The Pecking Order

The Pecking Order
‘Mr Smith, Mr Smith’ she called in that overly kind voice reserved for patients with cancer. He stood up, he was thin and hairless, ‘on treatment’ she thought. Her own hair had grown back but she still had the bad skin and the shuffle that the chemo had given her. Mr Smith walked carefully over to the next waiting area and she read the screens again – yes, they were still running 75 minutes late. Usually meant that some poor buggar had held things up while he tried to deal with the implications of ‘your scan’s not so good this time’.
She had been often enough to know the receptionist by name. She knew how to pick up the cues now. If the nurse was in the room too you were in for bad news. The doctor delivered the blow in a jolly way, ‘you have some bits and bobs we need to deal with’ as if she had had a bad hair cut that needed an additional trim. He always seemed incapable of facing the truth of what he was telling you. Never could he say, straightforwardly, ‘it’s spread, you are pretty much f**ked’. Never, ever, could he utter the very worst word, never could he say ‘death’. He said, one memorable clinic day ’we oncologists, we’re not good at talking about death’, She wondered who could talk about if they couldn’t, but accepted his offer of yet another treatment with even worse odds than the last lot.
She hadn’t minded the surgery too much. It had been quite jolly on the ward and she always trumped every other operation, cancer always wins in the life and death stakes. Seasoned patients could order by stage as well. ‘Stage 4’ was always greeted with wise nods and knowing looks and the offer of a seat in the queue. Stage 4 meant that the nurse would talk to you with her head on one side, body carefully arranged to send off the right signals (as per recent training) and tissues at the ready. Heaven help you if you cried though, a frenzy of tea and stale biscuits would erupt and you would be there for hours. Before you knew where you were the Mac nurse would phone to ask if she could pop in. These people did a lot of popping and the more ‘poorly’ you became the more they popped. They were unremittingly cheerful and extolled the virtues of ‘keeping your spirits up’ and, more recently ‘living in the moment’ as if, she thought she could live anywhere at all.
At first she was fairly uninteresting, run of the mill really, a bog standard breast, early stages. Having affected lymph nodes in her axilla from the get go gave her extra points, extra visits and additional drugs. What really popped her up the pecking order was the discovery of liver mets. (She soon learnt the jargon and understood the abbreviations – she didn’t take long to twig that growth into the liver was not good news at all.) The clinic had run 65 minutes late that day. Entry onto a clinical trial gave real kudos but the clincher was being ’terminal’. It was the one every body understood. But whilst you were beatified by your imminent death, you were also a lost cause to the oncologists and best moved on so as not to die on their watch. Your move to ‘palliative care’ marked your demise and your slide down that slippery slope.
Everyone aimed to be equal in the hospice and no on made a distinction between the old man quietly shuffling off in bed 2 and the young, beautiful mother and her ever stoical husband in the side room. But she knew that there was a pecking order even here. She knew that beauty trumped age every time. She was pretty much invisible as she had always been really. Quietly getting on with it, not complaining. She spent her time ordering her lovers. She graded them first by romance; she knew who came out top there. Her next category was wealth, same winner really. Then by sexual prowess and she was delighted to see that once again it was Paul. She rang him, ‘Paul, my darling’, she whispered, hoping she sounded beguiling, ‘I just wanted to let you know that you have come out tops’. He sounded a bit taken aback and only muttered a brief ‘what?’ She had intended to be upbeat and jolly – not even letting on where she was. But it tumbled out in no particular order. ‘Just hang on ‘ he said, ‘I’ll pop round, you always were my favourite’. She closed her eyes, happy to know that at last she had was top of a list that mattered.