With the End in Mind. Kathryn Mannix

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      I explained all this to Alex, who had been told it all in clinic, but as is often the case with shocking news, he had retained only a little: cancer, everywhere, chemotherapy, blood tests, sperm count, bald, sick, off work. Helpful details like curable, optimistic, getting back to work, had simply gone over his head. He was terrified, and ashamed of being terrified; like all mountain climbers, he could face the fear of a fall and sudden death, but the idea of watching as death approached, helpless as the sacrificial virgin tied to the stake to await the dragon, was paralysing. He should be a hero like his namesake, not a helpless victim. He felt his fear and labelled himself a coward. His shame outweighed even his fear.

      Laughter from beside the windows: ‘Butch’ Wilkins, the England midfielder, was being interviewed on TV and had just been asked whether coping with the harsh tackles sprung on him by other teams’ defenders took balls. Cue belly-shaking laughter from the men with surgically adjusted tackle and single balls. Vicious humour was their weapon of choice in public. Behind the curtain, Alex regarded me with sorrowful eyes, slid down the bed while raising the sheet towards his chin, and whispered, ‘I can never be as brave as them …’ as a tear rolled slowly down his cheek.

      ‘You only need to get through this a day at a time,’ I began, but he started to rock backwards and forwards, gulping and trying desperately to remain silent as he was overtaken by sobbing. The window boys diplomatically turned the TV up. They knew, so much better than I, how the fear of the fear is the worst aspect of all.

       I feel so helpless and inept. Is crying in front of me even more undermining for him? If I leave now, will that look like abandonment?

      I could feel my cheeks burning, and my own eyes brimming with an overwhelming sense of helplessness before the immensity of Alex’s struggle.

       I mustn’t cry, mustn’t cry, mustn’t cry …

      ‘I just can’t imagine how hard this is for all of you in here,’ I said. ‘All I know is that everyone looks like you on their first day. They all did – and look at them now.’

      ‘I’m such a coward,’ he whispered as he continued to rock, his sobs abating.

      Lost for words of comfort or of hope, I reach for my tray of kit to set up Alex’s drip, and he holds out both arms as if to be handcuffed.

      ‘Are you right- or left-handed?’ I ask, and like so many artists he tells me he is left-handed. While I prep the skin, tighten the tourniquet and look for a suitable vein, I ask about his art, and he tells me how much he loves the creative process: imagining the work, almost feeling it as a reality; building each canvas, layer by layer and colour by colour; how he dreams in textures and surfaces as well as pictures and colours, endlessly fascinated by the combin­ations of surface and space, colour and blankness that he sees in nature when he is walking and climbing. He is completely transported as he speaks, and in minutes his drip is attached and his face is calm. I ask permission to pull back the curtains, and we see his five room-mates playing cards beside the TV, a circle of shiny heads and drip stands like a peculiar toadstool ring sitting in a copse of metallic trees.

      ‘Want to join in, mate?’ one of them asks. Alex nods, and grabs his drip stand. I escape to ponder whether bravery is about being fearless or about tolerating fear. Why do the ideas for helpful responses arise only as I walk away from the bed?

      By late afternoon, all the lads are high as clouds and vomiting for England. They lie on their beds and attempt to aim their laid-back heads towards the washing-up bowls that are provided for them: they are too sleepy and slow to catch sudden vomits in the small plastic kidney bowls used for the rest of the ward. They laugh at each other and cheer each other on, and by the time I head for home they are all singing along tunelessly to that year’s World Cup song – which may not, in fact, have had a tune anyway.

      Three weeks pass, and it’s another Monday in the Lonely Ballroom. Six lots of blood tests to collect; six drips to set up; six sets of mind-altering drugs to prescribe; six reviews of the last three weeks. Alex is no longer a new boy; he knows the drill, and his shiny head now matches his room-mates’. There is shared outrage at Maradona’s ‘hand of God’ goal against England. Alex’s chest X-ray shows that his many cancer deposits are shrinking very quickly. I take the big, grey transparencies to show him, and he is intrigued by the images, by the contrast of dark and light, the puffball shadows looming large and white against the dark lung tissue, and the huge reduction in size after only the first round of chemotherapy. I explain that all the other secondary deposits in his liver, kidneys and abdomen will be doing the same thing: shrinking away as the chemotherapy has its effect. This increases his chances of cure even further. He nods, serious and thoughtful. I wonder about asking how he feels in himself, whether his fear is still so raw, but I am afraid I may undo his mask, and that he may not wish to go there. I move on to the same, yet always completely different, conversation with each of the other patients.

      That week, I was on call on Wednesday evening. I always inspected the Lonely Ballroom drips before going home, because if any failed during the night I would have to drive back and resite them. The guys were quiet. England were on their way home from Mexico, there was a heatwave and the ward windows, facing south, turned the room into a hothouse that was only just cooling as the evening wore on. Most of the drips looked fine, but Alex’s skin was becoming slightly red around the drip-site, and he noticed that when he moved his arm, the drip stopped, causing an alarm to sound. I gathered a kitbox, pulled the curtains and set about resiting the line.

      ‘I still don’t know how to bear this,’ he said softly once the curtains were drawn. The ‘happy drugs’ have taken his guard down. ‘I mean, I know it looks as though I’m getting better, but even if it all goes away, we don’t know that it will never come back, do we?’

      I was trying to thread a plastic tube into a vein in his forearm, too focused to respond. Into the silence, he sighed, ‘I can’t bear waiting. How do people bear it if they’re waiting to die? I wouldn’t want to know.’

      I taped the tube in place and pressed the button to restart the drip. The ‘on’ light winked encouragingly. I sat back and looked at Alex. He lay against his pillows, bright-eyed with the absence of eyelashes and brows. He looked very relaxed, yet he was scowling to try to hold the threads of his thoughts.

      ‘Do people realise when they’re dying?’ he asked languidly. The effect of the drugs would mean that, however useful our conversation might prove to be, he was unlikely to remember it. Yet in the here and now, helped by the deep relaxation induced by his drugs, Alex was genuinely asking about the things he feared the most. This is a chance that might not arise again.

      I sit still and wait. A change comes over Alex’s face. He pauses, looks up at the curtain rail, and squints as though trying to focus. Then he says, very slowly and deliberately, ‘I’m not sure whether to tell you this …’

      Pause. Don’t interrupt. Let him keep his train of thought.

      ‘Have you looked out of the windows here?’ he asks eventually.

       Oh no, is this about the view of the cemetery?

      ‘Yes …’ Cautious response. Where are we going?

      ‘So you know how high it is, right?’ he drawls.

      I do. I climb those stairs many times a day.

      ‘And you know I’m a climber, yeah?’

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