Womb: Threshold of Life & Death
I see the elder hand pressing receiving supporting,
I recline by the sills of the exquisite flexible doors,
And mark the outlet, and mark the relief and escape.
Walt Whitman, Song of Myself
THE TV TOOK UP more space than the fireplace, but no one was watching it. A two-bar electric fire glowed in the dark socket behind the hearth. An ashtray shaped like a porcelain Pekingese dog was overflowing, and a confetti of cigarette butts littered the carpet. Along a line between the room’s entrance and the patient’s easy chair the carpet was worn thin; a trail greasy from the passage of dropped food and slippered feet. The sofa was longer than the room was wide, and seated on it were a man and a woman – the son and daughter of my patient. Both of them had to sit with knees splayed, to make room for the sag of their bellies. The son stood up to greet me, hands trembling.
‘She’s bleeding, doctor,’ he said, ‘from down below …’
Parked outside in the car, before stepping out into the rain, I had read Harriet Stafford’s medical history on the emergency service laptop. It read like a primer in the comorbidities it’s now possible to sustain through modern Western medicine, beginning with Emphysema, Coronary Heart Disease, High Blood Pressure and Diabetes – the four horsemen of the ageing society’s apocalypse. Beyond those usual four there were two other significant entries: ‘Multiinfarct Dementia’ explained her absent manner as she watched me approach, and ‘Endometrial Carcinoma – Palliative’ explained the bleeding – she was haemorrhaging from a cancer of the womb. At the end of the list was the plea, written by her own doctor: ‘Avoid admission if possible.’
‘Hello, I’m Dr Francis,’ I said to her. ‘How are you getting on?’ Her eyes startled with the customary panic of the demented – afraid she’d answer wrongly, or make a fool of herself. I pictured the circuits of her brain, as worn by routine as her carpet. Instead of the expansive possibilities of social intercourse she was left with a few reflex replies. Some people with dementia return almost to a pre-verbal state; like very young children they learn to trust or distrust not through words, but through tone of voice and a speaker’s manner.
‘Nice, yes, fine,’ she said, smiling up at me and dropping her guard a little. I picked up her hand and shook it gently. It was cool, her palm clammy, and her pulse was thin and rapid. ‘I’ve come to help you,’ I said. With the flat of my fingers I brushed the skin further up her arm; it was cold as far as her shoulder – she had lost so much blood that there was not enough left in her body to keep her limbs warm. The skin of her face was pale as candle wax, almost translucent. The whites of her eyes were bloodless.
‘I changed her pad half an hour ago,’ said her son. ‘But the cancer … it’s gushing out of her.’ He blushed at having to describe two taboos – cancer and vaginal bleeding – to a strange man.
‘I’m going to have to examine her. Can we lie her down somewhere?’ Off the hall was a small spare bedroom – she was no longer able to manage the stairs. Her son and daughter helped her up from the easy chair and, taking her arms as if encouraging a baby to walk, half supported and half carried her through. ‘It’s alright Mum, it’s alright,’ murmured the daughter, like a parent comforting a fretful child, before lifting her with ease and laying her down on the bed.
She lay flat on the bed, and I loosened her dressing gown. She had no idea who I was but the memory of doctors, and my appearance in a tie and white collar, echoed something within her and she accepted that being undressed like this was no cause for distress. Her blood pressure was so low it was almost unrecordable. ‘Sore?’ I asked her, trying to keep my language as simple as possible. She made a wincing expression and passed her hand back and forwards over her stretch marks. It seemed suddenly incredible that this son and daughter were once inside her womb; that her womb, having sponsored their lives, was now hastening her death. Pulling down her pyjama trousers I saw blood pooling in the pad, slick clots of crimson.
From a pack of vials in my suitcase I drew up some morphine, and injected it under the skin of her belly. The injection site was inches away from the tumour that was eating away at her womb, stiffening the organs of her abdomen and killing her as surely as if she had slit open her veins. As I stood watching her for a moment she closed her eyes and began to doze. On the wall above her head was a poster print of Jesus, with a bleeding heart and a Hollywood beard. Stacks of videocassettes were piled along the skirting boards. There was an open night bag, like the ones expectant mothers keep, stocked with talcum powder, cigarettes and spare nighties. ‘We keep it there in case she has to go into hospital,’ explained her son.
‘Should we sit down next door and have a chat?’
They nodded, and together we moved back through to the living room leaving Mrs Stafford lying on her bed.
‘I know you’ve not met me before, and I’ve just met your mum, but I can see on her records that she has a cancer, and we know she’s bleeding from that cancer.’
‘Aye,’ said her daughter, nodding. ‘They gave her weeks to live, and that was months ago.’
‘Well, she’s losing a lot of blood, and we could do one of two things. We could send her into hospital for a transfusion, or we could keep her here, and see what happens …’
Her son and daughter looked at one another, until the son broke gaze and turned to look out the window.
‘… and what might happen is that the bleeding stops, and she rallies, and things go back to the way they have been. Or what might happen is that she keeps on bleeding and fades away.’
‘How long has she got?’ the daughter asked.
‘I wish I knew, but …’ I hesitated for a moment, then met her eyes, ‘… she could die tonight.’
‘Just leave her here,’ her daughter said, decisively.
‘Alright,’ I said, and a few moments passed. ‘I’ll come back in three or four hours to see how she’s getting on.’
Before I left I wrote up notes in the district nurses’ folder by the bedside, and helped her daughter change the pad. As I was pulling up her underwear I saw that the new one was already scarlet with fresh blood.
IT WAS THREE in the morning before I could come back. At the door I was met by her granddaughter who, in her haste to get to me, tripped and fell forwards, butting her head against the glass. ‘The priest’s in,’ she gasped as she opened the door to me. She was heavily pregnant.
I stopped at the doorway, holding my case, wondering if my expression was serious and pious enough for a meeting with a priest over a deathbed. I felt a spasm of guilt that it was my warning – ‘she could die tonight’ – that had brought him out in this weather. There were ten people in the room including the priest: a tall, well-built man in his late forties or early fifties – better nourished as a child than his parishioners. He nodded to me from the foot of the bed. From my doorway glance, I could see that Mrs Stafford had already drunk the blood of Christ, taken the viaticum of last rites, and now lay propped up on pillows.
I waited just outside the doorway. On the sofa behind me I could see that the folder I had written in was lying open; the whole family had been poring over it, as if over tea leaves. The prayers went on for ten, fifteen minutes more. And then there was a bustle, and one by one Mrs Stafford’s son and daughter, her granddaughter and several grandsons, began to leave the room. ‘Evening, Father,’ I said to the priest as he nudged past me on the way out of the room.
‘Evening, Doctor,’ he said, clapping me on the shoulder and giving me a quick, businesslike smile; ‘it’s fine work you’re doing.’ Before I could offer, ‘You too,’ he was already gone.
I entered the room; Mrs Stafford opened her eyes and I took her hand, wondering if she recognised me at all. ‘I met you earlier,’ I said, ‘I’m the doctor.’ She grunted an acknowledgement, closed her eyes again and laid her head back on the pillow. This time her pulse was faster, and I couldn’t find her blood pressure at all. Her hands and feet were just as cool as they were earlier. ‘She says she feels cold,’ her daughter added, coming in from the living room behind me. ‘We’ve got the electric blanket on, but …’
I undid her dressing gown again and began to gently press on her belly. She uttered a low moan, and I drew up another vial of morphine, and again injected it into the skin of her abdomen. ‘Have you had to change the pads many more times?’ I asked, looking over my shoulder at her daughter.
‘Aye, twice since you were here last. But maybe it’s slowing.’ I pulled up the elastic on her pyjama trousers and looked down on the clots of blood that slipped out of her like leeches.
‘I’ll come back before finishing my shift around breakfast time,’ I said. ‘Try to get some sleep.’
WHEN I RETURNED to the Stafford house it was just before eight. The bin lorries were out, and the rain was easing. It took a while for the door to be answered.
‘Well, she’s still breathing,’ was the first thing her daughter said, stepping aside to let me in. ‘But only just,’ added the granddaughter, sitting back and stroking the tense, swollen skin of her belly. ‘She’s said nothing since you left.’
Her son was asleep on the sofa, snoring. His slippers were placed neatly beside the Pekingese ashtray. The television was still on, but muted. I pushed open the door to the bedroom for the third time that night. Her breathing was deep and steady, and her face seemed to have even less colour in it, despite the natural light now falling in through the window. ‘Did the bleeding stop?’ I asked, ‘I mean, have you had to change many more pads?’
‘Just the one after you left,’ her granddaughter said, ‘I’ve not needed to since. Is that a good sign?’
‘Sometimes,’ I said.
Her pulse was even thinner than before – I could barely feel it. Her breath was deep, sighing and sporadic. Her eyes were half-lidded, and grey crusts of spittle had gathered at the angles of her mouth. The creases of her wrinkles seemed smoother, and the tone of her skin had yellowed from wax to something more like old vellum. I was standing holding her wrist, feeling for her pulse, when she made a long, rattling sigh, then fell silent. I stood still for a few moments, out of respect, before glancing down at my wristwatch to count. One minute passed, then two.
‘That’s it, isn’t it?’ her daughter asked.
‘Yes,’ I said. ‘She’s gone.’
And she began to sob, but silently, showing only in the shudder of her shoulders and the way she rocked on her chair. Her own daughter put an arm around her shoulders, and pulled her close.