David Dickinson: Death of a Pilgrim

‘Thank you so much for coming at such short notice,’ Dr Moreland began, a slight smile moderating his look of extreme gravity. ‘Believe me, I can only imagine how difficult a time this must be for you, Mr Delaney.’

Delaney was trying desperately to stop himself looking at Matron’s eyes. ‘Not at all,’ he replied. ‘I am so grateful for all you are doing here for my James.’

‘I’m afraid I am going to be frank with you this morning, Mr Delaney,’ said Dr Moreland, who had to steel himself for these difficult encounters with a small shot of brandy before they started. ‘I want to put a proposition before you. You know by now, of course, of the difficulties we have with James’s condition. We believe it to be some form of leukaemia, but we do not what form, what shape it is taking. His illness does not a have a name. If it did,’ he pointed at the lines of books that lined two whole walls of the room from floor to ceiling, ‘there would be articles about it in places like the Lancet or the New England Journal of Medicine or the Proceedings of the Harvard Medical School which line the walls here. But there is nothing. We are working in the dark, groping our way to some form of treatment that might effect a cure. So far we do not believe we have found the answer.’

Delaney brightened slightly. ‘If it would help, Dr Moreland, I could endow a Chair for the study of this strange disease at the university here in the city. Or I could establish a Foundation to look into it.’ This world of self-interested philanthropy was one he knew all too well.

‘Please, please!’ Dr Moreland held up his hand. ‘Your offer is most kind and most generous but I do not feel this is the right time or place to raise such questions. We are concerned with one life here, a life that is, as we speak, ebbing slowly away a couple of floors beneath us.’

Michael Delaney winced. Wealth was not going to save him here as it had saved him so often in the past.

‘You see, Mr Delaney,’ the younger doctor cut in, ‘we know so little. If I could draw a very imperfect example from your own world, let us suppose that you are going to build a new railway line across some difficult mountains.’ The young man did not see fit to mention it, but his father was the senior engineer on the Kansas, Topeka and Santa Fe Railroad. ‘When you come to work up your plans, you have a pool of knowledge to draw upon: surveyors who have mapped similar lines in the past, engineers who can estimate the optimum route to avoid the high places where possible, men who have designed the rolling stock and the engines to carry the trains most efficiently across the difficult terrain. Others have trod the path before you. But with James, we have nothing at all, no maps, no charts, no previous experience. We have been changing James’s treatment all the time. Nothing seems to work. Very slowly, little by little, he is becoming weaker every day.’

There was a distant peal of thunder and a flash of lightning lit up the New York skyline for a brief second. Delaney, Matron thought, sneaking a surreptitious glance at the man in case direct eye contact should set him off again, was looking miserable, more miserable than she had yet seen him.

Silence ruled briefly in the library. It was Dr Moreland who broke it. ‘I hope I have tried to make it clear to you, Mr Delaney, right from the beginning, how little we know. In the medical profession,’ he glanced briefly at his colleague and at Sister Dominic, ‘we wear these white coats to impress the patients and their families. Sometimes we carry medical instruments with us, hanging around our necks. The Sisters and the nurses are dressed in special uniforms to imply they too have special knowledge. At Harvard, my old university, you see the professors wearing their gowns with scarlet hoods lined with fox and ermine and their dark mortarboards to impress on the students that they too have special knowledge. I once saw a formal assembly of lawyers processing through the Royal Courts of Justice in London with wigs and robes and emblems denoting who was Master of the Rolls and so forth. Fancy dress implies fancy knowledge. I cannot speak for the lawyers or the academics, Mr Delaney, but in so many medical cases we have no claim to special knowledge. In the case of your son James we have, in fact, almost no knowledge at all.’

‘I’m sure that’s not true, Dr Moreland.’ said Delaney. ‘You are most distinguished in your field, the pair of you.’

Dr Moreland brushed the interruption aside as if he were swatting a fly from his forehead. ‘Let me cut to the point,’ he said, leaning forward to look Delaney in the eye. ‘There is a choice to be made here. Only you can make it. I am not sure I would have presented you with such a choice were you not such an eminent man.’

‘What is the choice?’ asked Delaney very quietly as another blast of wind rattled the windows.

‘If we carry on with the current treatments, then I think your son will die very soon. I could be wrong. Our knowledge is so limited. We have been making things up as we go along. If we stop the treatment altogether, then again, he might die very soon. But he might recover. Our drugs may be doing him more harm than good. We just don’t know. That is the choice, Mr Delaney. Continue as we are and he may die – if you pushed me hard, I would say it is very likely. Stop them, and there is a chance, only a chance, mind you, that he might recover.’

Father Kennedy spoke for the first time. ‘What a terrible choice. I pray that God will guide you in the right path.’ Matron threw caution to the winds and smiled at Delaney.

The man was silent for a moment. ‘Can I ask you a couple of questions, Doctor?’ he said, sitting forward in his chair and twirling his hat in his hands. ‘Let me thank you for a start for being so honest. In your opinion, is stopping the drugs the only chance of saving James’s life? Is there any other way? And when would you start, or maybe I should say stop?’ He sent an agonized look to Dr Moreland. ‘I mean, if you did it, how soon before you would know if it was working, that James was beginning to recover? Or to put it another way, how long,’ Michael Delaney fought back the tears, ‘how long before he dies?’

Dr Moreland answered immediately. ‘I cannot promise you anything, Mr Delaney. I cannot promise that stopping the drugs is the only way to save James’s life. There might be other ways, but we have tried all we know. As to how soon we should stop the treatment and begin to treat your son with non-treatment, as it were, I think I can give you an answer. We should do it as soon as possible. The young man grows weaker. His ability to fight the disease lessens by the day. The longer we wait, the less likely the non-treatment is to succeed.’

‘Do you mean’, said an aghast Delaney, ‘that you want me to make the choice now? Here, in this room?’

‘I do not wish to rush you in any way,’ said the doctor, leaning back and looking at Father Kennedy, as if appealing for help. ‘It is a most terrible choice. Only you can make it. But I emphasize what I said before: the sooner we start, the better our chances. Which, as I hope I have made clear, are not very good in the first place.’

Michael Delaney rose to his feet. He walked very slowly to the window. He was still fiddling with his hat. He stared out at the rain cascading down the windows, the dark clouds racing across the sky, the busy streets of the city outside in a healthy world.

Sister Dominic found the whole encounter had a terrible fascination. So many times she had watched families and loved ones almost literally torn apart by the doctors’ words in this room. But she had never seen a man of such wealth and power face such a situation before. She wondered what he would do. Silently she began saying Hail Marys. The younger doctor, Dr Stead, was trying, yet again, to work out how long it would take for death to happen or recovery to begin if the treatment were to stop. Father Kennedy was planning to slip away quietly after this meeting and fetch the little box from his house, the little box that would enable him to administer the last rites. He should, he told himself bitterly, have brought it earlier. Dr Moreland was running the discussion back through his mind, hoping that he had made the position clear. Delaney thought of his dead wife and what advice she would give about the life of her only son. He thought of his own parents, now long gone, who had watched young James tottering across the floor on his first faltering steps and had been in the front of St Patrick’s Cathedral as he took his first communion. Delaney’s dead remained silent. No answers came from beyond the grave.