‘At the moment she is alive, alert and enjoying life.’
I thought of Leah watching Countdown, beating the contestants at their own game.
‘You are right,’ I said thoughtfully, ‘she does enjoy life.’
‘If we stop the drugs someone might say that we were deliberately hastening her death.’
‘But is that likely? Would anyone say such a thing?’
‘It is quite possible.’
‘Have you discussed it with the relatives?’
Yes, and they said they will leave the decision to us.’
‘Have you discussed it with Leah?’
‘No.’
‘Does she know she has cancer?’
‘No.’
‘No? Why will no one talk about death? That’s at the root of the trouble.’
‘I know. But I have to safeguard the good name of the nursing home. I can’t discuss philosophical issues.’
At that moment a young man in a T-shirt and open-toed sandals breezed into the office.
‘Philosophy? Sounds a bit heavy! Is that how you spend your afternoons?’ He laughed good-naturedly.
‘We were talking about Leah, Doctor,’ said the matron.
‘Leah? She’s fine, going on nicely.’
Encouraged by his obvious good nature I said, ‘I was wondering why she is still on cardio-vascular drugs and diuretics.’
His smile vanished. ‘What’s the trouble? Have you any complaints?’ he said abruptly.
‘No, not at all. Quite the opposite, in fact.’
‘Are you a relative?’ he demanded.
‘No, a friend.’
‘I cannot discuss a patient with friends,’ he said curtly, and walked out.
I must have looked really put out, because Matron said, ‘You shouldn’t have said that. For all he knows you might be a journalist looking for a story about hospitals or care homes. The newspapers could probably do with something like that to boost circulation.’
‘I hadn’t thought of that,’ I said quietly.
The strength of the media, with their seemingly insatiable desire to criticise the National Health Service, came home to me.
‘I see what you mean. It would require more courage than the average doctor possesses to say “no more”. He would probably have to face an internal enquiry to justify his position.’
‘Exactly. And in the meantime, Leah is as well as can be expected.’
‘Yes, she is. In fact, she’s better than I expected, for which you are to be thanked.’
We shook hands and I left, but before leaving the building I poked my head around Leah’s door. She was deeply engrossed in Countdown, eagerly writing things down, crossing them out, looking up and thinking, then scribbling again with evident satisfaction. The friend who had arrived at three o’clock was nowhere to be seen. Presumably she had been sent packing by this doughty, irrepressible old lady.
Cycling encourages meditation. There is something about the gentle, rhythmic movement, the fresh air, the curve of the road, the passing hedgerows, that promotes thought. As I cycled home from the nursing home, I reflected that I had undoubtedly been in the wrong. Three times in the past twelve months I had thought that Leah would die, and in the back of my mind I had suspected that it would probably be the best thing for her. She would die quickly and peacefully, without suffering. When I had seen her in the hospital after the embolism I had really thought she would not survive the night. But she did survive – triumphantly. She had lived to enjoy six months at home, gaining strength, improving her walking ability, seeing her family and friends … in short, living life as fully as a lady of her age could expect. None of this would have been possible had it not been for modern medicine. The intervention of cancer was not really surprising. We all have potential cancer cells inside us, and a shock to the body, such as Leah’s broken leg, would be enough to trigger a growth. It is quite possible, as medicine advances, and death is pushed further and further into retreat, that many of us may die of some form of cancer. And yet … and yet … it nagged in my mind … isn’t it better to die of heart and circulatory failure, before you have to die of cancer? In the end, we are all in the hands of God, and nothing we do will alter our fate.
I had gained a good impression of the nursing home. The matron was the only trained nurse on the staff, but she set a good example and the assistants and carers whom I met all seemed pleasant men and women, who looked after the residents with cheerful goodwill. I saw a lot of smiling faces the day I was there. Leah’s room was spacious and airy, with two windows facing south and west, both overlooking the gardens, and she had a large bathroom leading off the main room. I felt she would be comfortable and happy there in the last weeks and months of her life.
However, an incident occurred that shattered the calm. Leah was barely digesting food, felt nauseous much of the time, and sometimes she was sick. Both constipation and diarrhoea plagued her. Most of these nasty emissions she could control, but not always. One night, shortly after I had seen her, she tried to get to the bathroom, but what with the struggle to get out of bed and manoeuvre her Zimmer frame, she could not quite make it, and vomited all over the bathroom floor.
Leah called for a member of the night staff, to whom she explained what had happened, apologised, and asked if the woman would clear it up. The woman looked at the mess, looked at Leah, said, ‘Clear it up yourself,’ and walked out.
Leah told me that she had struggled into the bathroom again, and managed, though she was fearful of falling, to detach the showerhead and spray water all over the vomit. Then she got hold of towels and spread them over the watery mess to soak it up. Finally, she returned to bed and got some sleep.
But that did it for Leah. In the morning she demanded to see the matron, told her what had happened, and said she was leaving that day. Poor matron was profuse in her apologies. She said that the woman came from an agency and would never be employed there again. But nothing would change Leah’s mind. ‘Because of that woman I am leaving this morning,’ she said. A taxi came, and by ten o’clock she had left the nursing home, although she was in no way fit to do so.
Matron was deeply ashamed and embarrassed. None of her staff were trained nurses, and ninety per cent of them came from agencies. Only ten per cent were employed full or part time because of the impossibility of getting rid of anyone who was unsatisfactory. If an agency care assistant did not work properly, the matron could say that she would not have the person back. The care assistants were always being shifted around, and some were trained, some not; some experienced, others not; some were very good, others poor or bad. It was always a lottery who was sent by the agency, and night duty was the hardest to cover satisfactorily.
Poor Leah arrived home, and no one was expecting her. She was seriously ill, and had to climb the front steps to the house, open the front door, which is heavy, cross the hallway, and open the door to her flat, which had been double-locked and is even heavier due to fire regulations. She was cold, and the heating had been switched off. She had to go to the cupboard and pull down the main switch, which is stiff. I just cannot imagine how she managed to do all this in her condition, but she did. Later that day a driver brought a case with her things in it, and left it in the hallway. That was the first clue that anyone in the house had of her return.
Steve went round to her flat and found her in a state of utter exhaustion, collapsed in her armchair. He telephoned the family in Israel to inform them. The doctor and community nurses had been informed by the matron, but visits could not be started straight away and Leah had to wait several days for a district nurse, carer, or home help. Sandy cooked meals for her, but she could not eat.