The wee small hours

One of the last duties my father felt necessary to perform in this life was to ensure I knew the tragic circumstances my mother had endured as a girl, before she and my father knew each other and while she was still living at home as a student.

He asked me drive him to the harbour at St Andrews, where a newish moon was rising through brindle clouds over the East Neuk, while the North Sea boiled and roared. Despite the fact that he had been slowly dying of metastatic bowel cancer for some time, I did not realise that this was going to be the conversation.

He explained to me that he had made full provision for my mother’s further maintenance, that everything was in place for her safety for years to come. I knew these things of course. He skirted round stuff a bit and then wanted to know if I knew what had happened. At which point, I was initially unsure what he meant, until he started taking about the death of his mother-in-law, the grandmother I had never met, but whose influence continued to be felt long after her demise. After which in the conversation, I was able to join in more easily – for many years my mother and I had been enjoying long discourses about all sorts of stuff, including indeed the tragic events in her family that had persuaded her after much external cajoling that she should move away with her new husband and make a new family of which to be proud; much better than to repeat damage established in previous lives. My father was perhaps reassured, but also maybe taken aback a little and disarmed that I was able with such frankness to discuss stuff I knew only from speaking to my mother that he found difficult to discuss. I do not know. He was never a man who gave away much emotionally. But he never held a grudge.

One of the final conversations I remember witnessing my mother having was with an admissions nurse at Ninewells Hospital in Dundee. This was the final admission of a series from Christmas 2014 during which she was sometimes taken into respite care at a care home in St Andrews, sometimes at home with my brother or I, or another member of the family or friend. Again, I did not get it into my head that this was going to be the final visit to hospital – despite all previous periods of hospitalisation having been in Kirkcaldy, and this most urgently being directed at some inconvenience towards Dundee, a city I knew my mother associated only with her father, who she adored, her great uncle Andrew Ewing, and the happiest periods of her own past – living in the Sidlaw Hills looking after young horses on her father’s new farm, after events beyond their control had torn her away from The Grange in Edinburgh.

The nurse kindly asked the same questions she asked every elderly person who is brought in (again) to answer the same questions (again) to a kindly nurse doing the job of caring for this transition into the great unknown. They drank animated cups of tea, fully engaging with one another. I hung back listening. As I do. One question the nurse asked stuck in mind: who would my mother say was her best friend? It seemed like an odd – almost unkind – question to of ask a little old lady, friends of whom had been dying off with greater frequency than hitherto. After many months enjoying her lucid and charming company, my ego lit up a little too with the idea that I might appear somewhere on the list. But not a bit of it. My mother’s greatest friend was no longer with us. Her husband, my father, had been dead been for more than ten years, having made sure she would be looked after into the future, not only financially, but by her sons; she missed his kindness though, and the fact that he really did know her better that anybody, that he was the one who knew how to look after her, to advise her when she became anxious and to comfort her in distress.

At this point, I realised at last what was going on here. We sat for a long time before I left, chatting and holding hands, just being together; though I left the hospital knowing that I would probably never again see her alive, I felt she had found a peaceful place for her final days, protected by the the same collective commitment to social care as I am experiencing here now, that my father knew too in his last days at the Victoria in Kirkcaldy, and that everybody in the land was once promised from cradle to grave. The next time I saw my mother, barely 24 hours later, she had been pronounced dead; her presence still filled the ante room where she had been lain out though, and did not dissipate for the period I sat with her, encouraging her to find peace, or the next life, or whatever, and beginning to understand that my mother was now no longer with us.

There is no doubt that John Spence (left in above picture) recognised the hidden genius of his youngest child Eleanor, protecting his daughter from family dysfunction and the ravages of bourgeois Edinburgh by discharging her into the professional care of a nanny, Catherine Agnes Grey, ensuring she would be taught well during the conflagration of World War Two at an exclusive boarding school in the peace of Galashiels in the Scottish Borders. Later, after they were married, my father made sure that throughout her life she was able to say, to believe and to think whatever she felt right, and to conduct herself according to her own conscience on all matters at all times. Of all her suitors, she told me during the months we cared for her at home before she died, my father was the only one who did not want to make her into a little version of himself, or expect her to follow him into a career in the Military, the Civil Service or the Foreign and Commonwealth Office.

Instead, he became a teacher of History and English at a Comprehensive School in Angus, she became a wife and mother and then later, after the family moved to Fife, a part-time social work assistant at a psychiatric hospital, working to ensure the safe transition of patients from institutionalised to social care in the community. My parents gave up their dream of borrowing an Aberdeen Angus Bull from her father, using its issue to finance an itinerant life of casual insemination, and chose instead to work together in professional positions with the rest of the population who, as it was said, had never had it so good in the new post-war Welfare State, rebuilding a society not long since ravaged by brutal global war, now determined to care for all of its citizens from the cradle to the grave, despite an impeding sense of wider conflict and conflagration always hanging over from some bit of the past, threatening to disturb the general order of things into the future.

It is testament to my father’s integrity that he allowed his first born son so receptively to be indoctrinated into his wife’s rather unusual medial opinions. His own upbringing could hardly have been more different. In the brick terraced house in Hull where he was brought up, the doctor came from an entirely different social class, whose presence was summoned only under extreme circumstances at at great cost, and whose anticipation was accompanied by deep spring cleaning, starched linen, crisp pyjamas and maybe even a discreet visit to a barber or hairdresser. As a child when my father was taken ill, he was sent to bed with cod liver oil and expected to do exactly what the doctor told him. Exactly.

My father grew thus to accept without question the usual relations of society to medicine, to accept that medicines exist in order to cure disease, to entertain no doubt that there is any non material aspect to illness, that disease is most emphatically an external agent, which in order to be cured, must be eradicated or excluded by another agent, substance, procedure or medical intervention. That the power of cure lies in the knowledge of medical science over the mechanisms of anatomy, physiology, biochemistry and pharmacology. Until the day he died. Not that my father had any greatly detailed understanding of what these mean – he was an historian – but certainly he trusted that knowledge of material reality such as this existed, and that it did what it purported to do; to explain the machinations of the biological, bodily world of disease, so he and others could be cured of it, just as his own discipline of history would explain the vagaries of political economy, causation and consequence, and to offer the hope of improving the lot of humanity.

The differences between my parents’s attitudes to health and disease have over the years defined a tension in my mind – quite simply because these have so often been as starkly presented as aforementioned during the course of my life. It is a tension that reduces in principle to something much less polemical and divisive than when specifically applied to how to be healthy; simply between needing to explain things systematically and completely; and finding merely a satisfactory story that will tie up the loose ends and get on with the rest of the day.

In practice, for the moment, my mind is balancing a whole lot more than usual: I have split my body into a mechanistic bit to which I have given full access to medical engineering, while at the same time maintaining a wholistic bit, which I am jealously guarding with my usual regime of fresh fruit, bloodymindedness and Buddhism. (About which more elsewhere later.)

I started writing this piece expecting that the differences between the opinions and procedures about health and disease uneasily compromised upon by my parents during the upbringing of their first born infant would be the source of further much more fundamental conflicts. For on the surface of it, these were intense and irreconcilable; I can still remember the difficult emotions and strained silences, even after nearly sixty years – there is after all no real compromise between the idea that no medication will ever work as it is supposed to, and the idea that all will always work as expected.

Be that a it may, the actual differences between the specifically medical elements of these ways of thinking (both picked up informally through family circumstances rather than by way of education) demonstrate only a need to record the regularities of things in a well defined rule governed system of repeatable procedures; that are at the same time partially undermined by the realisation that even such limited regularity is a thing of fiction, that regularity is open-ended and never returns to the same position. 

The regularity of the world is something we make up with active minds, designed specifically to seek out regularity, while the world itself continues to change as it does, regularly sometimes yes, but also less regularly so, often sporadically and unpredictably, quite autonomously even. Because what happens is always and entirely a matter of perspective, which means that each can always and everywhere be regarded from many other perspectives. And so it goes. Nobody has a privileged view of events, the notion that any single viewpoint might be better is less a consequence of knowledge than of power.

It pleases me a great deal to know that I know this because I learned how to integrate and analyse the very different views of the world with which my parents were presenting me, and that they did so in such a way that never (at least obviously) emphasised anybody’s authority over anybody else’s.

Looking back, I always imagined it was my father who had the most to compromise; for he was a very private and deeply spiritual man, who under other circumstances might have followed a career into the clergy. For him, none of the above refers in any case to anything but theory; nothing of what he would have thought of as substance, these are differences only of opinion, about the way things are to be accounted for in the world, not about what is important, not about how we behave and conduct ourselves towards one another. This is what my father taught me, that how we conduct ourselves towards each other is what is most important.

My father was an educator; so from his point of view, it was important for his students to have learned to the best of their abilities, with pleasure for the task at hand; not in order that they then take up a particular position or opinion, but rather that if they did, they would be able to back it up, argue the case for it as good practice. I could imagine him now satisfied with a degree of pride; that had he found a good mother for his sons, that her odd opinions about medicine were turning out to be a fruitful and intriguing catalysts for developing interest in other things as well as learning more generally.

Any opinions he may have picked up on the way about medicine were simply a matter of his own personal upbringing, of a more conventional, authoritarian attitude toward medicine at the Duncan home in Hull, than the turbulent bourgeois narking shop that seems to have been de rigeur Chez Spence in Edinburgh.

Having said that, there was naturally something very threatening to my father’s ascribed, secomd-hand, acquired notions of health and disease from my mother’s wisdom and experience, which of course he held in common with rather a lot of the rest of the population. But he never stood in the way of her; every year gladly he took her to the Kingston Clinic in Edinburgh for another period of detoxification, while he stayed at home looking after his boys, for how ever long she felt she needed space safely to heal up again from the many poisons and toxins her life had piled against her.

So I discover once more a happy circumstance: this journey into the unknown is already explicitly divided into an organic wholistic bit, which continues to be animated and determined by my agency; and an entirely mechanistic bit, which has been defined and refined by medical engineering down into the microscopic details. This has been necessary in this crisis, and because I trust now the medical profession to be working in my interests, I have nothing to fear.

None of this though this has absolutely anything to do with any differences in my parents’ opinions about health, nor any conflicts they may have endured about how my sickliness were to be managed when I was a child, and made no difference to how they cared for me. It is simply a reflection of the balance of reason that they struck together. No more, no less.

I never really felt any kind of doctrinal conflict between physiologists working out what is by nature going on in my body to keep so assiduously this disease at arm’s length, and clinicians keen to do something more to alleviate suffering and postpone demise a little bit further.

For the moment the two processes are working intelligently side by side, fully integrated with each other, neither claiming priority, nor perhaps claiming to be separate process, governed only by my native powers of healing, lying in the comfort of an acute cancer ward at the Western General Hospital in Edinburgh full of many other troubled souls battling our demons, chasing down the important answers to the big questions before it becomes too late, wandering restlessly and confused, working out where we are, how we got here, finding respite from the pain, drifting with the morphine into peace, meditating reflecting healing, or maybe just looking to get a good night’s rest.

In any case …..

Martyn and Coll the dog are already planning the logistics and doing the ground work for the next Munro!

My plan is to get out of here as quickly as possible, with a clearer idea of what this disease is doing to me, what limits it is now setting on my life and how I should be adapting the way I do the things I do. The first physiotherapists who spoke to me after the radiotherapy about pain management asked what I might be expecting of myself when I am discharged: I said I would be quite happy to get to the summits of another couple of Munros in the near future – the planning for the first of which is already underway. I think they got the impression that I was serious, that despite financial setbacks, the vagaries and challenges of the disease, the emotional discouragement and all the rest, the course is always already set.

So. It remains my intention to reach as many Munro summits as possible before the disease makes it impossible. On the basis of current progress, the medics are doing a sterling job balancing the pharmaceuticals needed to mange some degree of recovery from the trauma of cord compression.

Pain is being managed. New limits are making themselves known from beneath,

Love and Peace

🙂