The Doctor’s Proposal

From where the diminutive old lady lay, Mavis could see out over the veranda. She could see her granddaughter making her mud pies. She could see the hens scratching among the rose bushes, and in the distance she’d see the cows ambling lazily up toward the dairy from the clifftops further away.

Who would choose to be ill in hospital when you could be ill here? Kirsty thought, stunned. No one.

But the lady herself was in trouble. The look in Mavis’s eyes suggested fear and pain. Relentless pain, Kirsty thought. She’d seen that look so many times. Acceptance that pain would be with her until the end.

A bottle of morphine mixture stood on the bedside table. Any time she wanted she could use this, Kirsty thought, appreciating that Jake had ensured Mavis could ease her pain whenever she wanted and drift into painless sleep. But she was obviously choosing not to.

Sleeping into oblivion had a distinct downside when there was so much life just through this window.

‘So you’re a pain specialist,’ Mavis said as she walked in, and Kirsty realised she must be tuned in to everything that was said in the outer rooms. She’d be aching to be a part of the world again.

‘Hello, Mrs Hipton,’ she said, taking the lady’s proffered hand. It was dry to touch-was she dehydrated? ‘I’m Dr McMahon.’ She hesitated, then added, ‘Call me Kirsty.’ That was something she’d never do back home. The use of first names in her Manhattan hospice was frowned on by the powers that be, but here it felt right.

‘Where do you fit in?’ Mavis whispered, and Kirsty saw it was an effort to talk. ‘Don’t tell me you flew in all the way from the States just to give me a consultation.’

‘Kirsty’s sister was married to Rory Douglas,’ Jake told her, and the lady’s eyes lit up with interest.

‘Married to Rory. Angus’s Rory?’

‘My sister’s visiting Angus,’ Kirsty told her. ‘So I thought I’d make myself useful while they get to know each other.’

‘So Angus has family again,’ Mavis breathed. ‘Well, well. Isn’t that lovely?’ She managed a tight, pain-filled smile. ‘Everyone should have family,’ she whispered. Her sharp, intelligent eyes moved from Kirsty to Jake and back again. Questioning without words. ‘Even Dr Cameron.’

‘I think twins are enough family for anyone,’ Kirsty said lightly, ignoring the innuendo. ‘Mrs Hipton-’

‘Call me Mavis.’

‘Mavis, then.’ Kirsty smiled. ‘Could you bear it if you and Dr-if you and Jake gave me a complete history of your pain?’

Kirsty listened. For a while she didn’t comment. She waited while Jake completed his normal examination. She sat while Jake talked, while he checked a pressure sore on Mavis’s back, while he listened while Mavis told him about her granddaughter’s attempt to conquer a tricycle. Jake was deliberately giving her space to think.

So she thought.

‘I think I may be able to help a little,’ she said at last, tentatively. ‘That is, if you trust me.’

‘I’ve checked Dr McMahon’s credentials,’ Jake told Mavis before the old lady could respond. ‘She’s the best.’

She shot him a surprised but gratified look. That was a compliment that must have come via her boss back home, but hearing it from Jake felt good.

‘When did you last have morphine?’ she asked.

‘About four this morning.’

‘Why not since?’

‘I didn’t need it.’

‘You’re hurting now. A lot.’

‘I can bear it,’ Mavis said. ‘I thought… You get used to it. You get addicted to that stuff so it’s not effective. If it gets really bad…’

‘It’s bad now,’ Jake said gently, and Mavis flashed him a look of fear.

‘I’m not dying yet.’

That was always the unspoken terror, Kirsty thought. That the pain would get worse and worse, and then when you needed it most the drugs wouldn’t work.

‘No,’ Kirsty said softly, and she lifted Mavis’s hand and held. ‘You’re not dying yet. But you are in pain. You know, morphine is an odd drug. If you take it to forget your troubles, as many addicts do, then, yes, you’ll become addicted. It’ll lose effectiveness and you’ll need increasing doses. But if you have real pain-as you have-then it never loses its effect. I promise you. Mavis, I’m thinking you’re suffering a lot of unnecessary pain because you’re frightened of becoming addicted and because it’s making you drowsy. Because of your fears, you’re not taking the morphine regularly, which means you’re getting a lot of pain before you take the next dose. You reach the stage where the pain’s unbearable and then you finally take it. That’s right, isn’t it?’

‘I… Yes,’ she muttered, and Jake said nothing.

‘Mavis, I promise you that morphine is not addictive if we use it in the right dose for the pain you’re having. I promise you also that it will stay being effective for as long as you need it. What we need to do is to find the right dose. The dose is different for everybody, because everybody’s pain is different. You need to start off by taking a prescribed dose of this mixture regularly every four hours. Slightly less than you’re taking now-but regularly. I want you to promise me that you’ll take this dose regardless. After a day or so the sleepiness will ease. The dose I’m prescribing will leave you free to enjoy life. It’ll be regular and it’ll keep the pain level tolerable. If, despite this, you have breakthrough pain, then I want you to take more, but I want the background dose to stay constant. I want you to call me every day, and we’ll gradually increase the background dose until the pain is completely gone. Completely. And it will happen, Mavis. I promise. Then I’ll change you over to a really convenient long-acting tablet that you can take just twice a day. That way we’ll stay one step ahead of the pain, and you should rarely need to take the mixture. We’re aiming to get rid of the pain completely-not just aim for good enough. We’re aiming to get you out on the veranda, back into the kitchen when you’re feeling well enough-not just watching life through a window.’

‘But the morphine makes me so drowsy,’ Mavis whispered. ‘I don’t want that. I have so little time. I can’t just sleep…’

‘Drowsiness often happens if you take a little too much occasionally,’ Kirsty told her. ‘You’re waiting so long that you need a big dose to fight the pain and so you’ll go to sleep. What we need to do is give you a little and often. Drowsiness is much less likely to happen then.’ She smiled. ‘And this is only step one. If morphine still makes you sleepy, we’ll ditch it and try another drug. No excuses, Mavis. We need to get rid of this pain completely. Will you work with me to do that?’

Mavis glanced at Jake. Jake was smiling.

She looked back at Kirsty.

‘You’re staying for a while?’

‘My sister’s expecting a baby in a month. I’m not going anywhere.’

‘So our Dr Jake has a partner for a month.’

‘I guess he does,’ Kirsty said. ‘And you have a very bossy palliative-care physician. If you’ll have me.’

‘Jake doesn’t mind?’

‘Jake doesn’t mind,’ Jake said solidly from behind them. ‘Kirsty looks like being a gift horse, Mavis, and I’m not one for looking gift horses in the mouth.

‘Me either,’ Mavis said soundly. ‘Welcome to Dolphin Bay, love. I’d very much appreciate it if you could make me more comfortable.’

‘Good,’ Kirsty said cheerfully. ‘Great.’ She beamed at her patient. This sort of case was the reason she’d decided on her specialty. She’d missed her work so much, and to be useful again was wonderful. ‘I’ll have you bouncing in no time,’ she told Mavis. ‘But meanwhile you need to answer the question that every palliative-care physician worth her salt asks every patient.’

‘Which is?’

‘What’s happening with your bowels?’

‘That was fantastic.’ Jake turned the car homewards and shot Kirsty a look of appraisal that was more than tinged with approval. ‘Really great.’

‘We don’t know yet whether she’ll follow instructions.’

‘She’ll follow instructions,’ he said bluntly. ‘Why wouldn’t she? She’s been in so much trouble that she wanted