In the Midst of Life

expect?’
    ‘I’m not sure that age comes into it.’
    ‘Apart from Warfarin, what other drugs does she have?’
    ‘Statins, cardio-vascular drugs and stimulants, anti-coagulants and diuretics, as well as regular analgesics.’
    ‘But that’s crazy. She has advanced cancer. It is better to die of heart failure than cancer.’
    ‘I know that. You know that. The doctors know it. But we cannot discontinue the drugs.’
    ‘Why? I don’t understand.’
    ‘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.’
    Atthat 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.
    *
    Cyclingencourages 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