‘It would always be a difficult decision. Not to give antibiotics for the pneumonia. I'm not sure that I could make that decision. But I think I do understand.’
Doctor Jones looks at me sympathetically as he speaks. He knows what the problems are. I shake hands and leaving him alone. I return to her bedside.
She seems to be asleep with her eyes open. The room is warm and she looks comfortable, but her hands are freezing cold. I massage her hands and feet. Perhaps I can improve the circulation a little. Then I pull the covers firmly over her body. I sprinkle lavender on her pillow. Her eyes are still open but she lies unseeing and motionless. The door opens, a nurse comes in.
‘Would you like a cup of tea Ann?’
There is no response.
‘Is she asleep or awake?’ I ask.
‘We don't know, she's been like this all day.’
The nurse leaves the tea in a feeding cup for me to see if I can manage to get her to take something. She does not move. There is no attempt to drink or swallow.
‘Don't worry,’ says the nurse as she pops back with a cup of tea for me, ‘we'll try again later.’
I watch silently at first as I slowly drink my tea. Then I take out the poetry book. She loves poetry, especially the poetry she read to us as children. I can usually manage a smile or some sort of recognition when I recite to her. I read ‘I wandered lonely as a cloud’.
Until a few months ago she could manage to say some of this to the carers. Today there is no recognition, nothing. I try again ‘The owl and the pussy cat went to sea’. Normally she loves to hear that read. There is no sign that she has heard anything.
‘Up the airy mountain
down the rushy glen.
We daren't go hunting …’ *
*Fairy Folk
Up the airy mountain
Down the rushy glen
We daren't go a-hunting
For fear of little men
William Allingham 1824–1889
I stop. Her eyes have closed. Surely she is asleep now?
‘Why do people have to end their lives like this?’ I ask not for the first time. ‘She's been in this state for months just getting slowly worse. How does she carry on? Why do they keep her alive? Why is she having yet more antibiotics? I know it would be a difficult decision but … If only there could be some response, just a little response, to show she knows I'm here.’
I talk under my breath to no-one in particular. I sit holding her hand, watching and remembering.
* * * * *
The room is warm. I lie in the semi- darkness watching the embers of the fading fire. She comes in to the room.
‘Awake at last. Are you feeling a bit better after your sleep?’ She feels my head.
‘You're much cooler now. I think your temperature has gone down a bit. Let's get you up in the chair while I change your bed’.
I get out of bed, I feel wobbly and weak.
‘You were quite poorly,’ she says cheerfully, ‘but you're getting better now. The doctor says you'll soon be out and about again.’
I don't remember that the doctor came.
‘He says measles can make people very poorly. You gave us all a fright, but it's all right now’.
She fetches a drink. She helps me take it from the cup. I feel myself dropping off to sleep again and she helps me gently back into bed. There is such a loving look on her face. She sits beside me for a while and tells me stories until I drop off to sleep.
* * * * *
I watch her motionless body. She was always such a good nurse. Oh the indignity, she would be shocked to know that it would end like this. I gaze out of the window; a few flakes of snow are blown onto the panes. I draw the curtains and shut out the wild night.
* * * * *
‘Just look out of the window,’ she laughs as she draws back the curtains.
Through the frosted panes I can just see that the ground is covered in snow. We can go sledging. After breakfast we wrap up in our warmest clothes, coats, hats, boots and gloves. My sledge is home made. I am sure that it is the best sledge around. It's a wooden affair with the remains of railway lines for runners. It was made especially for me by the father of Auntie Win, my Mum's friend. We sledge up and down the hillside. She is like a child herself as we charge up and down. She has more energy than any of the children. But then I go sliding down on my own at great speed and land in the river at the bottom. It's cold, icy cold, but I know how to scream and she soon comes and drags me out. I cry all the way home.
‘Don't cry any more or I won't take you sledging again.’
‘No I'm never going sledging again,’ I reply with vigour.
* * * * *
I chuckle to myself as I remember how she loved to quote that story in later years.
There is no movement. Not a sign from the bed that she is still alive. I hold her hand again. She seems so cold. I pull the covers further over her and get out an extra shawl from the wardrobe. I stroke her face with Arthur, a large cuddly bear of a dog. She's like a baby with the toys around her.
* * * * *
The baby is tiny. We put her on a blanket on the floor. We put my doll April beside her. I am 6; our baby is smaller than the doll. We laugh that the baby is smaller than the doll. She is such a tiny good baby. She has very dark hair. She has no teeth. She's lovely. We all love her. I am so proud of my baby sister. I was an only child but now I have a sister. I rush to school to tell everyone. ‘I have a baby sister.’
* * * * *
‘Is she still alive?’ I listen hard to check that she is breathing. I feel her pulse. It's very weak but it is still there. She always had so much life and energy.
* * * * *
I am watching her as she cooks on a paraffin stove in a picnic area beside an autobahn in Germany. How is it that she always cooks such wonderful food? It tastes just as good here as is does at home. We are on our way to Austria. Our car, an Austin 8, GON 324, known affectionately as GON, goes everywhere. It's travelled all over Europe. It's not very reliable, punctures and breakdowns are regular occurrences. When we are going over the mountain passes GON boils. We all pile out to look for a mountain stream to fill her up with water. ‘GON again,’ she laughs, ‘can be relied on to boil.’ Everything is a joke, a game. Life is for enjoyment, for seeing things, for adventures, for family and friends.
* * * * *
Her eyes are still closed. Did she just move a little? No it is all just the same. I get another book. It's very familiar, its well worn pages and the faint musty smell of age conjure up more pictures.
* * * * *
She's reading to me. It's so comfortable to sit beside her when she reads. I am mesmerised by the sound of her voice. We love books. She loves to tell stories and to act in plays and recite poems. The King's Breakfast is one of my favourites. She is so clever she makes it sound real. I laugh when the King says ‘Bother,’ then, ‘Oh deary me,’ and then, ‘I only wanted butter for my bread.’ She turns it into a play for the Brownies but no-one else can say ‘Bother’ like she does. She makes everything come alive.
* * * * *
A Christmas photograph sits beside her bed. They were happy times we had all together. I sit gazing at the photo. It shows all the family on one of our Christmas walks. Everyone is there except my Dad. He must have taken the photograph. Does she remember any of it now?
* * * * *
It's Christmas day. We are all together. The children are so excited about everything. The living room floor seems to be filled with presents and wrapping paper. Everyone is happy. She loves these family Christmases. Her two daughters and their families are always here. She adores her grandchildren. Still a child at heart, she plays games with them. She tells stories and gets them to act in little plays. She loves to cook for everyone. She is such a good cook. There are roars of appreciation when the flaming Christmas pudding comes in. After lunch she insists that we all set off for a walk, some exercise to get rid of the lunch. She can walk as well as anyone else in the party. She loves to be active.
* * * * *
She hasn't walked for a long time now. She had so much energy and vitality but now she has gone through so much illness and tragedy. She is exhausted, but somehow she still clings onto life.
* * * * *
They are both in the bedroom when we get the news. They are so frail that dressing is a problem. She is weak. She can hardly walk. She can't remember much but she does know her younger daughter is ill. She senses that it's bad news. Both my parents know that their baby, their younger daughter has died. They don't have to be told. Both of them are nearly ninety and their younger child has died first. How can that be? My sister has died and my parents are frail. They are fading away and I am an only child again.
* * * * *
I feel her pulse. It is still the same. Why does it have to be like this? She's been through so much. If only she could give me a sign. Would it be such a difficult decision not to give her the antibiotics?
I wake with a start. How long have I been asleep? There is a noise. Her eyes are open. ‘You're awake,’ I say. I sound so much like she used to sound in my childhood. She is trying to speak. What is she trying to say? Her lips are moving. I don't understand. She tries again. Her speech is slurred, it's so difficult. ‘What is it Mum?’ She looks anxious. She just can't manage to say it.
Then, ‘little men, little men.’
Then suddenly I know, ‘For fear of little men’, the next line of the poem. She is unable to smile but I see she is satisfied that I have understood. I open the book of poems again. I read. I feel pleased. There has been a sign. My Mum did hear.
It would be an impossible decision.
- © British Journal of General Practice, 2004.