The Betrayal of Trust

‘There are a couple might be useful.’

‘Ping them up, will you? But listen … if in doubt, it’s import ant, OK?’

‘What, even “my Uncle Ron had a Lada done out of flowers for his funeral – he didn’t actually own a Lada, he just loved the jokes”?’

‘Go on then.’

‘What do you call a Lada with a sunroof?’

Simon went out of the door, almost closed it, then glanced back and said, ‘A skip.’

Thirty-nine

‘WE’VE TIME TO grab a coffee before we do the last three, Moll. I’ll go over their notes but, if you want to say anything about what you’ve seen so far, now’s the time.’

There was a warming plate and a jug of fresh coffee in the small staffroom.

‘And decent biscuits.’ Cat pushed the plate towards Molly. ‘Small perks of working in here. Relatives are so generous – you’d pile on pounds if you ate all the chocolates and cakes and biscuits people bring in. Help yourself.’

Molly sat at the table looking thoughtful. Cat recognised the signs. Seeing half a dozen terminal patients, one after another, two of them quite young, was a shock and there was no way of preparing any student or junior doctor for it, they had to plunge in and cope. The important thing was that they had a vent for their feelings afterwards.

‘So … thoughts?’

‘I’m just – impressed. It’s so different, isn’t it? Everything, everything’s different.’

‘But what most of all?’

‘Time. You know what a ward round is like in the General – one two one two, good morning, this is Mr Smith, being prepped for a lung operation later this morning, stats are as follows, treatment has been this, how are you feeling, Mr Smith, fine, fine, nothing to worry about, right, ladies and gentleman, on we go, keep up, keep up.’

Cat laughed. ‘Nothing changes.’

‘Here, you sit down, you listen, you answer their questions properly. The nurses do the same. You tell them about this or that treatment option, how they might feel tomorrow … you just … yes. It’s that one word, isn’t it? Time.’

‘It’s a luxury in a general hospital. It’s an essential here. It’s perhaps the most important part of the palliative care process because if we spend enough time we can help them towards peace of mind. A lot of the treatment isn’t physical, though that’s vital – especially pain and symptom relief – it’s mental, it’s emotional. And that takes time. I can change the dose on a syringe pump in twenty seconds. I can spend an hour before I get a patient to admit they’re terrified of choking to death or of dying when no one is with them.’

‘Pain control isn’t difficult, is it?’

‘I wouldn’t say that. Sometimes it’s straightforward – people respond well and we can keep them quite comfortable. But what about intractable bone pain? What about intracranial pressure? Not so easy. Pain isn’t obsolete yet unfortunately.’

‘Nausea. So many people in a general hospital are nauseous for one reason or another, but somehow it’s regarded as nothing much, no one hurries to sort it out.’

‘I know, but anyone who has ever had morning sickness will tell you what kind of priority it ought to have.’

‘Chemo?’

‘Almost always makes people sick, but there’s no need for them to suffer it, we’ve got a whole cabinet of anti-nausea drugs. You can’t give anything to pregnant women but you sure can to cancer patients.’

‘There’s something else I noticed. Listen, I know you’re a Christian and all that and I really don’t think I am, I’m not anything, I just couldn’t reconcile any sort of God with the stuff I’m seeing most days. But … I don’t know why but there’s something in this place … I suppose it’s calm and peace but it’s more than that … It’s something spiritual and I don’t do spiritual.’

‘But you do. Obviously. You’ve just said so.’

‘No. I absolutely don’t.’

‘Molly, I’m not trying to convert you or convince you. I understand what you mean, that’s all. I’ve never been into a hospice which didn’t have this sense of – tranquillity, you could call it. Spiritual is the right word, whatever you happen to believe.’

They finished their coffees companionably and went back to the ward to see the last three patients. C ward had already been closed and mothballed.

‘Mrs Mary Stalker,’ Cat said, outside the door. ‘She’s eighty-nine and has one of those long, slow-growing cancers of old age. She’s been in and out of here half a dozen times in the last year for pain relief and general care – she lives with her daughter who is seventy herself and not very fit, so the respite times are important for them both. But I’m not sure if Mary will ever go home again. She’s been pretty sick this week.’

‘Where is the cancer?’

‘Everywhere now – started in the bowel, but they didn’t want to start chopping her about and she’s done quite well without any treatment to speak of. We just kept an eye on it and it only started to spread quite recently.’

Mrs Stalker was propped up on two pillows, her eyes closed. Her skin was yellow-tinged and there was almost no flesh left on her, but when she heard the sound of the door she opened her eyes and they glittered like black beads in the skull. Her wisps of white hair had been combed and arranged across her head by one of the volunteers, her nightdress was set off with a pink lace bed jacket.

‘I hoped I wasn’t going to miss seeing you,’ she said to Cat, ‘by dying before you got round to me. Now who’s this?’

‘This is Molly. She’s shadowing me today to learn how we work here. If you’d rather see me on my own, Molly won’t mind going outside.’

‘It’s all the same to me, Doctor, bring them all in, we’ll have a party.’ She scrutinised Molly carefully. ‘You look a bit young to be a doctor. You look a bit young to be out by yourself, come to that.’

‘I’m not quite qualified yet – I take my final exams next month.’

‘I hope you pass them, my dear. You won’t look any older if you do though.’

‘How’s the pain in your back, Mary? It was troublesome the other day and I changed your medication around a bit. Did it help?’

Mary Stalker made a face. ‘So-so, but what I do to it is a lot better than any of your drips and tablets.’

‘Whatever do you do?’ Molly asked, glancing at Cat.

‘I give it a good talking-to. By the time I’ve finished it skulks off into a corner.’

‘Are you eating and drinking much?’

‘No. Don’t see the point. A fat corpse isn’t any use to anyone.’

‘Mary …’

‘Am I shocking you?’

Molly looked embarrassed.

‘Listen, my dear, when you’ve been a doctor a few years and you’ve seen a lot of old worn-out coats like me, you’ll understand a bit better. I’m dying. I know it, Dr Deerbon knows it, they all know it. So now you know it. I’m dying and I don’t mind, I’ve had a very good innings. The only problem is I’m not dying fast enough. I’ve been in here expecting never to come out I don’t know how many times – how many times is it, Dr Deerbon?’

‘Quite a few.’

‘Yes. And much to my surprise, I’ve been off out of those doors again. But not now. I’m a bit further gone. And that’s the way things are, you see. You get old, you die. If you didn’t how would there be room for the next lot coming on?’ She looked at Cat. ‘There’s one thing driving me mad, though, and I don’t see why I should put up with it as well as with dying.’

‘Tell me.’

‘Itching. My skin itches. It’s like creeping things all over it and I scratch until I bleed – look, here.’ Mary stretched out an arm. The yellowing loose skin was dry and flaking and there were marks where her fingernails had scratched through it and brought blood, which had then dried.

Cat lifted the arm and turned it gently. ‘Is this on your legs as well?’

‘It’s everywhere.’

‘Did the nurses not give you any cream for it?’

‘Oh, I didn’t bother them. I thought I’d wait till you came round.’

‘Mary, that’s just silly … it’s what the nurses are for, they could have saved you scratching and making yourself bleed like this. It’s probably because of the drugs, I’m afraid, but I’ll give you some tablets and a cream and that’ll stop it in its tracks. You don’t have to put up with this sort of thing, you know.’

‘I’ve put up with a lot worse.’

‘I dare say, but please let us do what we can for you, Mary – or are you up for some sort of bravery award?’

Mary laughed, showing half a dozen stubby teeth sitting like ancient tombstones between the fleshy gaps.

As they were leaving, Mary held out her hand to Molly. ‘Let me hold it,’ she said. Molly put her own hand into the old woman’s. Mary stroked it. ‘I like that,’ she said. ‘Lovely young soft skin. I like that. That cheers me up.’

She patted the back of Molly’s hand and let her go.

Outside, Cat said, ‘If everyone was like Mary …’

‘She’s very philosophical, isn’t she? She seemed to be almost happy to be dying, which can’t be true.’

‘Why not? She’s had a long life and I guess quite a hard one. She only has one daughter who is crippled with rheumatoid arthritis and can’t really cope. She’s been in awful pain, her symptoms are making her uncomfortable – the itching, the nausea, the loose bowels, the cough, the backache … she’s had enough. She’s tired.’

‘Is she religious?’

‘No. We had a chat about that once. She says she isn’t looking forward to another life, one’s been quite enough. She’s ready to go.’

Molly shook her head.’

‘Now, this is a difficult one. Roger Flynn. He’s thirty-seven and he has non-Hodgkin’s lymphoma. His outlook is grim, the chemo made him very ill – he’s had severe allergic reactions to just about every drug in the book – he’s had a terrible time. He was married just under a year ago and he was diagnosed not long afterwards. It’s a bugger and he is very, very angry – he’s angry with the illness, with himself, with me, with the nurses, with God … probably more than with the rest put together.’

‘I don’t blame him.’

‘No. But he’s an evangelical Christian, very born-again, converted in one of those mass rallies in a football stadium. He gave his life to Jesus and he became an evangelist himself, he’s a preacher, and then he started to heal people, or so it seemed. He had a ministry at one of the evangelical churches in Bevham, laying on of hands, charismatic healing … you know the sort of stuff.’

‘Yes and it gives me the creeps. Actually, if he’s angry, I’d be angrier. I just don’t know how people can fall for that sort of thing.’

‘Discussion for another time but basically I agree with you. Mass hysteria is a dangerous thing. But now, of course, Roger is up against it. He really expected a miracle. His congregations expected a miracle. Half the charismatics in the country have been praying and expecting Roger to be healed – and he hasn’t been.’

‘Well, of course he hasn’t.’

‘If you believe God is a magician up in the sky who favours only you and your kind then it comes as a nasty shock.’

‘But you’re a Christian, Cat.’

‘Yes. Only I don’t think God is a magician.’

Roger Flynn was tall and lay straight as a felled tree trunk in the narrow bed, his head turned to the wall. He had a small fuzz of hair on his scalp, his skin was reddened and scaly, his eyes sunken down. His hands were clenched on the sheet.

‘Hello, Julie,’ Cat said. ‘Roger. This is Molly, she’s following me today. Do you mind her being here? You only have to say.’

‘Of course not.’ Roger’s wife was pretty, round-faced, with bubbly curls, but her expression was lifeless, her voice flat, her eyes almost unseeing. She looked exhausted and as if she could not face anything else that might happen but fully expected it to do so, and then worse.

‘Thank you.’ Cat went round to the far side of the bed and took Roger’s hand. He let it lie in hers but did not respond. ‘How are you today?’

‘Tired. So what’s new?’

She looked at his chart. ‘How’s the fever? They gave you some paracetamol in the night.’

‘Sweating like a pig. Do pigs sweat?’

‘I’ll look it up. Are you more comfortable now?’

‘Not really. But I’m not going to be, am I? How long is this going on?’

‘Roger …’ his wife said, but it was a token protest.

‘I don’t know, Roger. I know it’s what I always say and that it isn’t very helpful but I’m afraid it’s true.’

‘Get me out of this.’

‘I wish I could.’

‘What use are you then?’

‘I understand.’

‘No, you don’t. Can’t you give me something?’

‘What’s it for? If it’s pain, I’ll check your dosage.’

‘No. Something to put me under. Like dogs and cats.’

‘Roger …’

‘If vets can why not you? Our vet put the cat down just because it was old. I give you permission. I know it happens.’

‘No, it doesn’t.’

‘Happens every day.’

‘Not in this hospice it doesn’t.’

‘It should. Put the lot of us down. Nice injection, fall asleep, that’s what the vet did. Shit.’

A tear pushed its way out from under his tightly closed eyelid. He wiped it off angrily and went on wiping.

‘I’ll make sure you’re not in pain, though you’ll be sleepier. Just go with it. Relax, Roger.’

‘Fuck off.’

Julie looked anxiously at Cat, who shook her head, then bent down and gave the young woman a hug.

As they left the room, a nurse came down the corridor and raised her hand to Cat.

‘Mary,’ she said. ‘I just popped in to see if she wanted anything …’