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The Last Ward by Susan Howe

© Susan Howe

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(short story)

It was less than a week since she’d received the call from one of her mum’s friends... Lily hadn’t been lying there long... her tea was still warm... lucky she happened by... not her usual day for visiting... just a stroke of luck...

Just a stroke. With her history of high blood pressure, it had been her mother’s greatest fear.

‘Don’t let me suffer,’ she’d said. ‘I don’t want to be a cabbage. Promise me, Fran, you won’t let me suffer.’

Fran had promised, she wasn’t sure what, and crossed her fingers the day wouldn’t come when she’d have to find out.


Fran recalled the conversation as she drove, white knuckled, the ninety miles to where her mother lay in intensive care, tethered to life by wires and tubes. For five interminable days she paced the hi-tech unit, occasionally taking a break in the canteen or outside, in the grounds of the scattered arrangement of buildings that comprised the largest hospital in the county. Much of it was new, a shining structure of glass and metal, largely funded by an NHS Public Private Partnership. However, several wards were still housed in old prefabs that appeared no more than well-lit sheds, vibrating with the strain of overworked ventilation systems. Fran pulled her collar up against the vicious March wind and walked on, marvelling at the resilience of daffodils, blown flat one moment and springing back the next, refusing to be beaten down.

On the sixth day she arrived to find someone else in her mother’s place. Her heart stopped as panic rose in her throat. Surely not. Surely they would have let her know?

‘Hello.’ The tiny Filipino nurse, who had tended her mother with kindness and skill, looked up at her with a broad smile. ‘Your mother has been moved.’

Swaying slightly, Fran wiped her eyes as tears of relief rushed in.

‘You think she die?’

Fran nodded.

‘No. Your mother a fighter. They take her to Hope Ward. You talk to doctor down there, OK?’

She pointed to the lift and Fran took her hand and thanked her.

She beamed back. ‘My pleasure.’

A labyrinth of corridors and stairs led outside, where a sign pointed towards the prefabs; Faith, Hope and Charity Wards were located across the car park. Shivering, Fran bent into the wind, wondering how such old-fashioned names survived fifteen years into the twenty-first century.

She recoiled from the wall of heat and stale school-dinner smell that met her as she entered the low, black building. A nurse in a light blue uniform, carrying a covered tray into a side room, stopped her.

‘Can I help you?’

‘Yes, I’m looking for Hope Ward,’ said Fran.

‘It isn’t visiting time, you know.’ The nurse turned to block her path.

Fran stepped back. ‘Oh, I’m sorry. My mother’s been moved from Intensive Care and I didn’t know there were set visiting times. I’d like to see her, if I may? And speak to the doctor.’

The nurse’s eyes narrowed as she studied Fran.

‘Doctor Hart is on his rounds. You can speak to him during visiting hours.’

‘Then can I just pop in and see my mother?’ Fran’s voice hardened slightly and the nurse tilted her head.

‘Yes, if you’re quick. It’s the last ward on the right.’

‘You’re very kind,’ Fran replied, hoping the irony wouldn’t be lost.

She pushed open the double doors to find herself in a hot, dark room, wrinkling her nose as she inhaled a sour mix of disinfectant, urine and musty, old fabric. The curtains were pulled against the weak morning sun and her eyes took a moment to adjust. There was no one around to stop her, so she wandered between long rows of beds, checking whether it was Lily who lay, snuffling, under the grey waffle blanket. There she was, last but one on the right, unshackled by tubes but pale and still. Fran touched her face and was rewarded by a slight shudder. She smoothed back the fine grey hair from her temples and a soft gurgle in her mother’s throat told her the gesture had registered. The old lady’s eyelids flickered.

‘It’s all right, mum, it’s only me. Fran. I can’t stay now, but I’ll be back later.’

Another croak. Message received. She kissed her mother’s cheek and tiptoed away.


Is that you, Frances? It’s hot in here. My throat’s so dry, I can’t swallow. I need a drink. Where are you, Fran?


Fran massaged her mother’s hand as she watched the starched sheet rise and fall with each shallow breath. The hand was cold, despite the stifling heat that lay heavily on the grey metal beds stretching out on either side, uniform but for the shape of the mound beneath each cover. She shrugged off her sheepskin coat, tucked well-cut, auburn waves behind her ears and picked up the water jug, which was full of tepid liquid. As she looked around for somewhere to refresh the drink, a shriek of laughter ripped through the background murmurings. She followed the noise to a booth at the end nearest the entrance, where five nurses sat in a circle, coffee mugs resting on their knees. Putting her head round the door, she held out the jug.

‘Sorry to interrupt. Can you tell me where I can fill this?’

The nurse from earlier, a sharp-featured woman in her mid-thirties, looked her up and down, then pointed with her free hand. ‘Out into the corridor, second on the left. Ladies’ toilets.’

Fran stared back. ‘That doesn’t sound very hygenic,’ she said.

‘It’s all right, Pat, I’ll see to it.’ A young black nurse in a grey dress put her mug down. ‘Come with me,’ she said with an apologetic smile, leading Fran out into the corridor.

‘They’re very tired,’ she said as she rinsed out the jug and refilled it at the kitchen sink. ‘We’re on double shifts because of this ‘flu bug. Some of them have been here since last night.’

‘That's hard, I know,’ said Fran, ‘but I have to put my mother's welfare first.’

‘Yes, of course.’ She held out the jug. ‘I’m Cilla. Cilla Jones. If there’s anything else your mother needs, let me know.’

Fran thanked her and took the water back to the ward. She poured a little into a glass, dropped in the straw she’d brought and, with her free arm, levered her mother’s frail shoulders forward so she was almost in a sitting position. Her nearest eye fluttered and opened, just a fraction.

‘Come on, mum,’ Fran said. ‘There’s some nice cool water here. Try and sip, if you can.’

She pressed the straw gently to one side of her mother's dry, cracked lips and watched as she drew the liquid slowly up the pink and white striped tube. As it went in at one side, so most of it dribbled out of the other and onto the sheet. Fran looked round for help, but all she could see were the tops of three bobbing heads in the narrow window at the top of the booth.

‘Nurse! Nurse!’ A shout from behind made her jump.

‘Turn me over, turn me over!’ the shouting continued.

The heads stopped moving for a moment, then carried on as before.

‘Turn me over!’

It was getting louder. Fran sighed and let her mother gently down onto the pillow, dabbing at the spills with a tissue. She moved round to the woman who was moaning, tears running down her papery cheeks. She lay on her side, wisps of dyed ginger hair sticking to her face.

‘Oh please, turn me over,’ she sobbed.

Fran hurried to the booth and knocked on the open door.

‘There’s a lady calling for help,’ she said. ‘She wants to be turned over.’

The nurse called Pat, who appeared to be in charge, smoothed her straight, mousey hair back. ‘That’s Elsie,’ she said. ‘She shouts like that all the time. You’ll soon get used to it.’

Fran gaped. ‘But she’s crying. I think she’s in pain. Can’t you help her?’

Pat’s eyes flicked up at the clock. ‘She’s due her medication in half an hour and we’ll sort her out then.’

Fran opened her mouth to reply, then turned on her heel and walked out into the corridor, where she leaned against the wall, trembling. A hand on her shoulder startled her.

‘Are you all right?’ Nurse Jones peered into her eyes, her face concerned. ‘Your mother’s OK, isn’t she?’

Fran straightened.

‘Yes, I’m fine. I was upset because nobody would help the lady who was shouting.’

‘You mean Elsie? Yes, it’s tricky. She does call out a lot and it takes two people to turn her, so sometimes she has to wait. We’ve got three big wards to manage.’

She looked at Fran and hesitated, then touched her finger to her lips and whispered, ‘Come on, we'll do it together.'

It only took a moment, carefully following Nurse Jones’s instructions, to fold back the covers, scoop up the fragile body and lift her onto her other side, and the gratitude in the old woman’s eyes made it more than worth the effort. Cilla took a damp flannel from inside a plastic bag and wiped her tears away.

‘There you are, dear,’ she said softly. ‘Now, you be a good girl and stay nice and quiet until it’s time for your pills. We don’t want to upset Nurse Trent, do we?’

‘Thank you, Nurse Jones,’ Fran said, as they moved away.

‘Cilla,’ she replied. ‘Call me Cilla. Can I get you a cup of tea?’

Fran’s shoulders sagged. ‘That would be kind.’


Don’t go yet Fran. Don’t leave me alone with these people. You don’t know what they’re like. They don’t care. Stay a bit longer. Please.


Each day Fran saw a slight improvement in her mother. The movement of a finger or twitch of her mouth could fill Fran with hope and joy. Every afternoon, she would refill the jug, tuck a towel round her neck and sit patiently while the old lady drank. Then she’d wash her face and hands, brush her hair and settle down to read her extracts from the local paper, or her favourite Agatha Christie stories. She was getting used to the sudden cries from surrounding beds, but didn’t ignore them. Sometimes she helped Cilla turn Elsie and then they’d chat.

‘Most of them don’t have any visitors, you know,’ Cilla told her.

‘That’s awful.' Fran replied. 'They must be widows, without children, but you’d expect them to have one or two friends.’

‘Perhaps the friends are dead. Some of them have been here for ages.’ She sighed. ‘So sad.’

Fran learned that, as a Student Nurse, this was only Cilla’s second week of a three month rotation on Hope Ward.

‘How are you finding it?’ Fran asked.

Cilla shrugged. ‘A bit depressing. Most of them will die here. The NHS keeps moving less treatable patients off their system into these privately managed wards. It’s a problem; so many old people and nowhere to put them. They call it ‘Best Value’, but I don’t know who for.’ She looked down for a moment, then smiled, her dark eyes dancing once more. ‘My next rotation’s in a children’s ward and I can’t wait.’

Fran laughed. ‘You like children, I take it?’

‘I come from a big family; lots of little brothers, sisters and cousins. They’re such fun and I miss them so much...’

Fran squeezed her arm. ‘I’m sure they miss you too.’


Doctor Hart rarely appeared, leaving Staff Nurse Trent to answer Fran’s questions about her mother’s progress, in the briefest manner, giving her the impression she was using up valuable time.

Fran sighed as she looked round at the helpless bodies whose fate, in Hope Ward, belied the expectations of the name. With the exception of two or three, this was where their lives would continue and, eventually, end. She began to visit each of them for a minute or two every day, patting a hand or smoothing a pillow. Some smiled and mumbled a few words, but most showed no sign the kindness had registered. They seemed to fade a little more each day, shrivelling like fruit left out in the sun to dry. She noticed their water jugs stayed full, day after day, tell-tale bubbles clinging to the sides, indicating it was some time since they had been moved. She mentioned it to Cilla, who looked down and shuffled her feet.

‘We do our best,’ she said, but there was something about the way she glanced back, a wariness as her gaze slid away, that disturbed Fran. She touched the nurse’s arm but she stepped out of reach with an almost imperceptible shake of her head.

Fran sat by her mother, wondering what Cilla had meant. Before she left, she gave all those who could manage it, a small drink of water. As she passed the booth to refill her jug, she noticed Nurse Trent watching and, on her way back, glanced in to see the nurse on the phone, frowning as she kicked the table leg.

Fran was putting on her coat as Doctor Hart entered the little room. Pat Trent’s head began to move rapidly, thrusting forward as though emphasising a point. The top half of the doctor’s face was visible through the glass and he was very still, listening intently. Then his gaze travelled in Fran’s direction, his eyes briefly locking with hers before he turned away. By the time she’d kissed her mother goodbye, he’d disappeared.


I’m still thirsty, Fran. It’s so hot in here, I can hardly breathe. I can’t wait ‘til tomorrow. Please, Fran, just a little more water.


The next day Doctor Hart was waiting by Lily’s bed at the start of visiting time. His smile was warm as he held out his hand.

‘Hello Mrs - er.’

‘Ms,’ Fran said. ‘Ms Davies.’

He grinned, as though this was good news, and Fran noticed how attractive he was. It was a long time since she’d allowed herself to see such things and she was briefly shocked by her increased heart rate.

‘Well, Ms Davies, I was just telling your mother how pleased we are with her. We’re going to start physiotherapy tomorrow morning and I think you’ll soon see quite a difference in her.’

The old woman’s watery, open eye rolled from Fran to the doctor and back and two fingers lifted off the blanket. Fran swallowed hard and picked up the bony hand.

‘Oh Mum,’ she said, ‘That’s great news, isn’t it?’

Her mother made a grating noise in her throat.

‘There we are, see - she’s feeling better already,’ said the doctor.

He turned to Fran. ‘Might I have a quick word?’

He put his hand under her elbow and led her out of her mother’s earshot. She breathed in his scent; he smelled good too. She gathered her wits and returned his gaze.

‘Nurse Trent mentioned she saw you giving the patients a drink yesterday?’ His eyebrows arched over startling blue eyes.

‘Yes. It’s so hot in here, I’m parched after ten minutes. Why? Did I do something wrong?’

He smiled. ‘Not really. But I’m afraid there were several accidents during the night, which meant a lot of extra work for the nurses. More seriously, some of our patients have difficulty swallowing and could choke if it isn’t done properly.’

‘Oh, I’m sorry,’ she said. ‘I didn’t realise...’

‘No harm done, but perhaps you’d better leave it to the nurses? They monitor everything very carefully, so there’s no need to worry. You just concentrate on your mother; we’ll have her up and out of here in no time.’

‘Do you think so? That she’ll be able to go home again?’

‘I didn’t say that. Let’s just take it one step at a time. But with a daughter like you, she stands every chance of making a good recovery’.

Fran blushed. He still held her arm and the heat from his hand burned through her sleeve. Then he gave her a dazzling smile and turned to go, letting his fingers trail lightly along the underside of her arm as he moved away.

She sank back into the chair and stared at his retreating back. He was tall and slim, walked with confidence and grace. He’d been flirting with her, she was almost certain. But she’d been wrong before. So very wrong.

The movement of the sheet jerked her back to reality. Her mother was gripping the bedclothes between two fingers and thumb, pulling as hard as she could. Fran stared in amazement, but the old lady’s eye rolled and glared, as if willing Fran to understand.

‘What is it, Mum?’ Fran stroked her arm, and one side of her mouth moved, her lips pushing air out as she gurgled and rasped.

‘Are you worried about what the doctor was saying? It’s good news, Mum. He thinks you’ll soon be able to leave. He was just asking me not to give the others a drink. It seems cruel, but I expect they know what they’re doing.’

The hand stopped its frantic activity and fell inert by her mother’s side as she closed her eyes, exhausted by the effort.


No, Fran. Don’t listen to him. It’s not like he says. I’ve heard them talking. Him and that nurse. They’ve got a plan. Don’t go yet. Don’t leave me here alone with them.


On Saturday afternoon, despite filthy weather, Fran was delighted to see that two other patients had visitors. One was Elsie and, as she passed, she stopped to introduce herself to her relatives.

‘I’m glad we had chance to say hello,’ replied the dumpy middle-aged woman, smoothing her creased, purple trouser suit. ‘Mum told us how kind you’ve been. And that young nurse too. Not like them others.’ She jerked her head towards the nurses’ room. ‘It’s not a bit like the ward she was in when she had her fall. They couldn’t do enough for her! It’s gone downhill since this new Partnership thing. Now it’s all about the figures and the money.’

‘Ssshhh,’ hissed Elsie. ‘They’ll hear you and then it’ll be the worse for me. It was just me teeth last time, thank God.’

Fran raised her eyebrows.

‘Oh yes,’ said Elsie’s daughter. ‘We complained they were leaving mum too long on one side. She’s in terrible pain, you know? Anyway, the next time we came, she didn’t have her teeth. They’d lost them just after we complained - I don’t think! Poor mum hadn’t been able to eat a thing all week. She was as weak as water by the time we found out. We can only come on weekends, see.’

‘They lost someone else’s hearing aid when they complained,’ said her husband. ‘It cost a thousand pounds to get a new one, and do you know what they said?’

Fran shook her head.

‘They said she should never have had it here in the first place if it was that valuable! I ask you. How was the poor old duck supposed to hear what they were saying without it?’

Fran was lost for words. From what she’d seen, she wasn’t surprised, but it was one thing to lose something by accident and quite another to remove it as a punishment. Could they be right? It didn’t seem possible. She looked towards the booth to see Pat Trent’s head duck out of sight; she must have been standing on tiptoe, watching them. Fran walked back to her mother, who was asleep, small and vulnerable. Fran's heart lurched. She looked around; all these women had been loved at one time, but not any more. They were alone and at the mercy of anyone who cared to take advantage or mistreat them. The hairs on her arms prickled.

When she left the ward an hour later, she saw Dr Hart, deep in conversation with Nurse Trent, in the corridor. As she approached, they jumped apart and the nurse hurried away. Dr Hart caught her arm as she passed.

‘I was hoping I’d see you today,’ he said, his eyes glittering in the harsh fluorescent light.

‘Were you?’ she replied. ‘Any particular reason?’

‘Well, yes.’ He hesitated. ‘Two, actually.’

She waited.

‘Firstly, your mother is responding well to the physiotherapy. We’re very pleased with her progress.’

‘Yes, so I understand, thank you. And the other?’

‘Yes, the other.’ He pulled her to one side as a group of visitors from Charity Ward came by, heads bent under the weight of sadness.

‘I have to go away for a couple of weeks to give some lectures. But when I get back, perhaps you’d like to go out for a drink?’

Fran’s mouth dropped open. She’d been expecting another ticking off.

He laughed. ‘Why so surprised? You’re a very attractive woman, you know?’

She swallowed. ‘That would be nice,’ she managed to say. ‘Have a good trip.’

Confused, she walked out into lashing rain.


Nurse Trent and Cilla were busy stripping a bed as she arrived the following day, but there was no sign of Dottie, one of the shrunken, wraithlike figures with little apparent grip on life. Fran raised an eyebrow at Cilla, who nodded sadly, but Pat Trent turned and scowled when she saw who it was.

While Fran held a straw to her mother’s lips, she pondered this. Apart from the misunderstanding over drinks, she hadn’t done anything to upset her. Unless... Pat had noticed Dr Hart’s attention to herself and was jealous? Yes, that must be it. Fran remembered how it felt.

The glass was almost empty. Her mother could now lift her arm enough to push the base with her knuckles, tipping it to reach the last of the water. And she could move her right leg, slowly up and down the bed, as though she were riding a bike up a hill. Fran had brought a notebook and pencil, hoping her mum would be able to communicate that way but, despite her best efforts, it didn’t work. Although she managed to grip the pencil between her fingers, all she could produce was a spidery trail across the page. Fran’s heart ached as a disappointed tear rolled down Lily’s face.

Hoping to raise her mum’s spirits, while she fed her small pieces of banana, she told her about Dr Hart’s surprising suggestion. Her mother stopped sucking and pushed a slimy mess out onto the sheet with her tongue.

‘Mum! What on earth did you do that for?’

She studied her mother’s face, trying to decipher the pattern of growls and consonants. Frustrated, she began to wonder what to do when her mum was well enough to leave the hospital and decided to ask Dr Hart’s advice, next time she saw him. She smiled at the prospect.


Don’t be so silly, Frances. I‘ve seen that look in your face before, and see where it got you? For pity’s sake, look around. This is your doctor’s handiwork. Look at the empty bed. There’ll be another one tomorrow, the way they’re going. I know you're lonely, Fran, but don't let him fool you.


The next afternoon there was another empty bed half way up the ward - clean, flat and ready for its next occupant. Already there was a new incumbent in Dottie’s place. She seemed a giant compared to the others, but Fran realised she was a normal size and the longterm residents had become so withered. The new patient lost no time in letting people know she was there, shouting constantly for attention and, above all, for a drink.

‘My throat’s as dry as a vulture’s armpit,’ she shouted at Cilla as she hurried past with a bedpan.

Fran went over and asked if she was allowed water.

‘Course I am,’ she said. ‘Why else would they leave it there?’

So Fran poured a small glass and held it steady while she drank.

‘Thanks, love. I’d rather have had a beer, but never mind. Put it where I can reach it will you? I don’t know how they think I can stretch right over there. They don't give a bloody fig!’ She raised her voice. ‘I reckon it’s a plot to kill us off. A drain on profits, that's all we are.’

Fran’s hands shook as she refilled the glass and placed it within reach. An intolerable notion she had pushed to the back of her mind catapulted forwards, knocking her off balance. She staggered against the bed.

‘You all right, love?’ said the woman. ‘Looks like you need a sit down. Nurse!’

Cilla rushed over and caught Fran as her legs gave way.

‘I need to talk to you,’ Fran whispered. ‘After visiting time. In the ladies’ toilets.’

Cilla’s eyes widened but she nodded and helped Fran into the seat by her mother’s bed before she scuttled back to work.


There you are. I knew they were up to something. They’re dropping like flies. I want to go home. For God’s sake, Fran, get me out of here!


Fran followed Cilla into the toilets just after the bell signalled the end of visiting time. She bundled her into the disabled cubicle and grasped her arms above the elbow. The nurse looked terrified.

‘There’s something going on here and don’t you deny it,’ whispered Fran.

‘I-I don’t know what you mean.’

‘Yes, you do. I’ve seen it in your face. They’re killing old people through dehydration. That’s why they stopped me giving them water. No other reason.’

She shook the little nurse. ‘Admit it.’

Cilla started to cry, looking up at Fran through thick, wet lashes.

‘I just do as I’m told,’ she sobbed. ‘I’m new and they always stop talking when I’m near. I don’t know what they’re doing.’

Fran relaxed her grip.

‘I just want to finish my rotation without getting into trouble so I can go and work with children. That’s all I want.’ She wiped her eyes on the back of her hand.

Fran saw it was useless and pulled a tissue out of her pocket.

‘Look, I don’t want to get you into trouble, but I’m going to speak to someone about it. I’ll say it’s nothing to do with you. Okay?’

Cilla nodded. ‘I have to get back. They’ll wonder where I am.’

Fran followed her out, noting Pat Trent lurking in the kitchen doorway, watching as they went separate ways. The malevolence in the nurse’s expression hit Fran like an icy blast and she faltered, frozen in mid-stride, suddenly afraid for her mother. But what could happen with so many people around? No, she was being silly. What they were doing was horrific, but was so subtle it had gone unnoticed until now. It was a geriatric ward; people were expected to die. They wouldn’t want to draw attention by doing anything stupid. Especially if they knew Fran had guessed what was happening, despite the charming doctor's attempt to distract her. She allowed herself a moment's regret before resolving to take her suspicions to the hospital authorities the following day.


Nurse Trent was waiting, arms folded, by Lily’s bed the next afternoon.

‘We’ve decided your mother’s stable enough to go into a Care Home. We can’t do any more for her here and we need the bed. There’s a list on the cabinet of Homes that might have places and a liaison officer comes in on Tuesdays and Thursdays, or you can speak to Social Services.’

Stunned, Fran watched her stalk off. Was that it? Their job done? Her head spun as she grappled with the concept of finding somewhere so soon. She took her mother’s hand.

‘You hear that, Mum? We’re going to find a nursing home, until you’re better.’

Was it her imagination, or did the corner of her mother’s mouth lift as she received the news?

Two hours later Fran entered the main building, trembling at the prospect of making her observations known. A riot of cheerful young voices drifted through the multicoloured doors of the children’s ward and she couldn’t help peering in. Cilla Jones sat on the end of a bed holding a story book as children climbed over her, hanging round her neck and competing for her lap. Fran was astonished. Didn’t she still have nearly two months on Hope Ward to finish? As Cilla smiled around at the excited faces, she spotted Fran, forehead against the glass, and her grin faded. The child on her knee said something and she hugged him close. She gazed at Fran for a moment, then held out her hands, indicating the boisterous little crowd, closed her eyes and shook her head as if to say she had no choice.

Mouthing, ‘I’m so sorry’, Cilla turned back to her charges and began to read.

Fran stumbled on, her mind whirling. Nobody cared. Cilla, her only possible ally, had been shifted out of the way and the other patients’ families were afraid of reprisals. So she was on her own - again.

She considered the consequences if she spoke out. After all, what proof did she actually have? It was going to be a struggle as it was; she would probably have to move back, give up the life she’d made, take care of her mother herself. She drew a weary hand across her eyes as doubt slowed her steps.

Heavy with exhaustion, she stopped and stared out at the daffodils, finally broken by the storms, their sunny faces ground into the dirt. Tears pricked her eyes and she blinked them away.

But no, she was wrong. One flower stood amid the wreckage, battered and torn, but defiant. Fran lifted her chin. She wasn’t finished yet. Rolling her shoulders back, eyes gleaming with renewed purpose, she strode to the lift, stepped inside, and pushed the button marked Executive Floor.

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