The oncologist said, “But I assume a care worker did it for her?”

“I’m sorry?” Harold’s pulse stopped.

“She won’t be well enough to sit in an office, typing letters. Someone at the hospice will have done it for her. It’s nice she managed the address, though. You can see she really tried.” The oncologist gave a smile that was plainly intended to be reassuring, but it remained fixed on his face, looking like something forgotten or even misplaced.

Harold took up the envelope. The truth dropped like a terrible weight straight through him and everything seemed to fall away. He didn’t know any more if he was unbearably hot or freezing cold. Fumbling again with his reading glasses, he saw now what he had not been able to make sense of; the thing that had been wrong all along. How had he not realized it before? It was the childlike handwriting, with its downward slant and almost comical irregularity. It was the same as the messy squiggle at the bottom of the letter, which, now that he looked again, he found was a botched attempt at her name.

This was Queenie’s handwriting. This was what she had become.

Harold replaced the letter in its envelope, although his fingers were trembling so hard he couldn’t get the corner to fit. He had to take it out and fold it again, and give it another push.

After a long moment the oncologist said, “How much do you know about cancer, Harold?”

Harold gave a yawn to stifle the emotion building up inside his face, while gently and slowly the oncologist told how a tumour is formed. He didn’t rush. He didn’t flinch. He explained how a cell may reproduce uncontrollably to form an abnormal mass of tissue. There were more than two hundred types of cancer, he said, each with different causes and symptoms. He described the difference between primary and secondary cancers, and how ascertaining the origin of the tumour dictated the type of treatment. He explained how, when a new tumour forms on a distant organ, it will behave like the original tumour. A breast cancer growing in the liver, for instance, would not be liver cancer; it would be primary breast cancer, with secondary breast cancer in the liver. But once other organs were involved, the symptoms could get worse. And once a cancer had begun to spread beyond its original site, it became more difficult to treat. If it had got into her lymphatic system, for instance, the end would be quick; although with the immunity so low, another infection might kill her first. “Even a cold,” he said.

Harold listened without moving.