It feels the right place to be. There are Christmas trees in Piazza Venezia. Lights sway above the narrow streets, and the shop doors are framed by electric stars. We go into churches, where our foosteps echo from marble, stirring shadows under the arches, and the cold smell of incense. The clunk of a Euro coin in a machine bathes sudden light across a martyrdom, an angel, a pietà. In dark side aisles old women pray. Outside, the streets are full of Christmas shoppers, bars, and little studios where old men carve picture frames, or squint through lenses at antique coins. We climb the steps of the Campidoglio and stop at the railing, looking out over the ruined forum beyond. The wind suddenly feels cold. A dead city, this, in contrast to the living one: broken arches and buried streets, fallen roofs, columns entwined with weeds. Rome stares back at us, half-face, half-skull.
You’d expect people to recoil from all this decay, all these abandoned shops and palaces and temples. Instead, tourists take selfies against a backdrop of ruins. Perhaps we fear death less than we think, or know it better than we imagine. School groups pack the steps of the Trevi Fountain: Russian, Chinese, English, German. Who hasn’t lost someone? A father, a daughter, a wife … Crowds flock in silence along the street that runs through the forums. I imagine each person leading their lost ones beside them, the crowds doubled and redoubled by those we have all lost. Next to Augustus’s forum an old beggar, bare-chested, shakes a plastic cup at the passers-by. He makes me think of the old man in the A&E ward at St Thomas’s: It hurts … it hurts. At night, gulls float above the ruins, their wings lit white from below.
In most towns, streets join and part logically, and the past is buried. Not in Rome. Here, the dead are entangled with the living, clinging to one another not in archaeology’s neat layers, but with the immediacy of an embrace. On a street corner the pavement falls away to expose the skeleton of a shop, unburied, or a dead street where people used to walk. Three columns crumble against the wall of a church.
My thoughts feel the same. I seem to have lost my memory since Nicola died – I can’t concentrate; things don’t connect. When I think about Nicola and the past year she comes back to me in a mosaic of fractured memories and dislocated ideas that lead nowhere, just like the streets of Rome.
I write in the early morning. As night retreats, the apartment block opposite comes slowly into view: a grey shutter with sagging slats, key stones splaying above a window, a carved lion. Our Christmas tree winks in the corner, and I think of Nicola, the presence no longer next to me; a presence so constant, so vital, it was a part of my own life, as I was of hers; her smell so familiar it was simply the air’s smell; her touch, the life pulsing in my own veins; her voice, the clamorous music of thoughts in my own head. We were indivisible, indistinguishable. Waking in the morning meant her weight in the bed next to me; life meant the consciousness that somewhere, perhaps in an office, someone’s kitchen, a coffee bar, she was talking, laughing her irrepressible, sweet laugh, her lips widening in her loving, adorable smile.
In the past few months I’ve gathered all our emails together, all our texts and WhatsApps, and put them in order. I imagine one day I’ll be able to make sense of what I’m writing, as an archaeologist untangles Rome, deducing a temple from a pile of stones, or matching a statue to the niche from which it was torn. In any case, all my thoughts circle the one overarching reality, which is the absence beside me.
On 17 August 2015 Nicola began her third course of chemo. It was routine by then. She packed her bag, chose books, folded her headscarves. We had an early supper at home, then I drove her into Guy’s.
Her arm ached. It seemed desperately unfair, but she was afflicted with a frozen shoulder that caused her constant pain. Common enough for women of her age, the doctors said; perhaps connected with chemo, perhaps not. We remembered Caroline, the friend we had met at Erwarton Point, hobbling across the grass towards us with a smile, lugging a picnic basket. Chemo had wrecked the joints of her hips. We remembered her trying to play rounders with her young sons, insisting on running from base to base so as not to miss a game which might be her last. But no, the doctors said, this was probably just a frozen shoulder.
All fine, Nicola texted. Still in remission.
She was sick, no one was quite sure why, but pills made her feel better. The doctors decided to allow her to come home each evening, until her counts fell. We ate early and I drove her back into hospital, clutching her bag on her lap. Watching her slight, lonely figure disappear into the alleyway that led to Guy’s I remembered being dropped off at a boarding school, and the gulf of homesickness and fear that opened up inside me as my parents drove away. I felt bereft, abandoned to a world of arcane rules and routines I couldn’t control; robbed of freedom; surrounded by strangers. Nicola must have felt the same. She walked slightly hunched from the pain in her shoulder. She never complained. I sat at the wheel and watched until she disappeared around the corner that led to the entrance.
The only good thing about being apart, Nicola texted, is the looking forward to being with you tomorrow.
There was other good news. In America, a friend’s daughter was born, and we were sent a picture of a sweet baby in a white woolly hat. Eyes closed, fists clenched: new life.
Things couldn’t have gone more smoothly. Horizon lifting, our thoughts turned to the bone marrow transplant that lay ahead. That would be the final stage in her treatment. We weren’t sure what to think about it. Some doctors spoke of it airily, as a routine treatment little worse than chemo. Others seemed to suggest it was frightening, to be avoided if at all possible.
It wasn’t going to be possible for us, apparently. Dr Clay explained blood markers. One of Nicola’s tests had showed positive: an indication that, without the transplant, leukaemia would recur.
‘So we’ll spin you along to King’s,’ he announced breezily. ‘They’ll soon sort you out there. You’ll meet Dr Anand.’
We did. She was short, intense and inspired confidence; Nicola liked her at once. Dr Anand explained the principle. Leukaemia is a malfunction of the bone marrow, which starts to produce cancerous white cells. But the bone marrow can be replaced. We pictured a horrific operation, bones cracked open like crabs’ claws. It wasn’t like that, Dr Anand explained. A donor’s stem cells were gathered from their blood. Injected into Nicola’s bloodstream, her own marrow would simply absorb them. It was vital, of course, that a donor be found with a close genetic match to Nicola’s, or the stem cells would be rejected. Not a relative, usually. There was a database of donors they would search. Many were German. She could introduce us to people who’d been through the process. We booked a date, 11 September, to visit the unit at King’s together.
There were risks, of course. The new stem cells would create a new immune system, wiping out the old one like a computer hard drive being wiped clean. For a time Nicola would be vulnerable as a newborn baby.
‘You should read this pamphlet,’ Dr Anand said. ‘It’s a bit scary, I’m afraid. It explains everything.’
Nicola was quiet that evening. Dr Anand’s pamphlet lay on the bed next to her. She’d been crying.
I sat down and laid a hand on her forehead. ‘What does it say?’
‘Don’t read it.’ She pushed it away.
‘Why not?’
‘It explains what can go wrong. Dr Anand said it was scary. They have to tell you what can go wrong, of course they do.’ Nicola shook her head, brushing away fear, and smiled at me. ‘I’m going to be fine.’
She had that ability to push worry away from her; she had that strength. I can never ‘not worry’ about something – worry gnaws me; anxieties wake me at night. But Nicola was able to put things out of her mind at will. It was part of what made her so serene. It enabled her to live through cancer and grow sweeter and stronger with every day. I’d give everything – everything – to change places with her now. For it to have been me who put up with the probings and the needles, the endless pain; the anxiety that never quite vanished, and the terror she felt at
night and divulged not even to me. But I would never have borne it so well. Nicola stayed resolute. She knew neither panic nor self-pity; her stoicism was bone-deep. She could spend hours sitting under drips, or waiting on plastic chairs while her blood span in a centrifuge. She laughed off the petty frustrations of NHS treatment – the crossed-wire letters and post-dated appointments – and kept her sense of humour intact. Putting worry from her mind, she did Sudokus, sat on her bed, emailed friends, read detective stories. She was able to banish cancer to the shadows.
And we both knew that this ordeal was not all bad. Yes, we longed to return to normality, but there were things we relished in our new life. We felt all its urgency and freshness. For as long as we were exiled to this strange place, cancer, we felt the thrill of each morning; the thunder of the sun rolling over the horizon; the flare of orange burning the world each night at sunset. Light refracted strangely from walls; the air tasted sour and bitter. And the past had been returned to us. Between treatments I found Nicola turning the pages of photo albums. We recalled holidays we’d taken before the children were born, parties, our wedding, in a detail that had always escaped us before.
With the future out of bounds, the past had never seemed so real. It became absorbed in the present, as if time existed not in a weary sequence, with the present moment running like a bead along a string, but all at once, simultaneously. The day we met felt as real as the consultant’s visit yesterday, the pain of giving birth as recent as our weekend sailing up the Stour. No fog hung over our twenty-eight years together. No twilight hid the joys of conversations we had, of places we’d seen, of making love, of being together. The time we’d been given spread out around us, rolling over hills, so broad and wide, so full of incident and life that the tiny moment we occupied – the small room we sat in, the bed, the lamp, the gentle knock as the cleaner stopped her trolley outside, or the monotonous bleat of an alarm from the ward – was merely a cockleshell on a sea; it seemed no more vivid, no more important than anything else. It was just a vantage point from where we could look out over years in which Nicola had not been ill; in which death lay over the horizon; in which the sun warmed our years together, our growing family, our happiness.
The treatment seemed easy this time, a routine. Nurses wheeled in the trolley of chemicals each morning. I visited at lunchtime, and again in the evening. Joe was working in Pret A Manger, saving money for his gap-year trip to America. He’d wanted to stay home until the transplant was over, but Nicola insisted he go anyway. She hated the idea that her illness might stall his life; and so his room filled up with rucksacks, T-shirts and boots. The summer drained away. Nicola came home on 23 August, after just a week. We planned to see friends.
Perhaps we had become too cavalier about immunity. Watching television together on the sofa, on 2 September, Nicola felt something was wrong. She tried her temperature. It was above normal, though not by much. I don’t know how she sensed this was more than the usual fever, why she was so insistent that we leave straightaway.
I drove her to A&E. The doctor on duty was young and inexperienced. It was frustrating to have to go through details that seemed obvious to us: Nicola was a blood cancer patient from Samaritan; she had Acute Myeloid Leukaemia; she was neutropenic. The ward was busy so they found us a side room, then left us. Nicola sent me out for water – it was hot. Everyone seemed to be rushing. A harassed nurse refused to catch my eye. When I came back, Nicola snapped at me for almost the only time: she wanted me to push harder for attention. She worried the handbasin was dirty; she worried who had been there before, whether the bed had been properly disinfected. Through the door we could hear voices at the desk, and phone calls being made – none about us. We could see families huddled on chairs at the far side of the ward, a wheelchair being pushed past, and a girl groaning on a gurney, her shoulders covered in sweat. At last a consultant came. Nicola needed to stay in hospital, she said – that we knew already. They were looking for a bed but every ward was full.
They gave Nicola paracetamol to control her rising temperature. Her head ached. The nurse who came to administer the drug didn’t know how to use a Hickman line and wanted to put in a drip instead. Nicola dug in her heels until they found someone with the right training. I’d brought sandwiches with us but she didn’t want to eat. We swapped texts with Joe, at home. It would be late, the nurse said, before a bed came free.
We waited. Sometimes I went up to the desk to see if there was any progress. From there, I could see into the next cubicle: a girl who was drunk, or perhaps had taken drugs; her family around her. At last an ambulance came. The street was empty. I watched them load Nicola onto it but she wouldn’t let me come with her. It was only an infection, after all. I watched the ambulance lurch down the ramp, then walked home along the empty streets.
Before going to bed I texted her: I hope you’re asleep. I’m worried you’re getting so weary of it. It really will come to an end. I love you so totally. Xxxxxxx
She replied, Would love to be on final stage but it’s probably not to be. Temperature spiked again so have just been given paracetamol and hoping for a good night’s sleep. I love you so much xxxxxxx
Before, they’d always managed to kill off infections within a day or so. This one dug in. The doctors tried new antibiotics, hoping to hunt down whatever strain was taking hold of her. A consultant, one we’d never met before, explained, ‘Different antibiotics work on different bugs. We try a whole spectrum.’
They took blood, hoping to grow lab cultures that would reveal the nature of Nicola’s infection. Sometimes, the consultant said, Hickman lines became infected, so they swabbed the end and took blood samples to see if anything would grow.
Nicola’s temperature stayed high. She’d been put on a different ward to start with, but a bed soon came free in Samaritan. That was familiar, at least, frustrating as it was to find ourselves back there. Nurses took Nicola’s temperature and blood pressure every hour. Paracetamol brought false dawns of lowered fever, but by evening her temperature always climbed back up again.
I remembered my mother taking my temperature as a child, flicking the glass tube to shake the mercury down, then prodding it under my tongue, where it squirmed uncomfortably, sharp and cold, while I waited for what seemed hours. Nicola’s temperature was taken in moments, with a probe in the ear whose plastic cap the nurses could flick into the bin with a single deft movement. We learned the centigrade limits: 37.5 was a temperature, 38 was worrying. Nicola spiked to 39, hair slick over her hot forehead, then 40.
They changed the drugs yet again. One morning, a few days in, Nicola texted, Had reasonable night but very breathless. The breathlessness was new. The doctors thought the infection might be in her lungs. That evening, when I went in, I found her wearing a mask that gripped her nose and mouth. Oxygen hissed from a tap in the wall and a new monitor by her bed recorded the level in her blood. 95 was just high enough, the nurse explained. Nicola’s showed 88. Nicola tried to grin at me through the mask, but I knew she was tired.
The next evening, arriving from work, I found a doctor in dark-red scrubs reading her charts.
‘I’m from the CCU,’ he said.
I didn’t know what that was. The Critical Care Unit, he explained – Intensive Care. His manner was different from the cancer doctors, who wore shirts and jeans. A stethoscope dangled from his neck. He felt Nicola’s abdomen and pulse, and left, promising to come back in a couple of hours.
We tried not to worry. We were glad that quietly, efficiently, they were pulling in extra help around us. The nurses bustled around, tucking in sheets, administering drugs. Nicola’s chest laboured under her hospital gown, my brave, strong wife looking ill really for the first time.
A bit shaky but feeling clearer headed, she texted later that day.
I replied from work, Shall I come?
No urgency, she wrote.
But that night she was worse. They’d turned up the oxygen. A CCU nurse was examining Nicola when I arrived. Noth
ing had come back from the latest round of tests, but the air in her lungs was sour and too thin; I could hear the rasp in her throat as she struggled for breath. That evening she didn’t want me to go home. I slept on a cold, hard plastic sofa in the unused visitors’ room. In the middle of the night the nurse woke me up: Nicola was asking for me. Her hair was slick with sweat and the skin white and taut over her temples.
The duty doctor was short, very young, and nervous. ‘We’re going to take her down to Intensive Care,’ she said. ‘It’s just a precaution; there really is nothing to worry about.’
A porter stood outside. I held Nicola’s hand. I could see a crust of dead skin on her lips. She squeezed my fingers.
‘I feel f-fine.’ Her voice was fevered.
To move her, they had to unhook the oxygen, then reconnect it to a temporary bottle to take her down to the CCU. But the connector didn’t fit. I could sense the doctor getting anxious beside me. It was frightening how quickly Nicola’s counts dropped: 88, 86. A technician came. He wrestled with the adaptor. In an American drama this is where the doctor would have bellowed, ‘I want oxygen now!’ Our NHS doctor said, ‘Could you hurry up, please?’ The technician hit the tap anxiously with the wrong end of his pliers. At last it slipped round, and air gushed into Nicola’s infected lungs.
Outside Samaritan they hurried the bed along darkened corridors. The cold blue light of fluorescent tubes shone on anxious, calm faces, practised movements as the bed was manoeuvred into a lift too small for it. Somehow they squeezed me in too. The doctor gave a reassuring smile, then her eyes flicked to the monitor clipped to the end of Nicola’s bed. It was bewildering how quickly infection had taken control of my wife’s vulnerable body, how contemptuously it had brushed aside the antibiotics. The lift door opened. I didn’t know this part of the hospital. We went down a broad, empty corridor. A row of wheelchairs stood in an alcove; we passed locked doors. Nicola’s face, labouring for breath, looked small and crumpled on the pillow. We might have been at the top of a tower or deep in the earth’s bowels. I was lost.
A Moment of Grace Page 6