I meet with M. for the first time three days into my residency on Oncology Ward 12 at Singleton Hospital in Swansea. I have been several times into the room where she lies in her bed next to the window but until now she has always been sleeping. I ask, and she willing agrees to be involved in the project. She is very interested in what I am doing and, like many other patients I have worked with she is happy to share her experiences, “if it helps”. So we begin. I set up the recorder to capture her words and she agrees readily to my request to draw her portrait as she lay with a plastic feeding tube inserted into her nose and secured on her cheek with a piece of tape. M.’s diagnosis is squamous cell cancer of the left tonsil. She can’t eat or swallow, thus the nasogastric (NG) intubation.
M. is undergoing radiotherapy. The plan was for thirty sessions, of which she has now had twenty-seven. The treatment is nearly over then, and although it has left her weak it is about to become clear to me that it is more than physical debilitation that has given rise to her reluctance to conform to further medical instruction. M., vulnerable as she is, is causing the professionals around her some misgiving and, as an ‘unusual’ patient, she has been the subject of much discussion in the daily morning briefings for the staff and doctors on the ward. I have been made welcome at these meetings as part of the residency (see previous post). Despite being deemed well enough to go home after completing her remaining radiotherapy sessions M. is refusing to take on the normal ‘patient role’ that seems to be expected of her. Rather than gratefully accepting the medical judgement of the clinical team responsible for her care; rather than willingly and obediently following the dictates of the treatment plan, she is taking an individual decision not to take instruction in how to manage and clean the NG tube herself. This obviously limits her choices, and her further insistence that her husband would not be able to manage the tube for her either, only increases the odds against the hospital being able to let her return to her own home. All of this has been discussed, not without some frustration, at the morning briefings and so I have an impression of M. even before I finally meet her, properly awake. But such impressions, made outside of flesh and blood, and in this case at least, without emotional corroboration, are often unreliable.
I position the dictaphone close to M.’s face, resting it on the pillow so as to best pick up her voice, which is very low and whispery as if it was coming from a place far away and darkened. Across the ward in the opposite bed is V., a patient who has already given of her time to the recorder and whose resemblance already nestles in the pages of my sketchbook. V. smiles encouragingly at M. before quietly and respectfully settling down to her book. I take a seat at the end of M.’s bed and begin to draw.
M.takes a minute to begin but, with a painful sigh and speaking very slowly and deliberately she says,‘When I first heard that I had cancer. I wanted to die.’ My pencil stops its passage across the page and V. buries herself deeper into her book but M., seemingly with a sense of relief, goes on. ‘I still do. This is what I feel. Because it sounded so daunting – thirty treatments. I’ve had a good life and I didn’t want to suffer. I was quite happy to die.’
I suddenly experience what seems like an overwhelming sense of utter respect for this elderly woman and her profound honesty and openness at a time when her life is, if not wholly dependent upon, then definitely subject to the effects of science.
Radiotherapy (taken from NHS choices)
- Radiotherapy is a treatment involving the use of high-energy radiation. It’s commonly used to treat cancer.
- Almost half of all people with cancer have radiotherapy as part of their treatment plan.
- For people with incurable cancers, radiotherapy is a very effective way of controlling symptoms.
- Common side effects include sore skin, tiredness and hair loss. These tend to get better within a few days or weeks of treatment finishing.