After the End(22)

Leila cannot sugarcoat what she is about to tell Dylan’s parents, and so she doesn’t try.

“The tumor has grown.”

There is a silent gasp from Pip, an openmouthed intake of breath she holds and then releases oh so slowly. Leila explains that the centimeter of tumor left behind after surgery—because removing it completely was impossible—has become one point three centimeters. It is growing slowly, but it is growing.

“Does he need more surgery?” Max asks. He is frowning; Pip bites the inside of her lower lip. Both are leaning forward, listening, waiting. They want Leila to suggest something new—something they haven’t yet tried.

Something that will work.

“The tumor is close to the brain stem.” Leila speaks softly, knowing the impact each of her words will have. “Further surgery would carry significant risk.”

“More chemo, then?”

Leila looks at them both in turn. “Mr. and Mrs. Adams, the damage to Dylan’s brain is global and extensive. His condition—ultimately—is terminal, and although further treatment might buy him some time, we have to balance that against his quality of life.”

There’s a burst of muffled laughter from the corridor as footsteps pass the door to the quiet room.

“What are you saying?” Pip’s voice is a whisper.

A hard lump forms in Leila’s throat. When she was at medical school one of her fellow students worried that she would never be able to break bad news without crying herself. She was emotional, she said—always had been. The tutor advised her to focus on a spot on the bridge of the nose of whoever she was talking to.

“From their point of view, you’re still looking directly at them,” he explained. “But you won’t see their eyes—you won’t experience the same emotional response.” To Leila, it had felt like cheating. She looks into Pip’s eyes. Her head moves from side to side; the tiniest motion, but it doesn’t stop. No, no, no, no, no . . .

“I’m asking you to make a decision about Dylan’s future.”

Pip lets out a moan. It comes from deep inside her and escapes from between barely parted lips, going on and on until there can be no breath left in her body.

“I know this is everything you’ve been dreading since Dylan was admitted, and I can’t tell you how much I wish there was something else we could do.”

“How long?” Max says. His voice is too loud for the space, and Leila sees Pip flinch. “Without more treatment. How long would we have?”

The one thing every relative wants to know, and the one thing no doctor can answer. “There’s no way of knowing for sure,” Leila says. “We’d make Dylan comfortable, manage his pain, possibly give him more chemo, but it would be palliative—purely to alleviate symptoms and ensure he didn’t suffer.”

“How long?”

“Weeks. Three months, at most.” Leila’s eyes sting. She can’t lose it now. She has to be the one in charge, the one in control. She swallows.

“And if we keep going,” Pip says, her voice choked with tears. “More surgery. Chemo. Radiotherapy. What then?”

Leila hesitates. “It is possible you could have several months. Perhaps a year—even longer. Even with aggressive treatment it is extremely unlikely that Dylan would live beyond another two or three years, and the extent of the neurological impairment means he would be severely disabled.” Pip closes her eyes, her face contorted into silent pain as she curls forward over her clenched fists.

“Many people with disabilities lead contented and fulfilling lives,” Max says abruptly, as though he’s quoting from a public service announcement.

He is right. Of course he is right.

“Dylan is paralyzed from the neck down,” Leila says. “He is unlikely to ever walk or talk or swallow, or have control over his bladder or bowels. Without medication he will be in constant pain. It is unlikely that he will have any awareness of his surroundings. He will depend on you for all his needs.”

Slowly, Pip looks up. Her forehead creases. “We’re his parents,” she says. “That’s what we’re here for.”

“More research is carried out into cancer than any other disease,” Max says. “There are new drugs, new treatments being trialed all the time.”

“Yes,” Leila says.

“There are miracle cures all the time.”

Leila says nothing. She does not believe in miracles. She believes in science, and drugs, and MRI scans. She believes Dylan has suffered enough. But it is not her decision.

“People write books by blinking, paint pictures with their feet.”

“Yes.”

“Disabled people do incredible things every single day.”

“Yes.”

Max leans forward, searching Leila’s face. “You said Dylan is unlikely to walk—you don’t know that for certain, do you?”

Leila hesitates. She is as sure as it is possible to be that Dylan Adams will never regain voluntary movement. But can she—can anyone—be completely certain?

“No.”

Max stands, and Pip follows, leaving Leila no alternative but to stand, too. He holds her gaze. “Then we keep trying.”



* * *





How did you leave it?” Nick and Leila walk toward the car park, Leila’s steps twice as fast as Nick’s long strides.