Breaking and Mending Read online

  On one particular day, I had just about exhausted the entire oncology department (and the outpatient clinics and the chemotherapy suites) looking for A Patient To Talk To and, in a last-ditch attempt, I approached the friendliest-looking nurse on the ward and asked if she knew of anyone who might put up with me for ten minutes.

  The nurse glanced around, shook her head and said she didn’t think so.

  ‘What about the woman in the corner bed?’ I said. ‘The one who’s knitting? She looks like a possibility?’

  The nurse stared at me for a moment, and then she reached into the trolley and handed me a set of notes.

  The woman in the corner bed had end-stage bowel cancer. She had exhausted all the treatment options and was being cared for by the palliative team. With the help of the Macmillan nurses, and the skill and expertise of everyone working in community healthcare, she was being discharged. The woman in the corner bed was going home to die.

  After I’d finished reading, I looked up at the nurse. ‘It would be selfish to ask, wouldn’t it? To waste her time?’

  ‘It’s not that. She’d be only too happy to speak to you.’

  ‘Then …?’

  ‘You can talk to her,’ the nurse said. ‘But only if you promise not to say the word “cancer”.’

  ‘Pardon?’

  ‘Or malignancy or palliative or tumour, or even growth. None of those words. She doesn’t want to hear them. She refuses to hear them.’

  ‘Then what words do I use?’

  ‘All the other words,’ said the nurse. ‘All the tens of thousands of other words in the English language – just not those ones.’

  The woman in the corner bed was indeed very happy to talk to me. Her husband, however, stayed silent. He had obviously arrived at her bedside straight from work, the remains of his day lying in the folds of his jeans and carved into the leather of his boots. He watched from the chair next to her. The woman chatted non-stop, although the knitting continued as we spoke. There was knitting all over the bed. Wool in every colour you could imagine. Backwards and forwards the needles went, clicking away at all the other thoughts and dismissing them.

  We talked about many things. We talked about books and television programmes and holidays. She told me she was knitting baby clothes, because the woman in the corner bed had just found out that her daughter-in-law was pregnant. I swayed for a while on the edge of that topic. It would have been so very easy to fall into it. To colour in future scenarios, scenarios we all knew were not destined to happen. I resisted, because I knew I would be voicing those scenarios, not for the comfort of the woman in the corner bed, but in order to make my own, carefree life just that little bit easier.

  ‘They’ve been married a year,’ said the woman. ‘A year last August.’

  ‘Have they?’ I said.

  ‘Around the same time, they told me I had a problem with my bowel.’

  It hid itself among all the other words, but the story was there. You just had to listen for it.

  I could see the woman’s husband lean forward just a fraction of an inch.

  ‘But I’ve had all my treatment now, and I’m going home,’ she said. ‘Although the Macmillan nurses are going to be helping. Just for a while.’

  ‘Oh, Macmillan nurses are incredible,’ I said. ‘They were so lovely when my dad was ill.’

  I did it.

  I fell.

  I was doing so well, and yet I stumbled over a piece of my own misplaced kindness.

  The knitting needles stopped.

  ‘And how is your dad now?’ said the woman.

  I hesitated. I looked at the woman’s husband. The exhaustion in his eyes. The unforgettable, unmistakeable look of someone who has a complete absence of hope, and I realised that he was the one who gathered up all those unwanted words and carried them around with him each day all by himself.

  My dad would have understood. He would have forgiven me.

  ‘He’s fine,’ I said. ‘He’s doing really well.’

  When I arrived back at the hospital the following Monday, the woman had been discharged. Someone else was in her place – another story, another set of words – and I began to circle the wards again, looking for a patient to talk to. I took many histories as a medical student, but the woman in the corner bed taught me more about the power of words than anyone else. How saying you’re sorry isn’t always the kindest thing to say. How some words are so heavy that, whether you mean to or not, handing them over to someone else can change a person forever. How – medic or non-medic – we should all choose our words with more care because we never know the scales with which they will be measured.

  Medical students are always looking for someone to tell them a story. If you ever find yourself lying in a hospital bed, you will almost certainly be approached by at least one. Try to accommodate them, if you can. They will be unsure and nervous, and they will falter over their words, but they will be deeply grateful you took the time to speak to them. It’s a way to practise history taking, to understand investigations and medications, and treatment plans. When you arrive on the wards, role play becomes reality, and the page in a textbook becomes someone’s life.

  Talking to patients is the very best way to learn.

  But it isn’t always easy.

  The Wrong Kind of Kindness

  As a doctor, one of the most important things to realise is that patients will always remember how you treated them. Even decades later, they can immediately recall the way a doctor spoke to them or looked at them, and how those words and looks made them feel. I know this because I have been a patient myself, and I too remember very clearly how it made me feel.

  I very often think about my car accident, usually when I’m driving. I have no idea why. I very rarely need to travel along the road where it happened and it’s not something that is always on my mind (although, like many major life events, I’m sure it’s there somewhere, hiding behind all the other thoughts).

  Sometimes, I mention it in passing, usually when someone suggests getting a taxi or sharing a lift. I have to bring out my usual ‘I was in an accident years ago and I don’t like other people driving me anywhere’ speech, and I have a familiar surge of anxiety each time I am involved in a decision about how to get from A to B. Sometimes, though, as I drive across the bleak hills of North Derbyshire, with not another car in sight, I start to think about it.

  When you go through an incredibly traumatic experience, something that alters the course of your life forever, your brain seems to sieve out all the big details and it leaves you with just a residue of tiny memories. Sounds. Smells. Textures. I don’t remember the accident itself, but I remember (very clearly) the moments beforehand. I remember driving along a straight country road and being overtaken by a number of cars because I am, thank heavens, a very slow driver. I remember climbing a hill. I remember it was a cool, clear evening and I remember wondering what I might have to eat when I finally got home.

  The next memory I have is of opening my eyes and realising that the car wasn’t moving any more. I was perfectly still. Right in front of me, only an inch away, my headlights lit up a dry stone wall. It was so bright – like the stage in a theatre – and I studied the blanket of moss that covered the surface of the stones. Tiny and flowerless, yet so beautiful. How have I never noticed this before, I thought, on a journey I travel every day. But I knew something was wrong. I knew I shouldn’t be facing a different way in the middle of a road, marvelling over the beauty of moss, and so I reached out to put on my hazard lights. That was the moment I first saw the blood on my hands.

  I must have lost consciousness again, as I was trying to make sense of everything, because when I next opened my eyes, a man was standing by the car. He told me that he was a police officer. He said it was the second accident he’d stumbled upon when he was off-duty. So, I thought, I have had a car accident. I wanted to ask him questions, all of the questions, but he didn’t look at me the whole time he was speaking, and so I stared at th
e loose button on the sleeve of his jacket instead, and I thought how easily that button might disappear and be lost forever.

  Eventually I was lifted out of my vehicle. They sat me in the front of a police car, and I was left alone, with the smell of chewing gum and hoovered upholstery, trying to arrange the jumbled, concussed thoughts that were swimming around in my brain. There was a hiss of a police radio somewhere nearby and, among the clutter of words I couldn’t decipher, I heard it say that this was a fatal road traffic collision. Fatal. I didn’t realise then that there was another vehicle involved, and my mind charged into a panic, trying to think who might have been travelling with me, who might have died. I went through everyone I knew. Everyone I cared about. I exhausted every possibility, until I finally satisfied myself that I was alone in the car. But, I thought, if I was alone in the car and it was a fatal accident, then the person who died must have been me. I held on to this thought for a very long time. It was probably only moments, but they were the most terrifying, surreal moments of my life, thinking this must be what it feels like to be dead. Being cold and alone in the dark. Listening to the voices of strangers in the distance.

  It wasn’t until they put me in the ambulance, until they strapped me into a narrow, blanketed space filled with machinery, that I accepted the fact that I was alive. I was still here. I just didn’t realise until much, much later how unlikely that was. Just like the off-duty policeman, the paramedic didn’t look at me either. He stared at his boots. He stared out of the tiny window in the back of the ambulance. The window was made out of that strange, frosted glass you get in emergency vehicles, and I remember wondering why anyone would stare out of a window when it didn’t offer them a view. I tried to talk to him, but I’m not sure the words ever left my head. He certainly didn’t answer. I wasn’t in any pain at that point, and the only thing I could feel was a wetness around my mouth. It felt as though my nose was running, and I kept trying to wipe it with the back of my hand.

  ‘Don’t touch your face,’ he told me.

  They were the only words he spoke for the entire journey. At that stage in my life, the one reference point I had for a paramedic was Josh in Casualty. The paramedic from my accident was no Josh. In my second book, there is a whole scene involving a paramedic. The paramedic in my book is kind and reassuring and thoughtful, because I think, as writers, we sometimes retell the experiences of our lives and turn them into what we hoped they might have been.

  When we reached the hospital, I was wheeled through a waiting area filled with staring, and into Resus, where a cluster of people gathered around my trolley. I couldn’t see who they were. I could only see their forearms and the navy blue of their sleeves, their scrubbed hands, and the things they passed over my head. I could see the blur of strip lights in the ceiling as I was wheeled down a corridor to be scanned and X-rayed, and all the time, I was hoping someone would just wipe my nose for me. It was all I remember wanting them to do. I always tried to remember that experience whenever I worked in Resus, how your only view is of people’s sleeves and arms, and the blinding fluorescent lights about your head. How terrifying it is.

  After it was decided I was stable, the cluster of blue uniforms drifted to the periphery, and I was left alone again. It was then she appeared. The junior doctor. She was very young, perhaps only a little older than me, and she leaned over the side of the bed.

  ‘Don’t worry,’ she said. ‘My friend did exactly the same thing to her face on some rocks, when she was scuba diving in Greece.’

  I remember her exact words. I remember the compassion spilling from her eyes.

  ‘It was awful at first, but you’d never know,’ she whispered, ‘looking at her now.’

  It’s just a scratch on my face, I wanted to say. It’s nothing. They’ll probably put some butterfly stitches in and send me home. Why are you talking to me like this? Why are you looking at me with so much concern?

  But I didn’t say any of these things. I just stared at her. Because her words made me realise, in that small moment of a stranger’s reassurance, that I had turned into someone who needed to be pitied.

  I understood, when I became a junior doctor myself. I understood that you are constantly surrounded by people who are far wiser, far more experienced than you think you’ll ever be. You feel pointless. Redundant. You feel you have nothing to offer a situation, and so you give the only thing you feel confident in giving. You give compassion. You give words. And you over-give those words in order to compensate for your sense of helplessness. The junior doctor in Resus was just trying to be kind. But her kindness terrified me.

  Much later, I realised why she had said it. When I had been taken to a ward, and I had persuaded the nurses to let me go to the toilet alone. When I had stood in that toilet, and looked up into the mirror over the sink. When I saw my new face for the first time, and I took a step backwards in shock, because I thought someone else had walked into the room. I discovered, finally, why it felt like my nose was running. The impact of the accident had crushed the entire bonnet of the car, and I’d gone down on to my knees in the footwell. The crash threw me head first into the dashboard and, in the days long before airbags, I had broken the steering wheel with my face. The hard, sharp pieces of plastic had torn into my mouth and nose, and ripped flesh from the bones. So much so that – had you wanted to – you could have lifted my face from my skull, like a mask. The only reason I wasn’t in agony was because there were no nerve endings left to tell me I was in pain.

  I think about all of these things as I’m driving, but I don’t think so much about the injuries, about the months of rehabilitation and the many years it took me to get used to my new face. I think mainly about the junior doctor in Resus. I think about how her misplaced kindness, with all its best intentions, terrified me at a point in my life when I didn’t think I could possibly be any more terrified.

  I think about the dangers of kindness.

  For many months after my accident, I couldn’t eat because of the damage to my mouth. (I had to sip banana-flavoured Ensure drinks through a tiny straw and many years later, I remembered its taste each time I had to prescribe it for someone else.) I couldn’t speak, either. Or at least, I could speak, but the noise that came out was completely incoherent to everyone else (even though it sounded perfectly understandable to me). So I was forced to write down all the things I wanted to say. Writing down all the things you want to say is a wonderful exercise. It teaches you to be less grumpy. Less snappy. More mindful. As unhappy and frustrated as I was at the time, writing my thoughts down first meant that I didn’t let the unhappy, frustrated words go free without a great deal of consideration. I think that, if we were all to choose the words we speak with as much care as we do the words we write, then the world might be a much more bearable place in which to live.

  As much as I love the idea of everyone embracing compassion and being lovely to one another, and as much as I like the hashtags and the wonderful ethos of small acts of kindness, you can’t sling kindness around like mud and hope it sticks to the right place. Kind words, like all the other words that come out of your mouth (and your keyboard), need care and placement. You really can have the wrong kind of kindness. Kindness isn’t a one-size-fits-all. Kindness isn’t a bandwagon to be jumped upon, and while kindness might be one of the most powerful, and most empowering, qualities we possess, without consideration, it can be just as debilitating as the most brutal and well planned-out act of cruelty. Because the echo of a kindness really does last forever, for the good or the bad, and you might find that words that you gave with the very best intentions in the world, will be remembered by a stranger many years later, as they drive over the bleak hills of North Derbyshire, with not another car in sight, on the long drive home.

  Rose Cottage

  On the first day of medical school, we were told that over the next few years we were going to be trained to treat illnesses, to help patients live well, and to also help them to die in comfort. And we were told to never
lose sight of the patient. ‘Always palpate the patient’s abdomen’ said our professor (our anatomy lecturer, a surgeon who would retire that same year). This was his lifetime advice – advice that many years later would go on to be described as patient-centred care. ‘Always palpate the abdomen.’ The same surgeon that told us to be humble enough to accept that some of the things we were going to learn may be outdated even by the time we finished medical school, to never stop learning and to accept that what we once held as the truth may change. And to say sorry. Those words have come back to me many times over the years.

  The consultant

  In the third year of medical school I was loitering around the nurses’ station, trying to look useful, when I overheard the ward sister on the telephone.

  She was calling the porters’ lodge. Porters are constantly requested throughout the day and night. They are summoned to move trolleys and people, and machinery. They weave and whistle through hospital corridors with requests for X-ray films and blood results, and nervous patients. But this telephone call was different. This request was quiet and unhurried.

  ‘I have a package for Rose Cottage,’ the nurse told them.

  I didn’t understand at first. Was Rose Cottage one of the administration buildings? Was it part of Estates? Was it some building in the distant corner of the hospital grounds, where secretaries typed and filed all the patients away? If so, why were we sending a package there, and why was it spoken about so quietly?

  To me at the time, and to those passing by the nurses’ station and anyone else who might be listening in, it meant nothing, but to the nurses and to the porters it was a code. It meant that a patient had died.

  The package for Rose Cottage is a body for the mortuary.

  As a junior doctor, the first job I was ever asked to do was to certify a patient’s death. I arrived at the hospital on my very first day, still warm from medical school. I was fresh and unblemished, as yet undamaged by exhaustion and a sense of hopelessness. Still fuelled by a vision of the kind of doctor I wanted to be. My bleep went off within minutes of arriving, and I answered it with the wide-eyed innocence of a child.