And I keep thinking, He didn’t want to see it coming. He got his wish.
Yet I know that, after the serpentine blood clot has been removed, the bedding changed and Alex’s body washed, and his family are allowed to see him to say goodbye, they will find no comfort in the notion that he will never need to jump from a high building to escape the fear of knowing that he is dying. Alex has left the building, without ceremony or leave-taking. But the absence of farewell will be a lifetime burden for the little family of heroes.
And in the morning, we will need to tell the Lonely Ballroom occupants that Alex has finished his treatment.
This was a hard story to tell, and probably shocking to read. While most dying is manageable and gentle when it approaches in an anticipated way, the truth is that sudden and unexpected deaths do happen, and not all of them are ‘tidy’. Although loss of consciousness during a sudden death usually protects the dying person from full awareness of the situation, those around them retain memories that may be difficult to bear.
Bereaved people, even those who have witnessed the apparently peaceful death of a loved one, often need to tell their story repeatedly, and that is an important part of transferring the experience they endured into a memory, instead of reliving it like a parallel reality every time they think about it.
And those of us who look after very sick people sometimes need to debrief too. It keeps us well, and able to go back to the workplace to be rewounded in the line of duty.
The vigil around a deathbed is a common sight in palliative care. In some families it is peaceful; in some there are rotas and care-for-the-carers as well as care for the dying; in some there is vying for position – most bereaved, most loved, most needed, most forgiven; in many there is laughter, chatter and reminiscence; others are quieter, sadder, more tearful; in some there is only a solitary sitter; occasionally it is we staff who keep the vigil, because our patient has no one else. So I had seen it many times before I had the perspective-changing experience of sitting at the bedside of someone I loved dearly, and would miss greatly, for the first time.
Well, this is unexpected.
The room is dark. A nightlight above the door casts a dim glow over the four beds and their sleeping occupants. Occasional muttered mumbles or stertorous snores from the other three beds emphasise the silence of the white-haired woman in the bed before me. I am perched on the edge of my chair, gazing at the pale face on the pillow, her eyes closed, her lips moving gently with each breath in and nostrils flaring briefly with each breath out.
I am searching her face for clues. A slight flicker of an eyebrow movement – is she wakening? Is she in pain? Is she trying to speak? But the metronome of the breath in, breath out continues unflurried. Unconscious; unaware; untroubled.
This is my grandmother. She is nearly one hundred years old. She has seen wonders in a lifetime lived in step with the twentieth century: as a girl, she watched as the lamplighter lit the gas lamps outside her home, and admired the dresses and evening capes as her neighbours boarded horse-drawn hansom cabs for a night on the town; as a teenager, she saw her brother falsify his papers to be allowed to fight in France, and welcomed home the hollow remnant of him that returned, twitchy and restless, after six months as a prisoner of war carrying German shells to their front line; as a young wife she saw the Great Depression, the death of one son from a disease now prevented by routine infant immunisation provided by the National Health Service, and later the death of her husband from an infection now treated simply by antibiotics that had yet to be invented then; she accompanied her remaining children into evacuation in the countryside during the Second World War, working in a munitions factory where the women on the production line twisted the detonator wires of occasional bombs in the hope that civilian lives in Germany would be spared; and then returned to her inner-city home through which an unexploded German incendiary bomb had dropped, its own detonator inactive thanks to unknown sisters in Germany. She saw the birth of the NHS; her children had access to higher education; she watched men walk on the moon. She is the matriarch of a family that now counts four living generations. And she is dying.
She draws a sharp breath in, and mutters on the out-breath.
‘Nana? It’s all right, Nana. We’re taking you home tomorrow. You can sleep now. The rest of us are here.’
I listen. I mean I really, really listen. Are there words in the muttering? Is she dreaming? Is she awake? Is she afraid?
The monotonous rhythm of unconscious breathing returns. I sit and gaze, searching for clues in this dear, familiar face.
I have seen families keeping this watch, maintaining this searching vigil, many times. I have been working in palliative care now for eleven years, watching deathbeds on a daily basis. How can I have been so unaware of the deep, analytic attention of the families who sit and wait? This is not a passive activity; I am actively, keenly alert, probing her face for clues, interrogating every breath for evidence of – what? Discomfort? Contentment? Pain? Satisfaction? Serenity? This is the vigil, and suddenly I am encountering its familiar pattern of gathered family, and sitting rotas, and detailed reporting of almost no information, from an utterly new and unexpected perspective.
I happen to be in my home city to deliver a lecture. I was delighted to accept the invitation, because it would give me a chance to stay with my parents and to visit other family members. Then, while I was on my way here a few days ago, the family called from the hospital to ask me to divert my journey. Instead of sharing a meal at my parents’ home, we assembled in a cubicle in the city hospital’s emergency department around Nana’s uncomplaining smile. Here, her back pain was assessed, her large but unsuspected colon cancer was finally identified, a bed was found in this bay, and once I had managed to convince the shiny, newly qualified ward doctor that painkillers would be appropriate, the hospital’s palliative care team arrived to give their expert and welcome advice, so that I could be simply one of her grandchildren.
The next day, we palliative care professionals met again at the conference they had invited me to address. I stepped out of ‘family anxiety’ and into ‘conference speaker’ mode for two welcome hours of respite from my sadness, leaving a small posse of the family with Nana. The speaker after me was a social worker whose moving talk about bereaved families pierced my armour; I paused in the ladies’ cloakroom to remove the mascara stains from my cheeks, and rushed back to the hospital. The posse reports that Nana has had ‘tests’. She has widespread cancer. She wants to return to her nursing home, because it has a chapel and being close to God is her top priority. She is not alarmed – she has been preparing to die for decades, and has astonished herself with her own longevity, the solitary survivor of her generation and lonely for beloved people she has not seen for many years.
The news of the cancer had an interesting effect on Nana: almost as though she had been waiting to know what would bring about her eventual death, she seemed so relaxed that several family members wondered whether she had really understood the news. But this is the wisdom of a long life: none of us is immortal, and every day brings us closer to our last. In her eighties, Nana had a stroke that affected her use of language. She lost words, and substituted others in ways that sometimes made her speech impenetrable, and on other occasions was unintentionally wildly comical. Her mobility became limited too. She accepted these burdens with determined stoicism. In retrospect, I suppose she expected that another, fatal stroke would rescue her from living a limited life, but here she is more than a decade later, still talking to us about sausages and ‘You know, that … whatever …’ with a roll of the eyes that says, ‘Mm-hm! You know exactly what I mean!’ while we cast around for ways in which ‘sausages and something else’ might be relevant to the conversation about, for example, her