In the Midst of Life

THE BROOM CUPBOARD

The greater one’s experience of death, the more cautious one becomes in making a pronouncement. The ways in which people face death are as different as the ways in which we all live.

Perhaps I should qualify this statement. The last ten to thirty hours before death are very much the same; a semi-awareness of space and time and people takes over, leading into a different level of existence, accompanied by peace and tranquillity. If left undisturbed, death is not an agony. It is the earlier period, the weeks or months, or even years of illness or ageing that are so different.

Mr Anderson was consultant to a firm of international financiers. He was a very successful man, confident, self-contained, a person who needed very little amusement or even warmth – his work was enough, and filled most of his time and his thoughts. For relaxation he liked to go long-distance trekking in mountain ranges, sleeping in wooden huts and scrambling over rocks and riverbeds. It was a total change from his business life, and kept him fit. His private life was less successful. He had married a pretty girl whom he thought he loved, mainly because it seemed the right thing to do, but he had no idea how to handle women, and his wife soon left him for another man. He was not particularly upset, and enjoyed the freedom of a bachelor’s life.

He had never had a day’s illness, and prided himself on keeping fit through his walking, a sensible diet, no smoking and moderate alcohol intake. He had no time for some of his business colleagues who ate and drank too much, smoked like chimneys, went everywhere by car or taxi and then complained about feeling out of shape. ‘What do they expect?’ he said to himself.

When he developed stomach pains and felt sick, he was slightly offended – it shouldn’t be happening, he thought, so for a week he cut out rich meats and fats from his diet and ate only salads. Things seemed to improve, and he was satisfied that he had nipped the problem in the bud. But a week or two later the nausea returned, along with heartburn. He had heard of something called a hiatus hernia, but lots of people get hernias of one sort or another, so he was not particularly worried. He felt well in other ways, work was busy and he was planning his first trek in the foothills of the Himalayas. Life was too full and too interesting to bother about a little heartburn.

But things did not improve, and so, a month later, he went to see his doctor, who examined him, and found an unexplained lump in the upper abdomen. He said that another medical opinion should be obtained, and advised a gastro-enterologist at the Royal Free Hospital.

Mr Anderson was indignant.

‘But I’m busy! There’s a lot of work on, and I’m going to the Himalayas trekking in ten weeks’ time.’

The doctor replied that they must get him into good shape for the trip, and wrote his referral letter.

At the Royal Free, Mr Anderson was taken to theatre for a routine laparotomy with exploration, and possibly a partial gastrectomy (there were no electronic scans in those days). In theatre, the surgeon opened him up, took one horrified look at an intractable growth of carcinogenic material, involving the stomach and duodenum, and stitched him up again. He looked despairingly at the theatre staff.’ ‘How can one tell a man of forty-five that he has inoperable cancer and has only a few weeks to live?’

No one answered. Everyone knew how great was the responsibility of telling – if they decided to tell at all. Sometimes, it is better to maintain the illusion of recovery; sometimes, it is better to tell the truth. But how is one to know what is best for a particular patient? The strong-minded person who says ‘I want the absolute truth,’ can be the one who goes to pieces when told. But the truth can be received by another calmly, and in unexpected ways may bring resolution to life. One can never be sure, and usually it is better to let the patient take the lead. Only then can you get an inkling of what he or she wants to hear. Even so, you can be wrong, because people deceive themselves. A dying man rarely looks death in the face until the end. In the early stages of terminal illness, he might have a shrewd idea of what is going on, but usually, at that point, he doesn’t want to know.

Mr Anderson was not told directly that he had cancer so advanced that it was inoperable. He was simply told that six weeks of radium therapy would be beneficial. He entered the Marie Curie feeling well, and was by far the most active and alert of our patients. He appeared scornful of the other men, and complained about not having a private room.

‘It is bad enough that I have no privacy. But it is intolerable that I do not have the use of a telephone.’

I said that we had a pay phone for patients’ use.

‘Pay phone!’ he spat out in disgust. ‘You mean I will have to put pennies in every time I need to make a phone call?’

I said I would discuss the matter with Matron. At Marie Curie we had a policy of keeping our patients happy, as far as possible, especially if we knew their days were numbered. Matron frequently went to great lengths to oblige, and she discussed the matter fully with Mr Anderson. It transpired that what he really wanted was the use of an office from which he could continue to manage his business enterprises with the help of his secretary.

Matron swallowed hard. This was something quite new to her experience. A hospital is a hospital, not an office block, she might have said – but she didn’t. He was a dying man, and who could refuse such a request? There was a broom cupboard on the first floor that was little used, would he care to look at it? Together they examined it, and Mr Anderson said it would suit him if it could be cleaned out, and a desk found. Matron did not think a spare desk was available, so he said he would have one supplied, and would also pay for a telephone to be installed. It was surprising how quickly the broom cupboard was converted into a small but adequate office. The secretary, a smart young man, immaculately suited, arrived with a car load of files and folders, and within two days Mr Anderson was at work. We never knew what business he was engaged in, but it was most unusual and the nursing staff was very impressed.

Matron’s arrangement was highly beneficial to Mr Anderson, because it kept his mind occupied and his energies engaged. Sickness usually dominates the thoughts of a patient with cancer, but too much preoccupation with illness can have a destructive effect on the mind, and knowing what can happen frequently becomes self-fulfilling. Today, people who are ill will spend hours surfing the internet to find out all they can about their illness – but this isn’t always a good thing.

Although Mr Anderson had not been told of his condition, he was an intelligent and thoughtful man, and he must have known that radium was given for cancer. We anticipated that he would start asking questions. One day, during a routine ward round, he said to the Chief: ‘I am due to go trekking in the Himalayas in six weeks’ time. Do you think I will be fit by then?’

The Chief hedged. ‘That sounds pretty strenuous.’

‘Yes, it will be. But it will do me good. I need a bit of fresh air and exercise.’

‘I think you should find something less demanding – walking in the Wye Valley or the Cotswolds, for example.’

‘I see. I will think about it,’ he replied. He picked up his book again and appeared to be reading; but I knew that he was watching us as we continued the ward round.

It was not the first time I had had the feeling of being watched. Several times I had seen him observing the nurses as they went about their work, and wondered if he fancied one of them.

One day, he said abruptly: ‘I have been watching you and your nurses.’

‘Yes, I know, and I have wondered why.’

‘You don’t miss much.’

‘Nor do you, it seems. But why?’

‘Because I can’t understand how you, any of you, can do it.’

‘Because we are trained to.’

‘But why start the training in the first place? From what I can see, nursing is such a filthy, disgusting job. Why should anyone want to do it, especially a pretty young girl – and some of your nurses are very young and very pretty.’

Such a statement gave me a bit of a jolt. I had never thought of nursing the sick as filthy or disgusting.

‘I can’t agree with you. Admittedly we deal with the clinical indignities and intimacies that sickness entails but—’

‘That’s what I mean. Some of these old men …’ he glanced around him fastidiously ‘… are in such a revolting state that I wonder how anyone can go near them, let alone do the work that you girls have to do.’

I tried to explain that each man was a person with a life, loves, dreams, hopes and beliefs, and that the illness imposed on them did not alter that in any way; in fact, illness intensified it.

‘I’ve never seen anything like it,’ he said thoughtfully.

‘No. Few people even think of what illness can lead to.’

As soon as I had said the words, I wished I had not done so. I did not want him to identify himself with the ‘revolting state’, as he had put it, of some of the men around him. People never see themselves reaching the terminal stage of illness.

‘I’m damned sure I couldn’t do it,’ Mr Anderson said emphatically.

An incident occurred in the hospital, and, for a while, everyone in our small, enclosed world was talking about it. Matron was a sweet, trusting soul who saw no harm in anyone. When a gentleman called at the hospital and announced that he was a representative of the British Patients’ Benevolent Fund and that the society wanted to offer the Marie Curie Hospital a television for the benefit of the patients, she fell for it. A charming conversation over coffee and biscuits followed and the gentleman was shown around the hospital, which he assured her was a most heart-warming experience. A suitable location for the television was selected, and the gentleman said that the cost of installation would be ten pounds – a very large sum of money in those days, far more than an average week’s pay.

Matron wrote out a cheque to the Patients’ Benevolent Fund, but the gentleman requested cash, because he said he would have to pay the electricians in cash. She swallowed that one also, and went to her petty cash box and handed over ten pound notes. They parted with great goodwill on both sides, and the television and electricians were promised to arrive that same afternoon. One need say no more. Matron had many fine qualities, but spotting a con man at three paces was not one of them.

The patients had all been told of the kind offer and those that were well enough were very excited. Televisions were expensive items in the 1960s, and few of our patients had even seen one. The afternoon wore on. Several patients and nurses eagerly looked out of the front windows, and Matron was a-twitter with expectation. But the minutes ticked by, then the hours, and no electricians or television set arrived. Five o’clock came, then five thirty, and still nothing.

‘Perhaps they will come tomorrow,’ said a hopeful voice.

‘Not a chance. He’s got his ten pounds. We won’t be seeing him again,’ said a realist.

‘It is disgusting,’ said Mr Anderson, ‘I despise such a man. Tell Matron that I will buy a television for the hospital, and pay for the aerial to be installed. I can enjoy it for a while, and when I am gone it will remain for the enjoyment of others.’

This was a very unexpected and generous offer, but I wondered about his use of the words ‘when I am gone’. It sounded as though he knew he was going to die.

Cancer can overwhelm the body with frightening speed. Although the radium treatment was probably reducing the growth in the abdomen, we could not tell to what extent without performing another laparotomy exploration. Mr Anderson was losing weight rapidly. He was a spare man, with strong musculature, but within a few weeks he became pathetically thin. He found swallowing more difficult, and waves of nausea frequently beset him after a meal. We gave him anti-emetics, which helped a little, but one day, as he drank the mixture, he said to the nurse, ‘This is not going to improve me, is it?’

‘Oh yes,’ she said brightly, ‘we wouldn’t give it to you if it wasn’t.’

‘There is only one thing that is going to help me,’ he said, ‘and that is work. My secretary is coming at two o’clock and I must go to my broom cupboard.’ He grinned at the girl.

Mr Anderson always dressed in a suit to go to his office. We thought at first it was an affectation to assert his superiority over the other patients, who usually wore dressing gowns, but as time went on we realised that it was to preserve his self-respect and sense of dignity. As he lost weight, the jacket hung loosely on his thin shoulders, and he had to make new holes in his belt to keep his trousers up.

Excepting the days when he had radium therapy, Mr Anderson went to work. He even went on the day following treatment, when we usually advised patients to stay in bed because they often felt very ill. He would struggle out of bed, and one could see him trying to control the nausea and dizziness flooding his head, as he shaved and dressed. He usually returned to the ward about lunch-time, looking somewhat better. Obviously, the work was doing him good.

Pain is associated with cancer, and as the growth encroached further into the stomach and duodenum, Mr Anderson’s discomfort increased. Pain is something we cannot measure. No one can tell when the level passes from inconvenient to severe, to unbearable, and we all have different pain thresholds. Mr Anderson’s was probably getting to the severe stage – we could tell by the look in his eye, by the intake of breath and biting of his lip, by a slight moan that escaped as he bent over to try to ease the abdomen. But he would not take any painkillers. He had tried the Brompton Cocktail on a couple of occasions, but it had made him so sick he would not take it again, and he adamantly refused any injections.

Putting on his suit was such a struggle that particular morning.

I could see the effort it was costing him and he gave a little gasp as he leaned over to tie his shoelaces. He remained bent in that position for some time, and when he sat up, his face was grey.

‘You really must have some analgesics,’ I said to him.

‘No, I can’t. I’ve got to keep my head clear.’

‘Then why not stay in bed for the day?’

‘I am expecting some important telephone calls this morning.’

‘Your secretary will be coming. Can’t he take them?’

‘No. I have to make crucial decisions. No one else can do it. And then there will be a lot of follow-up work.’

‘Surely it cannot be so important that it can’t wait until tomorrow?’

‘It cannot wait. A great deal of money is at stake.’

I gasped, almost unable to believe what I had heard. Money, of all things! What on earth would he do with more money on the brink of eternity? A man obsessed with money has never appealed to me, but because I saw him wince in pain I said gently: ‘You might be feeling better tomorrow.’

‘I will not be feeling better tomorrow, Sister, and you know that as well as I do.’

Our eyes met, and, for the first time, I knew that he knew he was dying. The game of ‘let’s pretend’ was over. I was greatly relieved.

‘So you know, then?’

‘Of course I know!’ he said savagely. ‘Radium is given for cancer. Do you think I’m a fool?’

‘Do you want to talk about it?’

‘Yes, but not now. I have work to do. We can talk later. The only question I really want answered is, how long have I got?’

‘That is impossible to answer. Accuracy can never be assured.’

‘Weeks or months?’

‘No one can say. It depends on so many things.’

‘Then I will continue to act as though it is weeks, and I have work to do. You could oblige me by helping me to my feet, Sister.’

I helped him to stand up, and watched with sorrow and admiration as he straightened his back, gritting his teeth as he did so.

People with abdominal pain find it eases them to bend over slightly. But not Mr Anderson – he was determined to stand straight, and he walked firmly to the door and along the corridor towards his broom cupboard.

It is generally assumed that doctors know all there is to know about death, and that, if a patient is to be told that his condition is incurable, it is the doctor’s prerogative. In my experience, this idea is overstated, because most of the time doctors are not on the wards, whereas nurses and carers are.

During the time when I was a probationer student nurse in Reading, I was working on a male medical ward. I carried out simple duties such as washing the locker tops, and was at the bedside of a man who was very ill. He grabbed my wrist, and with fierce intensity barked: ‘Have I got a growth, Nurse?’

Startled I said, ‘Yes.’

‘Thank you,’ he croaked. ‘No one would tell me. Am I going to die?’

‘I don’t know,’ I said truthfully.

‘But what do you think?’

‘I honestly don’t know. No one knows.’

‘Thank you, Nurse.’

He sank back on the pillows and sighed. It might have been a sigh of relief or despair. One could not tell.

I did not dwell on the incident, and it certainly did not occur to me that I had done anything wrong, until a few days later when Sister called me to her office.

‘Did you tell Mr S that he has a growth?’

I probably looked blank, but said, ‘Well, he asked me, so I said yes.’

‘Nurse, you are still in your probationary period. I must report this to Matron.’

The same morning I was called to Matron Aldwinkle’s office. The conversation I had had with the ward sister was repeated, but I added, ‘Well, what could I say if he asked me? I couldn’t say “no, you haven’t got a growth” when I knew that he had.’

‘You should have told him to speak to the doctor.’

‘But he had seen the consultant and the other doctors that morning. It was just after the ward round.’

‘Nurse, we do not tell a patient directly that he has a malignancy. Most patients cannot accept it.’

‘But what are we to do if we are asked?’

Matron struggled to find the right words.

‘I know it can be very difficult, but you have to think quickly. Something like “I don’t know” or “it has not yet been diagnosed” would be suitable.’

‘But it had been diagnosed. And I did know.’

‘You have to understand, Nurse, that we cannot simply blurt out the truth.’

‘If I had told a lie, I’m sure he would have seen it in my face. I’m no good at lying. I’ve tried it before, and my face always gives me away.’

Matron appeared to be slightly exasperated. ‘You have to learn to be more sensitive to a patient’s needs. Well, I am going to move you to another ward. I do not think you should continue on Victoria Ward at present. I have confidence that you will learn, and improve. You may go, Nurse.’

It would probably surprise many doctors to know how frequently very junior nurses are confronted with a dilemma such as the one described. It occurs because nurses are so much closer to patients than doctors are, a situation that doctors have cultivated, creating a barrier between themselves and their patients. Often, most hospital patients are in awe of doctors, especially consultants, and feel they cannot engage in a conversation with one of these superior beings. But they are not in awe of nurses, who are with them all the time, and therefore more accessible. Indeed, since the changes in the nursing profession, requiring nurses to be college-trained rather than ward-trained as my generation was, patients don’t have much contact with student nurses. So when a frightened patient asks, ‘Have I got a growth?’, the person most likely to be approached is a care assistant or an auxiliary, one of the many people who do the most basic and intimate of nursing duties for helpless patients. Someone close to them is what people need, someone who is on their own level, not too high-and-mighty, but approachable. And carers are nearly always women. On the whole, they are kindly, compassionate and humble. They work for the lowest of low wages, and are completely taken for granted by hospital managers. But they are the women to whom fear-ridden patients will often turn, for assurance, consolation and comfort at the time of death.

On that day, Mr Anderson returned to the ward a couple of hours later than usual, and sank into bed, exhausted. I was furious that he had over-stretched himself in that silly office, and resolved to have a word with the Chief.

Throughout the afternoon Mr Anderson slept, sometimes wincing in pain – we could see him curling up his body in an attempt to ease it – but still he slept on. He stirred as we were doing the six o’clock drug round, and sat up looking refreshed. Suppers were served at seven o’clock, and he ate without nausea or discomfort. I began to revise my opinion about the office work he was doing.

After supper is usually a good time to talk to people. The ward is quiet, the day’s activities are stilled, the light is changing, and the human heart and mind seem to change with it. Mr Anderson was sitting up in bed, watching the sun sink behind the trees. It was a reddish sunset, with bands of fluffy pink clouds. Mr Anderson appeared relaxed, and I thought, with a leap of the heart, that perhaps the radium might effect a complete cure. Spontaneous recovery from cancer is possible, and whilst no one can explain what happens, I have seen it.

It can be a bit awkward talking to someone in the middle of a hospital ward. You have to sit close, and talk very softly. It is no good asking a patient to come to the office; that is too formal, and very often the person is tongue-tied in such a situation. No, the bedside is usually the right place, and the right moment can only be judged by intuition. I pulled the curtains around his bed and sat on the edge. He moved his legs over so that I could sit more comfortably, which was encouraging, because it indicated that I was welcome.

‘It’s a lovely evening,’ I said, ‘a lovely sunset.’

‘Beautiful. I would like to go on to the balcony to see it better, but I can’t be bothered to make the effort just now.’

‘I could help you.’

He smiled. ‘No, it’s not worth it. The sun will be gone by the time we get there.’

‘You are looking very much brighter this evening.’

‘Well, I did a good morning’s work. Excellent, in fact.’

‘It obviously does you good. I thought it had tired you too much, but I was wrong.’

‘I have always needed to exert myself – it’s just the way I’m made. If I could get rid of this damned cancer by sheer will power and exertion, I would do so.’

‘You are having radium treatment, that will limit the growth. And a positive outlook, such as yours, will help a great deal. We don’t think you will be able to go trekking in the Himalayas, but Wales, or the Wye Valley, as the Chief suggested, could be possible.’

‘That’s encouraging. I will hold on to that one, Sister. The Wye – a bit of rough canoeing, wonderful, and some climbing – oh, I’d love that.’

‘Perhaps you should cancel your Himalayan trek and concentrate your thoughts on the Wye Valley.’

‘Why not? I will get my secretary to order the maps from Stanford’s tomorrow.’

His eyes sparkled with eagerness, and as I looked at the wasted muscles that could not find the energy to step on to the balcony to see the sunset, I pondered the phenomenon of hope.

Hope is the one thing that people never lose, and even though they may know that they are dying, hope never deserts them. Most people hope for a new breakthrough in medical research, a new drug, a new treatment, a miracle cure, and we have to encourage this, however unrealistic it may be. But hope does not preclude an acceptance of death, and it can come in many forms.

Most doctors believe that they must never allow a patient to give up hope of a cure. The implication of this is that the medical profession is the single source of hope. This is too narrow a definition. Hope is an abstract concept, and is by no means confined to physical cure. Hope means something different to each one of us. Hope to see a daughter married, or a grandchild born, can keep life buoyant and content for weeks, or even months, beyond the realistic expectations of a medical prognosis. Many people, knowing they have cancer, have done the most extraordinary things: run marathons, cycled halfway round the globe, written books, taken degrees. Hope, directed towards an achievement, is the driving spirit, and makes the future endurable. Belief in an afterlife is also hope.

‘The Wye Valley will be lovely in a few weeks’ time with the spring coming,’ said Mr Anderson dreamily. ‘You know, when I first suspected I had cancer, I simply did not believe it. They’ve got it wrong, I thought. I had always been healthy, and led a healthy life. I couldn’t have cancer, not at my age. I thought it must be a misdiagnosis and I was furious with the doctors.’

‘Did anyone tell you?’

‘No. Lies, half lies, evasions, silences – that’s all I ever got. It’s an insult to one’s intelligence.’

‘How did you discover?’

‘When I came here – I knew what radium treatment is for.’

I was silent. It was so obvious, so irrefutable.

‘And no one has talked to you about it until now?’

‘No. Far from dispelling my fears, the lies and evasions only added to my certainty.’

‘How did you react?’

‘When I saw the fearful condition of some of the other men in the ward, I decided that I must kill myself. I never want to get to that stage. Never.’

‘Suicide is not easy.’ I said.

‘No, it’s not. And you know something? I don’t think I have the guts. There is a window upstairs, thirty feet up, with concrete underneath. For many days I thought “I could do it today, there’s no one around. A quick jump and it will all be over.” But each day I hesitated – “Not now. This afternoon perhaps, or tomorrow.” And then I realised I just didn’t have the guts.’

‘It’s not a question of guts,’ I said, ‘most suicides are associated with mental illness, and you don’t strike me as being mentally ill. You’re a realist.’

‘I like to think so. But I cannot face the reality of the last stages of this pitiless disease. If I get to that stage I will want someone to polish me off.’

I didn’t say that nobody realises they are getting to that stage, because by that time they are incapable of recognising it. Instead I said:

‘You are having radium now. The side effects can be very severe, which is why you feel so ill and exhausted. But you must believe me, it is destroying the cancer cells in your body.’

‘I do believe you. That’s what keeps me going. I feel ghastly, but I have a mental picture of the cancer cells being bombarded with radium and giving up. It’s a battle. Them or me. And I intend to win.’

‘That’s the spirit,’ I said, enthusiastically.

‘It’s a fight to the death and I am a realist – you said that yourself. I have always had to fight, from my early childhood, and I always win.’

Some people are like that – failure is never a possibility – but I said, ‘You would make it easier for yourself if you rested more.’

‘I don’t want anything to be “easier”,’ he said scornfully. ‘Life is not easy – never has been. I don’t go for the easy option.’

The night nurses were coming on duty. I had to go. He squeezed my hand.

‘I’m glad we had this talk. I feel better for it.’

‘And I’m glad too. I must tell the Chief about it when I see him.’

I slipped off the edge of the bed.

‘I hope you have a good night. What about some sleeping tablets?’

He shook his head.

The following morning, when I came on duty at eight o’clock, he was up and dressed in his suit. He looked very thin, but smart. He had taken no breakfast, but had asked for strong coffee. I was not happy about this, and questioned him.

‘Don’t fuss me,’ he said. ‘I have work to do, and I must keep my head clear.’

It was the same response he always gave to the idea of analgesics, and was the changeless resolve of a very determined man.

Mr Anderson spent longer each day in his broom cupboard. The pattern became regular, and how he found the strength to work as he did we never knew. His nights were not restful because of the pain, but he always rose at 6 a.m., bathed and shaved and dressed, although the effort required was enormous. He went to his office at about 7 a.m. and returned to the ward at two, looking half dead with exhaustion. We did not know what he was doing, but something seemed to have taken possession of him, and was driving him on.

I told the Chief about our conversation, and he was not really surprised. He talked with Mr Anderson, who was nearing the sixth week of his treatment, and they agreed that he should then take a holiday and return to the Marie Curie for check-ups two or three months later.

The day of his discharge was quite emotional. We had all grown to respect him so much that his rather aloof ways did not matter; they were just part of his character. He tied up the loose ends in his office and asked Matron if it could be left undisturbed, because he might need it later, to which request she readily agreed. We knew that he was going walking and climbing, but from the way he looked, that would require a miracle. He was so painfully thin, his legs and shoulders had no muscle at all, and his face looked haggard.

‘Do look after yourself, you might fall or something,’ a nurse said as he was leaving. He gave her a roguish grin, irresistible to women.

‘Now what have I got to lose?’ he replied. ‘Tell me that.’

She couldn’t reply, but said: ‘We are going to miss you.’

‘You’re a sweet girl. You all are, and I have grown very fond of you.’

He kissed a couple of the girls, and then turned to Matron. He hesitated for a fraction of a second – the navy blue uniform, the silver buckle, the high collar, the white cuffs, the frilly cap, were a touch intimidating for any man. Would he, wouldn’t he? He did. Cheered on by the nurses he kissed Matron, who blushed as pink as a peony.

Mr Anderson returned looking a lot better. He was tanned from the fresh air and sunshine, and although he had not noticeably gained weight, his muscles were stronger. He told us that he had started his walking with a paltry five miles a day, which was exhausting, but day by day he improved on this until he could manage twenty miles without too much fatigue.

‘And what about the rough canoeing?’ I enquired.

‘That also. It was a great help, having lost so much weight. You need to be light to shoot the rapids of the Wye.’

‘Wasn’t it dangerous?’ asked a nurse.

Yes, but that’s half the fun. And if you’ve got nothing to lose but a life that’s on borrowed time, you can do anything. I took far more risks than anyone else. It was great.’

He laughed in a devil-may-care way. ‘Now I’ve got to get back to work. There is a good deal to be completed still.’

Blood and serum tests were taken, and a series of X-rays. The Chief was so impressed by the apparent reduction in the size of the growth, and especially in the improvement in the patient’s general health, that he thought we could risk a further series of radium treatments. Normally, one has to limit the radiation because the effects on the body are so debilitating.

Mr Anderson was re-admitted, and his previous working pattern resumed. The effects of the radium were quickly evident, and the poor man became very weak and ill, but still he carried on going to his broom cupboard. It was pathetic, yet inspiring. There was no point in telling him to rest more; he took no notice.

The Chief had decided on a ten-week course of radium, which was longer than is usually ordered, and could easily kill a person, but they had discussed it, and Mr Anderson had declared that, by sheer strength of will, he would overcome the side effects. He was determined to go fell running in Cumbria, and the Chief felt sure he could manage this, although it is notoriously difficult and dangerous.

During the next two years Mr Anderson worked like a man possessed, in his city office during the months after he had been discharged, and in the broom cupboard when he was in hospital. He never let up. Work was punctuated by strenuous holidays – he walked the 190 miles of the Pennines in seven days; he climbed the Welsh mountains, including Mount Snowdon; he went frequently to Scotland, determined to climb each of the Munros and the Cairngorms. He did more in two years than the majority of us will do in a lifetime.

And it was not the cancer that killed Mr Anderson. It was the Cairngorms. In the mountain ranges, the weather can change from sunshine to blizzards in a few hours. Mysterious things can happen on those remote heights; perhaps he saw a beckoning hand, or heard a beguiling voice, luring him towards danger. ‘There’s nothing to lose,’ was always his spur. He had flirted with Death for so long that he almost loved Her. As he fell in the snow, and his body temperature dropped, his senses would have become numb and easeful rest would have seduced him to a sleep from which he did not waken. He had not wanted to die in a hospital bed, and the cold and the snow had saved him …

The mystery of what had been going on in the broom cupboard was later revealed. Through a combination of hard work, speculation and professional expertise Mr Anderson had accumulated millions of pounds. Every penny of it was left to Cancer Research.