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Ten
The sound of the breakfast trolley woke Victor, who
saw a
face peering in through the window in the door. It was one of
the kitchen maids checking if Jane was ready for breakfast. Jane
was still sleeping and Victor heard the trolley move on. He was
relieved she hadn't been disturbed. She needed the rest so badly.
Even in her sleep, the pain lines on each side of her mouth, where
in happier days there might have been a dimple, were deeply
etched. Her face had set in an expression which conveyed the
presence of pain through sharp creases, so unlike the natural
wrinkles of old age.
As he watched, Jane stirred without opening her eyes.
He
covered her hand with his. Her hand moved slightly in reply. He
said quietly, "It's eight o'clock, Jane, and it's a beautiful morning.
The sun's streaming down. Shall I draw the curtains?" He waited
for her to answer.
"No." Her voice was faint but distinct. "The light
will hurt
my eyes. I want to keep them shut."
"You can do that if I draw the curtains just a little."
He wanted
her to face the new day, to stay in touch with reality.
"I don't want to open my eyes," she said with sudden
vehe-
mence.
Another face peered in and it was Adela. He gestured
for her
to come in.
"How did you sleep, all right?" she asked cheerfully.
He was about to reply when Jane suddenly spoke up, still with-
out opening her eyes: "It's you, Adela, isn't it? I know your
voice."
Adela beamed. "Aren't you clever! How did you manage
it
with your eyes shut? "
"It's your accent," Jane murmured. "Is it Greek?"
"No, but you're not far off. Would you like to try again, dear?"
But Jane was in no mood to play games. "I don't want to think.
I'm so tired." Then she added more warmly: "Could you stay
with me? My father has to go now."
That surprised Victor. He was ready to interrupt
when Adela
said quickly: "I must say hello to the others—it won't take a jiffy
—then I can stay with you for a while."
She signalled to Victor to come out with her. She
whispered
to him, "I think you could help Jane best now by leaving her
alone for a bit." She added: "You've been with her all this time,
and she wants a rest from you."
He looked hurt. "You need a rest from her too," she
said more
gently. "It's only natural." Victor nodded stiffly and walked away.
When Adela returned to Jane's room, she soon learned what
was worrying her. Jane first wanted to be sure Victor had gone;
then she burst out: "Oh, Adela, I'm so frightened! I can't open
rnv eves. rnv evelide are so heavy. I can't see anything. I couldn't
tell him. What is it? I can't see! I can't see!"
Adela touched her hand reassuringly. "It's all right,
dear. It';
nothing to worry about, only the effect of all the drugs you've
had to help your pain. That's why you feel so drowsy, so heavy
and so do your eyes. It'll pass away soon; just rest now as much
as you can. If you feel like talking, talk—but don't worry about it.'
Adela's quiet confidence was catching, and as they chatted Jane
seemed to grow stronger. The effect of the drugs receded; her
eyelids no longer felt glued together. But the drowsiness made
her feel strange.
"Am I drunk, Adela?" No,
dear, you re as sober as I am. You were a little confused earlier,
but I think you're fine now.
"The pain's not as bad as it was, not now, but it'll
come back,
won't it? It always comes back worse than ever." The creases
in Jane's face deepened.
"It doesn't have to start up again," Adela said.
"People some-
times come here in terrible pain and in a few days we get them
better. Then they can go home and come back only if they need
something special—or a change from their relatives!"
"People go home from here?" Now Jane opened her eyes
wide,
trying to see Adela's expression. "You don't have to say things
like that to me. I know where I am. This is a hospice, people
come here to die. I'm not afraid of that . . . I don't think so . .
.
It's the pain I'm afraid of."
"People do go home from here," Adela said gently.
"I don't
know if you will, you may prefer to stay. There's no parking
meter by your bed. But your pain will ease, I'm sure of that. And
if you do go home, there'll always be a bed kept ready for you
here in case you need it."
Adela began sponging Jane's face with a touch as
gentle as a
feather. She managed to slip her nightgown off and wash her body
all over, but then decided the pain in her back was still too sharp
to risk putting the nightgown on again.
"I know how we can make it easier," she said. "Let's
put a
pyjama top on."
"
That would be even worse," Jane cried. "My arms
feel a bit
better today, but I couldn't move them enough to get into sleeves.
I just couldn't!"
"Of course not, dear. That's not what I meant," Adela
said
quickly. "We'll put it on back to front, so as not to hurt your
back. You hardly need move your arms, we'll slip one arm into
the sleeve in front of you, then the other . . ." She raised Jane's
arm a little to see how she would react.
It was still painful, but not as bad as yesterday.
"I suppose I can
do it if I have to," Jane said, "but what's the point of wearing
pyjamas or a nightgown? I like sleeping with nothing on, that's
how I sleep at home. I'd have liked to sleep naked at the hospital,
too, but I never dared ask." She looked up at Adela. "Do you
think they'd mind very much if I stayed like this? After all,
there's the sheet over me. Could you ask—maybe the sister in
charge?"
Adela didn't need to ask anyone's permission. "Of
course you
needn't wear your nightie," she said. "All that matters is that you
should feel comfortable."
"I know some people would be shocked by the sight
of a naked
body, but we're not like that in my family. I feel more natural
like this, so why pretend?"
"You don't have to pretend here, Jane."
Jane's eyes were wide open now. She was more ready to talk.
"Do I still have to guess where you come from?" she
asked.
"No, I'm quite willing to tell you if you don't want to work it
out for yourself."
Adela's jet-black hair was one clue. Jane still couldn't
see her
features very clearly. There was something Semitic about her
appearance, but she was sure Adela wasn't Jewish. She felt she
had enough Jewish blood herself to tell instinctively whether
someone else was a Jew.
"I thought you might be Greek because your accent
seemed
familiar. I was teaching in Greece a few months ago. Have I got
the right part of the world?"
"You're not too far off."
"The Mediterranean?"
"Warm. Try again."
"The Middle East, then."
"That's very warm."
"You're an Arab?"
Adela smiled warmly. "You see, you got it by yourself,
Jane.
Yes, I come from Syria. Did you teach geography?"
"No, but I've travelled quite a bit. I went on a
trip round the
world with Dad when I was fifteen, and that took in the Middle
East."
"Did you go to Syria?"
"No, but we stopped off in Israel. How do you feel
about
Israel?" Jane didn't want to lose her new friend. She'd known
Arabs who became hostile even at the mention of Israel.
"I've been back to Syria several times since the
war," Adela
answered carefully. "Did you know that there are Jews there,
and they get on quite well with the Syrians? It's the politicians
who make the trouble, not ordinary people."
Jane felt she could talk more freely. "I liked Israel
a lot. I went
back to work on a kibbutz the following summer. There's some-
thing about kibbutz life that makes you want to come back—1
even thought of living there for good. Then one day I saw some
Arabs being searched by the police. They took a man away. He
was scared, he didn't want to go with them. He argued, but it
was no good. They started pushing him towards the police car,
and he fell. It was a field road. He fell into the dust."
Adela and Jane talked more that morning, about Jews and
Arabs, about each other's families, about the lives they had led.
Soon they knew each other quite well. She had made a new friend,
Jane told Rosemary happily on her return a little later.
It had seemed a long night to Rosemary. She looked
anxiously
to see if there were any changes. The previous afternoon, Jane
hadn't been able to move her head on the pillow; now she could
turn it slowly towards her mother. But her eyes were large and
sluggish, and her face puffy from the drugs. Her lips moved slowly
and her voice was soft: "Am I dying, Mum?"
"Not just yet, darling," Rosemary replied calmly.
"It won't be
much longer, though. And we'll stay with you. It will be soon."
Rosemary wished she could be more specific and tell her exactly
when. She knew Jane wanted to get it over with before the decay
of her body overtook her mind.
"I hope it isn't long," Jane murmured. "I don't want
it to be
long."
"We know we have to lose you—what's important is
that you
should be as comfortable as you can until it happens. They are
determined to make it as easy as possible for you here."
"I feel so sleepy . . ." Her voice was hazy.
"We don't have to talk. Just rest. I'll be here if
you wake up
and need anything." Once more Rosemary felt torn by her con-
flicting emotions—wishing that death would come quickly, yet
still hoping for one of those miraculous reversals.
When Jane
was dead, there would be no hope left.
Rosemary looked around the room. Yesterday had been
too full
of anguish for casual inspections. It was a warm place. Yesterday
it had been a sick room; now it was a bedroom, a place of retreat
overlooking a garden. Jane couldn't see as far as the bird table
outside and the flowers planted in tubs on a terrace, nor to the
trees bordering the golf course. But the door to the terrace was
open, and she could experience the sounds and smells of June.
Perhaps soon she would feel well enough to have her bed pushed
through the wide door into the open air, so that she could watch
the birds and enjoy the flowers.
There was no sinister-looking chart clipped to the
bed. Nobody
had produced a plastic identification bracelet with the instruction
that it must be worn at all times. Jane had hated the bracelets,
always tearing them off as soon as she was out of the hospital door.
But here in the hospice she was already well known to the entire
staff.
She stirred and opened her eyes. "Mum, do they know
how ill
I am?" she asked anxiously. "Do they know I'm going to die?"
Rosemary stroked the hand she held. "Yes, they know. They
talk to us about it and about what they're doing to help you.
Everyone is very kind."
"And where do we go when we have to leave?" It was
another
reminder of her completely helpless state, of the total lack of
control over either her body or her future, and of the insecurity
she had come to feel in the months of wandering from hospital
to hospital.
"We don't have to leave here." Rosemary spoke slowly,
stress-
ing the words. "We can stay as long as we want. When they get
your pain under control, we can take you home, but only if that's
what you want. It'll be up to you to decide." Perhaps even the
thought of another journey would be too much for Jane. "We can
stay here as long as you wish," she repeated.
Jane seemed satisfied, and sank slowly back into
sleep. The room was quiet and peaceful until suddenly there came the sound
of
violent retching from the bedroom next door. It sounded like an
old man in considerable distress. Jane winced, but said nothing.
Footsteps hurried past, then came the voices of Dr. Murray and
one of the nurses. It was obviously an emergency. Dr. Murray
was due to visit Jane, but we heard him talk on and on next door.
It was one time when Jane wasn't irritated to be kept waiting.
He arrived at last in his shirt sleeves, without the usual white
coat. "May I come in?" Rosemary left him alone with Jane.
Half asleep, she looked vacantly at him, but as he sat down,
she smiled. He allowed time for her to adjust to his presence be-
fore he spoke.
"You may not remember I came to see you last night,
you were
in such pain. My name is David Murray." He enunciated slowly,
giving her a chance to remember.
"I know," Jane said quite clearly. "We met yesterday."
"How are things today?" he asked, as he took her
pulse. He
continued to hold her wrist lightly, gently, almost as if it were
a substitute for shaking hands.
"The pain isn't as bad as it was," Jane confirmed.
She felt like a human being again, with distinct thoughts and
varied sensations of her own. The overwhelming sense of pain
that had so recently blotted out her personality had subsided. But
she needed to restore her sense of self. Dr. Murray knew that
Jane's hospital experience had given her a fear of regimentation,
and he wanted to make it clear that she didn't have to be anxious
about that at the hospice. He spoke about getting to know her
as an individual. Everyone's reactions were so different, he said.
"We want to find out what suits you, Jane. Is there anything you
need?"
"I wish I had my tape recorder here."
"That's easy," he assured her. "There's a small portable
recorder
in the lounge for the patients. What type of music do you like?"
"These days I only seem to enjoy classical music—quiet
things.'
"I think we have some tapes for you." They talked
about the
composers they both liked. If Jane could discuss music, she must
be feeling much better than the day before. She needed strength
for the future. He had to help her handle whatever might happen
next. He usually tried to give his patients full awareness of what
was going on by explaining anything that puzzled them. He
wanted the patient to know that this doctor understood what
was happening, understood what he was talking about, and to
realise: "Now I don't have to worry any more."
Jane still had some problems apart from the pain—hallucinations
and drowsiness. Dr. Murray talked to her about them.
He explained that the drowsiness was caused by the
injections,
which were designed to ease her pain. But the pain was already
lessening, and he was thinking of changing the combination of
drugs. Her body had to have time to adjust. They were still ex-
perimenting to see what suited her best. Nor was the drowsiness
necessarily a bad sign. Her body required rest after all it had been
through.
"I don't find the hallucinations restful," Jane told
him.
"I did warn you about them."
"You said they'd stop after a time. But they frighten
me."
"They're caused by the drugs I'm giving you, and
should ease
off after a while. If not, there are one or two things I can try to
do about it. Just so long as we know they are hallucinations . . ."
"What else could they be?"
"This may be too fine a distinction for you, Jane,
but hallucina-
tions are one thing and misperceptions are another. You've been
having hallucinations, and that's why I know we can put things
right. We've studied the field quite thoroughly."
He watched her carefully. Could she take it all in?
"What is a hallucination, then?" she asked.
"I can give you the scientific definition, if you
really want it.'
"Please."
"A hallucination is an auditory, visual, or olfactory
experience
which arises independently of an external stimulus."
Jane smiled as if she had heard enough.
"How long will it be before I die?" She needed to
know how
much time was left for all that remained to be done. But he in
turn had to be sure that she was really ready for the truth.
"Before you came here, Dr. Sullivan told you it would
probably
be weeks rather than months?"
"Yes, but that's not really saying much, is it? It's
been going
on for weeks already. I don't want it to last too long."
"I don't think you have much further to go, Jane,"
David
Murray said softly. No other doctor had spoken to her with such
a matter-of-fact acceptance of death. "Quite how long it will be,
I just don't know—not at the moment. Let's control the pain first,
and then see how you are. Ask me again in a few days. I may be
able to give you a better idea."
"But I am going to die now, aren't I?" Jane seemed
to be seek-
ing reassurance. "In the hospital, they wouldn't tell me. Everyone
said something different, it didn't make sense."
"Yes, Jane, you are going to die. But we'll be here
to help you
through it. Nobody will lie to you here. You can ask anything
you want to know and we'll answer your questions. If we don't
know the answer, we'll try to find out. We're all well trained,
and we've had a good deal of experience."
She moved her hand slightly towards him—as far as
she could—
and he held it. "Everyone has been so good," she murmured, "but
you have helped me most, Dr. . . ." she waited for him to repeat
his name.
"Murray."
He made her feel secure. She could talk easily, freely,
to him
about what was happening to her, about life—and death. He was
la doctor she could fully trust, at last. She felt very close to him.
"I can't keep calling you Dr. Murray," she said.
"Call me David. Everyone else does."
Victor and Rosemary were also favourably impressed
with Dr.
Murray. We realised he was going to help Jane through the pro-
cess of dying, not try to cure her, as others had promised. There
had been so many doctors. At times Jane had seemed like the
baton in a relay race, passed from one hand to another as each
stage of her illness ended and a new phase began. Now at the
very end she had once again found a man she could trust, a fitting
successor to our family physician, Dr. Sullivan. And he reflected
the quality of the people who worked with him. In the hospice,
doctors, nurses and auxiliary helpers formed a close team. The
nurses had come to the hospice from different backgrounds, with
varying individual experiences, and they sometimes differed on
how a patient should be handled. The discussion between Pat and
Julia about drugs for Jane was an example of that. But they com-
bined their experiences and thrashed out their differences in a way
that served to strengthen their relationships with the patients and
with each other.
Jane was moved frequently in the bed so that her
joints
wouldn't stiffen and cause her more pain. She seemed more re-
laxed, and was soon lying on her side—a major achievement. Al-
ways before she had refused to change her position, afraid that
any move might increase her suffering. But Adela explained that
occasional changes in the way she was lying would protect her
from bedsores. Lying on her right side, she was no longer a pas-
sive, helpless patient staring into space. She had the confidence to
vary her position. She could also see a little better and was able
to
take part more in what was happening in her room.
Adela's attempts to get Jane to eat were typical
of her whole
approach. "When my children had no appetite we used to play
games together," she said, shaping the food with a spoon. "What
do you think that is meant to be? " She held up a moulded lump
of potato.
"I really can't be sure." Jane giggled slightly.
"It might be . .
a duck?"
"It is a duck," Adela said firmly. "One, two, three,
and it's in
your mouth!"
Jane swallowed it obediently.
They played a game that went easily from the make-believe
situation of a mother feeding her child to the reality of one adult
helping the other. Jane couldn't have played with her own mother,
and pretended to be a child again, but she could do it with a
comparative stranger like Adela. They had become so close that
when Adela went off duty for two days, we feared Jane would
be upset. Adela promised to try to call in, and Jane seemed con-
tent. That evening she started to go to sleep, then suddenly
her eyes
opened wide, focusing sharply on Rosemary. "Have you just
lost half your face? There's a gap below your nose."
Rosemary laughed uneasily and put her hand to her face. "No,
you're wrong. I can feel it's all there. It must be another halluci-
nation, Jane."
Sometimes the hallucinations worried her, but Dr.
Murray's
explanations helped her to come to terms with them. "David
said they should ease off after a while," she assured us.
Victor was sitting with her when, with a wicked smile, she
I informed him that his face was "quite funny." His ear was where
his nose should be, his eye was in his chin, and there was a gaping
hole in his forehead through which, she said, she could see the
sky. When he looked distressed, she consoled him. "It's rather
like a good Picasso," she said. The next time this happened, she
said she could only see half of his face, inordinately elongated.
"Very interesting." she chuckled. What. he asked, another
Picasso? No, she answered thoughtfully, rather like a Modigliani.
After seeing her again, David Murray was not worried by these
hallucinations. He told us: "She's much more alert now. I hear
she's chatting with Adela quite a lot. It's good to see them devel-
oping a personal relationship. The drugs help, but they can't do
everything."
"We wouldn't want to take Adela away from the other
pa-
tients," Rosemary said tentatively, "but it would be good if she
could spend as much time as possible with Jane."
"I think it could be arranged. Certain patients take
more to hers."
Had he heard about Patricia? "These things usually work them-
selves out."
"Now that Adela's off duty for two days," Victor
asked, "will
Jane maintain her improvement? "
"Yes, we've got things under control. With the pain
receding,
and Jane more aware of her surroundings, she'll be getting to
know the other nurses."
"But the pain receded only when you increased the
dose of
diamorphine," Victor said. "How long can you go on stepping
it up?"
"I think she's stabilised," David answered. "Now
that I know
where the pain is worst and where it comes from—her arms, for
instance—there are other actions we can take. Like a nerve block."
"We promised her no more operations," Rosemary exclaimed.
"I thought you agreed with us."
"I do. We might very rarely operate for palliative
purposes,
to ease the pain, but a nerve block isn't an operation."
"Does it matter what you call it?" Victor was not
reassured.
"Once you cut the nerve, you can't tie it up again,
can you? She'd
never have any feeling again in that area, neither pain nor any-
thing else."
"We're not going to cut anything, and it's not irreversible.
Let
me try to explain."
But we didn't want to hear any more. We had been
talked into
so many things we didn't really want at the hospital, so many
treatments. "We don't want to go through all that again," Victor
said petulantly.
"I won't try to talk you into anything you don't
want, I assure
you," Dr. Murray went on, with his usual deliberation. "I'm not
even sure myself that this is something we should do. I was merely
thinking aloud. I thought you'd like to know what the possibilities
are."
Then, "If it will control her pain, perhaps we ought
to think
shamefaced. been a long day, about it," Victor said, rather "It's
we're a bit on edge. But much better than yesterday, thanks to you."
"Don't thank me yet." He looked at them both. "But
I think
we're making progress." It was Rosemary's turn to stay the night with
Jane. They had asked us whether we would rather take turns at going home
to rest or both stay at the hospice. We didn't want to leave. Home was
where Jane was. So they gave us a room with two beds.
Victor found that there was another visitors' bedroom
next to it,
unoccupied, and soon he moved in his own papers and files. He
still had a newspaper column to write. When Jane had learned,
at Dairy Cottage, that she might not have much time left, Victor
told her he would give up writing his column for the duration of
the illness so that he could devote himself completely to her.
Jane's reply was to cry out in mock horror, "Help!" She made
him promise that he would keep up the column whatever hap-
pened. She did not, she said, want him to devote himself com-
pletely to her or there might be trouble. Now, at the hospice,
the staff told Victor he could use the second room as a study
so long as it was not needed for other relatives. He had not
missed a single column throughout her illness, and it was im-
portant to him, for Jane's sake, that he should not miss one
now. As Rosemary settled down for the night in Jane's room,
Victor went to work in his new study.
Nora, a young night nurse, came to give Jane her
midnight
injection. She tried not to wake her too suddenly.
"Just a little jab now, Jane."
Jane stirred and peered into the half-light. "Is
my mother still
here?" she murmured. "I'd like someone to talk to."
"I think she's asleep," Nora said gently. She was
about Jane's
age and identified strongly with her. "Do you want me to stay
a bit? I've got plenty of time."
It didn't take Nora long to put Jane at her ease.
"It's not that
I'm afraid of dying," Jane confided. "I'm scared the pain will get
bad again and that I'll go to pieces."
"We won't let that happen," Nora said firmly. "We'll
help
you as long as you need us."
"It's my father who needs help," Jane said.
"In what way?"
"He had a bad time in the war. I don't think he's
ever got over<_'
it."
"Got over what?"
"I don't really know. He won't talk about it."
"Perhaps he will, now that your pain's more under
control."
Nora had seen many families come together in the
hospice. Talk
was sometimes more truthful when death was close. It was her
hope that Jane could help her father.
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