Chapter 1

Dear Counsellor

Re: Andrew Anthony Smailes, DOB 10/04/1960

Thank you for seeing this 59 years-old gentleman who lost his wife to a metastatic brain tumour just a year ago. He came to see me with his daughter this week and admitted that he is not coping. I have prescribed Citalopram, 20 mg and suggested to him that counselling might help.

Yours sincerely

Dr Elizabeth Jones MB, BS, DHC, MRCGP

John put the letter unfolded into Andrew Smailes’ newly created folder, slid it into the section marked ‘Assessments’, closed and locked the filing cabinet. After fifteen years of working for the Bereavement Support Service it was a pretty familiar letter, a story with variations that he had heard many times before. Yet he understood that to the family, this was a devastation outside of anything they had ever known. He would listen to it with fresh ears and eyes, as if he had never heard anything like it before. And of course, the truth would be that he wouldn’t have heard the story before because each person’s experience of loss is as unique as their DNA. It was the second time he had read the letter. Although when it arrived with the GP referral three weeks ago, he had glanced at it, now he read it slowly and reflectively, because this afternoon was the client’s first, assessment session, and it was likely that he would be continuing to work with him.

Early in his counselling career, John had tried to avoid working with male clients prematurely bereaved of their spouse. He had personally experienced other losses, but not the death of a much-loved wife and soulmate. Eventually he had discussed this unease with his clinical supervisor, who had gently but firmly suggested that it was unfair to colleagues not to take a cross section of clients. Now he had learnt to face the fear and had become good at working with grieving men, especially those of his own age like Andrew Smailes, who he would meet in a few minutes time. He made his way to the service reception area to be ready to greet the desolate man he expected to arrive.

After fifteen minutes, John returned to his office. At one time he would have been irritated and annoyed at the wasted appointment that someone else could have used. Once, expressing his anger at a similar event, a wiser, more experienced colleague had said with a smile,

“John, the client is grieving, sometimes that’s what grieving people do.”

Andrew Smailes drained his can of Special Brew, crumpled the can and dropped it by the side of his chair with the other one. He looked at his watch, but didn’t really register the time, which didn’t matter anyway. Barely audible daytime television filled the backdrop to Andrew’s misery. Next to the unopened packet of antidepressants, a half-eaten ham sandwich, made by his daughter yesterday, lay dried and curling on the table by his chair. His chair, “Dad’s Chair”, as it had been for 20 years, replacing the previous Dad’s chair of his long, contented marriage. He had always sat in that spot, shouting at the telly and putting the world to rights. Now none of it mattered, none of it had any purpose, the chair, the room, his house, his life. Now the only reason that the telly was even on, was to fill the void. He jumped when the phone rang, partly because he didn’t expect it to still be charged. Amy was always nagging him to put it on charge before he went to bed,

“What if something happened in the night?” she’d say, “How would I contact you?”

Sometimes he just wished she’d leave him alone, even though he knew that would never happen.

“Hi Dad, I’m just checking that you’ve remembered your counselling this afternoon.”

“Yes, I’ve remembered”, he fibbed.

“Do you want me to come with you?”

“No love, I’ll be fine, the walk will do me good.”

“Are you sure? It’s quite a long way.”

“I’m sure love, I better go and get ready. Bye!”

Andrew had no intention of getting ready, because he wasn’t going. What would be the point? What difference would it make? He made his way into the kitchen for a third can.

John picked up the office phone 

“Bereavement Support Service, John speaking.”

“Er, hi, my name’s Amy. You were seeing my dad, Mr Andrew Smailes, for counselling yesterday. I’m just checking to see if he turned up.”

“I’m afraid that due to confidentiality, I can’t tell you. Could you ask him?”

“Er, yes, I suppose so, thanks anyway .. er if he didn’t come, could he still get another appointment, or has he blown his chances?”

“If people fail to keep an appointment, we offer them another one.”

Another appointment was made. This time, when John approached the reception area, his client, accompanied by whom he assumed was his daughter, was already waiting, sitting tightly together on the small sofa. John reflected on what it might have taken to get this sullen, recalcitrant man to the appointment. For a moment he fantasised about father tethered to daughter by one of those wrist straps parents use to stop toddlers from wandering off. The father stood up as John approached.

“Do you want me to come in with you Dad? Is that allowed?” she added, turning to John. Dad glanced back.

“No thanks love, I’ll be fine.” 

Client and counsellor walked the short distance to the counselling room in silence. The client chose a chair and John sat opposite him. Nothing between them, no paperwork, no clipboard, nothing but humanity, a therapeutic space should the client wish to use it.

“I’m John, what would you like me to call you, Andrew, Andy or something else?

“Only me mum has ever called me ‘Andrew’, or ‘Andrew Smailes’ if I was in trouble. Mates call me ‘Andy’ or ‘And’

“I’ll call you Andy, if that’s okay. We have up to an hour, or a bit longer if we need it, to find out what’s brought you here, what you need, and how counselling might help you. At the end I should be able to answers those questions, then we’ll do the inevitable paperwork. Is that okay.”

“Yep”

“If you feel able to say, can you tell me the story of what’s brought you here today, in as little or as much detail that you feel comfortable with.”

There was a silence. The wall clock loudly ticked away the seconds. Andy’s back visibly stiffened,

“I thought you had a letter from my doctor, haven’t you read it?”

“I have, but it can help me and maybe help you, if you can tell the story in your own words.”

“She had breast cancer, it went to her brain and six months later she passed away. What else do you want to know?”

“Can you tell me a little more?”

“About what?”

“Well, I don’t know your wife’s name.”

“Janice.”

“When was Janice’s breast cancer diagnosed?”

“About three, four years ago? Dunno. Can’t remember.” Andy looked at his watch. He fought back the anger that threatened to swell from deep within him.

“Look I don’t mean to be rude, I know you’re trying, but I can’t see how talking about it can help. I’m best not thinking about it and getting on with things.”

There was a long silence, only punctuated by the clock’s tick. John waited, in case there was anything Andy wanted to add, but nothing was forthcoming

“So what made you decide to come to today?”

“Amy, my daughter. Nag bloody nag. And my doctor said, ‘Why not give it a try?” So here I am, but it’s not going to bring her back, is it?” He looked at his watch again.

John tried to engage eye contact with his client, who was looking into the middle distance, eyes blurred by tears. He felt so much for this man’s sadness, imagined how it would be if he was in the opposite chair. He wasn’t that far from tears himself. Andy took a tissue from the box on the arm of the chair and scrunched it in the palm of his hand. John said gently,

“It may be that counselling isn’t right for you, or that you’re just not ready yet. But can I ask you few more questions so that if you do decide to come back, we’ve completed this part of things?” There was a long silence. Andy considered how cross his daughter would be if he reappeared in such a short time, yet he was desperate to escape this prying intrusion into this private world he so hated. He tried to swallow the lump in his throat. The wall clock marked the silence. Tick, tick, tick, tick.

“Go on then, ask me some more.”

“I’m guessing, from what you’ve said so far, that it’s hard to be reminded of what’s happened. What’s it like looking at photographs of Janice?

“Can’t. There’s one in our hall. Both of us on holiday in Malta”. For a moment he allowed himself sweet memories of the warm evening, the flowing cotton dress, the seafood, the wine, the walk back to the hotel, hand in hand. Kissing like teenagers. “I know it’s there, framed on the wall, but I don’t look at it.”

“So, I guess any music that reminds you…”

I just turn it off. And if a funeral, or any mention of cancer comes on the telly, God no. Thank you, ‘Off!’” He mimed pressing a TV remote.

“And what have you done with her clothes?”

“Still in the wardrobe.” Andy stopped there, not telling this stranger that sometimes he would open the wardrobe door, burying his head in her summer dresses, drinking in her scent which still lingered.

“Was Janice buried or cremated?” The starkness of the question jolted him back into the room. So cruel.

“Cremated”

“And her ashes?”

“Amy’s got them. The funeral director kept sending reminders. I let her get them.”

John checked the clock on the wall near to Andy. 

“We’re nearly done here, just a few more things to check to keep you safe. Are you sleeping okay?”

“If I’ve had a drink yes. Usually, I keep drinking till I’m drowsy, then I go to bed. If I wake up again, that’s it for the night, and I might as well get up”

“Has your weight changed since Janice died?”

“Yeah, I lost a couple of stone, but I’ve put it back on and more. Too much beer and the wrong food.”

“Are you taking any medication for your grief?”

“Nah. The doc gave me some tablets, but I’ve not taken them. I don’t want to get dependent.”

“Okay last question about keeping you safe. Have you felt that you don’t want to live any more?” Silently, Andy recalled the night he stared purposefully at a Stanley knife blade, wondering if he would have the guts to do it.

“All the fucking.. sorry. All the time”

“That’s okay, swear if you want to. Have you thought about ending your life?”

Andy paused for a moment. “ I thought about it early on, but I couldn’t do it to Amy, not after losing her mum like that. Or the grandkids”

“Oh, what have you got?”

“Boy and a girl, 12 and 15.”

“Do you see much of them?”

“Yes, quite a bit. They miss their grandma.”

“It must be hard for all of you. It seems so hard, so unfair to lose a wife, mother and grandma like that. How old was Janice?”

“56 when she passed.” Andy dabbed the corner of each eye with the ball of tissue and looked at his watch.”

John sensed Andy’s desperation to escape. “Nearly done,” he said. ”I can fill in the form later and I’ve got your contact details and medical details from your GP. I’m just going to tell you what I think, based on what you’ve told me. Is that okay?” Andy nodded.

“I think you’re ready for bereavement counselling if you want it, and I feel strongly that it could help, although there are absolutely no guarantees that it would. On the other hand, if you don’t feel ready yet, that’s fine. It’s never too late to start, but it can be too soon, and perhaps your avoidance of the awful reality is part of nature’s way of keeping you safe until it feels okay to think and talk about it. I’m not going to judge your drinking, but I will just remind you that alcohol is a depressant. I don’t know, from what you’ve said, whether you are depressed as well as grieving, but those tablets from your doctor can help with grief even if you’re not depressed. I will write down what I’ve just said to you in my notes for if and when you come back. Do you want to make another appointment now, or do you want to think about it?”

“I’ll think about it?”

“No problem.”

John checked his assessment form to make sure there was nothing forgotten, although he pretty well knew the content off by heart. After he had explained the limits of counselling confidentiality, he stood up, and Andy followed. In reception, an anxious Amy greeted her dad. As they left, she turned to John and mouthed “Goodbye” and “Thanks”. Mr Andrew Smailes, DOB 10/04/1960, did not look back. His daughter hurried to catch him up.

“How did it go Dad?” Amy asked as she clicked her seat belt.

“Waste of an afternoon.”

“Oh, for God’s sake Dad, how could it be a waste? Like you’re busy? You’d have been watching crap on telly and drinking yourself stupid.”

Amy drove slowly out of the car park, her vision blurred with frustrated tears. Andy yearned to reach out to her, but he was paralysed by the crushing numbness that had consumed his life for the past twelve months. Misreading no response for wilful stubbornness, Amy went on the attack.

“Enough is enough Dad, Mum would be so cross with you, she wouldn’t want any of this, sort yourself out!” There was the angry beep of a car horn, and Amy intuitively braked hard, throwing both of them forward. So very nearly had she pulled out onto the main road without looking.

“Don’t you DARE, ever, tell me what your mum would have done, don’t you EVER use her against me.”

Amy arrived outside Dad’s house, her childhood home of so many memories. The car was still in silence. Each wanted to reach out. Amy recalled her mum so often saying, 

“You’re as stubborn as your dad, no wonder you two argue all the time.” Andy was the first to break, genuinely ashamed of his earlier outburst.

“Are you coming in for a cup of tea?”

“No thanks Dad, I think I’ll get off.”

Andy put the kettle on out of habit but fetched a can of beer from the fridge. He put the telly on and sat back heavily into his chair. As he leaned back, his chest tightened, and his heart began to pound violently against his ribs. He fought to catch his breath. Hi insides churned and his head swam. He picked up his phone and looked at his watch, estimating that his daughter would still be driving home. He called anyway and to his surprise, Amy answered straight away.

“Yes Dad.”

“Are you home already?”

“No, I’ve stopped at the shops for some milk.” She could hear his breathing and sensed his panic.

“Dad, what’s the matter?” The was a long pause, as Andy gulped and snatched a breath.

“Dad, Dad! What’s the matter?”

“I… I… think I need to go to hospital.”

Chapter 2

Stephen, the service administrator, knocked on John’s office door.

“Andrew Smailes is on the phone, remember him?”

“Yes, lost his wife to cancer, has a daughter who looks after him and he vanished after his assessment session.”

“That’s the one. Well, he’d like another appointment.”

John thumbed through his diary. “Next Tuesday at 11.00 am or Thursday at 3.00 pm?”

“Okay, I’ll offer him one of those,”

This time, when John went to collect Andy from reception, he was on his own. No daughter to ensure he arrived. He was more approachable than the taciturn man John greeted all those weeks ago. Andy even made a passing comment about the weather before they reached the counselling room.

“It’s good to see you again Andy”

“And you John, thanks for seeing me so quickly.”

“So what’s been happening since I last saw you?”

“God, where do I start? Two hours after I saw you last time, I was in hospital wired up to heart monitors, bloods taken, all bloody sorts. I thought I was dying. When I got home after seeing you, my pulse started racing and I couldn’t breathe. Amy phoned for an ambulance. The paramedics checked me out and said they thought it was a panic attack, but to be certain, they took me to hospital. The doctor I saw said it wasn’t a heart attack, but he thought I might have an irregular heartbeat. Long story short, I’ve seen heart specialists, had portable monitors fitted, the works. They’ve decided I have atrial fibrillation and atrial flutter made worse by stress. Now I’m on warfarin, statins and …. “ Andy took a packet of pills from his jacket and read out the label, “Tildiem LA 200 mg prolonged release capsules. Apparently, they keep my heart beating steadily. And before you ask, John, yes, I am taking them, religiously”

“That must have been pretty scary,” said John, “but it sounds like you’ve been in good hands. How are you managing your grief?”

“That’s why I’m back here. I’m still not managing very well, but I recognise now that I need help and could benefit from counselling.”

“Recognising that you need help and being ready to try counselling is a huge step forward Andy. I’m aware that there are all sorts of things that I don’t know about you and Janice. Let’s start with your job. What do you do?”

“Nothing at the moment. I’m a mechanical engineer specialising in aviation. I did an apprenticeship with the RAF. Three years ago, I got made redundant when the air force base where I worked closed down. I got a huge pay-out, and Janice was having lots of hospital appointments, so I didn’t look for another job – not that I’d get one doing that – too specialised, plus there’s far more electronics involved now. Not really my thing”

“And what was Janice’s job?”

“She’d always done office work since leaving school. At the time she got ill she was PA to a company director. The firm were very good to her, it showed how much she was valued and respected.”

“So I imagine she was very organised. Was that true at home?”

“God yes! She never forgot an appointment, organised our holidays. When we were first married she managed all our finances so well that we could save the deposit for our first house.”

“How did you meet?” asked John. Andy smiled, oblivious that he was being drawn to memories he had been avoiding.

“We knew each other from school. We were in the same class. I fancied her but never plucked up the courage to ask her to go out with me. All the boys liked her, but so did the girls. They didn’t seem to resent her looks and popularity because she was fun, and she saw the good in everyone. She was popular with the teachers too, and good at sports.”

“So how did you finally get together?”

“Some of the lads at school had formed a band. They got quite good and were even writing their own songs. Loads of us used to follow them around the local pubs, and one night I found myself at a table next to Janice. I’d perhaps had a bit too much to drink, but I told her I’d always fancied her and asked for a date. We’ve not been apart since, until….” Andy stopped himself saying more. John was not going to allow him to stop.

“Janice sounds like very special lady.”

“She was beautiful John. I often told her I was punching above my weight, but she’d just laugh. As she got older, I think she just got more beautiful – well no, I don’t just think it, she did. She knew how to choose clothes to make her look good. She didn’t wear much make up, didn’t need it with her natural looks, but her hair was always immaculate. I was a lucky man.”

“I’d love to see a picture of her.” Andy reached into his pocket for his phone and scrolled through pictures of his daughter and grandchildren, plus a few of his garden in better times, and the odd picture of military and civil aircraft. Eventually he found the picture he wanted and handed the phone to John. Most good men would see their partner as attractive, perhaps with a degree of loving subjectivity, but John was being shown a picture of a stunningly attractive woman in her late forties, with tanned skin and flowing dark hair. She was wearing a loose fitting floral print dress with thin shoulder straps revealing an elegant neck and toned shoulders. Behind her were palm trees and in front of her, an orange coloured cocktail. She had the beautiful smile of a woman in love with the photographer.

“She’s beautiful Andy. Did she have to work out to look like that?”

“Not ever. We walked quite a bit at weekends, but she could eat what she wanted without putting on weight. Me, I just look at a pizza and I’ve put on a stone. We did used to joke about it.”

“John started to hand Andy back his phone. As Andy reached out for it, John paused.

“What would it be like for you to take time looking at Janice?”

“I can’t do it John, it was hard enough just to scroll to find it.” Andy shut down the picture app with barely a glance and pocketed his phone. 

“A moment ago,” continued John,  “you were talking about joking with Janice. It sounds like she had a great sense of humour.”

“We made each other laugh. That was perhaps one of the greatest things about our marriage. We laughed every day at something. She had what I call an intelligent sense of humour – very dry sometimes. She could observe someone and sum them up in a few words which made me laugh. She did good impersonations and she was very good at taking the piss out of me. I can be a bit serious sometimes.”

“She was good for you.”

“God yes.” Andy’s eyes flooded with tears. “I miss her.” He cried silently, his back and shoulders gently convulsing.”

“What do you miss most about her?”

“Her just being there. Her touch, her laugh.” Andy let out a quiet primeval wail, like a wounded animal, then fell silent again. It was long silence as Andy recomposed himself, but not an uncomfortable silence for either of these two men. Eventually, John spoke.

“How are you feeling now?”

“Knackered,” said Andy laughing. “Exhausted. But I’m glad I came. I’ve been bottling that up. That’s the first time I’ve cried since the funeral, and the first time I’ve talked about Janice.”

“And they’ll be lots more opportunities to talk about her if you keep coming back here. If you want to come back, we’ll work at your speed, as slowly as we need to. I must warn you that quite often, bereavement counselling makes people feel worse before they feel better, so some people quit at that point, which doesn’t help. Going through the painful parts of counselling is part of the process, and the pain you meet isn’t ‘going backwards’, it’s part of moving through your grief.”

“Yes I want to come back.”

“I wish I could promise you that counselling will help you, but that wouldn’t be fair. However, I pretty sure from how you’ve been today, that it will help, although it might take a long time. Trust yourself and trust the process. Will Amy ring you to see how it went?” Andy grinned. 

“Is the Pope Catholic?” John laughed.

“Here’s a bit of advice, which you don’t have to take, but it comes from years of experience seeing clients get into hot water with their family. It’s great, helpful even, to talk to those close to you about how you feel between counselling sessions. It’s perhaps best to not go into detail about the actual content of the session. Amy could get used to hearing a blow by blow account of each session, but what if one week you just talk about her for an hour and don’t want to tell her? If after weeks, you suddenly clam up, it could cause an avoidable tension. If it was me, I’d just tell Amy how I was left feeling each week.”

I wouldn’t have thought about that,” Andy reflected. “I’ll think about it.”

“Last time we met, I went through all the essential parts of our service confidentiality, but I’m not sure how much you took in. I explained about the legal and ethical limits of confidentiality, when we break that confidentiality and who we talk to. For example, our service policy is to talk to the client’s registered GP or surgery if the client talks of suicide plans or intentions. We also have a policy of team confidentiality. That is we sometimes find it helpful to talk about to the others in our team, including Stephen who you have spoken to on the phone. We won’t speak to anyone outside of the team without permission, with one exception. Each of us has a clinical supervisor who is also a counsellor bound by confidentiality, and we don’t use your name in supervision. We see our supervisor once a month, and talk about some, but not all clients.” Andy nodded in agreement. 

Is there anything you want to ask about that, or anything else, or say before we finish?

“I don’t think so. I’m beginning to feel a bit less shattered. I think it was a release to feel something, like a weight’s been taken off my shoulders.”

“I’m glad. Same time next week?”

Stephen, the admin assistant  was in John’s office when John returned with Andrew Smail’s file. He said,

“Wow, I saw Andrew Smailes in reception earlier and stopped to talk to him. He was a different person. What’s made the difference?”

“He had a health scare, which was perhaps a wake-up call. And maybe his daughter has got to him. He was able to tell me some things about his life with his wife before her cancer.”

“Miraculous progress!”

“It might look that way, but talking about easy things is not the same as tackling stuff that’s being avoided, and it’s even harder for someone like Andy to talk about feelings, especially considering what he’s been through. We’ve a long way to go.”

Andy turned the key in his front door and closed it behind him with his back. For a moment he caught Janice’s smile in the photograph.

“Hello stranger,” said Janice, “Are you going to talk to me?”

“I can’t love, not yet. I will, I promise.”

His phone rang. Andy didn’t need to look to see who it was.

“Hi Dad, how did the counselling go?”

“It was good.”

“Ooooh! not a waste of an afternoon then?”

“Okay, okay, point taken.”

“What did you talk about?”

“Your mum mostly.”

“That’s good. Tell me more when I see you, have to go, byee.”

Andy glanced back at Janice and returned her smile. He hung his keys on the cup hook Janice once screwed into the side of the hall stand and made his way into the kitchen He filled and switched on the kettle out of habit. For weeks after Janice passed, he would get two cups out of the cupboard. He opened the fridge for a beer, took out milk instead, and made a cup of tea.

Janice and Andy sat side by side in the busy waiting area, on NHS utilitarian chairs they had moved closer together so that Andy could hold Janice’s hand resting in her lap. In a small office fronted by a plate glass wall, three women chatted about their weekend, between organising patient notes, answering the phone and greeting new arrivals. Opposite Janice, on a large notice board, was a brightly coloured poster about cancer self-care, with hand cut bright, bold lettering, small posters, pictures cut from magazines and cartoon figures from a talented artist. The whole display was quaintly amateur, almost childlike, but put together with care, no doubt by overworked Macmillan nurses in their own time. Andy was thinking about the appointment letter, those ominous words, ‘You may wish to bring someone with you.” Janice was thinking about Andy, Amy and her grandchildren should all this go pear-shaped. One of those silver and white institutional clocks on the wall ticked away life by the second. A disembodied voice interrupted their separate thoughts.

Chapter 3

“Mrs Smailes, do you want to come this way?” The anonymous person behind the voice, clutching a file of notes, led the way down a featureless corridor and ushered Janice and Andy into a small office. For the first time, Andy properly understood the expression, ‘My heart was in my mouth’. The pounding in his rib cage rose to a crescendo and its interminable sound squeezed past the lump in his throat, crying out to be uttered in words. Only social convention and the parched dryness of his tongue kept him from shouting for help. The first person to catch Janice’s eye was the MacMillan nurse sat to one side of the consultant’s desk. The expression between the two women told Janice all she needed to know, before anything else was said. Janice sat down next to Andy and held his hand limply.

She had met the consultant before, a kind woman who clearly loved her work and her patients. Janice anticipated what she was about to say.

“I’m sorry to say that the results of the mammogram, the scan and the needle biopsy all confirm cancer”

The consultant said a lot more, about ‘no sign that it had spread… mastectomy…. get you in soon… lymph nodes… chemotherapy… good chance’… survival rate’, but Janice heard nothing past the C word. The room was swimming. She felt alone. Andy tried to catch the words for her, but they flew around the room, eluding his grasp.

“Have you understood what I’ve said? Is there anything you want to ask?”

Janice said there wasn’t. Andy stood up and thanked the consultant and the nurse. They walked back to the car park in silence.