So, it’s never a good sign when a hospital phones you at 2am, is it.
My dad was diagnosed with cancer a little bit over three years ago. No doubt it was growing inside him for a year or two before that, but three years ago was when it suddenly became symptomatic, when he woke up one morning to discover he was randomly bleeding from his nose and his mouth, because his blood had given up on the concept of clotting. Prostate cancer had already spread from his prostate through most of his skeleton, to the point that it was Definitely Not Curable. Manageable, though, so much so that he may well, they said, die of something else first.
At first when the phone rang, I thought it was my alarm. Then realised it was a landline number, from my old home town, some sort of switchboard number. I didn’t catch it before the phone stopped. Then, whoever it was immediately rang back a second time.
I’d last spoken to him a couple of weeks earlier, after he phoned to tell me that he’d been to his consultant again. That was that. Not worth taking any more chemotherapy. He was going to be keeping him on one of his current treatments: it might, if he was lucky, keep him alive until the end of the year. If it didn’t work, he probably had a few weeks left.
I answered the phone rather blearily, to a random woman with my old home town’s accent asking if it was me. I found I couldn’t really speak, because I had already guessed where she was calling from and why she was calling. “He’s very confused and very tachycardic. We think you should come to the hospital.”
My mum had phoned a few days earlier to tell me he’d been admitted. He was having trouble breathing, so they had rushed him in in an ambulance, on oxygen. His spleen was failing. “They said his spleen is dead,” in my mother’s words. Now, I know you can happily live without any spleen at all, if you have to have it pulled out for some reason, but when a cancer patient suddenly starts to have unconnected organs turn into big and entirely non-functional lumps of meat, you know it’s not going to be long before phrases like “multiple organ failure” make the rounds.
The hospital was four hours’ drive away. I sat down and had a cup of tea.
Driving through the night, I wondered quite how I was going to react. I don’t think I’ve ever seen my dad show any sort of emotion of any sort. The day of his mother’s funeral, or any of the days leading up to it that I was home for, he didn’t cry a single tear. After the funeral we went home for lunch, then went out to buy a new camera. I tell a lie: he could get angry, he could shout, he could withdraw into a fuming silent rage. I’ve never seen him be sad, though, or show any kind of tender emotion. The roads were quiet, at first, and I had plenty of time to think about it. By 6am I was overtaking long lines of trucks heading to the North Sea ports, all of us still over half an hour away from our destinations, and I was driving towards a faint smear of dirty orange dawn light. By the time I reached the hospital, worked out where to park, it was just about dawn.
Of course, being half asleep when I’d answered the phone, I hadn’t actually thought to ask where in the hospital he was. It’s a big place, although strangely smaller than it felt when I had to go there to have my teeth sorted as a child, but the oncology ward was a very, very long walk from the entrance. When I reached the doors I had to ring a few times before a nurse came to the door to let me in; and then they hadn’t heard of him.
“Is he in A&E?”
“No, he’s an Oncology patient, and he was admitted on Sunday.”
She kindly led me to the nurses’ station and sat down at the computer, working down the list of wards until I spotted his name. And then another long walk, almost all the way back to the entrance and round another long set of stairs and corridors. I glided through the ward doors behind a nurse coming onto shift (hospitals are generally terrible at security) and found the nurses’ station. “Someone phoned about my father; he’s dangerously ill,” I said; they didn’t really need to ask who I was. “Oh!” they said instead, “you drove all that way straight here!”
He was in an isolation room at the far end of the ward. Not covered in tubes and probes as you might expect, other than an oxygen tube to his nose. He was almost naked, seemed to have thrown all the covers off the bed. Pale, almost hairless save a whiskery patch on each side of his chin, as if hairs had poured down from the corners of his mouth. He laid awkwardly, but he was awake, mumbling. My mother was there, and one of my uncles. I have a pair of uncles who are identical twins, and now I only see them occasionally every few years, it can be hard to work out which is which. I mentally started thinking to myself to avoid saying anything which might imply I thought I knew which uncle it was.
Dad’s eyes were dull, but he looked at me, and said something to me. “See, I said they’d come to see you,” said my mother. He mumbled. Even unintelligible, he still had the same patterns of speech. He fumbled, moving his legs, trying to slip one out of the bed.
“Lie down and rest,” I said, like dealing with a sick child.
Mumbling: something about getting up. His breathing was forced, gasping, but strong and regular.
“No, you need to rest. You’re better here.” His skin was speckled with strange, fresh moles, some of them gory red lumps, like overactive birthmarks, standing proud from the skin by a quarter-inch or so. He was covered in bruises, including a large one roughly where, I suspected, the “dead” spleen would be, although I found out later that was just where all his medication had been injected. He started to pull at a sticky pad on his leg: it wasn’t actually being used, but looked as if it might have been for fastening a catheter tube down. “You can’t pull that off,” I said, “it says the glue is too strong. You need a special solvent.” It did indeed say “only remove with alcohol,” and I don’t think it meant “take shots so you don’t feel it.”
Mumbling: thirsty, maybe?
“Here’s your tea,” said my mother, passing him some very milky tea in a lidded plastic beaker. I knew when he had been admitted he had been nil-by-mouth; had that passed because it wasn’t necessary, or had that passed because he was on the way out anyway?
It felt like a long time, at the time, but writing this a few days later, my memory has compressed hours into a few flashes. My mother phoned the friend who gives her a lift to church every Thursday. “I’m in hospital,” she said, as if there wasn’t anyone else in the room. “They called me at 1am.” I wondered to what degree I was the second resort - how long had they waited between phoning each of us? I don’t trust my mother’s memory for facts.
He drifted away to sleep a little, but the nurses came to wash him and change his sheets, as they did at that time every morning. They asked us to leave the room, so we headed down to the deserted hospital restaurant, another very long walk away, down the same corridor that led towards the mortuary. I didn’t really want to eat, even though I had been starving whilst driving, so from the breakfast selection I asked for just a coffee, a sausage and a slice of black pudding. “Just that?” said the server, with a very puzzled look.
We sat by the window looking at the morning sky, and having relatively normal conversation. I tried not to wonder whether he would die whilst we were having breakfast, and instead wondered as to whether he would actually die today at all. This might be a false alarm; just a turn he had in the night.
He was still alive when we came up to the ward, in clean sheets, covered up now, still slumped sideways and vaguely half-awake. The nurses tried to rearrange his pillows, sit him upright, and he slowly drifted off to sleep. His breathing still the same: harsh, gasping, mouth open despite the oxygen tube by his nose. He slumped sideways again, and the nurses decided to leave him be. In his sleep, he dozily tried to pull the oxygen tube from his shoulder, but didn’t have the energy or the coordination.
The consultant and the doctors arrived on their morning round: a garrulous Scottish chap in a red shirt, Mr McAdam. “I’m sorry we have to meet like this,” he said, and complimented me on my appearance. “We had a very lucid conversation the other day,” he said, “and we agreed it would be wrong to take any further serious interventions. Just too much suffering. He was happy with that decision.” And he ran through the list of problems my dad was facing. A burst stomach, leading to a thrombus. An infarcted spleen. Liver failure due to an additional liver disease. He didn’t actually say “multiple organ failure,” but he didn’t need to.
I realised, which I don’t think the doctors did, that Dad’s breathing was getting noticeably weaker as the doctors were stood around him. He was still breathing, though, even though it was definitely more shallow, definitely longer between breaths. The doctors filed out, trying to strike a balance between the bustle of rounds and the sombre tone needed around the families of the dying.
We watched him breathing, slower, slower and weaker, because there was not much else to do or think about. “I thought he’d gone there,” said my mum, “but then he started again.” She leaned in to see more closely, and held his hand.
There were a few seconds between breaths. The breaths themselves were shallow, hard to hear, very different from the gasping of a few hours earlier. And then: I didn’t think I could hear or see any movement any more. Nothing, and more nothing. I slipped my phone out of my pocket, and took a photo of him: the phone made his skintone much healthier than reality did. “I think he’s gone,” I said. It was five to eleven in the morning.
A nurse passed the door, so I waved and beckoned her in. “We think he’s gone.”
She looked down at him, carefully. “I’ll call the doctors,” she said, “so they can pronounce. Do you want a cup of tea?” She went out, closing the door this time, and came back with tea, in the big mugs of the nurses, not the small mugs that visitors get; and some biscuits. We sat, dipping ginger nuts, the almost-certainly-dead corpse of my father in front of us. “I keep expecting him to jump up and say it’s all a joke,” said my mother.
It took over half an hour for the doctors to arrive; their job is to care for the living, after all. We stood outside the closed door of the room whilst they ran through whatever it is they do, working in a pair, I assume in case a lone doctor might be tempted to Shipmanise a still-living patient. “Do you want to go back and see him after they have done?” said a nurse. We went back inside the room; they didn’t appear to have moved him at all. Still slumped against the siderails of the bed, mouth still open, eyes still shut. His skin, getting on for an hour now after death, was white-pale and waxy-looking. I took another photo; the camera still tried to give him a normal human skintone.
“I don’t want to say goodbye,” said my mother, but we walked out of the room and closed the door behind us.
“The doctors will write up their notes,” said a nurse, “and you have to go to…ooh, I don’t know!” She shouted to another nurse: “Where do they get the certificate? Is it the cashier?”
“It used to be the cashier,” said the other nurse, “now it’s the bereavement office.” Well that should be obvious, I thought. “I’d go in the morning, it probably won’t be ready today. Give us a call first to check. I’ll give you a booklet.”
We walked back down the long, long corridor, holding our fresh copy of “Help for the bereaved: a practical guide for family and friends” Where the corridor joined the next, we had to squeeze past a folding screen which hadn’t been in our way before, and a sign that said “For Ward 3 Enquiries, ask at Ward 4″; and I realised, it was a death screen, to make sure that no random strangers saw my father being wheeled in his bed, slumped against the siderails, over to the lifts and down the long corridor down towards the restaurant and the mortuary. We walked out down the corridor, and I wondered what would happen next.