The Patient (23 page)

The button was pressed, and the circus was called to town. Nurses, orderlies, equipment. Finally, a doctor, responding to the alarm, walked in. ‘What's the story?'

‘We found her in this state just a couple of minutes ago, and we pressed the arrest button.'

He walked up to the patient, told the nurse who was trying to resuscitate her to stop and looked up at the monitor. There was no cardiac activity. He felt the woman's neck.

‘She is fucking stone-cold dead. What is going on here? Is this some sort of joke?' He was not a particularly diplomatic registrar. ‘Time of death was probably four hours ago. I'm calling it. Cancel the arrest alarm please.'

Jonathan, watching the whole thing from his bed, was devastated. He covered his face with his hands and felt grief for the woman and a sense of hopelessness about his own situation. The curtains were drawn, and the circus moved on to await the next call. Jonathan got up and washed his face and went for a walk to clear his head. He got into a lift and stood at the back, shrinking away from everyone else.

‘Oh, thank God. Thank God. I really never thought that we would get him home,' said a woman in her mid-20s to an older woman who he guessed was her mother. ‘I can't believe he's finally coming home tomorrow. God bless those doctors and nurses. They are saints, really.'

‘I'll never forget that day the police came and told me about the accident. Truly, they have done miracles to get
him to live and walk. I can't wait to have your dad home.'

So something good was happening in the world. Life and death followed Jonathan wherever he went. He missed the sterile environs of his corporate world of so long ago – it felt like almost a lifetime now – where he'd had no cause to think of mortality. He idly wondered what Jake was doing and realised that he wished him neither evil nor well. Like almost everyone aside from Jonathan's immediate family, he was irrelevant to his daily struggle to stay alive.

Jonathan and Tracy sat silently as the oncologist explained that the persistent nausea and vomiting was not a result of chemotherapy. The problem was that the tumour had done something unexpected: it had seeded in Jonathan's brain. The increased pressure in his skull due to the tumour was causing the vomiting.

‘It is all quite evident here on the CT scan.' The doctor pointed to the celluloid films from Jonathan's most recent tests. Jonathan felt sick again. Tracy had no interest in looking at them. The doctor seemed fascinated by the extent of the tumour.

It was a simple explanation. No frills. No softening of the blow. Despite the months of treatment, the operations, the sacrifices they'd made, the tumour had moved into an area of the body that was immune to chemotherapy, protected by the blood-brain barrier. Jonathan had been handed the death sentence, just without the red robes of the judge or the black hood on the executioner's head.

‘Surely there's something that can be done, doctor?' Tracy was in tears.

‘Well, there is experimental treatment in which the tumour is excised surgically and then radiotherapy is administered to the brain. This is followed up with chemotherapy, to kill any remaining cells elsewhere in the body. The prognosis is not good, but there are some reports in the literature that are promising. I'll see if I can get the neurosurgeon to come up and talk with you both.' The oncologist was clutching at straws. He felt obliged to suggest something. Anything. This man was young and his wife was pleading.
What can I do? I can't just sit here and do nothing
, he thought.
What trial can I put this man on? What research is there to help me help them?

Jonathan held Tracy's hand. So far, it had been a matter of surviving until the treatments were complete, because there was somehow still hope. Now it just seemed that the treatment was endless, with no hope of success. Brain surgery, radiotherapy, chemotherapy. They were both reeling at the doctor's pronouncements. The other patients in the ward could hear the conversation, masked only by a cotton curtain, and were now silently eavesdropping. Despite their own predicament as cancer patients, hearing of the misfortune of others gave them comfort and diminished their own sense of suffering. This
Schadenfreude
kept many of them alive.

The curtains were swung back as the doctor left. Tracy and Jonathan sat in bewildered confusion. So many thoughts raced through their heads. Flashes of anger that the treatment had not worked, that the cancer had escaped, that their suffering and the amount of money they'd spent had been to no avail.

Jonathan's father was sitting with the two girls in the
waiting room, expecting to visit. Finally, Tracy went out to tell them, and at the sight of them she broke down in tears. Mr Brewster took her in his arms.

‘It's not good news,' she managed to say. ‘The doctor says that there is a part of the tumour that has gone to his brain. He's going to need more surgery.' The girls were now hugging her too. The nurse in charge of the ward showed them into a quiet room away from the prying eyes of visitors and patients.

‘Can I get you a cup of tea?' she asked.

‘No. We're fine. Thank you.' Mr Brewster spoke on their behalf. ‘Can I go and see him, Tracy?'

‘I think he'd like that.'

Mr Brewster walked up the corridor of the Oncology ward with a heavy heart. He had read between the lines and realised that Tracy was clinging to empty hope when she mentioned surgery. It was not supposed to be like this. A man should be buried by his son, not the other way around. He had prayed so hard for Jonathan's treatment to work, for him to be cured, for God to extend his graceful hand to save him. He stopped for a moment, then turned around and left the ward. He didn't have the strength to stay composed in front of him. He left the ward without farewelling Tracy, went straight down to the ground floor and ran into the park opposite the hospital. There, for the first time in his life, Mr Brewster challenged God's will.

‘I have given my life to you. I have prayed. I have read the Bible each day. I have been loyal and lived a good life,' he said out loud, looking up at the sky. ‘I have never asked you for worldly goods or for wealth. I have asked but two things of you: save my wife and save my son. That is all I
have asked. Where are you now? Where are you? What could you possibly gain by this cruelty to my son? First, you took my wife. Now, you want to take my son.' With that, Mr Brewster took out the small Bible he kept in his top pocket and threw it up in the air, as if to throw it back to its author. He picked up a stone and threw it upwards too. The stone and Bible fell to the ground, as dictated by the laws of physics, and the sky remained silent. There was no thunder, no sudden shafts of light, no burning bush. Mr Brewster fell to his knees in the park, angry about the unfairness and cruelty of life. His faith in a merciful God had slipped away, leaving him a bitter and hollow man.

As Mr Brewster stared at the grass before him, a young man of 20 stopped his red Ferrari at the nearby traffic lights. He looked across to see an old man kneeling in the middle of the park.
Strange
, he thought. His phone rang, and his assistant spoke in code to say all was in order and that his private jet was waiting at the airport. He was on his way to a drug deal that would net him millions. The lights changed, and he accelerated away, dismissing the man in the park as some homeless hobo. Life was carrying on as normal, dispensing its rewards and punishments seemingly at random. Eventually, Mr Brewster got up slowly from his knees and headed back to the ward to see his dying son.

Tracy and the girls were in with Jonathan, who had on his lap a colourful ‘get well soon' card that Kate had painted at school that day. Tracy gathered the girls up and they farewelled Jonathan with a kiss. He was left alone with his father, who stood silently at the end of the bed, staring down at him. Father and son were holding back tears, the
son feeling like he had let the father down and the father filled with regret that he had not shown his son the love that brimmed in his pained heart.

He walked around the bed and held his son's hand, brought his other hand underneath Jonathan's head and pulled it to his chest, hugging his boy with all the love that a father could have. Jonathan brought his arms around his father's back and cried unashamedly, sobbing out his pain and anguish. Gently, the father set his son down again.

‘What do you think you'll do? Have treatment or not?' He did not wish to make the same mistakes with his son as he had made with his wife, whose suffering had gone on too long due to medical intervention. The doctors constantly suggest treatments – that does not mean you have to take them. A patient is obliged to question the doctors' advice.

‘I don't know, Dad. I've had enough, really. But I don't want to orphan my kids if there is some hope. I don't know. I'll think about it over the next couple of days and see. The doctor says there have been some good reports in the research.'

‘It will all become clear, I'm sure.' His sobbing having subsided, an exhausted Jonathan fell asleep. Mr Brewster did not want to wake him, so he just sat next to his son, holding his hand in silent contemplation. He remembered Jonathan's childhood, the times he and Jonathan had spent playing chase, the rocking horse he had constructed for him. Normally, Mr Brewster would have prayed at a time like this. No prayers came to him now. No words deafened his thoughts. Instead, images, sounds, smells, reminiscences of joyful times sprang to his mind. It was midnight before Jonathan stirred again.

‘Dad, what time is it? Why aren't you home yet? How are you going to get home?' Jonathan asked sleepily, then turned and fell asleep again.

When Jonathan woke again and opened his eyes in the dim ward, his father had left for the night. He sat up to silently meditate on his fate. Surgery on his brain, radiotherapy and then more chemotherapy. Now there was a daunting set of treatments, with even less promise of success than any of the treatments that had already failed. He had had enough. Medicine had offered all it could, and now the doctor could offer him nothing but a vague possibility of extending his life. What was the alternative? Death. Death, but with dignity.

Memories of his girls being born came to his mind, and he smiled happily to himself. Memories of his mother and father, his childhood. His thoughts turned to Tracy. His adoring wife had been through enough. He regretted that he was not going to be there for her in the future. She was going to have to bring up their girls alone. A widow. His smile turned to sadness. She had loved him far better than he had ever loved her. Even before the cancer, his wife was the only one who backed him throughout his ordeals – his ladder-climbing at work, his quest for a better job, and a better one after that, on and on. She had prepared him for each interview and had sat in silent vigil waiting for an outcome, had kept life going for the family at home while he sought advancement. He had justified his total absorption in his career on the basis that he was doing it for her and for the girls. He was not. He faced that truth now. It was all for him. His ambition. His fantasy of self-actualisation, as if it could come through a job title or status. He lay in
his bed filled with the regrets of a life spent taking instead of giving.

As dawn's early light started to filter through the windows of the ward, Jonathan resolved that he was going to have no further treatment. He was not going to go ahead with the advice the doctor had so gingerly given. Clinging to false hope with nothing but a guarded prognosis was not the way a man should die. Jonathan resolved to die with dignity. Die in his own way. He got up, went to the nurses' desk, asked for a pen and some paper and returned to bed. He wanted suddenly to write a message to his girls – something to guide them, to help them on their life's journey. He put the paper down. He could not find the right words, something profound enough. Then, it came to him, from a passage he had read as a young man and kept with him all his life: ‘This too shall pass'.

He was still well enough to walk and travel, and he wanted to live again before he died. By the time the nurses had started their morning activities, he was dressed and standing once again at the nurses' desk.

‘I wish to discharge myself, please,' he said.

‘Well, that is not possible. The doctors will be coming in shortly, and you can discuss it with them. Mr Brewster, please go back to your bed and wait for their ward round.' The nurse did not want to go through the paperwork.

‘I wish to discharge myself now, please. You cannot hold me against my will.' He was adamant. He had had enough of being a passive victim.

The nurse got on the phone and called me. Jonathan's case was currently caught in a crack in the monolithic departmen
tal structure of the hospital, between my Urology team and the Oncology team, who were looking after his day-to-day care. It was six-thirty; I came straight in.

‘Hi there, Jonathan,' I said gently. He was fully dressed and packed. He was obviously determined.

‘Dr Khadra, I've just had enough,' he said. ‘I don't want to continue with all of this unless there is some definite hope in going through the hell of more treatment. Can you reassure me of that?'

‘Jonathan, your oncologist feels that there is a chance with the triple-therapy approach – the brain surgery and then radiotherapy and more chemotherapy. There have been some reports around the world of patients responding.' I was taking the coward's way out of this situation. What I should have said is, ‘Jonathan, go home and spend some quality time with your family before the end comes. Do not let the hospital lead you into more experimentation and torment.'

Tracy entered. The nurses had called her at home and urged her to come in.

‘What's going on?' she asked, looking panicked.

‘Tracy, I want to go home. They're not going to offer me anything that I want to put up with. I want to be with you and the girls without having to put up with more surgery, radio and then more chemo as well.'

‘Doctor Khadra, you have to tell him that he needs to stay and undergo the treatment,' she said. ‘What is the choice, Jonathan? You have to stay.'

I sighed and thought,
It is better said than left unsaid
. I would not have been able to live with myself if I had not at least presented another option.

‘Tracy, Jonathan's cancer has a very low chance of being cured or controlled by the treatment that's been proposed. The
complications are high. It is possible that during the brain surgery to remove the tumour, the surgeon could cause neurological damage. He could end up paralysed or perhaps even die on the table. I suppose I just need to present the alternative. It is an option for Jonathan to choose to reject further medical treatment and let nature take its course. I really feel that it is his choice.'

Tracy was crying. She knew that it was right for her husband to come home. They had both had enough of the ravages of hospital treatment.