A Question Of Identity Part 7

Cat shook her head. Often, as a palliative care doctor, she had to accept that there was little or nothing she could do for a patient, in the sense of curing them or extending their lives, though there was usually something to be done about pain relief, and almost always she could talk, listen, comfort. But once in a while, either because of the nature of the disease or the patient's temperament, she felt helpless. Redundant was a word that came to mind then. Yes, she thought, going down the corridor now, in spite of all her medical training and experience, plus her innate instinct, sometimes that was it she was redundant.

As she tapped and opened the door of Room 9, she had the momentary sensation of moving into some other-world. The sun on the snow outside radiated a silver-white light through the windows, which touched the far wall and made it gleam in an unearthly way. To die now, in this, must surely be to die in radiant peace, no matter what else was involved.

And what was one of the first things you learned? Cat asked herself, going in. Don't sentimentalise to make yourself feel better.

Jocelyn Forbes was propped up on the backrest and pillows, breathing with the help of an oxygen mask. She was parchment-pale and her arms on the sheet were so thin the bone gleamed through the skin. She had motor neurone disease, but she was patient, uncomplaining and, above all, sanguine about her situation and apparently not unhappy. MND did not usually cause clinical depression but Cat was surprised how cheerful she was. It was her daughter Penny who had sunk into a downward spiral of misery and helplessness. Much against her will she had gone with her mother to a foreign clinic where Jocelyn had intended to commit a.s.sisted suicide. The experience had been so scarring, frightening and unpleasant that Jocelyn had fled home and continued with her life, physically deteriorating but able to get enjoyment out of the smallest things. At first, Penny, an unmarried barrister, had moved back home to be her carer but she had found it upsetting and difficult, so she had returned to her flat, struggling with work and having psychiatric help and medication for depression, unable to face even calling on Jocelyn briefly. There had been a succession of carers, some good, some poor, none lasting. After spells in hospital and in a private home, Jocelyn's condition had deteriorated so far that Cat felt justified in admitting her to the hospice.

Now she was in the terminal stages of her illness, tube-fed, paralysed, breathing with help, only able to speak a little before becoming exhausted. But serene, accepting and cheerful? Yes. It sounded so unlikely, Cat thought, closing the door quietly behind her. But true.

Jocelyn Forbes opened her eyes, eyes that were fading, growing paler. What had been sapphire was now rinsed-out blue-grey. But there was a light in them still, and she smiled through the oxygen mask. Cat went over to her bed. The eyes did the talking now. The eyes said, 'Please take this thing off my face.' Cat did so, and quickly replaced it with two thin tubes that went into her nose and connected via them to the oxygen supply.

Jocelyn smiled. She could move the fingers of both hands, but not raise an arm. She could turn her head a little to the left but not to the right. Her neck was supported in a collar, which made sleeping uncomfortable. She did not complain. Every time she had seen Cat after her return from what she always referred to as 'the death place' she had said she had been given back her life, or given a new life, had been reborn or even resurrected, that everything she saw and heard and smelled and sensed was as if for the first time. Colours were brighter, sounds clearer, the air sweeter and fresher, music and voices more melodic. She had been overwhelmed by it, before being plunged into a period of darkness and guilt.

'I'm not religious,' she had said to Cat, 'I didn't believe in G.o.d before and I don't believe in G.o.d now. This didn't do anything to change my mind. I know some people want to end their lives for good reasons and I think they have a right to, so why do I feel guilty? Because I've no right to have this delight in life given back to me, have I? In spite of the illness, and what the end will be, I wake every morning with such joy in every single thing. I don't deserve it.'

'Do we all get what we deserve and not what we don't? I'm a believer and you are not but it often seems so random like the good and the bad being chopped up into pieces and thrown out of a window. They just fall where they fall . . .'

'It rains on the just and on the unjust, you mean. So which am I?'

Her condition had deteriorated over the past week. Now, as Cat took her wrist to feel the weak, uneven pulse and saw that breathing had become a great strain, she doubted if she would live much longer, and was glad it was so. Her quality of life was almost at zero.

Jocelyn smiled her lopsided smile and Cat wiped the dribble from the side of her mouth.

'Thank you,' she mouthed. No sound came, just the hiss of breath.

'I'm glad I could get here. Have they told you how much snow there's been? Lafferton is at a standstill.'

The smile again. It lit her face, even though the muscles of her mouth could barely move now.

For the next half-hour Cat stayed, and it took all of that for Jocelyn Forbes to try and say what she wanted to say. But by Cat's questioning, repeating and suggesting, while Jocelyn tried again and again, they came to an understanding. It was simple and not unexpected. She did not want to be kept alive with tubes, or to be resuscitated, or to be given antibiotics if she contracted pneumonia. She knew that she was close to death and she was ready to die. She also knew that Penny would not be there. She had not seen her daughter for almost two months.

Outside, someone was shovelling snow, someone else laughing. The tyres of a car spun round. Jocelyn dozed, woke to the noise, smiled at Cat. Dozed again.

Cat would stay as long as she could before starting on the general work of the day because this was why she did the job. Over recent years there had been a major push for 'hospice at home' terminally ill patients looked after by palliative care nurses, away from both hospital and hospice. Sometimes, it was the perfect answer but Cat was concerned that the chief reason for pressure on patients to die at home was financial. Often, because of a shortage of trained nurses, difficulty over pain and symptom relief, and even more because of unsuitable home circ.u.mstances, she was sure that dying there was not the right option. Better a good death in a hospice than a distressing one at home. But there were great pressures on doctors not to refer patients to a hospice unless it was unavoidable and that made Imogen House's very existence look uncertain. How would people like Jocelyn Forbes fare then? They would be sent into a general hospital, and the whole palliative care movement itself would start to be undermined.

The rest of the morning was unusually busy, with other arrangements being made for patients who could not get in because of the weather, relatives stranded on their way to visit, which left those who were longing to see them disappointed and distressed. And inevitably some staff had also found it impossible to get in to work.

Cat was trying to adjust a syringe pump with which one of the junior nurses was having trouble, when her pager bleeped. She ignored it. The syringe failed again and she decided to give up on it and get a replacement. As she went out into the corridor, Lois was waiting.

'I've had Hannah on the phone. I think you'd better come. I'll get someone else to sort that out.'

Cat ran.

'Mum, Molly hasn't got up yet. I've given Felix some cereal. What shall I do next?'

'Have you been up to her room and knocked on the door?'

'Loads of times. She didn't answer.'

'Did you go in?'

'No, because you always say Molly's room is her room and '

'I know, but this is different Hanny. Take the handset with you and go upstairs. Bang on the door again, and if she doesn't answer, go in . . . and then tell me what's happening.'

'She often sleeps in but I thought I ought to ask.'

'You did the right thing. Don't worry though, because sometimes she takes tablets if she can't sleep and they make her woozy.'

She could hear Hannah's breathing into the receiver and her footsteps up the stairs. From below came the sound of the television, fading as she climbed higher.

'I'm here.'

'Right, bang hard first.'

The banging started, stopped, started again.

'She isn't answering.'

'OK, in you go. If she's sound asleep try and wake her but gently, don't yell in her ear or anything.'

'The curtains are still drawn but it's really light because of the snow. She's turned the other way in the bed.'

'Put your hand on her shoulder and shake her gently, and say her name as you do. Just go on doing that until she stirs. The tablets make her sleep quite deeply.'

She waited. Heard Hannah's steps. Hannah's voice, saying Molly's name quietly. Then more loudly.

'Mummy?'

'Has she moved yet?'

'No. Mummy, I think she's dead.'

Seven.

'OH, WOW!'

They had walked through the belt of pine trees, their footsteps making almost no sound on the gra.s.sy-sandy ground. No one else was about and there had only been three other cars parked down the long avenue that led from the road. They had stepped onto the last section of boardwalk and then clambered down the uneven steps cut out of the bank, which were treacherous with ice. And then, they were on the beach.

'Wow!' Sam said again as they stood looking ahead to the faint gleaming line of sea far away, to the silver rivulets of frozen water criss-crossing the flat sand, and to the snow, a couple of inches deep and extending seventy or eighty yards out, until it thinned away to nothing. The huge sky was pale silver blue, arching over them and over the sea, the sand, the sh.o.r.eline. There was no wind at all so that apart from the plaintive mewling and calling of seabirds it was utterly quiet. They stepped down onto the snow.

'The sand is frozen,' Sam said. Then he went a few yards on and bent down beside one of the salt.w.a.ter pools. 'And the seawater is frozen. Wow!'

Simon looked at his watch, as smothered with dials as the control panel of an aircraft, as Cat had said when he'd bought it the previous year. Among the dials was a temperature gauge, showing minus one.

'Come on . . .' Sam began to run.

Simon followed more slowly, looking up at the sky as a skein of geese went honking over, arrowing their way inland. To the right, two dog walkers stood watching their black Labradors chase one another, the wild barks coming sharply across the flat open s.p.a.ce. Another walker came in sight, terriers giddy with delight, kicking up sand and glittering arcs of icy water that caught the brilliant sunlight.

Sam was far out now, his scarlet woollen hat marking where he was running towards the tide's edge.

They had been in Norfolk for three days, had another four to come and Sam was like the gleeful child he had once been, shedding his adolescence and the mild sullenness and sloth that went with it as he walked beside Simon for miles, read and listened to bands via his headphones while Simon drew seabirds and church towers, apparently perfectly happy. They had rented a cottage just off the marshes, which in winter were quiet, the streets of the little villages empty except for twitchers and dog walkers. Simon had promised for too long to take his nephew away so that they could have some time together. There had been plans for climbing in Wales, walking over the Brecon Beacons, visiting the Scottish island where he had enjoyed a month's leave, but one thing or another, usually police work, had got in the way. This Norfolk week, Sam's half-term, had been arranged at the last minute. The snow had come as they had headed east. They ate in pubs, or Simon shopped for local fish and cooked it with great panfuls of chips, and Sam was easy company. The one thing he did not do much was talk. Simon, used to being by himself on holiday and when walking or out with his sketchbook, was untroubled by this but his sister had hinted strongly that the week away would be helpful in getting Sam to tell his troubles, and perhaps talk about his father. It was almost four years since Chris Deerbon's death. Felix was too young to remember and Hannah had cried all of her emotions out, but Sam had barely reacted and would never answer questions about his feelings.

Now, looking at him bounding and leaping at the far sh.o.r.eline, Simon saw a boy full of energy and simple joie de vivre. Did it matter whether he talked about himself or not? Simon was sure that Sam would not share his feelings. He was not like his mother, nor the kind of open, cheerful character his father had been. Sam was like him.

He waved to his nephew. The plan was to head round the three miles to Wells and enjoy hot chocolate and buns in the cafe there, before returning to the cottage, but as Sam started to jump over the pools on his way back, Simon's mobile rang.

'Where are you? I've been trying to reach you . . .'

Rachel. Rachel, whom he loved as he had never loved a woman before. Rachel, who was loving in return, and generous, understanding of both his job and his personality. Rachel, who struggled with her conscience, married as she was to a man in the late stages of a debilitating illness but who had given his tacit blessing to her relationship with Simon. Rachel, who was beautiful, troubled, loyal. Rachel, whose calls he had been avoiding since coming here.

'Hi, sweetheart. Sorry this is a black area for phone signals.'

'Can you hear me OK now?'

'Yes, I'm on Holkham Beach and it seems to be fine but if we get cut off suddenly you'll know why . . .'

'I just wanted to hear you. I wasn't sure where you were.'

'I've brought Sam up here for half-term . . . good for us both. Sorry, I should have let you know but it was all arranged at the last minute.'

'You never have to apologise to me.'

'No. No, I know that. You're . . .'

He felt ashamed of himself something else new to him in his relationships with women. Rachel never demanded, never blamed. She accepted him as he was, loved him for that. Yet still he sometimes felt a desperate need to dodge, to run, to shut her out.

'Is everything all right are you?'

'Fine, now I know you are.'

'And . . .?'

'The same. It's no life, Simon. He . . . yesterday I went into the room and he didn't hear me and he was crying. Not loudly. Not so I could hear. He was just quietly crying. I can't describe . . .'

'Listen, I'm coming back on Friday. I'll ring you when I'm home. Come there. You can, can't you?'

He heard a faint sound, then silence, as the phone signal went.

'Hey, it's fantastic out there, the sea's so thin . . .'

Simon laughed in spite of himself.

'Thin? The sea is thin?'

'Shallow then, but you know . . . it's so far out and the edge . . . no, I was right first time. It's thin.'

'Great description. You look frozen, Sam, your face has gone blue round the edges.'

Sam thumped his arm, and they turned to walk towards the headland. Close to the bank the snow was thick, and the ground slippery, so they moved out to the sand which was firm and clear.

'I could so live here,' Sam said, whirring his arms round, 'right here and never go back. Can we do that?'

'I wish. But we'll come again, no problem. Glad you like it.'

'Love it.'

'Know the feeling. I get fed up with being landlocked.'

'Move then. Move up here. I could come as well.'

'Job, Sam.'

'They have police in Norfolk.'

'Yes. Not necessarily ones likely to move over and make room for a new DCS.'

'You don't know that. How do you know till you ask?'

'True. There's other stuff, though.'

'Like what?'

Ahead, a spaniel raced towards a flock of geese, feeding on a stretch of marshy gra.s.s, and the geese rose as one, making a racket that gave Simon an excuse not to reply. After the geese had left and they had walked round the spit of land into the next bay, Sam said, 'I'd leave like a shot.'

'What home, friends, all that?'

'Yup.'

'Right. Why?'

'Just stuff.'

'Always is.'

'You still on with Rachel?'

Simon missed a step. Caught up. Did not look at him.

'It's OK, I won't say anything. I don't.'