I do my best to listen and focus on what Rachel’s telling me. Remind myself that our patients are my main concern now. We currently have five patients in for respite and four others in the terminal stages of their illnesses. We’re waiting to admit another patient.
‘Mrs Doherty’s in?’ I ask.
‘Came in last night,’ Rachel says. ‘She just wasn’t able to manage at home any more, so she’s on subcutaneous morphine and Levomepromazine. She was very agitated and anxious earlier. So she was given 2 mg of Midazolam SC to help her rest. She’ll be due another top-up soon. I see no reason to withdraw it at this stage. I think we’re near the end now.’
I know it’s likely her medication needs will only increase at this stage.
‘Any family or friends with her?’ I ask, although I suspect I already know the answer.
‘Her son’s on his way from England, but he can’t get here until the morning,’ Rachel says. ‘One of her neighbours was in earlier this evening for a bit, but she’s mostly been on her own. She’s asked us to hold off on too much sedation until she sees her son, but, well, that’s something we have to continue to reassess as the night passes.’
I read her notes. She’s already on a high dose of morphine and is requiring frequent top-ups. As a woman who’d rarely complained about her pain levels before, I know things must be bad for her.
‘You never get used to how cruel this disease can be, do you?’ Rachel asks.
‘You don’t,’ I say, thinking there’s a lot of cruelty in the world that we can never prepare for or get used to.
I read the rest of the notes and leave the office quickly. I need to be away from Rachel as soon as I can and for as long as I can.
I walk down the corridor to Mrs Doherty’s room, peaking in through the glass panel on the door to see she appears to be sleeping, so I gently press down on the handle and creep in, keen not to disturb her unnecessarily.
It’s only been a matter of weeks since I last saw her, when she came in for respite care, but the brutal toll of the past three weeks is evident just by looking at her. She’s lost a lot of weight and her skin has developed a crepe-like appearance, almost grey in colour, except for some particularly livid bruises on her hands and arms where IV lines have been sited. Her face is already hollowing out, her cheeks sunken into her face. There’s no doubt this poor woman is actively dying in front of my eyes.
Her hair, which she’d been delighted to hang on to through the worst of her treatment, lies plastered to the pillow and the top of her head. She’s always been so elegant that I feel for her, lying there free of her usual make-up, her usual blow-dry and set, and even the pearly white dentures that made her smile so bright and beautiful.
‘Oh, Dotty, you really have been through the wars,’ I whisper as I try to check her heart rate and blood pressure as gently as possible.
Her hands are cold and I hold them in my own, try to warm them up but making sure not to squeeze. She’s in enough pain without me adding to it. As I care for her I explain everything I’m doing softly as if she were awake and able to hear me. It’s important to remember that even when so very ill, a patient retains the right to dignity.
I see her wooden-handled, soft-bristled brush on her bedside locker and begin to brush her hair gently. I’m no hairdresser and how she’s lying makes it difficult to style it properly, but I think I make it more presentable. In her sleep, she smacks her lips slightly. Morphine’s known for its tendency to cause dry mouths in patients, so I dip an oral sponge swab in water and gently run it inside her mouth, where she sucks on it without waking.
I check when she’s last had a top-up of pain relief to give her a break from the pain and note the time when someone should check on her again. I hope I’ll be free to do it. I feel the need to be with her.
I tell her I’ll see her a little later and leave her sleeping. I head back to the nurse’s station, where I immediately send a text to my mother to tell her that I love her. We still hadn’t been on the best of terms when I’d left this morning and my guilt at that is multiplied now that I’ve seen Mrs Doherty.
As usual for my mother, she replies within minutes:
I love you too, Eliana. How are you? How are things with Martin?
I reply I’m fine; I don’t mention that I’ve not really spoken to Martin yet. I certainly don’t mention the latest missive from my mystery stalker. She asks if she can call me when Coronation Street is over.
I’m pulling an extra shift in work. I’m fine though. Needed a little headspace. Don’t worry.
It’s only a matter of seconds before the reply ‘of course I worry’ lands on my phone. Just seconds later, it rings.
‘Mum, you know I’m at work,’ I say as I pick up. ‘I can’t really talk.’
‘I’m not happy, Eliana,’ she says. ‘You should be resting, first of all, not jumping at extra shifts, and you should be at home trying to find out just what Martin is at. I know it’s hard. I know you love him, sweetheart, but you can’t run from it. You have to know where you stand, before this baby arrives.’
I rub my temples and sigh. I want to cry. But I can’t allow myself to start to fall apart now. I’d be afraid I’d never be able to put myself back together again.
‘Mum, I’m fine with the shift. I wouldn’t have agreed if I didn’t think I could manage. I’ll talk to Martin when I get home. I just needed a little more space to try to get my head round it all. It’s a lot, you know.’
‘Don’t let yourself be taken for a mug, Eli,’ she says. ‘I love you too much to see you get hurt by him.’
‘I love you too, Mum,’ I say, and feel tears spring to my eyes – not just for my own situation, but also with love for my mother and with sorrow for poor Mrs Doherty alone in her room.