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A hard, heavy-hearted weekend that involved a solo round trip of over 400 miles in a single day, in order to spend half an hour with my Uncle Mal.

Uncle Mal has been living with cancer for more than two decades. “It’s got the key to the door”, he joked on the 21st anniversary of his diagnosis.  It is a type of cancer that is described as ‘indolent’, unlike the rampant cancer that over thirty years ago carried off Mal’s first wife, my Auntie Genia, within three months.  Notwithstanding its alleged laziness, after the initial round of treatment, Uncle Mal’s cancer spread from its soft-tissue origin into his bones, where it has been indolently busy ever since, very gradually crippling him.

My cousin Brianna phoned my mother to say that Mal had broken a limb.  He’s in hospital, but nothing could be done about the break except to splint it.  With the cancer riddling his bones, surgery wouldn’t help Mal and he would in any case be unlikely to survive the anaesthetic.  The splint was purely for his comfort.  The bone is almost certainly not going to mend itself.

I phoned Shelagh, Uncle Mal’s second wife, whom he married a few years after Auntie Gen’s death, to ask if Uncle Mal would be up to a visit.  Since Mal has been housebound, I’ve always tried to make a point of going to visit whenever we’ve been in their neck of the woods.  I’ve also tried to make a point of keeping visits reasonably brief, so as not to upset Shelagh’s routines or overtire Uncle Mal.  Shelagh said a visit would be fine, if it was just me, so I set off early on Sunday morning.  It was a long, unexciting drive, mostly on motorways and dual carriageways, with just a few country roads at the far end, and I arrived in time to have some lunch before the 2-4pm visiting hours.  I intended to leave by three at the latest so that I would have a little light for the start of the return leg.

The ward didn’t have the buzz-in doors that I am used to from children’s wards, but the staff desk was just inside the entrance, festooned with large notices asking you to state whom you were visiting.  “I’ve come to see Mr. Mal MacKay”, I said.

The nurse looked puzzled.  “What name?” she said, running her finger down a list.

“MacKay,” I said.  “Mal MacKay?”

“Oh, you mean Iain“, said the nurse.

Obviously not someone who was directly involved in his care.  “He’s always called Mal”, I said.

The eldest boy in Uncle Mal’s family has always been Iain Malcolm, time out of mind, and the tradition has been to alternate the name that is used in each generation.  Uncle Mal’s father was Iain Malcolm known as Iain or Nink and Mal’s grandfather Iain Malcolm was Colm or Callum, but there will be no more Iain Malcolm MacKays.  My cousin Iain is childless; Brianna’s children are all girls, and after her own brush with cancer a few years ago, Brianna won’t be having any more babies.

Perhaps their idiosyncratic nomenclature was one of the things-in-common between Uncle Mal and my father when they were teenage friends, sixty-something years ago.  My father, like Mal, never went by his first given name, except on official documents.  He didn’t use his full middle name either, come to that; also like Uncle Mal, he was always known by a diminutive of his second name.  Whatever it was that led to them becoming friends, also led to Mal meeting my father’s sister, Genia; which in turn led to a lot of other things, including Iain and Brianna….

The nurse broke in on my reverie by saying, “Well, he’s in side room 3.  Up there on the right.”

I had barely begun walking in the direction indicated, when a diminutive woman, trim in a ward sister’s uniform, skidded to a halt in front of me and said, “No visitors for Mr. MacKay.”  I must have done a double-take at her, because she said, apologetically, “He’s not at all well at the moment and his wife has said no visitors today.  Perhaps tomorrow.”

“I can’t come tomorrow”, I said, numbly.  “I’ve just driven over two hundred miles to get here and I have to leave in an hour or two, tops, because I’ve got to get back home to my children tonight.  But if Uncle Mal’s taken that much of a turn for the worse… well, if he’s too ill, he’s too ill…”  I trailed off, feeling my face crumple.

Sister looked uncomfortable.  “Are you the relative who was coming from Xton?” she said, naming the town where we used to live, which was only half the distance away.

“I live in N— now,” I said, “But I did get in touch with Shelagh yesterday to ask if it was OK to visit, so I expect she means me.”

Sister looked even more uncomfortable.  “Mrs. MacKay is aware that you’re coming and she’s sorry she couldn’t let you know before you got here but she’s said no visitors.  We have to respect her wishes.”

“Of course”, I said.  “Well, um, if you get the chance later, maybe you could pass on my love to Mal?  Tell him it’s from his niece Kara.  Chris’s eldest.”

As I turned and began to walk blindly back towards the exit, tears distorting my vision and making hot-then-cold tracks down my cheeks, Sister ran round in front of me again.  “Look,” she said.  “Mal’s having some treatment at the moment.  Go and get a cup of tea and come back in half an hour.  Maybe you can at least speak directly to Mrs MacKay for her to pass on the messages.”

“Are you sure?  I wouldn’t want to upset Shelagh, she must be under so much strain already.”

Sister’s face twisted oddly, almost as though she might start crying too.  Then she became nursily brisk.  “I’m sure.  Off you go.  Café’s on the ground floor.”

The café was a chain-coffee-shop concession, all striplighting and massive paper cups with plastic lids.  Nothing resembling real tea was to be had for love nor money, certainly nothing acceptable to a confirmed tea-jenny like me.  I had a brief vision of my lovely mother-in-law, the darling, who used to issue already-sugared-and-stirred mugs of builders’ best to my father-in-law and husband, and then present me with a tray bearing cup and saucer, milk jug, napkin, and an entire teapot of Darjeeling or Assam to myself.  I couldn’t face cardboard-flavoured hospital tea and I rarely drink coffee, especially not when I’ve two-hundred-and-odds miles’ driving in prospect.  I left the café and wandered around the car-park, watching semi-sodden brown leaves flap feebly on the tarmac in the stiff breeze. The light was already beginning to seep away.

When I went back up to the ward, I was directed to the day-room to wait for Shelagh.  It was obvious that no patients spent time in there: a table in the corner, flanked by a couple of chairs, held a few dog-eared magazines; a television with a sticky note proclaiming it to be out of order sat next to a mattress-less bed frame; the other corner of the room was a clutter of dripstands and digital sphygmomanometers on little trolleys.

After a few minutes, Shelagh came in, apologising for not having been available earlier.  “Mal’s very poorly, and there was a bit of a crisis.”

“No need to be sorry.  I understand how ill he is.  How are you?”

Shelagh blinked, then half-smiled.  “I feel much better than I did.  I just love him so much, I don’t want him to suffer any more.  Did you know he was on the orthopaedic ward in St. B’s  (the specialist cancer hospital in the nearest city) for the first ten days?” I shook my head.  “The way they looked after him, I couldn’t have asked for better, but when they decided they couldn’t do anything specific for him and said they would send him back here to be close to home for palliative care, I was absolutely frantic.  My old Mum – you remember her, don’t you? – she was on the elderly care ward here before she died, and it was dire.  Awful.  Dirty, and the staff were rushed and rough.  And you know Iain’s wife Rosa?  Her mother was on the same ward afterwards and if anything it was worse.  Rosa’s mum was in a terrible state – left dehydrated and unwashed.  As you know, Rosa didn’t get on with her mother and barely spoke to her for years but when she found out what was happening, she went ballistic – said she wouldn’t leave a dog or her worst enemy in those conditions.

“So when they said they were sending Mal back here, I just broke down.  I was begging them to keep him in St. B’s – I didn’t care that it was twenty-five miles away, as long as he was properly looked after.  I told them what I knew about the geriatric ward here and they told me not to worry – he would be kept within orthopaedics.  Of course, I was still terribly worried.  I couldn’t believe there could be that much difference between wards in the same hospital, but there is.  The staff here are amazing.  They say that they ask themselves every time, ‘What would I want if this person were my Dad, my uncle, my Grandpa?  How would I want someone I care deeply about to be treated?’  You can see it.  They have been wonderful.”

She paused.

“There’s only one nurse who’s been less than nice – she told me off for using the ward lavatory instead of going down in the lifts and right round to the front entrance to use the visitors’ lavatories.  I didn’t say anything, but I thought, ‘At my time of life and when my husband is so ill, I’m blowed if I’m going on a hike every time I need to spend a penny.’  Sister had told me to use that loo, anyway.  And later on, I had been doing some of Mal’s cares just before I left and she said “Remember to clean your hands before you go out!  Use the alcohol gel at the end of the bed!”  Like that, ordering me, you know, as though I haven’t been doing these things for Mal for years or was too stupid to understand the correct procedure.  I thought, right, that’s enough from you m’lady!  I said, ‘Thank you for reminding me to clean my hands before I leave.  Now please come with me to the desk because I want a more respectful nurse assigned to Mal.  And don’t you ever, ever, dare to speak to me, or my husband, in that tone again.’  And do you know what?  She looked at me and said, ‘Oh, I am so, so sorry’.  But I still asked for another nurse – and I got one.

“Everyone else has been lovely.  They are looking after us – me, and Brianna, and the children, as well as Mal.  Even little things, like telling us we could get a weekly parking pass.  We were paying every visit, and it’s three pounds for two hours – shocking, isn’t it?  Especially when you are here three or four times a day.  There are no notices anywhere telling you how to get a long-term ticket.  But the staff on the ward told us where the office was, and wrote a note so that we could get the other tickets refunded.  Well, the ones we’d kept, anyway – some of them had been thrown away by then, because we didn’t know, you see.

“They ask me how I want them to explain things to Mal – the upsetting things, you know – and they don’t discuss patients at the desk or in the middle of the ward . They take you into the office and shut the door when they need to talk to you, so that they keep confidentiality.  Do you want to come and see Mal?  You’ll be OK for a few minutes.”

Uncle Mal was half-sitting in an orthopaedic bed that could be positioned almost like a chair as well as in a flat position.  “It means they can change his position without him having to transfer to a chair”, said Shelagh.  Mal was very spaced out on opiates, but managed a few words.  “Oh, hello”, he said, a look of recognition crossing his features.  “This is … surprise.”  Then he nodded off for a few seconds and woke wheezing, confused and distressed.  Shelagh held his hand and stroked his hair.  “It’s alright, sweetheart, I’m here.  The doctor’s just getting you some medicine for your chest.  It’ll be better soon, darling.”

A healthcare assistant came in to do obs.  “So sorry to interrupt”, she said, pressing the alcohol-gel spout and rubbing foam over her hands, “But please can I just do your pulse and temperature, Mal?  I won’t try to do this thermometer in your mouth just now – are you all right if I put it under your arm?”  She waited.

“Arm”, croaked Uncle Mal.

“Thank you”, said the HCA.  She very gently pushed the blanket aside and positioned the thermometer and the pulse oximeter.  Thirty seconds later the machines bleeped and she removed them, deftly tucking the covers back.  “Thank you”, she said again as she left.  Uncle Mal closed his eyes.  I studied his face.

With his square jaw, cleft chin, high cheekbones, long-lashed brown eyes, straight nose, broad forehead and wavy hair, Uncle Mal in his twenties had the film-star looks of a matinée-idol cast to play Superman. Even now, in his eighties and desperately ill, he remains a handsome man, although, scrunched up in bed as he was, there was no impression of his once-powerful physique – the height, the broad shoulders, deep chest and long legs that gave him significant advantages as a fly-half and a swimmer.  His looks are helped, of course, by his having kept his own teeth, and a full head of hair – even if it is now silver-white instead of dark as it used to be.

The door re-opened quietly.   “Hello Mal”, said the newcomer.  “It’s Dr. Jess again, with your medicine.  Are you ready for this now?”

“Pl’se”, said Uncle Mal.

“I’m going to trickle it into the side of your mouth with this syringe, if that’s OK with you”, said the doctor.  “I don’t want to choke you, so I will only do a drop at a time.  Is that all right? “

“Mmn”, said Uncle Mal, eyes still shut; and for the next few minutes, the doctor dripped the medicine in, while Uncle Mal swallowed laboriously.  When it was finished, Uncle Mal leant back, apparently exhausted and murmured “Sorry such nuisance.”

The doctor leant over the bedrail and took one of his hands in both of hers. “You’re no nuisance, Mal”, she said, softly and warmly.  “It’s a privilege and pleasure to help look after you.”

Uncle Mal raised his eyelids with an obvious effort, then a ghost of his lady-killer smile appeared as he registered her blonde, willowy, barely-thirty prettiness.  He tightened his grasp slightly and pulled her a little closer.  “Say that again”, he rumbled in a low register with distinct overtones of the old come-hither.

The doctor gave a little laugh that sounded both surprised and flattered.  Shelagh smiled indulgently.  “He always did know how to butter up the ladies,” she said. “Didn’t you, you terrible flirt?” Uncle Mal raised his eyebrows at her, a faint gleam in his eye, then fell back to sleep.

The doctor smiled at Shelagh and said, “He is such a lovely man.  So gallant, in all senses of the word.  Makes my day every time.”  She tiptoed out.

A short while later, I decided it was time to leave.  Mal had woken again, but trying to talk was too much of an effort for him, so I kissed him and said I hoped to see him soon.  I handed over the little gifts from Grenouille and Eldest to Shelagh, and as Shelagh’s mobile rang with a call from Iain  – “Oh, thank you for calling back, yes, the nurses are saying you really need come today if possible”, – I slipped away.

Outside, the blonde doctor and a man in blue scrubs were waiting, holding a clipboard of paperwork and a tray of medical equipment.  “Is Mrs. MacKay on the phone?” said the woman.

“Yes, she’s just taking a call from Mal’s son.”

“In that case, we’ll wait a little longer.”

“Thank you for waiting just now”, I said.  They both made don’t-mention-it gestures.

“We don’t interrupt family unless it’s clinically necessary”, said the man.

“This isn’t urgent, you having time with your uncle is much more important”, said the woman.

“Well, thank you anyway.  I appreciate your consideration”, I said, and aimed myself through the now blurrily-swimming doorway, towards the lifts and the smeary dark outside.

I’ve always found those ‘How likely would you be to recommend this healthcare facility to friends and family?’ questionnaires faintly embarrassing.  I mean, if you need a hospital, you need a hospital and you are unlikely to have much say about which one you end up in, so what’s the point?  And the survey-monkey generic nature of the questions means that the collated data are so unspecific that they are unlikely to contribute meaningfully to decision-making.

So I still think the questionnaires are pointless.  But if I knew somebody whose relative needed orthopaedic treatment in the area, I would recommend that they stamp, scream, shout and move heaven and earth to get their relative’s aftercare there, on Uncle Mal’s ward, even if they had their surgery somewhere else.

Maybe not next year, or even next month – places change as people move in and out.  But this week?  Definitely.