Dear Life by Rachel Clarke

Author:Rachel Clarke [Clarke, Rachel]
Language: eng
Format: epub
ISBN: 9781408712511
Publisher: Little, Brown Book Group
Published: 2020-01-29T16:00:00+00:00

9

A Piece of Work

I can’t go on. I’ll go on.

Samuel Beckett, The Unnamable

‘Please let me know the moment he arrives,’ I said to Nina as soon as I’d heard the patient’s story. Simon was a man in extremis. Blue-lighted from home, and on his way to the hospice, he had a cancer of his thyroid that was threatening to suffocate him. Already requiring oxygen at home, this morning his breathing had taken a turn for the worse and now, we had been told, he was fighting for air.

Simon, a former policeman in his sixties, had retired a few months earlier. He was looking forward to having time to while away in the fresh air, walking and jogging. Shortly afterwards, he had noticed a lump in his neck, painless, innocuous and perhaps, he had assumed, related to a recent head cold. But the lump, unlike the cold, persisted and, more unnervingly, continued to grow. Still more curious than concerned – he regularly ran ten miles before breakfast – Simon visited his GP. The speed of his referral to hospital impressed him, innocent of the fact that he was on a two-week cancer pathway, its celerity commensurate with his doctor’s worst fears. There was to be no well-earned peace in the countryside for Simon. The scan became a biopsy, and the biopsy a consultant, murmuring cryptically about inoperability, as Simon sat stricken, pinned to his seat, hearing nothing of substance after ‘cancer’.

I heard him before I set eyes on him. Specifically, I heard the sound of air being sucked into his lungs through an airway severely compressed by tumour. Stridor – the harsh rasp of air with each intake of breath, audible only when the trachea is critically narrowed. Once heard, never forgotten. Patients with stridor have nowhere to go. If the obstruction worsens, they will suffocate.

When I entered his room, Simon was sitting bolt upright, eyes darting frantically, his shirt ripped off and both hands gripping the bed like his life depended on it. From deep inside his body, from the depths of his spinal cord, he trembled with fear. Beside him stood a woman in her thirties, distraught and dishevelled, saying, ‘It’s OK, Dad. Look. Look, the doctor’s here. Everything’s going to be OK now.’

Simon stared up at me, beads of sweat on his brow, gulping for air. There was no way he could sustain this work of breathing. At the same time, I observed, the oxygen required to keep his saturations healthy was sufficiently low to be delivered not through a mask, but through small tubes in the nose. Although petrified, and with good reason, he was not – yet – in respiratory failure.

In an A&E department, Simon would have been whipped straight to Resus, gowned, cannulated and hooked up to lines and monitoring, all within moments of arrival. I chose instead, you might argue, to gamble. If Simon was about to die, I reasoned, none of this paraphernalia was going to prevent that. But if, as I suspected, panic had exacerbated his airway obstruction, then I knew how to help.

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