Yes, he’s getting on nicely, thank you; he’ll be up and about soon, you’ll see.”
The last evening of his life came surprisingly quickly. Rash is the professional who will predict death. The young can die while your back is turned, yet the old and frail, who you think will die in the night, live on for weeks.
The late summer evening was beautiful as I approached the prefab estate. Long shafts of sunlight glimmered on the river and made the little buildings glow like pink marble.
Peggy greeted me at the door with the words, “He’s changed, nurse. About an hour ago he just changed. Something’s different.”
She was right. A deep motionless stupor had come over Frank. He did not appear to be in any discomfort or distress. In fact I have never in all my experience known anyone to die in a state of distress. “Death agony” is a common idea, but I have never seen it.
Frank’s breathing had changed. It was very slow and deep. I counted the breaths and there were only six per minute. He was slightly blue around the mouth, nose and ears. His eyes were open but unseeing. Peggy took his hand and grasped it firmly. She stroked his forehead with her other hand and leaned over him whispering, “I’m here, Frank. It’s all right, my love, I’m here.”
He seemed quite unconscious, but I saw his hand move as he gripped hers more firmly. What is this mystery we call the unconscious? I felt sure he knew she was there. Perhaps he could even hear her and understand her words. I felt his nose, his ears, his feet. They were quite cold. I felt his pulse; it was only twenty beats per minute. I whispered, “I’ll stay here quietly. I’ll sit over by the window.”
She nodded. I sat down to contemplate them both. She was completely calm and relaxed. She did not look unhappy or even anxious. Every nerve of her concentration was focused on the dying man. She was with him in death as she had been in life.
His breathing rate dropped to four per minute and the hand holding Peggy’s fell limp. I felt his pulse again, but could not locate it, and when I did it was a feeble eight or ten beats per minute. I sat down again, and Peggy continued to stroke his face and his hands. The clock ticked steadily, and quarter of an hour elapsed. Frank gave a deep, deep breath, which made a rasping sound as it passed through the collapsed throat muscles. A little fluid oozed out of his mouth and trickled down the pillow. His eyes were still open, but a white film was collecting over them.
Peggy whispered, “I think he’s gone.”
“I think so. But wait quietly for a minute.”
She sat unmoving by the inert body for about two minutes. Then, to our surprise, he took another huge, rasping breath. Would there be another? We waited for a full five minutes, but he did not breathe again. There was no pulse or heartbeat.
Spontaneously Peggy said, “Into Thy hands, Oh Lord, I commend his spirit.” Then she recited the Lord’s Prayer, in which I joined her.
Together we straightened and laid out the dead man’s body. We closed his eyes. We could not keep his mouth shut so I tied the chin with a bandage to keep the lower jaw in place. We could take it off when rigor mortis had set in. We had to change the bed linen completely, because at the time of dying his bowels and bladder had emptied.
We washed him all over, and I said, “We will leave him in a shirt, put on back to front. The undertakers will bring a shroud.”
She replied, “I’ve got one. I got it several weeks ago. I couldn’t have left him indecent could I?”
She fetched a chair and climbed up to a small cupboard high above the gas meter. There was a box in it from which she extracted a shroud. We put it on him. I asked her if she would like me to contact the undertakers. She thanked me, and said she would be grateful. “But tell them not to come till tomorrow morning, will you, please?”
That was perfectly normal. In those days the deceased often lay in the house for a day or two as a mark of respect for the dead. Family and neighbours would come in to “pay their respects”.
Throughout, Peggy was completely calm and tranquil. Her face and voice betrayed no sign of sorrow or loss. In fact I would have said she had an almost ethereal quality about her. I left her with a feeling of admiration.
At the door, she said, “If you see anyone, any neighbours, don’t tell them Frank’s died, will you? I’ll tell them tomorrow. I want to tell them myself.”
“Of course not,” I reassured her, although I would have to report it at Nonnatus House.
Her anxiety passed.
“That’s all right. It’s just the neighbours, I don’t want them to know yet. They can come tomorrow to pay their respects. But not tonight.”
We smiled at each other, and I squeezed her hand. No one would come barging in tonight, not the undertakers, nor the neighbours, nor anyone. She could be alone with her thoughts and her memories. Would she like a couple of sleeping tablets?
She thought for a second. Yes, that would be a very good idea. I opened my bag and handed her a couple of Soneryl.
Peggy shut and locked the door when I left. She sat for many hours on the edge of the bed, unable to take her eyes off Frank, their life together tumbling through her mind. Her happiness had been perfect and complete, she had always known that, and now she was not going to be parted from him.
She pulled up a chair and climbed again to the cupboard above the gas meter and took out two more boxes, one very small, the other larger. She undressed and brushed her hair. She opened the larger of the two boxes and took out a white shroud, which she put on, tying the ribbons carefully at the back. She opened the small box and tipped out fifteen grains of morphine, to which she added the two Soneryl. She took a bottle of brandy and a glass from the bedside cabinet, and swallowed all the tablets in two or three gulps. She continued drinking brandy until she could no longer sit up.