I was 6 or 7 when our bouncy terrier was hit and fatally injured chasing after one too many cars. We wrapped him in his old blanket which soon got badly stained with his blood. I watched as his breathing became laboured and his obviously painful whining faded into silence. Then the sparkle disappeared from his eyes: they went sightless and without anyone having to tell me, I knew he was dead. It wasn't the first death I was aware of in my family, but it was the first time I observed and understood the difference between living and dead. I was about the average age at which children can grasp this concept, the distinction between life and death. I could comprehend the fact that the transition is irreversible. Once we are dead, there is no way back to life again, at any rate outside the pages of gothic and supernatural fiction.
Paediatric cancer specialists with empathy know that it is cruel and wrong to withhold the truth from children over the age of about 8, when ultimately their cancer is going to kill them - and that this might happen rather soon. Children of that age have enough insight and self awareness to recognize that they are getting worse, not better. They do not like their parents and their doctors to lie to them, and it is harmful and wrong for parents and doctors to deceive children who want to decide for themselves who will get their most treasured possessions. What's more, many children who face this fate are able to do so with courage and good humour. I have not had to care for many children facing inevitable and imminent death, for which I am thankful. In 1952 when I was a paediatric resident at Edgeware General Hospital in North London, a little girl about 9 years old was dying of bone cancer. She was cheerful most of the time, except when the pain of her cancer escaped our best efforts to suppress it. She played happily with her doll and her teddy bear, reading aloud to them. She got sad when her parents came to see her because, she said, her Mum always cried and her Dad looked so unhappy. My chief, Dr Margaret Baber, asked the child if she knew what was going to happen to her. I can't recall her exact words, but she knew her leg had been cut off near her hip because it had got cancer, knew that the cancer had come back, and knew that she would soon die. As far as Dr Baber, the experienced nurses, and I could tell, she accepted her fate calmly, without bitterness or anger. Was she courageous? Perhaps. She may have been in denial. I can't say one way or the other.
I've seen enough deaths to be aware that courage or bravery aren't usually important issues. Wendy and I knew immediately that the neurologist Pierre Bourque gave her a death sentence when he told us his diagnosis of her vaguely defined symptoms and signs was ALS, or motor neurone disease. She accepted it calmly, more calmly than I did, and we lived with the inevitability of her death for 14 months until it became a reality. Previously we had talked several times about the end of our lives and how best to prepare for this. In our mid-80s we were well adjusted to the certainty that death would come to us sooner or later. We were greatly reassured when our palliative care physician Louise Coulomb described how Wendy would die and what we could do to minimize distress. Philosophical acceptance of inevitability describes her attitude, and mine, better than courage or bravery. We were both profoundly grateful for long, useful, well-lived lives that turned out much more interesting, exciting, and fun than we'd have expected if we'd thought about it on the day we decided to join our lives together.
My own first unequivocal close encounter was my departure from Paris in April 1952. I flew, to allow me to have the maximum time in Paris. As we took off from Orly to return to Heathrow, an engine caught fire, the pilot slammed on the brakes and we ended nose down, propellers buckled, in a ditch well beyond the end of the runway. I had a momentary flash of alarm as I looked out the aeroplane window and saw all the flames and smoke pouring from the engine; after that everything happened so quickly there was no time to feel afraid. I had a delayed bout of something like panic as a replacement aeroplane raced along the runway a couple of hours later, and I was shaking all over for a few minutes, but it passed off once we were airborne. In November 1958, Wendy and I and baby Rebecca flew to New Zealand to meet Wendy's family. I was incubating a nasty chest infection as we flew across the Tasman Sea, and a few days after we arrived at Mum and Pop Wendelken's home I was delirious with a high fever. My recollection of the next few days is very hazy and incomplete. I was admitted to a local hospital and put in an oxygen tent with a detergent mist to loosen the sticky mucus that was choking me. For a day or two, in my lucid moments I and the young chest physician caring for me thought I might die. Well, he thought I would die; I was delirious and unaware for much of that time, but as I began to get over the worst, I became obsessed with anxiety about my seemingly imminent death - anxiety about leaving Wendy destitute with baby Rebecca not yet a year old and Wendy heavily pregnant with another one. Since the 1950s I've had several more terrifying experiences in the air or approaching a runway in bad weather. It hasn't helped when the aircraft have been in an obvious state of disrepair. Flying out of Medellin in Colombia between towering mountains, into Hong Kong in a monsoon deluge, in and out of boondock airports in Indonesia, also in monsoon rains, were nail-biting experiences but at the time none felt like my last moments. There've been near misses in traffic a few times too, and once at least when swimming in heavy surf off a North Shore beach in Sydney when I really thought for a few moments that I would drown. My life didn't flash before my eyes but as in the oxygen tent in Blenheim, New Zealand, the thought of leaving Wendy and the kids ill prepared financially made me determined to live. That didn't require courage, just muscle power enough to fight the waves and the tide rip for a few moments longer until I was out of harm's way. Courage or bravery weren't what I needed and found, just determination to survive. My father and his wife possessed it too, when they survived in a lifeboat in the North Atlantic off Iceland after their ship was torpedoed a week before Christmas in 1940. Several others in the lifeboat younger and perhaps fitter than they were didn't survive. 'Will to live' - whatever that is - accounts for it I suppose. When we were young and middle-aged adults Wendy and I had plenty of will to live. Now, not so much.
Battlefield conditions in wartime are far from the only setting in which courage and bravery - and their opposites - are revealed and displayed. The display may be unobtrusive, low-key, or dramatic, flamboyant. The accompanying states of mind likewise vary greatly. Wendy's state of mind throughout her terminal illness can be summed up as philosophical acceptance. Mine was much the same. I had mixed emotions about facing life without her, on one hand, thankful that I was behaving as a gentleman should, letting her go first, sparing her the emotional stress of clearing up after a long, loving marriage ends; and on the other hand, sadness and even despair at the thought of life without her by my side. Four years later, those emotions are unchanged, but I've accepted my fate and am trying as best I can to carry on without her.
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