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Hughes, R., 2011. Dear Reformulation. Reformulation, Summer, p.22.
Dear Reformulation,
In October my father passed away. He had just turned 80 and had been struggling with his health more acutely from the beginning of the year. He was a keen amateur photographer, and the packages of pictures he sent me from time to time had seemed to be of more poignancy. He didn’t want to leave yet but, I think his images were perhaps a way of leaving something for us to remember him by and to hold in mind our family and our shared transcendent experience of nature. Dad began making photographs on a homemade enlarger as a teenager after the war, and when we were children we’d print black and white photographs with him, one of us for each part of the chemical process, a quietly awesome experience. In recent years and well into retirement he had mastered digital photography and photoshop printing of his work. His images took on a supranatural quality to my urbanised eyes, but less so when seen in the context of the fantastic Welsh landscapes of his childhood and of the timeless line of ancestors from these parts to which he had returned.
He was a quiet man, devoted to my mother whom he’d met soon after the many disruptions of his wartime childhood. He was in Birkenhead when war broke out and, as a native Welsh speaker, he was unable to speak English at first. He was evacuated back to Wales, living with a number of families until he settled with his aunty, living a rural life now long gone, a life of oil lamps, horses and carts and weather read from the sky. The sky formed a dialogical other, where he was assured a patch of blue big enough to patch a man’s trousers indicated a good day ahead. There was a spiritual dimension to this world.
Dad had to be independent, to face life against the vulnerabilities of economic hardships and the repeated disruptions to attachment that his times brought in their train, and he learned a lesson he taught to us, growing up – the inevitability of aloneness at times and the centrality of both bonds and self-sufficiency. He was clever, modest and, where he could, lived by his own decision.
His last days were spent in his local hospital. Water around his lung, removed in a routine procedure for the fit, became the active phase of his last negotiation with life. He had big hopes of returning home. I had seen him some weeks before and had a deep sense of sorrow for the struggle between robustness and fading that seemed to pass across his face.
Mum, myself and family members rallied around his hospital bed. For what turned out to be his last two days, I rushed back from abroad and by now he could only say single words and at times part of words. A few days earlier he had reconnected with his first language and sang determinedly of overcoming. My sister also sang to him, songs shared from childhood. He experienced some perceptions that he wanted to share, something in the space above him filled him with a pleasure he wanted us to know of. It was a delight for him. Once he took our hands and raised them in some sort of gesture of unity and greeting.
However, he was confused about the nature of the journey he was on and we too vacillated as, it appeared, did the medical staff. The day before he died, the Sister encouraged me to try and bring back his gaze to a focus in the room. The following morning he had pulled out his feeding tube for the second time and so a fix had been secured such that – I was distressed to be told – it would hurt if he pulled on it. He bled. We played his favourite singer and it dawned that there was no road back. During his last afternoon he was x-rayed in bed, pyjama tops changed twice and a young doctor poked a needle under his skin, wiggling it visible through the thinness, before connecting with herself and perhaps with the vulnerable old man before her, saying she would get someone experienced.
My dad had said to me ‘I’m finished’ and ‘ Hel...’ the day before he died. In his final moments, he squeezed my hand, my mother held him and one of my brothers held his other hand. I told him we all loved him. His breath began to pause and then he was gone.
In grief the mind is not so sharp in certain ways, but I have been trying to make sense of the of the impressions of those hours on the ward and the reciprocal roles and the self states that may have been prevalent, and perhaps by extension, those which particularly affect the dynamics surrounding critical illness, end of life, and the journey of the dying and their friends and families in medical care settings. What self- states came upon those people?
I think I observed these:
I think that something disturbed me alongside the grief, and that something was about the roles and self states which others adopt when they have power and control of the body of a vulnerable person. There is something politically correct in the asking for permission to touch and treat, but also something perfunctory and rushed in the over-load of work besetting doctors, nurses and auxiliaries. This may also in part be their defence, as loss and intimacy on a daily basis is potentially overwhelming. However, this is perhaps communicated to the patient through their touch and haste, something paradoxically useful but detached, hopeful but rejecting and abandoning. I wonder if this in turn impinges on the sick or dying person’s own internal process and experience. I wonder what roles and states those of our family around my father’s bed were trying to create. Was it warmth that we were defending in the room and the personal sense of this one unique person’s right to as much slow gentleness as could be held for him as he passed from us?
Who can do this for the lone patient, and is there something in our culture in the care of the very sick and the dying which the state has let pass without due care?
I don’t feel I have enough experience or resources to explore this, but it may be an area that CAT therapists can develop a useful understanding of, as we speak up increasingly about the societal pressures we see in the troubles of the clients in our consulting rooms. Perhaps we can develop a voice for those who have no voice in their last dialogue with life.
In loving memory of Peter Meredith Hughes 9/9/1930 - 10/10/2010
Rose Hughes, CAT psychotherapist