(Originally published in The Sunday Times, 7th January 2018)
The morning after it happens, it is hard to believe the sun still shines. I am standing in the kitchen, staring out across fields of frost, when a wren darts and whirs through the hedge in front of me. Dad, in a flash, is there too. “Look, Rachel! A wren!” His heart, like mine, never failed to lift at this smallest and most jaunty of birds. But, the night before, cancer finally claimed my dad. The wrens will keep whirring, but he has gone.
It’s the day after Boxing Day. Phials of diamorphine are still scattered on the dining room table. The hospital bed needs to go. For the final five days, we nursed him here. Mum, a retired NHS ward sister, me, a palliative care doctor, my younger brother and my twin sister. All at the bedside of the general practitioner who gave so freely of himself, for so many decades, to his patients. “You know they adored him?” his GP partner later told me. We knew. In Christmases long past, there were so many gift-wrapped bottles from grateful patients, we couldn’t fit them all under the tree.
At the end, my father, Dr Mark Rendall, chose not to be banished upstairs like a secret. He wanted the bed he knew he’d never leave to be placed downstairs, surrounded by love and life. Day and night during those final days, his hand was passed from one of ours to another’s. Not for one moment was he left alone. Mum slept by his side on a camp bed, her palm enclosing his until dawn. A syringe driver fed drugs that kept symptoms at bay. He liked the reassuring hubbub of his grandchildren playing nearby. Old enough to understand Grampy was dying; young enough, seemingly, to take it in their stride, for all his painful gauntness.
You’d think Christmas cards and morphine wouldn’t mix. But disease does not respect bank holidays and calamity, as we know, can strike at any time. So too can unexpected grace.
On Christmas Eve morning, Dad’s three children, three grandchildren and wife of 47 years gathered around his bed. He turned 75 that day and, jubilantly led by the children, a rendition of Happy Birthday made joy rise from the grief. Though by now he was too weak to smile, his eyes responded with silent delight. He summoned his strength. “Thank you all,” he murmured.
In the NHS hospice where I work, I used to think — naively — that I knew better than most how to face death unflinchingly. For dying is my day job; it surrounds me. Rarely, if ever, will a week go by in which all of my patients survive. I love, and am constantly humbled by, the privilege of helping people with terminal illness live as fully and richly as possible. Yet, for all this professional exposure to mortality, nothing prepared me for the scale of our desperation, when disaster strikes, to keep our loved ones with us, here, now, just a little longer.
Watching someone you love slowly die isn’t easy. Bit by bit, over 15 long months, cancer stole from Dad just about all it is possible to cull from a body. Yet his spirit and good humour endured. Several days before he died, his wristwatch stopped at night while he slept. “Well, that’s just marvellous,” he told me wryly. “Talk about being told your time is up.”
Dad faced death with equanimity. “Are you scared of dying?” I once asked him. He smiled. “Of dying? No, not of that. Of symptoms, maybe. But my only regret is that I will never see my grandchildren grow up into adults. I have lived a wonderful life.” It seems perverse to describe a dying man as lucky, but all I could think at that moment was that here, surely, is the very definition of being blessed.
The morning after Dad died, I didn’t want to surface. But, while lying beneath a duvet feeling empty, something unexpected cut through the numbness, a sudden surge of gratitude. Throughout it all — the surgery, the countless chemotherapies, the transition from active to palliative care — there were too many acts of tenderness to count. Dad’s was a lifetime of service to his NHS patients and, at its end, the NHS could not have repaid him more beautifully.
The technical brilliance of his surgeon and the meticulous skill of the chemotherapy unit were one thing. But what sung out repeatedly were the innumerable tiny kindnesses that, knitted together, make a patient feel cherished and an NHS hospital so resoundingly humane. There was Dad’s oncologist, who called him at home on his precious day off with his children. The exhausted nurse on his understaffed ward who took time to hold his hand. The community team who made him feel so special as they tweaked the diamorphine in his final days. None of it will ever count on any official ledger of “value” — these priceless transactions are not of numbers but of the heart.
On an impulse, I found myself posting a tweet of thanks to the small army of NHS community and palliative care nurses who had enabled Dad to die as he hoped, at home with his family at Christmas. In Britain, it is easy to forget that when you go through the struggle of a close family death, you are spared the trauma of a large bill at the end of it. We faced grief, pain and emptiness, I wrote — but not, at any point, bankruptcy. We never needed to panic about how we would pay for Dad’s care.
Improbably, the tweet set off around the world, being retweeted some 46,000 times and reaching nearly 9m people. The replies, from thousands of men and women I had never met, were completely overwhelming. An outpouring of kindness and kinship that felt like a living memorial to my newly lost father, and to the NHS that had cared for him.
“I lost my wife to cancer in October,” said one man. “The care and dignity with which she was treated will stay with me for ever.” Another wrote: “I will never forget the debt of gratitude that I felt for the NHS when I was in the same situation and lost my dad.”
From America, some of the comments were more harrowing. “My terminal friend died a few months ago,” wrote one woman, “and four bills arrived for his care the day I landed for his memorial. Hospital bills.” Someone spoke of their father abandoning his chemotherapy before he died because he couldn’t afford his hospital payments.
Although I am far from an expert on international healthcare, I learnt long ago from my father that caring for others is really all that matters. The NHS may be in crisis this winter, as depicted so graphically in last week’s press, yet hard-working NHS staff did my father proud, over and over again. Dad died the death he wanted because the NHS was there for him — as it is, in the end, for us all, irrespective of whether we can pay.
The evening after he died, none of us could face cooking dinner, so I set off for his favourite Indian restaurant to collect us all a curry. The owner, Dad’s patient for more than 30 years, knew he’d been diagnosed with cancer.
“How is your father?” he asked me.
“I’m afraid he passed away last night,” I replied.
“Oh, no, no, I’m so sorry,” he said, and I was startled to see tears welling up in his eyes.
Clutching a bagful of food, I walked out into sub-zero temperatures. The cold bit into my cheeks, but the warmth of his parting words remained: “Your father, he was such a kind man.”
With thanks to Dorothy House Hospice care, who looked after my father with such tenderness