It was arranged that I should call for home nursing twice a day, and that Sister would come any time that Peggy requested.
I do not know whether or not Sister Julienne noticed the sleeping arrangements in the little house. The prefabs were constructed in a rectangle with a single large room and two small rooms leading off it. These were intended as bedrooms, but one of the rooms in Frank’s house was a dining room, which we could see through the open door. The only room used for sleeping had a double bed in it. If Sister Julienne noticed these things, and put two and two together, at no time did she say so. The Sisters had seen it all before, many, many times. In cramped living conditions, where a family of ten, twelve, fifteen or more lived in one or two rooms, incest was hardly surprising. Families kept their secrets and the Sisters did not comment or judge. I felt that there was nothing in human life that they had not witnessed in the seventy years they had worked in Poplar.
Later Sister said to me, “We will have to keep up this pretence that he is going to get better. The charade has to go on – treatments that will do no good, drugs that are useless – to give, the impression of medical competence and nursing care. ‘Hope’ lies in those treatments and, without hope for the future, most of our patients would find themselves in torment at the end.”
One day when I called they were studying travel brochures received from Thomas Cook. Frank was very alert in his mind. His speech was slower and quieter, but his eyes were bright, and he seemed almost animated.
“Peg an’ me, we thinks we’ll go to Canada for a good ’oliday when the treatment’s done an’ I’m on me feet again. She’s never bin abroad afore. I was in France and Germany in Hitler’s war, an’ I never wants ’a go near Europe agen. But Canada, now – big clean open spaces. Look a’ this ’ere, nurse. Lovely pictures, aren’t they? We reckons Canada’s just the place for us, don’t we, Peg? Who knows, we might stop there if we likes it enough, eh, Peg?”
She was sitting on the edge of the bed, her eyes glowing with happy anticipation. “We’ll go on the Queen Mary,” she agreed. “First Class, like a couple of swells.”
They both laughed and squeezed hands.
Together Peggy and I helped him to the bathroom. It was difficult, but he still had the strength to get there. She washed him all over, because although he could get into the bath, he did not have the strength to get out. In clean pyjamas he sat in the sitting room looking at the plaster ducks flying across the wall, whilst Peggy and I changed the bed with the text over it, executed in big, childish embroidery stitches, ‘God is Love’.
We had taught Peggy many essentials in the art of nursing, such as treating pressure points and dealing with pain or nausea. She was quick to acquire any small skill to make Frank more comfortable. I enquired about appetite, pain, bowels, vomiting, headaches and fluid intake, and left them happy with their plans for Canada. Should it be Vancouver or the Rockies? They couldn’t decide.
The air was sweet as I left the little house, and the sounds of the huge cargo vessels, the cranes, the lorries, seemed far off. I thought of the thousands of powerful men working ceaselessly in that great port, and the fragility of life. Health is the greatest of God’s gifts, but we take it for granted; yet it hangs on a thread as fine as a spider’s web and the tiniest thing can make it snap, leaving the strongest of us helpless in an instant.
Frank received a six-week course of radium therapy and was taken twice a week by ambulance to the hospital. Both he and Peggy expressed wonder and a touching appreciation that all this was free on the new National Health Service. “It’s lucky I got ill now, an’ not a few years ago. I could never ’ave paid for all this expensive treatment.” They seemed completely confident that it would be effective, probably because it was so elaborate. That he was getting weaker every day was put down to the temporary effects of the radium, which would pass when the treatment was completed. Everyone – that is, all the medical and paramedical staff, which must have totalled at least thirty people – kept the illusion going, though there was no corporate decision to do so.
Nausea is an unpleasant side effect of radium treatment and was something that Frank had been warned about in advance. He attributed his weakness and weight loss to the fact that he could not eat much. ‘Cos a man’s gonna get thin like, if he’s not eatin’ like what I’m not. Once I get some good grub inside me, an’ keep it down, I’ll pack the old weight on, you’ll see.”
Pain was another matter. The control of pain is the first responsibility of anyone involved in the care of the dying. Pain is a mystery that we cannot fathom, because there is no measure. Everyone’s tolerance of pain differs, therefore the correct dose of analgesic will differ. One must balance the strength of analgesic to the level of pain perceived and not allow the pain to develop beyond the patient’s tolerance.
Frank was having half a grain of morphine three times a day. Later this was increased to four, then six times daily. It was sufficient to dull his pain to an acceptable level, but did not impair his faculties. He was interested in everything.
He once said: “Every mornin’ I hear the fishin’ boats come up the river. Can’t get out of the ’abit of wakin’ . In my mind I can see the sails, dark against the red sun, like wot’ they used to be like, comin’ quietly out of the morning mist. Boo’iful they was, just boo’iful. You’ve gotta have seen them sailin’ boats to know wot’ a lovely sight it was. Now I listen to the sounds of ve engines. I can tell you by ve sound if it’s an oyster smack or a mackerel trawler. I can even tell you ’ow many deep-sea vessels from the Atlantic come in. It’ll be good to be back at Billingsgate.”
Peggy and I agreed that it wouldn’t be long. He was getting on famously.
Peggy had given up all work now and never left his side, except for essential household duties. She spent hours reading to him. Frank had never learned to read fluently, and could barely write.
“Book-learnin’s never been my strong point – but Peg, she’s the scholar. I love to ’ear her read. She’s got a lovely voice.”
Peggy read about half a dozen of Dickens’s novels in this way, sitting close to him, outwardly reading but inwardly attentive to every mood and movement. She was conscious of every shade in her loved one, ready to close the book if she sensed tiredness, or to change his position if she saw discomfort. Peggy knew almost before he knew himself what his needs were going to be.
Love permeated every nook and cranny, every corner and crevice of that little house. You could feel it as soon as you entered the front door, like a presence so tangible you could almost reach out and touch it. If there is one thing that a dying person needs more than relief from pain, it is love. I have seen, later in my career when I was a ward sister at the Marie Curie Hospital in Hampstead, unloved, unwanted people dying alone. Nothing can be more tragic or pitiful. And nothing is more hopeless or intractable for the nursing staff to deal with.
Love prompted Peggy to sing to Frank every evening, the old songs, the folk songs and hymns that they had both learned in childhood. Love prompted her to move the bed so that he could see the masts and funnels of the boats as they approached the docks. Love told her which visitors to admit and which to turn away from their front door. They grew even closer. They had always been one flesh; now they were one spirit, one soul. And all the time she kept up the pretence that he was going to recover. If she cried alone in the kitchen, he never saw it.
It was Frank who first startled me. We had just finished a blanket bath (he no longer had the strength to get to the bathroom) and he had asked Peggy for a hot drink and a hot-water bottle. As soon as he heard the kitchen door close, he said, “Nurse, you must promise me you won’t let on to Peggy. It’ll break her heart. Promise, now.”
I was putting things away in my bag and my back was turned towards him. I didn’t move or breathe. I had to respond in some way, but I couldn’t find my voice.
“I want you to promise, now.”
“What do you mean?” I said, eventually. I had to turn round, and he was looking straight at me, his sunken eyes bright in their dark sockets.
“I mean I’m not gonna get better an’ I don’t want Peg to know until she has to.”
“But Frank, what makes you think you won’t recover? The radium treatment ends next week and then you will begin to feel stronger.”
I hated myself for this pathetic falsehood. I felt degraded by it. Why do we have to be like this? In India, apparently, a man often predicts his own death, says farewell to his family, goes to a holy place, and dies. Yet we cannot admit to someone that he is dying, so we have to play false, and I have been as big a deceiver as anyone.
He didn’t say a word, but closed his heavy eyes. We heard the kitchen door open. He hissed fiercely, “Promise. Promise you won’t tell her.”
“I promise, Frank,” I whispered.
He sighed with relief.
“Thank you.” His voice was husky. “Thank you, now I can rest easy.”
The radium treatment halted the malignant growth for a while, but could not be continued beyond six weeks, as it would destroy other organs. Frank’s deterioration was rapid when treatment stopped. The pain became more intense, and the morphine was increased to one grain, then two grains every four hours. He could barely eat, and Peggy sat beside him feeding semi-solids into his unwilling mouth.
“There, Frank love, just another little spoonful, put some strength into you.”
He would nod, and try to swallow. She washed and shaved him, turned him, cleaned his mouth and his eyes. She dealt with his urine and his bowels, and kept him clean and comfortable, all the while humming the songs he liked. He no longer looked at travel brochures, nor had the mental strength or interest to listen to Dickens, but he seemed to like to hear her singing. He rarely spoke and was drifting in and out of consciousness.
Frank was quietly slipping away into that mysterious border land between life and death where peace and rest and gentle sounds are the only needs. One day, in my presence, he gazed at Peggy for a long time as though he did not recognise her and then said, quite clearly: “Peggy, my first love, my only love, always there, always when I need you.” He smiled and drifted away again.
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.”