Epitaph

Ruth’s everyday story of living with cancer has finally come to its end.

The first clue probably came in the last round of chemo when, for the first time, Ruth actually admitted to feeling tired for a couple of days after the chemo sessions. In between the chemo though Ruth still lived life to the full and joined her extended family for a wedding in June where she danced the night away. At the back end of July we found that the spot on her liver was now a lot more than just a spot; it was now a full-blown secondary cancer site. This was the reason for her tiredness, not the chemotherapy.

At a family conference early in August we planned the coming months. Ruth wanted to see her birthday, Christmas maybe even next spring – always planning, always fighting. At the end of August Ruth saw her “wonderful Dr Charlie” for the last time and was discharged from the Royal Marsden and passed over to palliative care.

On Tuesday of last week I joined Ruth for a case conference with Social Services, Prospect House (who were providing the palliative care) and Sustrans to discuss how we could meet her objectives of staying independent, staying at home and continuing to work for as long as possible. On Wednesday she went into hospital for what we expected to be a routine drain of Ascites Fluid that had built up as a result of her declining liver function. The drain could not be done because Ruth’s blood was not clotting; the blood wasn’t clotting because Ruth’s bone marrow wasn’t producing platelets; which was in turn because the cancer had hit the bone marrow too. Platelet infusions and vitamin K followed but as the medical team checked the blood on Thursday we found that Ruth’s kidneys were no longer doing their job.

On Friday we finally had the drain, but there was no fluid to find; all the swelling was a combination of tumour, constipation and inflammation. Ruth hated being in hospital; we always knew she would, and we managed to escape each day to push her outside for an “adventure”. We revised our plans and made sure Ruth’s wish to return home was met and on Monday lunchtime we got her home. There in her own bedroom to the sound of the wind-chimes in her garden Ruth visibly relaxed and peacefully died with family and friends around her.

Ruth had fought and raged to make living with cancer just a normal every-day activity; no drama, no tragedy – just something to get on with. She had continued to work, continued to go out, continued to do everything she always had done. Ruth’s employer, Sustrans, were an absolute model employer in finding every way they could to support her. Social Services and Medical Care did all they could; sometimes they failed to deliver, not through any lack of good intention but through chronic under-funding and lack of resources.

Ruth died in the end but the cancer did not win.