Une Semaine de Bonté: A Week in Papworth Conclusion

from Max Ernst: Une Semaine de Bonté

I have been out of Papworth for a fortnight now, so am just one-sixth of the way through a twelve-week convalescence process. I am still very limited in scope. The potential problems are increasing the swelling on the leg by sitting too long or standing too long (ie working at my desk), the disposal of a residue of water on the lungs that makes me cough, which in turn can prevent me talking and, more importantly sleeping, for which I take water pills, and managing the the periods of exhaustion after relatively little activity.

I was glad to leave when I did. It wasn’t that there was anything wrong with Papworth but I was increasingly aware of being enclosed and of becoming a little stir-crazy. The closer to discharge date it got the more I wanted to leave even while knowing that I wasn’t quite ready. In the event I stayed one extra day because of irregular heartbeat (treated and cured with an extra day of drugs). 



During my time I found myself admiring almost everything about Papworth: the people, the routine,  the efficiency, the fascination of unfamiliar company. I have a paragraph in my notebook about the hospital as a model for the world. In it, everyone is working to the same end, everyone has a mutually supporting role, Everyone is sympathetic. Everything works across normal borders of class, language, culture, and politics. It is, I write, like entering a hive in a dream.

The only problem is that the conditions necessary to bring this about are indivorcible from the prospect of death. We are all there either because we are in danger of death or because we are dealing with the danger of death. The brevity of our stay there is a symbol of the brevity of our lives in general.  It is, essentially, a society that only functions in extremis. I never once dwelt on this, and not once did I think I was going to die, but there was no escaping the fact that it was the reason we were all there,

*

You want out of Europe? I’d say some 70% of the staff were European. One morning my bed was being made up by a Hungarian and a Greek. There were Kosovars,  Latvians, Portuguese, Italians, Spaniards, and many others. Like airports, railway systems, and many other public services, the hospital is a microcosm of the reality we actually inhabit. The microcosm is not of the neighbourhood but of everything that sustains the neighbourhood. That does not make it Utopia but it works and it is, in its own way, a vital, exciting place, constantly stimulating.

The main language of the hospital is English of course, but there are three varieties of it in use..

The first is that spoken betwen staff. It is the language of precision, the right dose of the right substance at the right time. There are proper names for things and processes without which chaos would ensue.

The second is the language of common conversation, generally between patients, which is, sometimes, hedged in by sensitivities and proprieties, but can at other times be direct in a way that it might not be outside.

The third is the informal language of staff to patient. I was re-watching Dennis Potter’s masterpiece, The Singing Detective, a few weeks ago. Potter’s central character, Philip Marlow, is suffering from acute psoriasis and rails against the patronising baby-language in which the doctors address him feeling that it is a reduction of his humanity.

I now see it a little differently. I have already mentioned the ordinary, indeed regular, terms of endearment addressed (chiefly by the female staff) to us as patients: darling, my lovely,  lovely, sweetheart, beautiful...These were everyday tokens of our relationship. I didn’t ever mind it. It seemed to help both parties. These symbols of affection and intimacy braced us against the more brutal aspects of the mechanical process.

There we lie, we patients: slumped, cramped, bent, straightened, prodded, pierced, racked and retching as in a play to which we ourselves are audience. We watch our bodies that are no longer our bodies, not the ones we had got so used to. We are semi-detached creatures.

*


Dennis and I were talking about the NHS. He is easily wealthy enough to have gone private but opted for the same care we all get. He wants to save the NHS. It is people of our age doing it in, he believes. On the other hand, he continues, it is also a monstrous bureucracy that should be broken up and parts of it privatised for greater competition. That is already happening, isn’t it, I ask. The man continues suffering. We live in the shadow of death, I think, and that keeps us talking.

One snippet of conversation between a new patient, Bill, and a nurse checking his details.



Nurse: You say your height is 5’8”?
Bill: 5’8 and a 1/2”
Nurse: Age?
Bill: Fifty-four. Just.



*



Clarissa comes daily. One day she brings old friend, Ed, and I am immediately in full loquacious flow, somehow super-articulate. I talk about the books I have been reading, about Demis Johnson. Robert Walser and Evelyn Waugh, about the hospital, about anything at all. I do this for about half an hour then blow up. I start coughing and can no longer speak but have to go back on the nebuliser.  So good to get out of the hospital ambit for a while. It is all too exciting. Ed has brought enormous strawberries and custard apples. Later I offer the strawberries round.

The biggest decision I make while there is to shave and to eat a proper breakfast. That done I am back partly in control of my own life. Or at least in so far as one ever is.

I have titled this series Une Semaine de Bonté after Max Ernst’s surreal frottages in which he blends parts of popular engravings to produce narratives that seem oddly familiar in terms of feeling while remaining utterly fantastical in terms of concrete imagery.  Une Semaine de Bonté means, literally, ‘a week of kindness’.The week is over. Now the recovery.

Une Semaine de Bonté: A Week in Papworth Who are we: Staff (2)

Dennis had a particularly trying time on my last night in the ward and Luiza was on duty. I thought Dennis was going to die but Luiza was a scornful of my concern. Dennis, as it happens, was running a high temperature and was delirious. During the night he wandered over in my direction and took the top off the central heating radiator then sat down on it. What are you doing, Dennis, I asked. A poo, he answered. The toilet is just outside the room on your right, I said. Right-ho, he said and set off in that direction. Over the rest of the night he was seeing a succession of doctors who examined him and pumped him full of anti-biotics.

I had two physios, one English, one Mexican. One had glasses the other did not. The Mexican with glasses, Fernanda, told me she was a writer. What do you write, I asked. Short stories, magical but material, she said. Do you mean Magic Realism, I asked. Yes, she nodded so I talked a little of Hungarian proto-magic realism, particularly about the Sindbad stories of Gyula Krúdy. She listened and made a mental note. I did three or four laps of the ward corridor with her and clambered up and down stairs.

The other physio, Alice, was cheerful but firm as she taught me ways to breathe, to march on the spot, and to extend my arms into the air, then reach down towards my knees. The more the better, she said. A mile a day, or half an hour at least. It seemed a hard command. Twenty laps of the ward, she demanded when I had only ever done four. But my blood pressure rose and my heart rate became irregular so they dosed me for that and 20 laps became 8.

*

Of the night nurses Melanie was my favourite, A tall, blonde, slightly gawky girl, she tried to help me and give me whatever I needed. She’d stroke my arm and call me my lovely, and my beautiful. Everyone else did that of course - it was the social language of the hospital - but, in her mouth, these things sounded different and had another dimension. It was not that she treated me like a special case. Everyone was special to her, it seems. She loved what she was doing, she said.

We had non-business conversations. Her first degree was in Graphic Design, she told me, but after a year or two's work in that field, she decided to retrain as a nurse. Her father, a headteacher, was not pleased about it but gave in at the end. In the meantime she had formed a long term relationship. But that broke up as she came to Papworth so she was living in nurses’ quarters now. She’d had a house and felt foolish selling it.

It was the non-essential things, as ever, that made the difference, especially in my half-hallucinatory condition. Her sense of generosity and interest mattered to me. Not that she asked me anything about myself. I was asking the questions but she was willing to wait, answer, and talk. It was she who removed the catheter.

When she came on duty one night she took a look around. Men! she snorted. It was not as clean or tidy as she would have it. When I come back I am definitely coming back as a man! But then when a female colleague was nagging at her and fretting she turned to me in confidence. Bloody women, they never stop whining, she said.

She had a great many other people to see in the course of her work. Her shifts, like everyone else’s, were of 13 hours duration.When she went home, especially after night duty, her routine was to go to bed and stay there until it was time to come in again. On her penultimate night she had given up her day-shift sleep to baby-sit for a colleague.

The night she clocked off - my penultimate night - she kissed us all a fond and proper goodbye but immediately returned,  hauling Mark and Atilla by the arm. Mark had said he would wash my hair the previous day but hadn't done so.  You are my witness, she told me, He is to wash your hair, is he not Mark? Mark looked awkward but smiled and said OK. Then she gave both Mark and Atilla a hug and executed a splendidly gawky dance out of the room. I didn’t see her after that.

There are times any patient feels needy but is too proud to say so. I was too proud myself. The vast mechanism of the body - I mean my very own body, the one standing and typing this - combined with the mechanism of the operation and then of the immediate mechanistic period after in hospital - is constantly detaching tugging away from self. The body becomes an it that is the sole concern of the hospital. The patient watches it behave or misbehave. There is a sense of both wonder and desolation about the detachment.

The spirit has wit and affections and interests and obligations. The body is, as Delmore Schwartz had it,' the heavy bear who goes with me. ' In whole life bear and self are one. In hospital the body is almost all.

One more post to come on this subject.

Une Semaine de Bonté: A week in Papworth Who are we? Staff (1)

All names changed.

At the top, beyond the very top, hovering over the landscape and appearing at unexpected moments like a glamorous creature, the surgeon, Mr Z. He is impossibly handsome, (he’s very handsome, said Clarissa), his dark hair flopping over his forehead. He looks like the leading man in a Bollywood movie. He works very hard cutting and grafting over long hours then he vanishes. Mr Z quickly became an object of fantasy for me chiefly because I saw him neither before the operation nor after, but then he’d arrive suddenly, day or night, behind my shoulder or turn up as I was looking elsewhere, to ask, All right? listen a moment then answer, Good, before vanishing again. I imagined him, at one extreme like a Miltonic Prince of Darkness at another as  a gigantic luminous moth.

Hospital does that. Everyone attached to it becomes an object of potential worship. There are plenty of numinous creatures to encounter. Maybe it is because they all carry some sort of authority while the patient carries none.

I had heard there was a Hungarian nurse on the ward, or rather there was a nurse with a Hungarian name. Atilla appeared one night when I needed more oxygen, more nebuliser. My cough was particularly painful. A young man, he - having spotted the Hungarian surname - spoke Hungarian to me from the start. Only this was in the middle of night and speaking Hungarian at such a time, in such distress, seemed like a test of some sort. I managed and so it went on with Atillla, whether he was on day or night duty. It transpired he was from the same part of Hungary-Romania as my mother, Transylvania and, for a while, I was wrongly assuming he came from the very same town.

Atilla was so much the Hungarian in his way of speaking (his English was excellent), his body language and his emotional distance, it was immediately recognisable to me. I think of the manner as the national shrug, a kind of yeh, so what issued to the world at large. What it says is I may be a waiter and you a customer but I’m as good a man as you and, damn you, I have no intention of being servile. The customer is not only not always right, he is quite possibly an idiot too. This is not coldness or indifference - they behave the same way to each other. This was the way we played it, Atilla and I, and it worked very well. Any time he appeared there was an interlude of Hungarian chat. Since he was the only Hungarian in the place he will have welcomed it. I asked him at one point how my Hungarian sounded to him. Very good, he said, it’s just your accent. In Hungary British, in Britain Hungarian. This is not altogether a disaster but it leaves one in a position of extended incongruity. Atilla has been here eight years. There are Hungarians in Huntingdon, he tells me. There is something almost hallucinatory about that sentence. It's as if he had said There are Unicorns in Upminster.

I am definitely frail. Everything is an effort.

Another hallucination, very brief but oddly insistent. Arms. There are two sets, one olive-brown like the arms of Sofia, my Greek nurse, the other much darker, African. I can see beads of sweat on them. The sweat turns to dew, beautiful, erotic, paradisal. I don’t have an African nurse. I see this very clearly for a few seconds and imagine it's real, then the image vanishes.

Sofia is one of a number of pretty nurses. If Mr Z can be handsome why shouldn’t Sofia be pretty? She carries her slender body straight and moves directly from place to place, thrusting her bottom out in a more pronounced way than anyone else as she goes.. She is not callypigian just trim. She misses Greece. She misses its weather. Greece, she feels, has been very badly treated. She will go home when she can. She has a partner who is also here at the hospital. It was he who wanted to come. She too is hallucination. It's just that she is also real.

Crisp little footsteps. Sofia is on her way.

Atilla and Mark are the only two male staff nurses in the place. Mark looked very young, hardly more than a boy. He lived at home. He was less prone to conversation than Atilla. He and Atilla made a pair of laddish ambassadors for men among women. Among the other women there is Molly, general nurse, late middle age, who likes a smile and later washes me, tucking my penis away under a towel.  There is little Honoria from the Philippines, guarded and a touch nervous, but more experienced. She spent ten minutes tying to unwind the lines attaching me to the various monitors and supplies.

Nor could I forget Luiza who was Spanish and had beautiful stern eyes. If you don’t drink three glasses of water in the next hour I shall be very angry, she told me. I wouldn’t have wanted to make her angry. She had had some suffering in private life. She might have had to tend to a severely ill mother. I'm not sure. I am not entirely sure she went into any detail. I douibt it.

The difference in relations between patient and patient and between patient and staff is that there are far more of the latter coming and going, so their appearances, as orderly as they are to themselves, always have a flittering quality for the patient. Patients talk to each other at times of rest. The visit of a nurse or doctor is always on business. Theirs is not quite as flittering  a presence as surgeon, Mr Z, but sometimes, in the early days, it is a little like the fairy photographs that fooled Sir Arthur Conan Doyle (see top). You believe in them, that is all that matters.

Une Semaine de Bonté: A Week in Papworth Who are we? 1. Patients

From here on, when talking of specific people, I have changed their names. Being a patient is not a solipsistic experience: it is a social one. This fascinated me as much as my own condition. The next post will be about staff.


The beds on the ward were in rooms of four or six, the lot arranged around a central hub.  There is a constant demand for beds so beds will usually be full. My room contained four beds. Patients come and go so by the end of the week I had been in conversation with six or seven different people, These people are not always in a condition or mood to talk but conversation is vital. After some shy, wary, and indeed exhausted silence from the new arrivals an easy banter develops among the old lags. Nor is it just banter. The talk can take a serious turn. We know so little of each other conversation can range far and wide. I was chiefly interested in listening. After all I would not have met these people under other circumstances and would probably not meet them again. If you want to hear the world talk, I told myself, don’t talk across it.

In intensive care one sees only shadows. There are conversations that swim in and out of focus like the one involving the old man and his fear of anticipated pain. My first social experience was when I was moved to P Ward where Clarissa and Helen visited me. This was, as I remember, on Sunday. Opposite my bed was a slightly older man I’ll call Brian. Brian was waiting for his operation but he kept getting calls from home informing hm of the football score. Chelsea were playing Milton Keynes in the FA Cup and went on to win 5-1. He was a Chelsea supporter, born down the Fulham Road. I asked him what went wrong this season. He didn’t want to talk about it. Just pleased we won tonight, he answered.

Brian was a milkman. It had been a dreadful two years for him. First he lost his wife then developed prostrate cancer, now this! He bore up very well. He was essentially a cheeerful man longing to be cheerful again. He smiled as he spoke. I was to see him as I was leaving five days later. His operation too had gone well. We had had few chances to talk that night because he vanished into the operating theatre. I felt a great affection for him, the way I have always done for workers of various kinds. His children were on hand to help him.

Next to Brian, and also occasionally glancing across at me - there is a lot of occasional glancing across - was Dennis whom I got to know more thoroughly since he was there the whole time. He was in his seventies, a highly educated practical man, a rebellious One-Nation Tory (or so I assumed), the product of a Dominican boarding school and the army. Dennis read a good deal in the best spirit he could because, unlike me, he was in real pain all the time, coughing and gasping for air. He had been in busienss and had two grown up children. He and his wife lived in a house with three acres and walked two energetic large dogs. Dominican school prepared him for the army, he said, and had been a valuable part of his life throughout.

The trouble was no one could quite decide what specific operation Dennis needed. He had been in hospital since August  The most conrete news he received while I was there was that he’d have an operation on the 12th, a week after my own discharge. He was known to have emphysema but there was some complication beyond that. The uncertainty meant two different teams of surgeons  would have to be assembled on the day in case they found two different problems. The delay was hurting him. You’re killing me day by day, he complained to the consultant when he came to visit.

Shortly after my own admission a new man was given the bed next to mine. Eighty years old, Den (also Dennis) had been an agricultural labourer and, before that, a squaddie. Den and Dennis hit it off together rather well because Den, like Dennis, had served in a  tank regiment, but there the resemblance ended. Den was, to put it as simply as I can, a good tempered, funny, quite warm-hearted, working-class, Labour-voting Fascist. Adolf Hitler got a few things right, he told me on one occasion. Homosexuals should be castrated, he confided another time. It ain’t natural. He knew his children disagreed with him on most political issues. His wife was completely incapacitated and could only move her head. The children came to see him. They .were clearly fond of their dad.

I could have asked Den what Hitler got right, and, while we were at it, why one should castrate anyone for their sexuality but I didn’t. I was more interested in him than he in me. He had never been on a holiday outside England. he took four sugars with both tea and coffee. He liked the plainest food imaginable. But it was perfectly possible to talk to him al ittle about his own life. His horrible views were partly the product of an obstinacy in which he took great pride. No amount of soft soap was going to take away his right to think just what he liked.

One day Den and Dennis were having a conversation about meals and what you called them. What is breakfast, what elevenses, what lunch, what tea etc?. This is the class system in a nutshell, I interjected. They both laughed at this and agreed but - in hospital at least - they saw themselves as equals within their spheres. Under the circumstances, under the gaze of mortality we were all equal.

A new patient had been brought in to fill the empty bed opposite me. It was a younger man, forty-two years old; a Kashmiri-born pastry-cook, now chef, called Ghafar, Gaff for short. He was quiet a long time, dozing off now and then. He had had something like a heart attack and they had brought him in for tests. Gaff did become more talkative later but he never led the conversation.. He had other resources: his brothers, neat fashionable dressers in leather. They’d  talk quietly among themselves but blossomed out near the end when it turned out that there nothing was wrong with Gaff.

Gaff cleary identified himself as British once the subject turned to history and politics. The British Empire was folly, a disgrace, said Dennis.  We shouldn’t interfere in other places. The Americans are a blight. They ruin everything they touch.. For the sake of conversation I put the colonial view that there had always been empires, some more humane than the rest, and that once having had an empire it is not so easy to turn it off like a tap. Gaff was busily nodding along, saying nothing. When asked about the troubles of Kashmir he told us it is essentially a peaceful place and that it was full of various religions including Christians who all got on fine.

Dennis could have gone private, he said, but preferred to support the NHS, even though, he thought, the NHS was falling to pieces under the strain of people like ourselves. Best to privatise what one can, the advantage of privatisation involving competition and a resultant fall in costs, whereas centralised bureaucracies are no more than state monopolies serving their own interests. I argued that privatisation, when confined to a few hands, is likely to be exploitative, keen on quick profit, liable to corruption and asset stripping. Dennis ddn’t disagree. There was no loss of temper, It would have done us physical harm to lose it. One could have a serious conversation with Dennis having developed substantial respect for his stoicism in the face of continuous pain. Besides, we were both interested in the view of the other. We both wished the NHS well.

Gaff would listen to such conversations and nod along. When he did talk he talked about Kashmir but the, to my suprise, he began to talk very knowledgably about Hungarian cuisine, of which he was especially fond. He did not eat hospital meals though they would have served him halal food had he asked for it. He ate what his brothers brought in daily. His business and residence was in Peterborough which is not so far away. He wouldn’t touch hospital coffee.

Gaff’s brother was a regular visitor. On the day Gaff was to be discharged he brought in Gaff’s two young children whom he encouraged to shake hands with me, before he introduced himself to me. Have you read the Quran, he asked. Bits, I said. What nobody uderstands, he said, is that Islam is the religion of peace.

Thank you, I said. He smiled back then they were on their way.

Une Semaine de Bonté: A Week in Papworth Operation and Waking: Procedures, Routines (2)

I lose track of which night was which in those first days, but one episode, probably the first night in intensive care, impressed itself on me. There was a conversation going on which grew quite loud and long. It was between an elderly male patient and various members of the nursing staff. It ranged widely, which at that time of night is itself unusual, though I couldn't actually follow it but, mostly, it consisted of the man telling anecdotes about his stoicism in the face of pain. At the same time there was a note of desperation in his voice. Nurses, and then a doctor, were trying to persuade him to something. Don’t you touch me! he cried. And Not enough morphine! And It isn’t taking effect! These cries would then settle into further conversation. Eventually I understood that the nurses were trying to take out what they call 'the drains'. I had read about the removal of the drains in the pre-operation literature and, honestly, the process sounded potentially painful. It wasn’t something I was looking forward to myself: now here was an older man clearly terrified of it.

Drains are where “blood, serum, lymph, and other fluids” accumulate during the operation. If such material were allowed to accumulate outside the drains it could put pressure on the surgical site and on various organs, so drains have to exist and have to come out.

The old man scared me but he also made me determined to show no fear. I would not let myself down by complaining. Eventually, after about an hour of cajoling and drugging, the old man gave in. There was no cry of pain. When it was over he fell asleep and so did I.

When my own drains did come out a couple of days later it was not at all painful. I lay down on the bed and the nurse told me to breathe deeply then out, and to do this three times but on the third to hold my breath in. As I did so he pulled the thin piece of wire from just above the stomach holding the drain together and out it slipped, with a faint whisk. It was a strange sensation but there was no pain. It may be, I thought, that the old man had a different kind of drain, or that he had a particuarly low pain threshhold. Maybe if I had to accommodate his pain I would not feel so smug now at having undergone the manoeuvre so easily.

What the removal of the dressings over the drain revealed was a scar some 30cm long. It was a scar that seemed almost to deserve its own name and character. I did not yet know that the scar on my leg was much longer, the length of the leg in fact. I was, of course, aware of the principle of the operation, whereby the narrowed blood vessels (in my case the four of them) feeding the heart should be replaced by others taken from elsewhere in the body. usually the leg. My surgeon had explained this to me and I had read it in the literature. The old vessels are not removed: they are, literally by-passed, as a road might be in order to relieve traffic. I don’t know how the grafting is done or how the sternum is opened. I imagined a small precise version of a Black & Decker for the latter job. They have to stop the heart for a while and use an external mechanical heart instead.

But there is no awareness of any of that. All you have once you come round is sensation and scars.

And the detested catheter. I kept asking when it could be removed but they couldn’t give me a definite time until one of the nurses on day shift told me it would be the next day. That night was very broken and one of my fairly regular night nurses, the kindest, said she could do it there and then. Do you have the authority, I asked in awe. Yes, she said, and with the usual magic instruction of Three deep breaths! she drew it out. It didn’t hurt: as with most other moments of anticipated pain it was a simple, slightly strange sensation that lasted less than a second.

*

Routine is everything in hospital. In intensive care there is the constant measuring of heart rate, blood sugar, blood pressure, urine analysis, the taking of temperature, of body weight, the intravenous feeding through of anti-biotics, and the regular ingestion of tablets, of which there are many, as well as a constant supply of oxygen..I had two complications that had to be treated: an early infection that led to a rise in temperature and, once I started walking, a rise in the heart rate accompanied by a certain irregularity, both treated with drugs - drugs I continue take now, after my discharge.

Meals are part of the same routine. You are given a menu sheet for the following day and tick what you fancy. There is always a variety of fruit juice, a soup, one very straight meal, one slightly more exotic one (a sweet and sour chicken for example), five or six varieties of sandwich (corned beef being the most popular, said one of the catering staff) and a choice of sweet always including jelly and ice cream. The time between these courses can be quite long, so lunch or dinner can take an hour and a half. I fancied very little for the first two days, choosing the minimal amount of the blandest and warmest, before moving on to proper means. Cups of tea and coffee are available throughout the day. You’re always asked if you want sugar. One of my fellow patients wanted four spoonfuls with each cup of coffee.

Day is far busier than night and I wasn’t the only patient in the ward. Day consists of pill taking, blood testing, some exercise, and patches of conversation alternating with silence. The various grades of nurse arrive, go about their tasks, then go. I will speak more of the staff later, just to indicate at this point that the team is big and there are many names to learn, some three-quarters of them foreign. Day is easily manageable if you have reading or newspaper puzzles to solve. There is neither TV nor radio. My mobile phone - once Clarissa had brought it in - offered some musical breaks, chiefly chamber music and jazz, both very welcome at night.

I was ambitious in the books I brought for reading while recognising that it would be best to focus on relatively light matter.. Here is the list: Stefan Zweig’s Casanova; Joseph Roth’s The Radetzky March (a re-read but rather too heavy in hardback); Graham Greene’s The Ministry of Fear; A Nicholas Blake ‘Nigel Strangeways’ thriller, A Question of Proof, The Penguin Book of Light Verse, edited by Gavin Ewart; and, received as a loan from my daughter, Denis Johnson’s Jesus‘ Son, a book of contemporary, short, funny yet terrifying stories set among highly articulate yet spaced-out, potentially violent junkies, and much praised by Jonathan Franzen.  Of that lot I managed only the Graham Greene and the Johnson. I tended to fall asleep over books in the middle of paragraphs or sentences. The Book of Light Verse would have been great but it was probably with Clarissa in the room she was renting nearby and I inevitably forgot to ask her for it. As for the books in general,  the criterion was not so much page-turning narrative, but small easy blocks of clear prose. I did toy with Evelyn Waugh’s Vile Bodies (another re-read) and I wished I had brought it because early Waugh is one of the glories of 20C English ficiion.

And, of course, I myself was writing, partly to keep myself focused, partly because that’s what I do anyway.

Night can be haunting and disturbed, altogther a trial. The beds have their own bedside lights but the curtains are not drawn so putting the lamp on could disturb others. Meanwhile other patients are finding the night a similar trial so the time is full of coughing. I had only one decent night the whole time and often had to call the nurses to provide me with an oxygen mask or, better still, a nebuliser, to deal with the painful coughing which always felt worse lying down. Encounters with night staff under such cirumstances are very dreamlike and maternal. You are a sick child again being tucked up by your parents. I grew very attached to some of the night staff as a result, particularly to those who acted most like kindly parents.

Une Semaine de Bonté: A week in Papworth Operation and Waking: Procedures, Routines (1)

It wasn’t a good night yet I felt perfectly well but for a dry mouth. They said they’d wake me at 6am but they came at 5:30. The male nurse took me to the shower-room where he shaved my chest, arms, groin and legs. These are indignities but dignity has little place here. You just shrug and let them get on with things. Then he put me in the shower and I washed myself all over with antispectic, including my hair. Once out, my blood pressure was taken and they also took a sample of blood to register the blood sugar level. This was the first time I was to meet the little stamp with the pin at the end that releases a drop of blood that is then encouraged to run down the tongue of a meter or roughly mobile phone size which delivers the level immediately. It didn’t hurt at all though I was warned it might. This was to happen every day, several times, during the whole extent of my stay there, including my discharge day. My blood sugar having been measured I slipped into a surgical gown tying at the back and pulled on a pair of small plastic knickers under. Back to bed.

Now I was ready and utterly resigned to whatever might follow, my only concern being the tube down my throat because I have a tendency to gag easily. Don’t worry, they said. The early TV news was on. It was not the moment for Joseph Roth. Clarissa came over to pick up my valuables including watch, mobile phone and glasses. Everything was a blur. My pyjamas and wash bag were deposited in a sealable green plastic bag that would travel with me.

Then they came for me, put me in a wheelchair, and drove me over to the appropriate building. It was cold and steely grey outside. Soon we were in a corridor, then in a waiting room with someone else in a wheelchair. I was chilly. Specialists bustled in and out. My anaesthetist called - a different one from last night - and told me what would happen. I’d be sedated first then anaesthetised. The whole would take five seconds.

For the next nine hours I was dead to the world. It was the 30 January 2016.

*

The first entry in my notebook after that is early morning, Tuesday, 2 February. The operation was on the morning of Saturday, 30 January.

My notebook records that I woke to the sight of Clarissa, Tom, and Helen standing over me. You look well, they said. Thank you, I think I said. I think I smiled. Then they went away. They had been together all day supporting each other, spending hours in conversation. Apparently the tube was still down my throat at that time but I wasn’t aware of it. In fact I have no conscious memory of the tube at all, either of its insertion or its withdrawal. I was aware of very little,  passing through clouds of perfectly acceptable oblivion, emerging into moments of haze, then slipping back into unconsciousness again.

I was however becoming increasingly aware of the need to cough, a sharp hacking cough which was the closest I got to pain. It went through my chest and neck and filled my head. Seeing I was in discomfort they gave me a small teddy-bear sized hard cushion they told me to hold against my chest whenever I coughed. I think it was I who first called it my teddy-bear but as it turned out all the nursing staff referred to it the same way.

This was intensive care. I kept waking and asking if it was morning yet to be told that it was only 8:30 in the evening. I wanted it to be morning because I didn’t like the night. I didn’t like lying flat on my back and coughing. I didn’t like not being able to see the clock for lack of glasses and not being able to tell the time for lack of watch and phone. I wanted to know the time and I wanted it to pass. Then came Sunday of which I have no clear memory except as escalating waves of oblivion and discomfort, and of being shifted to another ward, shared with three other men, one of whom was about to have the same procedure as I had had. I was a consolation and encouragement to him, chiefly in terms of appearance. Blimey, you look pretty good, he said. I began to be aware of specific nurses, male and female, and of various specialists wanting blood samples.

Beyond that I was aware of being hooked up to several appliances at once so that moving could be very awkward. The strangest and most detested of these  was the catheter inserted into my penis which didn’t hurt but felt peculiar because I felt I was urinating as normal, or was wanting to urinate as normal, though that was impossible. There were monitors and drips. I hadn’t yet got out of bed but was soon advised of the best way to do that.  They encourge mobility from the earliest possible moment.

To get out of bed you have to make sure your various tubes or ‘lines’ are on the best side. You don’t want to dislodge them. Since you mustn’t pull or push on your arms or elbows and hands, the best way is to swing your body rounds and get your feet down to the floor while in a sitting position. Then breathe deeply, hold it, and let the breath out. Do this a third time, the third time bouncing to your feet and standing. Of course you must first be released from the main monitor but you don’t escape the catheter and the bag of urine to which it is attached. You carry it round like a handbag. 

Why are you getting up? Chiefly so you can sit up in a chair rather than lie on your back shaken by that cough. You don’t need to get up for the loo. You have it with you, but sitting up helps.

Getting back into bed is more complicated and hard to do at the beginning without help. The trick is to move backwards until your calves and thighs are touching the side of the bed. Then you sit down and allow yourself to fall over to your side, towards your pillow while swinging your legs back on to the bed. Then, providing you haven’t disengaged or tangled your lines, you can ask to be tucked back in. Having been tucked in you can’t move much because your only way of moving up is by wiggling your bum and digging your heels in again. The trouble is there is little to dig against. The bed can be raised or lowered of course with a button device but, unless your bum is high enough to start with you will only slip down the rising slope of the bedhead. Is that clear?

Last night I asked to be allowed to sit in a chair with the lights on. I read Private Eye without laughing (that is not unusual, I am not even sure that laughter is always the point) and did the Codeword, Sudoku and Shorter Crossword in the I.

Une Semaine de Bonté: A Week in Papworth Diagnosis and Preparation (2)

On the rational and fully conscious level I have always expected to die, not necessarily at the end of my ‘natural’ span, but at any perfectly arbitrary time. Life is simply like that, I feel in my bones. My parents’ lives bear witness to it in the most dramatic way imaginable. The result is that I have always assumed that  living well in stable times is not the norm but exceptional good fortune. I was a lucky man: my parents were not. So, if I didn’t dwell on the possibility of dying on the operating table - in the case of a multiple by-pass the chances of that happening are roughly 100/1 - it was because there was always the possibility of dying any old how.

My most pressing thoughts were for Clarissa and our children, Tom and Helen. What would happen to them? How would they feel? How would it affect them? Clarissa and I have been married for over forty-five years and are so close we are almost extensions of  each other. I don’t thinhk any man could have made a better marriage. In the case of the children my worst nightmares have always been those in which they are endangered. I would want my wife, children, and indeed grandchildren, to lead lives at least as fortunate as mine.

I looked for practical things to do in case I died. We checked our wills, I ordered my computer files as far as I could, I contacted my literary executors (Cambridge University Library has most of my papers) and I tidied up, as best I could, the three books I am due to publish this year. The first, a collaboration with another poet, Carol Watts, is now ready for printing. The second, the book of poems for children, has been handed in to the publisher but still needs to be illustrated. There was no point in trying to complete the drawings before the operation so I wasn’t even going to start. The third, my new poetry collection, is due in October. The material for this has long been ready and lodged with Bloodaxe but a decent number of extra poems have accumulated since, poems that would not in themselves make a book, so - in consultation with my editor, Neil Astley - I prepared an alternative extended collection in case of death, that would include the later poems. It was the oddest thing I felt I had to do, but I did it because it was practical.

*

I am writing this in the luxury of an almost empty Orchard Ward, Papworth where I am being attended by two nurses. I consciously deliver myself over to them, doing their bidding with a smile. The surgeon and the anaesthetist call for visits. One nurse explains what needs be done before the operation: I need to have two showers with antiseptic and must shave my body, arms, legs, chest and groin. That will be done at 6 am. At that point my blood will be tested, then I’ll be sedated and finally put under anaesthetic ready for surgery. The operation will begin at 8 am and I will be unconscious until about 5pm. Once I am unconscious a tube will be inserted down my throat which will be removed while I am drowsy after the operation. Some days later the ‘drains’ would be removed.

Clarissa, who had driven me in for my 4 pm admission, was renting a room in a house made available for relatives. While I wolfed down the lasagne provided in Orchard Ward, she ate the food she had brought with her at the house. After that she returned at 9pm to watch the seond of half of Derby versus Manchester United live FA Cup tie on TV. with me. This has been a bad year for United and the result was in doubt. We watched the match with an anxiety that was probably greater than I was feeling about my operation.My heart rate went up as result.

After the match she returned to the house and I was left alone with the less tender but perfectly competent night staff. Before lying down to sleep I was introduced to the young Indian male nurse who would shave me.

Being alone is natural. Clarissa and I had been talking about just that, about how we are creatures of both relationship and solitude. Relationships (mother, father, brother, sister, son, daughter, husband, wife, lover, employer, employee, and so on) stabilise us There are places we must be and are fortunate to be, glad to be wanted and needed.  But a part of us floats free of every engagement hurtling through space like a rogue meteor. It was that part that took over now.

It had gone midnight. No drinks or food. Nil by mouth. I tried to read one of the books I had brought with me, a Joseph Roth, but the book was too heavy to hold and concentrate on. So I did the codeword, the simpler sudoku and shorter crossword in the I I had brought with me. Then I took out the exercise book I had brought with me and started to write.

Writing calms me. Verse particularly calms me. The ward was humming with heating and air-conditioning systems. I was awake a long time.

Une Semaine de Bonté: A Week in PapworthDiagnosis and Preparation (1)

My condition had originally been diagnosed in April 2104 as diabetes type 2 to be treated through diet modifications and exercise. The diagnosis was a surprise but it did explain my increased difficulty in walking fast, especially when laden down with luggage or moving uphill, or indeed walking at all straight after a meal.

I did as advised, much supported by Clarissa, but continued life as normal including working, reading, taking part in discussions, and travelling here and abroad, including shorter and longer periods in Malaysia, India, Singapore, Scotland, Ireland, and Hungary. Travel had become an ever more regular part of my writing life, particularly after my retirement from teaching at the end of 2013.

For October 2015 I had invitations to China (two distinct but overlapping ones in fact, one a month-long residency) and, later, more briefly, to India and Baghdad. The trouble was that, despite much improved figures on blood sugar and the rest so I was practically normal, the symptoms that first led to the diagnosis were rapidly growing worse. To combat them I was given more drugs including the ‘in-case of difficulty‘ spray-under-the-tongue Glycerin Trinitrate.

Doubts were rising about China all through August and September. There were suggestions of angina now and I was strongly advised, by three different doctors, to cancel the China residency, so, just a few days before the booked flight on 14 October, I did cancel it. I felt dreadful about this since both invitations had been modified to fit in with my own diary. My hosts were very understanding and assured me the invitations would be renewed next year.

In the meantime I was waiting for an angiography appointment at the NNH and that came through for the 21st.

That entailed a day at the nearby hospital, mostly spent in waiting, mostly in just a t-shirt, mostly cold. The cardiollogist was a severe woman whose look and manner reminided of Carol Brown Janeway who once gave me coffee at Claridge’s and clearly thought I was not quite up to the class of the place. I’ll call the cardiologist Dr CBJ. Eventually I was ushered into the surgery, laid flat on a bed, kitted out with various needles and pins, sedated through a cannulae, then a catheter was applied through my wrist and a dye pumped through it. The X-Ray machine moves all over the naked upper body. It takes about half an hour. None of this hurts: the little pin-pricks are as nothing. It is just that in  a t-shirt one grows colder and colder.

Dispatched into the waiting room, empty now by the end of the day shift. I waited another 50 minutes or so, still in the t-shirt, still with the cannulae in place. Eventually Dr CBJ returned. What do you do? she asked. I am a writer. I write poems. She sniffed. This was not impressive. If this had been an interview I would have failed right there. I must tell you something, she continued in her crisp manner. You will need a multiple by-pass, a triple or quadruple. You had better have it soon, let’s say November / December, at Papworth. You understand? Yes, I said. There was little to misunderstand though it hadn’t really sunk in. Right, you can get dresed now and go home. A nurse took out the cannulae. Goodbye, said Dr CBJ.

She left. I rang a shocked Clarissa and, there being no bus or available taxi, waited for her to pick me up.

You may ask - I do ask - what I made of this. It is hard to say. My constitution is such that dramatic events immediately enter a deeper level, passing through surface emotions so fast, I don’t really notice them. All my life it has been like this.  Anxiety - even terror -  exist at the level of dreams and unarticulated tension, presumably the kind of tension that eventually led to this very diagnosis.

Une Semaine de Bonté: A week at Papworth1. Foreword

My dearest friend in Hungary, on hearing that I was to have a mutiple by-pass advised me to read a book, one he had translated from the Swedish into Hungarian by the Hungarian-born oncologist, immunologist, cell biologist and essayist, George Klein. I already had the book since he had sent it to me with a warm recommendation some months before, but I had only nibbled at it. Do read two particular essays, he said, the one titled A New Meeting with Peter Noll and the one at the end of the book, titled A Third Meeting with Peter Noll.

Who was Peter Noll? He was a Swedish professor of law, known to Klein, who, learning that he had cancer of the bladder, decided not to have it treated or operated because, as he wrote in a book in  the time available, he believed that knowledge of the certainty of death gives the life remaining extra dimensions, more sheer content. Trivial things no longer mattered. One spent more time with those one loved and less with those one didn’t. As Dr Johnson once remarked, Sir, when a man knows he is to be hanged in a fortnight it concentrates his mind wonderfully. Noll operated on the same principle but there is a difference. Johnson’s remark was made while he was in a healthy condition. It also took more dramatic form. Noll’s was a more deliberate way of proceeding: a conscious facing of death and walking directly into it.

Klein tells us how much he admired Noll for this, then goes on to relate his own experiencce with by-pass surgery as an emergency procedure. It was an emergency far greater than mine since he had onlya few days notice before the operation. The meeting with Noll that Klein refers to is between himself as a man and his late admired exemplar. To meet Noll is, in essence, to meet the prospect of death. Noll is the symbol of that prospect. Klein’s account of his operation is minute in detail, philosophical in nature, and beautifully written (or translated). It is a pleasure to read. If I begin with Klein it is because my friend did and because, in some respects, his case and mine are comparable. I too was so much involved with international travel that I had to cancel three events at short notice. I too wondered what I might squeeze in before the necessary operation.

Beyond that Klein and I differ somewhat. I found the whole hospital experience fascinating. It was less my personal mortality as the lives of others around me that took my attention. This is an account of that experience. I record it for the pure curiosity value - to me at least - of recording it, not just as a personal experience but as a social and institutional one.

I hav written most of it, with only a final section to go but will wait to write that until most of the present material (over 7,000 words) is up.