The Observer



Edward Marriott


Sun 1 May 2005 

Starting at the end

He quit Auckland for Aldershot, and swapped an executive's life for an unpaid job as a hospice nurse. Here, Paul McDermott tells Edward Marriott how encouraging Val, a terminally ill cancer patient, to face death head on helped them both come to terms with life


Before his first meeting with Val Hall, whom he supported through the last 18 months of her life, Paul McDermott's experience as a hospice volunteer was limited to a single unhappy encounter with the parents of a terminally ill 12-year-old girl. A trainee psychotherapist, he'd offered his time to a charity which supported people who wished to die in their own homes. As yet only dimly aware of his hidden motivations, he found himself sitting in the living room of a couple whose daughter had just weeks to live. The couple sat on the sofa, facing him. Their daughter was in hospital. Behind them, her bed lay empty.

'The mother just started pouring her heart out,' McDermott remembers. Though confused and already grieving, she seemed to relax and soften as she spoke, as if the talking itself were making the experience bearable. As she opened up, though, her husband 'tightened up'. Periodically, he got up and left the room. On the rare occasions when he spoke, he avoided emotional territory, concentrating instead on what a great athlete his daughter was, how well she was doing at school. McDermott stayed for two hours. When he stood to leave, the girl's mother asked if he'd come back the following week. She'd never spoken to anyone this openly, and she'd found it very valuable.

The girl's father drove McDermott back to Camberley, where the offices of the hospice charity were based. They arrived, pulled up and McDermott got out of the car. As he walked away, the other man wound down his window. 'Don't you ever come back again,' he spat. Then he turned and drove away.

Not long afterwards, McDermott found himself sitting in his car outside a Fifties semi-detached house in Aldershot. It was 14 October 1993. As he sat there, he recalls, 'I began to regret being involved in the hospice charity at all, feeling a vague nostalgia for the nine-to-five security of the Eighties.' But then another car pulled up in front of him and a district nurse got out, introduced herself and led McDermott towards the front door of the house.

The woman to whom McDermott was introduced was 74-year-old Val Hall - 5ft tall, 'barrel-round', squat and wrinkled in a way that reminded McDermott of Yoda in The Empire Strikes Back. He followed Val, as he would later write, into a front room 'so valiantly decorated it increased my growing unease. The ceiling hung low, covered with dirty polyurethane rectangles full of tiny holes like a battalion of factory-made rain clouds. Cornicing was glued around the edges to keep the clouds in the room, drifting only eight feet above a typhonic swirl of pattern and colours; Gaudian wallpaper hung heroically over Daliesque carpet.' There were dark laminate cabinets and a 'colossal' fake velvet sofa.

Val made them both tea. She explained that she had multiple myeloma cancer, and then went on to say that Tom, her husband of 48 years, had himself just died of cancer. Val - rapidly emerging as cantankerous and demanding, though not without a certain sense of black humour - had been given a month to live. It was to be McDermott's job, as her hospice worker, to guide her serenely to the grave.

What drives someone to undertake such emotionally taxing, unpaid work is a matter to which McDermott has given much thought. Now, exactly 10 years after Val's death, he has written Pilgrims, a book which chronicles their relationship. From inauspicious beginnings, an unlikely friendship developed which, by the time of her death, on April Fool's Day 1995, had grown into something like love.

McDermott, now 46, grew up in Auckland, New Zealand, the second of six children who enjoyed 'a childhood of freedom, of going to the beach by yourself, a simple existence, safe and contained'. Yet, if outwardly idyllic, it was also lived in the shadow of a 'domineering' father, who pressurised his children to perform, and against a backdrop of guilt-inducing Catholicism. McDermott began to have fantasies about his father meeting a gruesome end, praying that he'd stumble over a tripwire as he arrived home, and get 'blown into bloody bags of bone and guts smashed across the front of the house'. And then, when he was 17, his prayers were answered: his father died of a heart attack. McDermott was left in conflict: 'Should I feel gutted, or relieved? I didn't know what to feel. By then I was so separated from my inner world that I didn't know what to believe.'

A year later, his beloved golden labrador died, and shortly afterwards he came close to death himself. He was surfing with his brother John and, though an experienced surfer, he'd never learned to swim. A big wave turned him over, ripped his board from him, and he nearly drowned. Ten years on, by now a successful businessman, he found himself in hospital with legionnaire's disease, once again at death's door. His temperature was 'one degree away from leaving me permanently brain damaged'. He narrowly escaped with his life.

All this while, McDermott was holding down a successful job as a computer programmer in Auckland. He was married and renovating a large house. And then, in 1988, at the age of 30, he was summoned by his boss and offered the helm of the company. He was promised three times as much money, a new car and round-the-world travel every year, and an open-ended expense account at the local liquor store.

'I'd worked very hard and had everything the world could offer. And yet,' McDermott says, 'when my boss made me the offer my whole world cracked open. I'd become this hard, successful businessman, but I'd completely shattered inside. I realised that not only my job had to go, but everything, this whole life I'd built up for myself.' He resigned on the spot, bought a one-way ticket to the UK, and a few weeks later arrived in a grey and cold London.

McDermott had lived in London for five-and-a-half years when he met Val. The previous years had certainly been busy. His first wife had followed him out from New Zealand, only to announce, on arrival, that she wanted a divorce. He'd worked for the Stock Exchange in London, had carried on making a lot of money and, having collapsed in tears in his brother's house after the end of a new relationship (the first time he'd cried since his father's death), had sought out a therapist. Though this ended in disaster, with his therapist - a woman some 15 years his senior - asking if he'd move in with her, he was by this time undergoing his own therapy training.

And then, in 1992, he heard of Hospice Home Support, a new charity that was setting up to enable people with terminal illness to die at home. McDermott contacted them and asked if he could volunteer. They asked him why. 'I don't know,' he replied, 'but I'm sure by the end of my training I'll be able to tell you.'

From the tone of his account, there must have been many moments during his opening weeks with Val when he questioned the wisdom of his decision. 'Val could be a total pain in the arse,' he writes. 'She could be superior, dismissive and opinionated to the point of bigotry.' On one occasion, seemingly forgetting the fact that it was a New Zealander who'd been sitting on her sofa for the past eight months, she began a diatribe about 'foreigners flooding into Britain and taking all the jobs'.

Her manner was often 'abrupt'. 'She toyed with me a lot,' McDermott remembers, 'because she could tell I thought I knew a lot more than I did.' In their early sessions together, she also seemed to enjoy embarrassing him. 'So, do you think I'm dying?' she'd ask him over and over again, watching for his response. She was prickly, and easily offended. She would exploit his willingness to help: once, she got him to steal some garden sand from one of her neighbours. Even the tools she handed him seemed in some way the choice of a sadistic mind: a squeaky-wheeled shopping trolley and a shovel with a broken handle.

And yet, despite the provocation, most of the time he managed to listen, to draw her out, to let her explore her feelings about dying. 'I sat down when invited and left when she hinted, in broad brush strokes, that it was time for me to be gone. In all other ways there were no rules, no map, no recipe; it was the experience itself that pulled us forward.'

He visited her on Thursdays, barrelling down the A3 from London on his Harley. One week, as they were looking out of the back window at a fibreglass fish pond Val had ordered when she'd first learned about her cancer, she asked him if he was a gardener. He demurred. Undaunted, she announced, 'We'll start next week, if the ground isn't too hard, and if there's nothing else I want you to do.'

As weeks turned into months, and Val's month-long period of grace became eight and then 10 months, she slowly began to tell McDermott more about her life. An illegitimate child, she was born Evelyn Turner on the King's Road, Chelsea, on 1 March 1919, and raised in the National Children's Home in London. At 14, she was adopted, chose the name Valerie, and moved to Aldershot. Two years later, she left school and got a job in Aldershot post office. At the age of 17, she met Tommy Hall, an army engineer, whom she married in 1942. Ten years later, she gave birth to Christine, her only child.

Throughout her life, she seemed to have perfected the art of alienating others. At one point, about a year after her diagnosis, she befriended Bill and Sue, a couple she'd met at bingo. Though McDermott only met them once, the beneficial effect of their friendship upon Val was clear. Bill helped mow Val's lawn; Sue visited two or three times a week. Yet, Val being Val, Bill and Sue didn't receive the same in return, and, when alone with Sue, she happily tore into Bill's character. Finally, such was the warmth Val felt for her new friends, she rang them and told them she was going to change her will. Sue and Bill arrived together, and Val told them that she'd thought long and hard, and was going to bequeath them her sofa - the velour monster that dominated her living room. A week later, Sue phoned Val to say that they'd not be visiting her again.

However indelicate Val may have been, however, McDermott saw it as his role to try to remain impervious to criticism. With a dying person, he says softly - a tumbler of red wine in his hand, the faint smell of incense in the air in his minimalist flat in Maida Vale, west London - it's important to eschew the normal kinds of niceties: when 'How are you?' would get the response 'I'm dying. How are you?' it's better, he says, just to sit 'quietly and calmly' and let the dying person do the talking. Yet there were times, he admits, when what he'd been taught during his training did him no favours at all. When Val, for the first time, alluded to her late husband's 'woman', he found himself putting an arm around her shoulder. 'Sorry about that,' she spluttered, suddenly embarrassed. 'I don't know what came over me.'

'A lot of training for volunteers or therapists is based on books, and not on experience,' he explains. 'I've been taught a lot of things that I felt in the end were damaging. Such as, if someone cries you give them a hug or pass them tissues. This just shuts them up. Handing someone a tissue gives the message that tears should be wiped away.' He was also instructed - in both his psychotherapy and hospice training - that he, as the expert, was there to help, to 'take the other person to happiness'. After his time with Val, he feels differently. 'It was my job to accompany Val, to be there while she discovered who she was, to follow rather than guide.'

At times, this was a hard discipline. When Val finally opened up about her husband's lover, when she spoke with such pain of her daughter, Christine, who now refused all contact with her, how tempting it must have been to wish away the pain rather than let her experience it and come to some kind of acceptance. Yet McDermott's approach allowed Val to talk in a way that, one senses, she'd seldom done before. After a while, she could even talk about her cancer with 'curiosity and relief, relief at being able to talk about it without hearing a response like, "I'm sure you'll pull through," or "How about a nice cup of tea?"'

Likewise, when she decided that she was going to opt for chemotherapy, McDermott had to fight to restrain his feeling of horror. Had her doctors mentioned side effects, he asked. 'Yes they did!' she replied. 'They said that if I responded well to the treatment, it could knock the myeloma on the head. Isn't that wonderful!' Over the coming weeks, McDermott watched as each dose of chemotherapy left her 'half dead'.

Yet, as the trust between them grew, Val began to see him less as a counsellor, more as a friend. She pushed for advice: 'What would you do about Christine if you were me?' In the end, he suggested that she write a final letter. Her response was typically withering. 'A final letter? But I've already written her plenty of final letters!' And yet such was her respect for McDermott that - though she expected and got no response - she went ahead.

Supported by McDermott, who by now was visiting her two or three times a week - coming, in fact, whenever she called - Val had begun reading poetry, searching for the meaning of her life and impending death. She had started combing through The Rubaiyat, poems by the 12th-century Persian poet and mystic Omar Khayyam, given to her by Tom many Christmases ago. 'Do we have more than one life?' she asked McDermott. Having lived an 'impoverished' spiritual life, she now wanted to know whether there was a God, and here again McDermott saw it as his job to let her draw her own conclusions. 'She had no use for anyone else's answer; she had only her right to be in the question, to not know, to be unsure.'

And then, one harsh winter day at the end of 1994, McDermott arrived at her house to find her unexpectedly excited. She had something important to tell him, she said. 'There was no immediate "Tea?", which could only mean one thing: something was up.' She told him she'd been preparing some food and then, knife in midair, had stopped, struck to stillness by revelation. 'While I was standing there I realised something, something I hadn't realised before. I said to myself, "I'm not Val." It was wonderful. So peaceful. I said, "I'm not Val. I'm not an old woman. I'm not this and I'm not that. I'm just me. I'M ME! And I love it!"'

Christmas came and went. Softened by McDermott's warmth, by his interest in her, Val was becoming less fearful. She began to read more. In her increasingly shaky hand, she wrote down bits from The Rubaiyat: 'The leaves of life keep falling one by one'; 'Think then you are today what yesterday you were - tomorrow you shall not be less.' When he flew to New Zealand for a holiday just before New Year, he carried her 'within me'.

He returned to London on 2 February and telephoned Val the moment he got in through his front door. No answer. He tracked her down to the hospice, and drove down the next day to see her. 'It was at once a shock and a relief to see her, as the cancer had not been patient. Her skin was grey, her limpid and listless eyes devoid of the irreverent glint.' He told her he'd missed her; she nodded, tears in her eyes. She asked him, 'Tell me, Paul, what is it exactly you do?' With nothing prepared, he began talking. 'Well, it's like you're on this journey, Val.' The reins were hers, he said; he was alongside, her companion. 'As long as you want me on the wagon, I'll be there. If you ever want me to get off, then I will, no argument. It's your wagon. And if you ever want to pick me up again, that'll be OK, too. It's up to you. I see it as a privilege. So that's what I do.'

Over the weeks that followed, she began to talk less about her cancer. She had a dream - 'except it wasn't a dream,' she explained breathlessly, 'I went to another level of consciousness' - in which she was riding a white charger, in which she saw a great city's lights laid out before her, and in which a voice told her to bring McDermott two messages. The first was from Hamlet: 'This above all: To thine own self be true,/ And it must follow, as the night the day,/ Thou canst not then be false to any man.' The second was from The Rubaiyat. 'The Moving Finger writes; and, having writ/ Moves on: nor all their Piety nor Wit/ Shall lure it back and cancel half a Line,/ Nor all your Tears wash out a Word of it.'

Val Hall died on April Fool's Day 1995. A week before, she'd written McDermott a letter. 'Just a line to thank you for all your kindnesses to me and I have enjoyed knowing you ... I feel strangely calm and I don't think I have too long a remainder of a journey to go - it's as if I'm drifting in the Bermuda Triangle and I am 99 per cent certain that our theories are correct.' In other words, McDermott says - though he'd never shared his religious ethos with her - 'she was sure she'd continue after death'.

At the crematorium, McDermott found himself 'neither sad nor grief-stricken'; instead, he felt 'grateful that I had known her, and that I'd known her at a most significant time in her life'. He was introduced to Christine, who'd steadfastly refused to get in touch with her mother during the last years of her life. She'd been bequeathed the house, and had already put it on the market. She and McDermott exchanged the briefest greeting, and parted. (He is unaware whether Christine knows about his book, and has not tried to get in touch with her.)

The 18 months he spent with Val left McDermott profoundly changed, he says. Though he'd not known at the time why exactly he'd wanted to volunteer for hospice work - just that 'I felt I had to' - now he can see that his 'previous experiences of death were like veins of gold that I hadn't yet mined'. While aware that Val took a lot from their time together, he's realistic enough to concede that he visited her, in large part, for himself.

'After she died,' he says, 'everything in my life was up for grabs again. I reassessed everything. I stopped watching television. I began to see that life was so full of distractions.' His second marriage broke up - 'I wasn't willing to be unhappy in order to meet other people's requirements; I'm not going to compromise who I am' - and he now shares the care of his son and daughter with his ex-wife.

Just as Val's dying 'had a purpose in it for her, which was to take her much closer to being herself, to accept herself before she could make this transition', so it also marked a point in his own growth. A 'theist' rather than a conventional Christian, he says that Val's death played a part in helping him reconnect to life 'as a religious experience, in the sense that everything is connected'.

Death, he now feels, is 'an opportunity, a fulfilment of all that has gone before. People these days don't see dying as having meaning, they see it as a catastrophe.' And, he says, this is echoed in wider society. 'In the past, the elderly were esteemed, they carried the wisdom of the community, and when an elderly person was dying it was seen as a very important community event. Now the dying are seen as waste products. I see dying as useful, as a fruitful transition. The wisdom of the dying is lost in our mechanised age. It's a shocking waste.'

Val's death, he says, brought into question 'not only my priorities but also the values of my life. You don't hear people in hospices saying they wished they'd watched more television in their lives, or wishing they'd worked harder. People wonder why they didn't take more risks, why they worried about having enough money in the bank. Even the crusty old businessman will admit, in the end, once he's lost everything and all control is gone, that the only thing that's important is love.' 

Pilgrims by Paul McDermott is published by Rider Books