In the Midst of Life

of nausea frequently beset him after ameal. We gave him anti-emetics, which helped a little, but one day, as he drank the mixture, he said to the nurse, ‘This is not going to improve me, is it?’
    ‘Oh yes,’ she said brightly, ‘we wouldn’t give it to you if it wasn’t.’
    ‘There is only one thing that is going to help me,’ he said, ‘and that is work. My secretary is coming at two o’clock and I must go to my broom cupboard.’ He grinned at the girl.
    Mr Anderson always dressed in a suit to go to his office. We thought at first it was an affectation to assert his superiority over the other patients, who usually wore dressing gowns, but as time went on we realised that it was to preserve his self-respect and sense of dignity. As he lost weight, the jacket hung loosely on his thin shoulders, and he had to make new holes in his belt to keep his trousers up.
    Excepting the days when he had radium therapy, Mr Anderson went to work. He even went on the day following treatment, when we usually advised patients to stay in bed because they often felt very ill. He would struggle out of bed, and one could see him trying to control the nausea and dizziness flooding his head, as he shaved and dressed. He usually returned to the ward about lunch-time, looking somewhat better. Obviously, the work was doing him good.
    Pain is associated with cancer, and as the growth encroached further into the stomach and duodenum, Mr Anderson’s discomfort increased. Pain is something we cannot measure. No one can tell when the level passes from inconvenient to severe, to unbearable, and we all have different pain thresholds. Mr Anderson’s was probably getting to the severe stage – we could tell by the look in his eye, by the intake of breath and biting of his lip, by a slight moan that escaped as he bent over to try to ease the abdomen. But he would not take any painkillers. He had tried the Brompton Cocktail on a couple of occasions, but it had made him so sick he would not take it again, and he adamantly refused any injections.
    Putting on his suit was such a struggle that particularmorning.
    I could see the effort it was costing him and he gave a little gasp as he leaned over to tie his shoelaces. He remained bent in that position for some time, and when he sat up, his face was grey.
    ‘You really must have some analgesics,’ I said to him.
    ‘No, I can’t. I’ve got to keep my head clear.’
    ‘Then why not stay in bed for the day?’
    ‘I am expecting some important telephone calls this morning.’
    ‘Your secretary will be coming. Can’t he take them?’
    ‘No. I have to make crucial decisions. No one else can do it. And then there will be a lot of follow-up work.’
    ‘Surely it cannot be so important that it can’t wait until tomorrow?’
    ‘It cannot wait. A great deal of money is at stake.’
    I gasped, almost unable to believe what I had heard. Money, of all things! What on earth would he do with more money on the brink of eternity? A man obsessed with money has never appealed to me, but because I saw him wince in pain I said gently: ‘You might be feeling better tomorrow.’
    ‘I will
not
be feeling better tomorrow, Sister, and you know that as well as I do.’
    Our eyes met, and, for the first time, I knew that he knew he was dying. The game of ‘let’s pretend’ was over. I was greatly relieved.
    ‘So you know, then?’
    ‘Of course I know!’ he said savagely. ‘Radium is given for cancer. Do you think I’m a fool?’
    ‘Do you want to talk about it?’
    ‘Yes, but not now. I have work to do. We can talk later. The only question I really want answered is, how long have I got?’
    ‘That is impossible to answer. Accuracy can never be assured.’
    ‘Weeks or months?’
    ‘No one can say. It depends on so many things.’
    ‘Then I will continue to act as though it is weeks, and I have work to do. You could oblige me by helping me to my feet, Sister.’
    I helped him to stand up, and watched with sorrow and admiration as he straightened his back, gritting his teeth as he didso.
    People with abdominal pain find it eases them to bend over slightly. But not Mr Anderson – he was determined to stand straight, and he walked firmly to the door and along the corridor towards his broom cupboard.
    It is generally assumed that doctors know all there is to know about death, and that, if a patient is to be told that his condition is incurable, it is the doctor’s prerogative. In my experience,