With the End in Mind. Kathryn Mannix

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СКАЧАТЬ been thinking. I don’t need to wait. It’s an easy traverse from the window ledges to the corner of the building. If you dropped from there, you’d hit the concrete full-on. Like, over in a second. Bam!’ His extended arm bangs the bed, and I jump.

       Oh, dear goodness: he’s worked out a suicide plan to avoid waiting to die.

      ‘You’ve been thinking about that a lot?’ I ask, holding my voice as steady as I can.

      ‘First thing I noticed when I arrived. Then I checked the stairwell too. But too many things to hit on the way down – too narrow. Outside’s better.’

      ‘And when you think about that, how does it make you feel?’ I ask, dreading the reply.

      ‘Strong again. I have a choice. I can check out – bam!’ – he whacks the bed again, but I am ready this time – ‘any sweet time I choose …’ He lolls back on the pillows, grinning and locking his eyes on mine to assess my response.

      ‘And do you think you might need to do that … um … soon?’ I ask, desperately wondering how I would summon help if he bounded out of bed now and tried to squeeze through the window.

      ‘Nah,’ he smiles. ‘Not now we know the bugger’s on the run. But if it comes back, I won’t hang around for it to mess with me.’

      ‘So should I be worried about you doing it this week?’ I ask, but he is sliding back into sleep. Within minutes, he is snoring. Tomorrow I will need to ask the liaison psychiatry team for advice, but for tonight I can see that Alex is too sleepy to move from his bed. I can go home.

      The bedside phone rings in the early hours. Stupid with sleep, I answer the hairbrush before identifying the phone set. I can barely say ‘Hello …’ before the voice of our night-time charge nurse interrupts me.

      ‘Alexander Lester!’ he barks – he’s ex-army. ‘Bleeding both ends. Have called ICU team. Just letting you know!’ The phone rings off.

       What? What has happened? Why is he bleeding? His blood counts were fine. He must have done something. Has he jumped? Oh, hell – what if he’s jumped? Where are my shoes? Car keys? What’s going on?

      It is a five-minute drive to the hospital, less at 2 a.m. with no traffic. I park in an ambulance bay and run up the stairs to avoid the Lift of Unreliability. Panting and sweating, I arrive on the ward to find the charge nurse striding along the corridor.

      ‘Ah, Dr Mannix, ma’am! Patient has been transferred to ICU as I came off the phone. Blood pressure unrecordable. Fresh red blood in vomit and per rectum. Extra IV access established and fluid resuscitation commenced. Family informed. Anything else, ma’am?’

      ‘What happened?’ I ask, bewildered. ‘Did he jump? Where is he bleeding from?’

      ‘Jump? JUMP?’ barks the charge nurse, and I myself jump, as if commanded. ‘Whaddayamean, jump?’

      I take a deep breath and say, ‘Just tell me exactly what happened,’ as calmly as I can.

      The nurse describes how Alex was restless around midnight, then asked for a commode, then passed a very bloody motion and dropped his blood pressure, then began to vomit what looked like fresh blood. No jumping. If I knew he was considering it and took no action, it would be my fault. Mixed waves of relief and alarm struggle for supremacy, and are trounced by a tsunami of guilt: I am worrying about myself when Alex is in ICU.

      ‘Looks like he’s having a massive GI bleed,’ continues the nurse. ‘Blown through to a major blood vessel if you ask me.’

      That doesn’t sound good. Ascertaining that I am not needed for other patients in the cancer centre, I am propelled by a mixture of concern and shame up the over-illuminated hospital corridor to ICU. They have called Alex’s consultant oncologist, who is on his way in.

      Alex lies on his side, unconscious; the room smells of bloody poo, a sweet, clinging aroma that I recognise and dread. He has two drips, one into a neck vein; his monitor shows a rapid pulse with a very low pressure. This is bad. A nurse keeps pressing the ‘low pressure’ alarm to silence its insistent shrieking. Pale beside the bed sits his mother; alongside her, a young man (‘Roly,’ he says briefly) looking very like a second Alex is shredding a polystyrene coffee cup. The ICU consultant is in the room. She is explaining that Alex has lost a huge amount of blood, that they are waiting for a cross-match from the blood bank because he must have virus-screened blood during his chemotherapy, that they are giving clotting factors and plasma, but that he is very, very sick, and not fit enough for surgery to try to stop the bleeding. This is really bad. We are curing his cancer – how can this be happening?

      And then Alex’s head is thrown back, almost as though it is a voluntary movement. A huge, dark-red python slithers rapidly out of his mouth, pushing his head backwards as it coils itself onto the pillow beside him; the python is wet and gleaming and begins to stain the pillowcase and sheets with its red essence as Alex takes one snoring breath, and then stops breathing. His mother screams as she realises that the python is Alex’s blood. Probably all of his blood. Roly stands up, grabs her and removes her from the room, accompanied by the nurse. Her sobbing screams become more distant as she is led away to a quiet room somewhere.

      I am stunned, paralysed by horror. Is this real? Am I still asleep, dreaming? But no. The coiled python is collapsing into itself like a large, maroon blancmange. Alex would appreciate the dense colour, the changing texture, the dark-meets-white on the bedding. Shouldn’t we do something? What?

      The ICU consultant seems to be far away, as though on a cinema screen, as she checks Alex’s pulses and says, ‘Not a good way to go …’ Attempts at resuscitation would be futile. She shakes her head, then offers me coffee, which seems strangely calming, and I accept. We meet Alex’s oncologist as he arrives, and sweep him up with us to the staff room for coffee and debrief. The oncologist has seen this before: beads of tumour that have glued gut to large blood vessels, shrinking to leave a hole as the cancer responds to the chemotherapy, channelling the whole blood volume out of the body. It is rare but recognised, and untreatable if the bleeding is massive.

      And I keep thinking, He didn’t want to see it coming. He got his wish.

      Yet I know that, after the serpentine blood clot has been removed, the bedding changed and Alex’s body washed, and his family are allowed to see him to say goodbye, they will find no comfort in the notion that he will never need to jump from a high building to escape the fear of knowing that he is dying. Alex has left the building, without ceremony or leave-taking. But the absence of farewell will be a lifetime burden for the little family of heroes.

      And in the morning, we will need to tell the Lonely Ballroom occupants that Alex has finished his treatment.

      This was a hard story to tell, and probably shocking to read. While most dying is manageable and gentle when it approaches in an anticipated way, the truth is that sudden and unexpected deaths do happen, and not all of them are ‘tidy’. Although loss of consciousness during a sudden death usually protects the dying person from full awareness of the situation, those around them retain memories that may be difficult to bear.

      Bereaved people, even those who have witnessed the apparently peaceful death of a loved one, often need to tell their story repeatedly, and that is an important part of transferring the experience they endured into a memory, instead of reliving it like a parallel reality every time they think about it.

      And СКАЧАТЬ