No-one knew why Alf was dying, but anyone could see that he was.
And as far as I could tell (it was difficult to ask), nobody knew why he’d refused any of the tests that might reveal the cause, chance of recovery, or time left. He’d been clear about that – certainly clear enough to reassure the medical team that he understood the consequences of his actions, and that his refusal wasn’t simply another manifestation of his illness. He may have explained his decision to them in detail. I expect he did. For us, the community health team, we simply had to accept that Alf had declined any further intervention, and wanted to be cared for at home. I can only guess why that was. Maybe he knew that anything they tried would be hopeless, and he’d lose his last weeks in a fog of operations, pain, nausea, medication. Maybe he was resolved simply to wade out with his eyes closed, and let the dark waters close over him. When I met him he was as passive as an anatomical doll, frail and uncommunicative, submitting to being rolled and cleaned from time to time, and not much else.
Alf’s deterioration had been so precipitous the family had started to gather in earnest, flying in from the extreme ends of the country, and abroad. The home they came back to was as unrecognisable as their father. Everything was in turmoil. There was a hospital bed in the front room, looking like it had been beamed up from a ward somewhere and crash-landed amongst all the fishing trophies and wedding portraits and domestic ephemera of a life. And it wasn’t just the bed. There was an abundance of medical supplies and pieces of equipment, the kinds of thing you need to treat an end of life patient at home, and beyond that, every available space was now given over to the cause, to temporary put-you-ups, and suitcases, and clothes hanging over balustrades, and then extemporary family huddles in the kitchen, or the garage, wherever they could gather together, and drink tea, and whisper severely, and let the old family rivalries play themselves out, as they ever will when families get back together for any reason, but most especially now, when one of their number is dying. They’d hurried across hundreds – even thousands of miles – and now they were here they found there was little they could do. Along with their horror of the situation they had to cope with boredom, and frustration, and being separated even temporarily from their own lives and problems, for an indefinite time. They relieved each other from their vigils at the bed. They did what they could to stay afloat. But the house was an anteroom of death, and the fact that no-one explicitly knew why made it worse for them.
Leah had been the first to come down. Leah had problems of her own. She was almost as skeletal as Alf, except in her case it was an eating disorder she’d struggled with for years. She tried to encourage her father to drink some of her own supply of fortifying milkshake, holding the straw to his lips and making softly encouraging noises.
‘He doesn’t want it,’ said her sister, Mae, her arms folded.
‘It’ll do him good. It’s designed to.’
‘Yes, but he doesn’t want it.’
Leah was wearing a strappy summer top that hung down from her, revealing the cruel extent of her illness. In fact, you’d have to say that there was only a degree or two of difference between Leah’s physique and her father’s, except – Leah was clearly on this side of the line, and he was on the other, and she was reaching over with her little bottle of banana-flavoured, fortifying drink, trying to do for him what she’d been trying to do for herself all this time.
‘He doesn’t want it’ said Mae.
‘But he might,’ said Leah. ‘Give him a chance.’
Mae was right, though. Alf’s eyes were already preternaturally large, made of some dull, inferior kind of glass, whilst Leah’s were still bright, and vital, and full of tears.