LITMIR.BIZ

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should we respond as professionals when there is no time left to adjust? Is complying with denial telling lies, or respecting the person’s choice?

      In a single hospice room filled with postcards, furnished with her own cushions and fabrics from home, an enfeebled young woman with a vibrant mane of red hair is pacing. Supported by her mother, she lowers herself carefully to sit on a brightly coloured blanket that has been placed on the chair. Her husband and her father look on warily from the small sofa bed. She strokes the softly brushed wool, and a stream of babbling words pours from her lips. ‘Feel how soft it is! It’s alpaca. Remember when your brother came back from Peru with it, Andy? When I’m better, we’re going to Peru with him; he knows all the best places to visit. I want to see those temples to the sun. The god has huge hair. He looks like me! I could be the sun-god …’

      She cannot settle. Rising to her feet, and almost falling as her swollen right leg fails to do her bidding, she bats away the anxious attention of her mother and limps back to the bed, perching on the edge. She faces the sofa, where her father and Andy are sitting in silence.

      ‘Cheer up, you two!’ she commands. ‘Nobody’s dead!’ She coughs and sighs. This is Sally, and she is dying. But nobody can mention it.

      Nicola, one of the nurses, enters the room, bringing Sally’s medications: drugs to prevent pain, nausea and breathlessness caused by the cancer that is tearing through her body.

      ‘Ah, cocktails!’ beams Sally with a brittle smile, and Nicola pours her a glass of water. Sally takes the glass, but her arm cannot take its weight, and the water spills on her clothes, on the bed and on the nurse. ‘Drat it!’ she shouts, suddenly angry. ‘Why did that happen? I’m soaked! Don’t just look at me like that’ – to the men. ‘Go and get a towel! No, Mum, I don’t want another one. For heaven’s sake, WHY ARE YOU PEOPLE ALL SO USELESS?!’ She bursts into tears.

      Nicola observes Sally’s restlessness, her weakness, her outburst of anger, the flood of tears. She wonders whether, despite her efforts to ignore the rapid deterioration in her health, Sally is starting to sense that all is not well. Using denial to cope with an unbearable sorrow can help someone to avoid facing their distress, but if they can no longer maintain their defence, the cataclysmic truth can rush in like an unstoppable tide, drowning them in their own dread. Nicola suspects that, after several years of staunch denial, Sally at last senses the oncoming torrent. Wisely, she deals with the spilled glass rather than the tide of terror, then returns to the office for help.

      I had known Sally since her cancer was first diagnosed. Then she was a party girl, a redhead with a sumptuous fountain of burnished copper hair, a glowing, shimmering radiance cascading around her shoulders; a Pre-Raphaelite goddess. And this is relevant, because chemotherapy makes people’s hair fall out.

      I first met her while I was a research fellow in the cancer centre, taking on a research project for the Professor of Oncology as part of my palliative medicine training; Sally’s party dancing was impeded by having had her right big toe amputated to stop the spread of a melanoma that had been found growing underneath her painful toenail. She told me that she was ‘going to fight it’ when I arrived to put up her drip; she was too busy enjoying life to let cancer get in her way. She had Plans.

      ‘Tell me about your plans,’ I encouraged her as I swabbed her arm and prepared to insert the plastic cannula through which she would have a chemotherapy drip for the next few hours.

      She gathered up her flowing, curly halo of hair with her free hand to keep it away from my work, then took a breath, smiled, and said, ‘Well, I want to learn to windsurf. Somewhere warm. Greece, maybe.’ Her eyes took on a faraway gaze. ‘You can go on watersports holidays and get taught to do all kinds of stuff. And then I want to go to Australia and visit the Great Barrier Reef and learn to scuba-dive. It’s supposed to be amazing!’ Then, leaning forward, she peered at the cannula now sticking out of her arm and said, ‘Have you done it already? I was expecting something bigger, and lots of pain and blood and stuff!’

      As I taped in the cannula and attached the saline drip, waiting for the chemotherapy bag to arrive from the hospital pharmacy, she carried on explaining her plans. She seemed simply to say aloud whatever was passing through her mind.

      ‘I want to travel,’ she said. ‘I want great holidays. I want to marry Andy. And we’ll have an amazing honeymoon somewhere really fantastic, like the Himalayas or the Alps. He loves climbing. But he hates water. We’re like chalk and cheese! It’s like that “opposites attract” thing, you know? I mean, he’s so quiet and thoughtful and clever, and I’m like, “Wheee! Look at me!” and he’s like, “I’m trying to concentrate here, do you mind?” with his head in a book or watching some film about climbing or nature and stuff. I don’t know how we’ll make it work, but we will. And I’ll learn to cook and make all his favourite meals and I’ll learn to be quiet – shhh – yeah, like’ – whispering now – ‘so quiet when he’s thinking about things.’

      She cannot maintain the whisper, and launches on, apparently exuberant and enthusiastic – or is she terrified and garrulous? It’s so hard to tell. ‘But obviously I can’t be a bride with like no hair and that, so we’ll have to wait until my hair grows back after the drugs, but it’s worth it to be cured and I’ll look back on all this when I’m an old lady and all this will seem like a crazy dream. I’ll beat this. I know I will.’

      I am caught up by her enthusiasm, so it is only later in the day, while grabbing a sandwich with my colleagues during a teaching session, that I consider the vital role of our big toe in balance. Windsurfing and climbing will be extremely challenging without a big toe. And do you need a big toe to flap a flipper when you’re diving? I waggle my outstretched foot thoughtfully, until the speaker meets my eye and I realise I have not heard a word of the lecture. Sally is occupying my mind, chattering and disturbing my concentration from the other side of the hospital.

      Three weeks later, she is back for her next round of chemotherapy. I almost don’t recognise her: without her tumble of hair she is delicate and pixie-like, her features naked without eyebrows or lashes. She greets me enthusiastically with another stream-of-­consciousness monologue. ‘Hi, doc! Here we go again! Oh boy, I was so sick after you left last time. Can you give me anything extra for the sickness? It’s just the worst. I hope I never get morning sickness. I mean, can you imagine feeling like that, but for months?! Un-be-liev-a-ble! I want lots of kids. Andy’s blond, so we might have more ginger-nuts like me. I think ginger babies look soooo cute, don’t you?’

      I explain that I will not be putting her drip up until I have checked that her bone marrow and kidneys have recovered from the previous round of chemotherapy; I will take a blood test now, and get back to her as soon as I get the results. She looks dis­­appointed. ‘Just bring it on!’ she announces. ‘I need to get better, so get that cancer-poison dripping!’ While I prepare my needle and tubes for her blood test, I ask her to tell me what other plans she has for her future life with Andy. She says she wants ‘at least four kids’, and she has ideas for their names already; the blood is in the tubes before she stops talking and blinks, eyes owl-like in her round, bare face. ‘Crikey! I never felt a thing again!’

      Actually, she is so distracted by her own ideas and plans that she simply doesn’t notice the jab of the needle. It’s not due to any skill on my part – it’s her own coping device, the power of her mind in action, to behave almost as though we are pals meeting for a coffee and catching up on all our news: ‘Nothing wrong here …’

      This week her drip is put up by one of the chemotherapy nurses, so I don’t see her again until I am leaving for home. She is sitting in the car park, drip still running, having a cigarette with a tall, angular man with short fair hair and round-framed spectacles. ‘Hey, doc! This is Andy. Andy, this is the Professor’s assistant. She’s the chief poisoner.’

      I walk across the car park to say hello. I learn that Sally just has to wait for a bag of saline to run through (‘It’s rinsing my kidneys. I know it’s doing me good!’), and then Andy will take her home. He looks tired and anxious. In fact, he looks like the sick person; if Sally were not bald

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