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Six
Jane had now been moved into the farthest corner
of the ward
where the nurses seldom passed. They would come to administer
the painkillers, but only after all the other patients had been
taken care of, even if Jane had been ready and crying for a pill
long before. They had strict orders that the pills were to be given
every two or three hours, so, to be on the safe side, they made
it every three. Those who had once
joked with her no longer
stopped by her bed. They were too busy with other patients for
whom they could still do something.
One young specialist used to visit her at the end
of the day
on his way home. He would ask how she was, would talk sym-
pathetically about her latest symptoms, but it was more a friendly
chat than a medical visit. Now even he had stopped coming.
When Jane did manage to talk to a doctor, she tried to question
him about her chances, but rarely received any answers. Although
no one said anything, Jane was getting the message. The signs
meant that she was reaching the end of the road. This certainly
wasn't what the doctors wanted to convey to her, but she picked
it up from the way they spoke, the way they appeared to have
given up. "What's the point of my staying here," she asked, "if
they can't do anything for me?"
There were other signals from within her own body
that
seemed to confirm it. She had been resting for a long time, re-
ceiving the appropriate medication and treatment, but she was
getting no better. On the contrary, she was growing steadily
worse. She could observe her own decline from day to day. She
was eating very little. When a doctor felt her stomach, there was
a hard ball under his fingers. It was "probably" constipation, he
said. Jane was alert enough to pick up the "probably."
If it
wasn't constipation, it might be another tumour, and she knew
what that meant.
That doctor now avoided her. We suspected he was
avoiding
us, too, so we tried to make an appointment with him. We were
told he was away. When would he be back? He wasn't expected
until after visiting hours, "by which time you will be gone."
"No, we won't," said Victor firmly. "We'll wait for
him."
We sat outside the ward to make sure he wouldn't slip past
us. He arrived late in the evening, pale and tired, and sat down
on the bench beside us. He had had to perform several operations,
he said, and then to give a lecture. He seemed to be trying to
convince us that he hadn't been avoiding us, and we believed him.
Perhaps nobody was ignoring Jane, either. Worry made the
imagination do strange things.
He talked to us about the difficulties of the illness
and about
pain. He was obviously making a real effort to meet us on a human
rather than a purely professional level. As he spoke about Jane's
illness, he was really telling us how little the medical profession
knew about melanoma. The specialists had previously tried to
give the impression they knew what they were doing, that they
were in command of the situation. But this doctor didn't pretend
to be a medical superman. He had no easy answers for us, no
reassurance, perhaps not even any hope. In the past our talks
with him had been strictly professional, businesslike, but now he
spoke of feelings. He told us he understood how we felt because
he had a sister suffering from an incurable disease. When he went
to see her in the institution where she was being looked after,
each journey was one of despair, each visit a nightmare. He, too,
asked himself whether nothing more could be done to ease her
suffering. "Believe me," he said, "I know how you feel about
these bloody doctors."
Somehow what he was telling us about his sister got
entangled
with what he was saying about Jane, how everything possible had
been done for her, too. She had had the most skilled surgery, the
most advanced treatment, the best care. It was almost as if he
were trying to justify himself. He spoke of Jane as of an old
friend; "the dear girl," he kept saying. We asked whether she
ought to be told now that she was dying. He rejected the idea
as unthinkable. "No, no, she isn't dying—we have no reason to
say so. She's so young—she mustn't . . ."
He was very emotional and very tired, but he tried
hard to
help us. Yet for all his denials, the impression we got was that
Jane was actually much worse, that he felt he had failed and was
guilty and distressed. We tried to reassure him, to tell him that
the hospital had done all it could, that he personally had been
most helpful, kind and supportive, although we hadn't in fact
always felt so friendly towards him. He must have realised that
he left us with a gloomy conclusion.
Next day he waved to us cheerily, rested, a new man.
"She's a
bit better today," he said. "She'll have the laugh on us yet, you'll
see. I've got a feeling she'll prove us all wrong and still be around
half a dozen years from now."
The effect of this remark on Rosemary was the opposite
of
what he had intended. Six more years of this, she thought
bitterly.
At last in May the tenants vacated Dairy Cottage.
We packed
our belongings with a sense of relief. We got up very early and
drove off before breakfast, through almost empty streets, out of
London, down the motorway to the country.
The world seemed especially beautiful. We never lost
that
inner anguish that had been with us so long, but this day it seemed
to heighten our awareness of beauty. The house and garden were
full of peace. We had come home after a long, hard journey.
But everywhere there were memories of Jane as she had been
and never would be again. The nightmare of the past four months
had travelled with us. Jane, who should have been there too, eat-
ing breakfast with us on the terrace, was imprisoned in a hospital
bed. Nothing had changed.
If only she could escape from the hospital and come
home
again, then what little remained of her life would be more toler-
able. Surely we would all be able to talk, understand each other,
clear up the difficulties and differences of the past weeks?
Two days later the blow fell. Victor phoned Rosemary
from
the hospital. "They've got the latest test result," he said. His
voice was heavy, flat. "It's in the bone marrow."
This was the death sentence. Finally and absolutely.
Melanoma
cells in the bone marrow meant that there was no hope, no sense
even in continuing treatments. There was nothing to be done.
Nothing. Jane would have to be told.
"You don't tell a twenty-five-year-old she's going
to die," one
of the doctors admonished Victor. "It would make her life miser-
able to the end, and you don't know how long that will be."
"Believe me," another said, "I've had a lot of these youngsters
through my hands. I know how they react." But mightn't Jane
be different? Did we want to take the risk? Once she knew,
there would be no way to undo the telling. The unhappiness, the
non-communication, the rejection—all could get much worse.
"Would we really be able to cope? Did we even want to try?
The old solution was offered again: take her away on holiday
and see how things went. "Give her a good time." In the mean-
time, they could speed up radiation to ease the pain before she
left the hospital. Then, if there was a crisis, they would send an
ambulance at a moment's notice and bring her back. She would
have all the drugs necessary for as long as she needed them. "She
won't know anything . . ."
Not only were the experts prepared to assume the
moral respon-
sibility for not telling Jane, they were urging her parents to avoid
making the decision, too. "If she does want to be told, if she can
take it, we'll know. We can decide then."
"That's a decision we will make." Victor suddenly
asserted
himself. But even as he spoke, he knew he had been persuaded.
Now that the time had come, we were glad to shift the respon-
sibility. The doctors' advice seemed intended to ease our own
burden during the period that remained. We could easily imagine
how Jane's anguish and resentment, her anger and bitterness,
could poison our lives and what remained of her own. If we
followed the experts, she might have as peaceful and quiet an
end as possible. If we didn't . . . Victor in particular was haunted
by the image of an incurable invalid, demanding constant atten-
tion, blackmailing us emotionally with the knowledge that death
was just around the corner. No, better that Jane should not know.
But when we called Richard in Boston, he insisted Jane should
be told at once that she was going to die. He would fly over
within a few days. He would be straight with his sister. "If you
can't tell her," he said, "I will." She had said that if Richard
returned, she'd know she was dying. How were we to let her
know he was coming? Neither of us could face it.
At the hospital Jane was informed she could go home
for the
weekend. This was her first chance to see Dairy Cottage since her
return to England, but she told us it wasn't worth the pain of
the journey. We wondered if she didn't want to be with us.
Then she relented. She told James she might go home the fol-
lowing weekend. To everyone's surprise, she took the news of
Richard's impending arrival quite calmly. She spoke of how good
it would be to see him again. She appeared to accept that he was
coming now because this was a convenient time for him to see her.
James brought Hugh, a mutual friend whose wife had recently
died of cancer, to see us. He hoped that hearing Hugh talk of
his own experience might be helpful. Hugh stayed for supper in
the garden. It was a beautiful evening, with the last rays of the
sun golden on the hill beyond the pond. The air was cold and
quiet, disturbed only by our voices.
"I want Jane to come home," said Rosemary. "I think
this
would be a far better place to die than in the hospital ward."
"No doubt about it," Hugh agreed. "She should be
at home.
That's the only place to be."
"We've been told that young people ought to be in
the hospital
because of symptoms that might be difficult to treat, because there
may be sudden crises, or just because it's more distressing when
someone so young dies."
Hugh grunted. "Nonsense. They said all those things
to me,
but I brought Catherine home."
"But how did you manage? YOU were working. . ."
"I brought nurses in," he said simply. "I used to go out and get
what they needed, pads for the bed and things like that. Yes. It
was the only place for her to be. We shared a bed until the day
she died."
Richard had brought a surprise with him—Arloc, his
fiancee's
son. At first Rosemary wondered whether Jane's dying was some-
thing an eleven-year-old should experience. But Arloc had
watched his grandfather die of cancer only two years before, and
the boy had coped remarkably unharmed despite the loss of
someone he loved. Richard, at odds with his parents over the question
of whether Jane should be told, needed the emotional support of his new
family. Joan couldn't come, but he and Arloc were very close. He thought
of Arloc as a son, and was sure it would be good for Jane to meet him.
He wanted Jane to know all
about his new family, in the hope that she would get a sense ot
continuity, a feeling that children were growing up to take
the place of those who left. She had a great sense of nature's
cycles and this might console her.
Rosemary had feared that Jane might break down when
Richard appeared, but as he walked into the ward, her face lit up
with delight. Then she turned to Arloc. "Who are you
you?" a little puzzled, only to add with a quick smile, "Of course,
how silly of me . . . Who else could you be but Arloc?" Arloc
smiled back at her. "Good guess," he said. It was the beginning
of a new friendship.
Jane looked better than Richard had expected, but
he found the meeting very painful,"devastating'." as he described it later.
He could see that she was less optimistic, and she plied him with
questions which, if left to himself, he would have answered
frankly. But he obeyed his parents' wishes. He didn't lie or give
her false hope, though perhaps that was what she wanted to hear
from him; instead, he hedged. He had come to help her when
she needed help most, and yet he had to play our game of decep-
tion, unable to share his feelings with her. He found it very
difficult.
In preparing Dairy Cottage for Jane we all tried
to forget the
family tensions. We were glad to be back with our family doctor
again. Dr. Sullivan told us he would do everything possible to
help us nurse Jane at home. The district health visitor, who was
responsible for organising home assistance as part of the National
Health Service, came to see us.
We sat on the terrace, discussing, first, the physical
arrangements
for Jane's return to Dairy Cottage and, then, the family obsession—
what Jane should be told. We recounted our differences to the
health visitor, a slight, dark-haired woman. She listened carefully
to each of us. She agreed with Victor and Rosemary that nobody
should force the bad news on Jane. She also concurred with
Richard that Jane ought to be told—"if she wants to know."
Nothing was decided, but we felt much better for having talked
in the presence of a sympathetic, neutral observer. It was impor-
tant to settle our differences before Jane came home.
Richard believed strongly that Jane's condition would
soon
deteriorate so much his mother wouldn't be able to look after
her. Rosemary felt equally strongly that home was the only place
for her daughter. She wanted no more hospitals, no more strangers
in charge. She could remember Jane's weak whisper on one of
the bad days: "Mum, don't let me die here, don't let me die in
the hospital."
"Can you imagine what it could mean to have Jane
here?"
Richard asked. In blunt detail, he described the last stages of
brain cancer in Joan's father. "Mum, please," he implored Rose-
mary, "you must be realistic. Jane will get much worse. You must
know that. She'll need expert care round the clock. You'll be
exhausted, drained, just when you need all your strength."
Rosemary's face showed no emotion; it was as
if she had hardly
heard him. Dairy Cottage, she insisted, had always been a good
place to live. It would also be a good place to die. As for looking
after her, nurses could be hired if necessary. She asked the health
visitor for her opinion: "Don't you agree that home is the best
place?"
Philippa—we were on first-name terms by then—agreed
there
was no better place than home, but stressed that some forms of
cancer could take a very difficult course. The National Health
Service would provide some free nursing help, and the Marie
Curie Society could assign full-time private nurses, day and night,
if Jane needed them. They should also bear in mind that if nursing
Jane became too difficult, a hospice might be the answer.
A hospice. Rosemary had made enquiries about St. Christopher's
Hospice, ages ago, it seemed now, but Jane wasn't interested and
they did nothing further about it. To Victor, who had been in
Washington at the time, this was a new idea. Philippa had to ex-
plain that a hospice was not a hospital, but a small unit designed
for treatment of the terminally ill, mainly cancer patients. How
could it help Jane when hospitals couldn't? Philippa told him that
patients could go in and out, often staying for a few days, just
the time required to get their pain under control. If Jane's pain
grew worse—and there was every reason to expect that it would—
she could have a short stay in a hospice and then come home
again. The staff were good people, she would be well cared for.
"It is not a house of death," Philippa added. There was a hospice
near Oxford, an hour's drive from Dairy Cottage. She suggested
we should look at it.
We felt there was still plenty of time; it was hard
to believe a
hospice could be that much different from a hospital. As Philippa
got up to go, she said: "Do remember now, you're not facing
this alone any more. We'll help you all we can." She left her
phone number and promised to visit regularly once a week, more
often if necessary.
We continued to argue about whether to tell Jane,
but at least
she had helped us to be more open with each other. Richard was
afraid Jane would begin to distrust him as she had come to distrust
us. Perhaps this was already happening. Soon, he feared, she might
decide there was nobody she could trust, and then she would feel
completely alone. We were starting to bend under Richard's
unrelenting pressure, but were not yet persuaded. We conceded
only that Jane should be told if she made it clear that that was
what she wanted. But when Richard said, "All right, let me ask
her," we wouldn't agree. What else could she say to that but
Yes? We managed to discuss everything concerning Jane's future
quite dispassionately except this ("They alternate between being
very sane and very out of it," Richard wrote to Joan), and yet
a decision would have to be made soon because Jane was coming
home at the weekend.
"Let's put the problem to Dr. Sullivan," Victor finally
sug-
gested. Rosemary liked the idea. They knew Richard admired
their family doctor's common sense. And he immediately agreed,
perhaps convinced that Sullivan would be on his side.
We made an appointment. When the time came, we all went
into the little office together to lay our views before him as if
he were some kind of arbitrator in a dispute. Richard was direct,
uncompromising. "She should be told the whole truth," he in-
sisted. Victor was equally uncompromising: "We can't possibly
let her know now. She couldn't take it." Rosemary also argued
that they should wait. "She rejects any effort at real communica-
tion. How can we tell her she's dying?"
"She lets me talk to her," Richard countered. "I
can tell her."
"Yes," Victor said angrily, "and then you'll go off
back to
America in a week or two and leave us. You won't be able to talk
to her then, and she won't be talking to us. What will her life
be like? You were describing the physical difficulties. What about
the psychological ones?"
"The psychological difficulties are there precisely
because you
won't tell her," Richard retorted. "You said yourself that she
doesn't trust you both now. That's because she can see what's
going on, she picks up the signals. Jane is no dummy. She can
understand that you don't really want to break the news, that
you would find it difficult to face, so even when you offer to
talk to her, she says No."
Dr. Sullivan had been listening with great patience,
letting
everyone argue without interruption. Now he quietly took
charge.
"It may be that she reacts differently to you for
the reasons
you give, Richard. But it may also be that her reactions change.
Perhaps she really didn't want to know at the time your parents
offered to tell her."
"Maybe," Richard agreed reluctantly. "But then wouldn't
that
mean she wants the truth now, to judge from all the signs she's
been giving me in her questions?"
"You may well be right," Dr. Sullivan said. "We'll
be able
to find that out when she comes home for good. She'll be more
relaxed; it should be easier to talk to her. And the radiation ought
to have lessened her pain by then."
Rosemary feared that if Jane knew she was dying,
she might
refuse radiation. We still hoped this treatment would ease the
pain and at least delay the spread of the cancer. But we also
knew Jane was afraid the radiation would affect her looks, cause
her hair to fall out.
"The kind of radiation she's being given shouldn't
have that
effect," Dr. Sullivan explained. "But if she does refuse it, it would
mean a lot of pain in the weeks to come, unnecessary pain."
"Jane has been asking me what the radiation is for,
what it will
do to her. What should I tell her?" Richard asked.
"Perhaps you should leave it to me," said Dr. Sullivan
calmly.
"I can explain to her, and that'll let you off the
hook."
"What do you propose to tell her?"
"That radiation does work well, but also that nobody
can be
sure it will clear it up. And that's the truth. So she won't be
too disappointed if she gets no better."
"And if she gets worse?" Richard persisted.
"I'll warn her explicitly that the cancer may crop
up again.
Then, after two or three weeks, if the pain is still there, I can tell
her this means the radiation didn't work. There'11 be no lies,
Richard."
"And you'll tell her she's dying?"
"Certainly, if it's clear that she wants me to."
"That's agreed, then, doctor," Victor said quickly.
"Richard
will be back in the States by then. He can trust you, even if he
thinks we won't have the guts to go through with it."
It was a peace offering; but Richard wasn't so easily reassured.
"What are we going to tell her about the bone marrow?"
he
demanded. "That's something else she keeps asking me. I think
she should be told the result of the test."
"The hospital said No," Victor objected. "If we tell
her,
there'll be hell to pay when she goes back to the hospital. They'll
say we're interfering with the treatment. They'll wash their hands
of her."
Dr. Sullivan assured Victor he was wrong about that.
But he
agreed with Richard that Jane should be told the result of the
bone marrow test. He would do this himself, he promised.
"You will?"
"I don't think you ought to doubt Dr. Sullivan's
word," Rose-
mary said, embarrassed.
"Well, I think I ought to be there when you talk
to her."
"Richard, really!" Victor cried angrily.
"That's quite all right," Dr. Sullivan said gently.
"There's no
reason why Richard shouldn't be there."
It was small comfort for Richard, but better than
nothing.
He felt he had let Jane down. He wrote to Joan: "I feel such a
failure for not pushing more successfully that Jane should be
told everything."
Meanwhile, Jane's own questions at the hospital were
becom-
ing more persistent. When she asked a doctor about the result of
the bone marrow test, he assured her there was no evidence of
cancer in the bone. That was what he'd agreed with her parents
to say. He told her playfully, "You already know too much,
Jane." To Jane, this meant that she couldn't trust him, that he
must be keeping something" from her. and she could guess what
"The doctor says Jane is withdrawing," Richard told
his mother
when he came home from visiting her in London. And he added
bitterly: "I wonder why."
Rosemary didn't reply. She wanted no more arguments.
She
was putting all her faith now in getting Jane home to Dairy
Cottage.
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