Chapter 20
20
Isla moved as quietly as she could, checking that the drip was functioning the way it should and replacing the electrolytes in her patient’s body. Stuart had his eyes closed, looking peaceful for the first time since he’d been admitted, when he’d been clawing at his throat and choking, his eyes wild with panic. He was struggling to swallow and, with an obvious progression of his Motor Neurone Disease, he’d been in a lot of distress. Isla had found it traumatic, so she couldn’t even imagine what it was like for Stuart. He’d been given pain relief which had helped ease his panic, and had allowed him to rest, which was why she was so keen not to disturb him now. Stuart’s bloods had been taken and he’d undergone a full examination, but for now the only treatment was to address his dehydration. A specialist from the speech and language team would be carrying out an assessment on Stuart’s inability to swallow, and they’d asked to see a copy of his advance care plan to see whether there’d been any discussion about the use of a feeding tube. The paramedics had said at handover that it was a carer who’d called for the ambulance, but no one had accompanied him, and there’d been no sign of any relatives yet.
Stuart must have been about the same age as Isla’s father had been when he died, and the panic in his eyes when Isla had first seen him had been like an echo of the final stages of her father’s illness too. In those last days, it wasn’t clear if he’d even known who his family were. But despite losing his ability to communicate with words, it had been obvious when he’d opened his eyes that he’d still been able to feel afraid, and that had been the hardest thing for her to bear.
‘Didn’t want to wake up.’ The words were hard to make out, but when Isla looked at Stuart, it was almost as if she could see them written in his eyes.
‘I’m so sorry, I didn’t mean to wake you.’ She touched his hand for a moment, but his only response was to sigh.
‘Enough.’ It was just one little word, but it said so much, and it was as if Isla could actually feel the heart she’d superglued back together when her father had died shattering in her chest all over again.
Chloe, one of Stuart’s carers, had arrived at the hospital about ten minutes after he’d woken up and spoken to Isla. The details of his advance care plan had set out that he didn’t want a feeding tube, and Chloe had told Isla, and the rest of the team caring for him, that Stuart had been adamant he didn’t want to prolong his illness. The progress of his MND had been relatively slow and he’d been living with the disease for more than three years already. According to Chloe, he had no living family, and most of his friends had drifted away since his diagnosis. Everything she’d said had broken Isla’s heart a little bit more, and by the time Stuart had been moved up to the ward, she’d had to go to the toilets to cry in private. Her tears were for her patient, her dad, and all that her family had gone through with the progress of his illness. But what she hadn’t admitted, even to herself, was the drip, drip of fear – like a broken tap – that situations like this had triggered since her own diagnosis. It was nothing like MND, logically she knew that, and she also knew she was supposed to feel grateful that things weren’t so much worse. But the not knowing how they would end up meant she couldn’t turn off that dripping tap, no matter how much she might want to. Instead, she pushed the feelings down and made it all the way to the end of her shift, without anyone needing to ask if she was okay. They might have queried the redness of her eyes, if she hadn’t pre-empted it by telling Amy that her hay fever was playing up, but she really thought she’d got away with it.
Amy had finished her shift at the same time as Isla, but she’d left the department first as Isla had needed to discuss the handover of one of her patients. She hadn’t expected Amy to still be outside the shop, tucking into a huge piece of cake, when she’d gone to grab a drink before leaving.
‘Oh my God, Isla, you have got to taste some of this pistachio cake Gwen has made, it’s the best thing I’ve ever put in my mouth.’
‘Well, I wouldn’t go that far.’ Gwen, who was the undisputed queen of innuendos, dropped one of her trademark winks as she made the comment, and Amy almost choked on the forkful of cake she’d just eaten. ‘Danni and Charlie have asked me if I’d be able to make the cake for their wedding, so I’m trying out a few recipes and I need guinea pigs.’
‘Come on skinny minnie, you can indulge just this once, because whatever diet you’re on is working a bit too well, if you ask me!’ Amy was already putting a slice of cake onto a paper plate, but when she looked up and realised that Isla had tears streaming down her face, she dropped it onto the table. ‘Hey, what’s wrong, and don’t try passing it off as hay fever, because even I’m not that thick.’
‘I don’t, I can’t…’ Isla could hardly see through her tears and her head was throbbing with the effort of trying to hold them back for so long, but then Gwen slipped an arm around her waist.
‘Right, come on you two, we’re not doing this out here.’ Within thirty seconds, Gwen had ushered them into the shop, behind the counter where one of the other volunteers was serving, and into the small stock room at the back, where much to Isla’s surprise, there was a three-seater sofa. ‘This is top secret, by the way, only the shop staff usually get to discover this space.’
‘You do know I’m coming here whenever I need a break, don’t you?’ As Amy turned towards Isla, the grin slid off her face. As hard as she’d tried, Isla hadn’t been able to get control of the tears this time, and they were still running down her face. ‘Oh Isla, what is it? Has something gone wrong with the fertility treatment?’
‘No.’ She was gulping for air now, like a fish out of water and Gwen took charge again.
‘Sit down, my love, and don’t talk for a minute. Just breathe and keep crying if that’s what you need to do. Then you can talk, but only if you want to. I’m going to get you a drink.’ Gwen was true to her word, returning a couple of minutes later with a hot chocolate. It might have seemed an odd choice for the time of year, but she obviously knew what she was doing, because when Isla took a sip it was like a warm hug. Amy had sat next to her in silence, while Gwen was gone, giving her hand a gentle squeeze, which in itself was nothing short of a miracle, as there was little Amy hated more than silence; she usually talked non-stop.
‘Thank you.’ Isla’s breathing was shuddery as she spoke, but the tears finally seemed to be drying up.
‘You’re more than welcome, my love; now, you take as long as you want. I can disappear back out to the shop if you want to chat with Amy in private, or you can both just sit here until you’re ready to leave, if you don’t want to talk at all.’ The reaction on Amy’s face to Gwen’s words made Isla smile through her tears.
‘I don’t think Amy’s ever going to forgive you if I follow that advice.’
‘I mean you don’t have to tell us.’ Amy pulled a face. ‘But isn’t there a saying about a problem being smaller when you share it?’
‘A problem shared is a problem halved.’ Gwen shrugged. ‘But you get to choose who you share it with.’
‘I’ve got leukaemia.’ Isla should probably have broken the news more gently than that, and Amy gave an audible gasp.
‘Oh my God, I’m so sorry.’ She enveloped Isla in a hug that almost knocked the hot chocolate out of her hands. ‘But you’re going to be okay. The success rate for treatment is really high and…’
‘I don’t think Isla had finished talking yet.’ Gwen’s tone was gentle as she interrupted Amy, but the words still stopped the younger woman in her tracks.
‘I’m sorry, I’m sorry. You know I’m a motormouth at the best of times.’
Isla gave her a watery smile, and braced herself to tell the story she’d been trying to tell herself ever since the diagnosis. ‘I’m lucky because it’s chronic myeloid leukaemia, which as Amy says, has a high success rate of being effectively managed by medication that stops the overproduction of white blood cells. Just tablets for now, that’s all.’
‘There’s no that’s all about it.’ Gwen sat down on the other side of Isla, fixing her with a look that made it difficult not to drop her gaze. It was going to be impossible to maintain eye contact, and keep trotting out the lines she’d just spun, making this sound like nothing, because Gwen was right, this wasn’t nothing. ‘A diagnosis like that would hit anyone hard. When did you find out?’
‘Almost a month ago.’ Isla’s voice sounded so small, but as a sudden thought struck her, she grasped Gwen’s wrist. Gwen had been friends with her grandparents for a long time and there was a good chance she’d feel they deserved to know. ‘But I haven’t told Nan and Grandpa Bill, and you can’t tell them either. Please , you’ve got to promise me.’
Gwen’s eyebrows shot up in surprise, but she was nodding. ‘I promise not to say anything, but you really should, sweetheart, they’d want to be there for you.’
‘I’m scared it will kill them. They’ve already had to go through losing their only son, and I can’t put the burden on them that I could die too. Or on Mum and Lexi.’
‘You could die ? I thought you said you just have to take a pill.’ Amy looked close to tears now, and this was exactly what Isla had been afraid of. But she’d started now, so she had to finish.
‘There’s a chance I could, if the inhibitors aren’t effective and the cancer progresses through several phases. But even then there are treatment options to move on to, including chemo. It would only be if none of those things work.’ Isla painted on a smile. ‘We’re a long, long way from that yet.’
‘It’s not just the chance of the worst-case scenario that’s worrying you, though, is it?’ Gwen was like some kind of all-seeing eye, and Isla shook her head.
‘No, it’s having to live with it that scares me most. The type of leukaemia I have is usually not curable, so it’s a lifelong condition. Not knowing if and when things are going to change terrifies me. I saw Dad go through it, and watched what it did to everyone who loved him.’ She sighed so deeply, it was as if someone had sucked all the air out of her body, and she had to take another shuddering breath before she could carry on. ‘I thought I was doing better. I’ve been to a couple of counselling sessions, and I’d made the decision to go ahead with the egg donation, and to freeze some eggs for myself too. It’s for insurance really, because if the leukaemia does progress, it might be too risky to delay chemo at that stage for a second egg collection. I thought I had it all straight in my head, but then we had this patient today, Stuart, who’s been living with MND, and it brought back so many memories of what Dad had to deal with. I don’t want to go through that, but more than anything I don’t want my family to go through it again. I’m pinning all my hopes on counselling helping me to find a way of managing all those feelings, but I just don’t know if I can. Not while I’m in a job like this. I’ve been avoiding seeing my grandparents too, because I’m scared I’m just going to blurt it out.’
‘Do you wish you’d never been told that your father was ill?’ Gwen was still looking at her in a way that meant she couldn’t have lied, even if she’d wanted to.
‘No, as awful as it was to know we were losing him, it also made me treasure every minute, in a way I wouldn’t have done at that age, if I hadn’t known we were on borrowed time. He always took every opportunity there was to make memories with us as well, and I think it helped us all to cope.’
‘I’ve always thought that’s the way we should all live, as if we’re on borrowed time. It’s what Barry and I have done ever since I came out of the other side of my horrible menopausal depression, determined to grab life and him, by the short and curlies.’ For the first time Gwen laughed, and Isla found herself smiling again too. ‘None of us know what’s round the corner, my love, not really. No matter how much we might like to pretend to ourselves that we do. So, whatever you decide about telling your family, follow your dad’s example and make as many memories as you can with the people you love. Hopefully your condition will remain stable for the rest of your life, but you’ll never regret having done those things if you stay well. But you sure as hell might regret it if you don’t, or if something else happens to take you away from them, or vice versa.’
‘Gwen’s right, we should all be doing that.’ Amy put a hand on her arm. ‘So no more excuses, you and me are booking that trip to Paris we keep talking about.’
‘Why do I feel like you’re using this as an excuse to railroad me in to holding your bag, while you pursue every good-looking man in a five-mile radius of the Eiffel Tower?’ Isla was smiling, and Amy responded with a casual shrug.
‘Can’t something have a double benefit?’ As Amy laughed, it was easy for a moment to forget everything that had been weighing her down, but as her friend started listing all the wonderful things they could do in Paris, Gwen leant forward and whispered in Isla’s ear.
‘Tell your family, you’ll feel better when you do.’ Isla gave an almost imperceptible nod, but she was already giving herself the excuse that she hadn’t made any kind of promise. Part of her might be almost certain that Gwen was right, but she still had absolutely no idea if she’d ever be ready to put her family through something like this again.