Dr Anand drew diagrams on a piece of paper, making nothing much clearer, but the essentials we understood anyway. The nuclear test was the first sign of returning leukaemia. Do nothing and the cells would multiply, as they once had before. And kill her didn’t need to be said. We faced transplant again, with a final round of chemotherapy to clear her blood beforehand.
Two risks hung over us.
Dr Anand had told us before, though she didn’t repeat it now, that returning cancer was harder to clear out.
‘Maybe you’ll need more than one round of chemo before you’re ready for transplant,’ she explained. ‘Some people do.’
Time dissolved around us. Cancer time. Back to work in six months, or a year? Two years? We had no chart to plot a course on.
And there was another risk as well: last time Nicola had chemo she had ended up in Intensive Care, her lungs infected. Could that happen again? Would chemo trigger it? Was the same infection still lurking in her chest, guarded only by an immune system that we were about to tear away?
‘We’ll send you for X-ray,’ Dr Anand said.
And more tests, and a check-up on her eyes, and an injection in her frozen shoulder. A donor had been found before Nicola’s autumn reprieve. There should be no problem, Dr Anand said, in putting the transplant in motion again. She counted back days on a desk calendar, frowning. Final chemo would start on the 29th. We’d booked a weekend in Florence to visit a friend who had lost her husband to cancer six months before. Should we go?
‘Of course,’ Dr Anand said. ‘You need a holiday – make the most of it.’
Nicola had spent her gap year in Florence, learning Italian, but we hadn’t been back in ages. We visited churches filled with calm grey columns, cloisters where an orange tree grew in a garden filled with sunlight. It was cold. We wandered through the Uffizi, looking at pictures until Nicola announced firmly that her energy was going. We talked. We watched the mosaics glitter on the ceiling of the baptistery. We knew religion only from old art, we realised, not from faith. In Santa Croce we looked at frescoes of grieving monks, a sorrowing mother. Our friend dropped us at the station.
Nicola and I had travelled throughout our time together, to France, Italy, Germany. We got engaged on the Charles Bridge, in Prague, the year the Iron Curtain fell. We were staying with journalists who came back from the border to report queues of Trabants, roofs piled high with boxes and trunks as families fled to seek new homes in the West. We never managed to go further afield, but Europe we knew and loved.
This was our last trip, though we couldn’t know it. Passport control; security. At the gate Nicola rested her head on my shoulder, tired. Flying over the Alps, the clouds below us looked like the hills of an unknown, unvisitable country, a place we would never see together again.
Nicola’s fourth round of chemo was harder than the previous ones. We were both impatient to get on to the transplant itself: we had tasted freedom and wanted more of it. We sensed open fields beyond the walls of the city in which we were besieged. Samaritan, Nicola’s shabby home, seemed too familiar. The view from the window didn’t excite her anymore. Two weeks’ treatment, the doctors said, but they kept her in for four. Everyone was worried about the infection she’d had before. Maybe it was still brooding in her body, waiting for chemotherapy to open the gates of her immune system. Maybe she was allergic to the chemicals after all.
If Nicola was scared, she didn’t show it. I think she knew, as I do, that the next best thing to feeling brave is to act brave. She didn’t talk about infection as they took her obvs, stacked pills into her bedside cupboard, inserted the Hickman line that would serve her through transplant. She texted, Dr Clay about to come and talk to me. Please remember lip salve.
To start with, they allowed Nicola home in the evenings. When I got back from work I found her waiting on the sofa. I’d cook supper; we might watch a film. At nine we got in the car and I drove her back, headscarf askew, clutching her bag, to drop her at the gate opposite the Shard. As I watched her slight figure dwindle under the streetlights I again remembered being dropped off at boarding school after a break. Homesickness eviscerated me; I hated the regulation, the loneliness, the distance from home. Remembering it all, I wanted to run after Nicola and hug her, but knew I would see her tomorrow. Darling one, dream of me, she texted. I replied, I love you more than you can possibly believe.
I had a cold. Visiting, I had to talk through a mask. But our love had once again burst into full flame. I can feel its heat now, as I go through texts. I can’t wait to see you in the morning … Darling one dream of me I’ll dream of you … At work I thought about her. At night, alone, I felt her shadow next to me in the bed. I texted as soon as I woke up; at lunch, I cycled to the cancer ward; at six, I left my desk and made my way through the shadowy alleys off Borough High Street to the post where I chained my bike, to the slowly revolving doors of the lobby, the lift, the locked ward door – and at last to the room where Nicola waited for me.
The feared reaction to Cytarabine didn’t materialise. A doctor she trusted said he wasn’t concerned about the transplant; Nicola had proved herself strong. They were too cautious to let her home, though. I went alone to a friend’s fiftieth birthday, and texted selfies to the ward. Infection threatened but didn’t take hold. At weekends we walked up to Bermondsey High Street, where Nicola had found a park she liked, with roses, stunted in February, and a bank of grass behind some housing blocks. Some friends took me to the opera. Martha came up from Cambridge to visit.
Joe, meanwhile, was about to set off for America. He had wanted to cancel when Nicola relapsed, but she wouldn’t let him.
‘You can stay in touch on the phone,’ she said. ‘Write a blog. You’re going.’
Keeping him in London would have acknowledged the possibility she might not survive, and Nicola had banished that thought from her mind. So Joe set up his blog, and went shopping for better shoes, a waterproof case. For his birthday I bought him a camera. Nicola stole my T-shirt to sleep in, and texted from hospital, Bored. Her blood counts were down again, responding to treatment, and she spent hours under drips, watching someone else’s red blood and yellow platelets slowly invade her veins. She was home for Easter Sunday.
Before her relapse we’d planned to spend Easter in France, but Nicola had left France for the last time after New Year, our wheels crunching on gravel as the house disappeared around the corner of the track. Instead, I cooked spring lamb for Anne and Peter and we drank wine from Cahors, to make us think of the south-west. Late March, I emailed friends:
Everything is going very well here. Nicola has sailed through her preliminary chemotherapy. Despite its strength she had no bad effects, other than tiredness, and they’ve just re-done the cell nucleus test which shows that she’s cancer-free even at the molecular level. So she’ll head into her transplant mid-April in the best possible condition.
Unfortunately they decided to keep her in Guy’s for most of the four weeks in case any infections transpired (they didn’t). But we now have a three-week lull in which to pack Joe off to the States and hopefully see some of you before she goes into isolation for the transplant itself.
Two days later, Nicola’s temperature started to rise. It was 4 April; she was due to go in for the transplant on the 17th. Joe’s backpack stood in the hall. Time seemed to be pouring away. There was so much we were meant to do in that last fortnight.
We wanted to see friends while we could. After the transplant, we knew, Nicola would be isolated for months. Still more important, we wanted to give Joe a proper send-off – his plane took off on the 6th. Then there were details to get ready before Nicola’s long stay in King’s, at the Transplant Unit.
On top of all that I’d arranged for building works while she was away from home. Roofers stood by to tear off our leaking gutters, and have all ready for the earliest date she might return. We wanted to use this last fortnight to gather our breath, pull our family around us for the final leg of our long, difficult
voyage.
And now her temperature was going up. Nicola sat on the bed, checking the little white thermometer: 37.8. Numbers were our judges, throughout her ordeal: of cancer cells and blood counts; of the oxygen, much later, that couldn’t penetrate her damaged lungs. 37.8 counted as a temperature. Nicola stuck the tube back under her tongue and gave me a dejected look. She didn’t want to go back into hospital, but when she called the ward they told her to come in.
It was the usual routine: St Thomas’s A&E. This time I didn’t go with her, though I don’t remember why not. I have her texts from A&E: I haven’t met a nurse yet. I was due in Edinburgh the next day – perhaps she wanted me to sleep. We swapped texts as I took the train north, went into meetings, ran to Waverley station for my return. After cycling fast to Guy’s, I found her in an unfamiliar ward: there were no beds in Samaritan. Her temperature was down, but the doctors were waiting for the results of a flu test. We both worried about the transplant.
And Joe was leaving the next day, while Nicola was stuck in hospital.
He went into Guy’s to say goodbye to her. I think about it now, still: the last time she spoke to him. I thought about it then, knowing the risks the transplant carried. And Nicola, of course, thought about it, too, for all her courage, for all the determination with which she insisted he leave. Her son, her youngest child: as she hugged him, she must have known she might be saying goodbye. When Joe flew back to us, seven weeks later, Nicola was breathing through a tube, sedated. When she opened her eyes, it must have been one of the ways she learned how ill she was, that Joe had flown home to be with her.
I took the morning off work and went to the airport with Joe. When Martha had left for a summer in Africa, three years before, Nicola and I had gone to the airport together. That was the moment Martha’s childhood ended: our daughter’s small figure swallowed by the security gates. On the train home we’d cried together. This time Joe and I sent Nicola a selfie from the Gatwick Express, grinning. His massive backpack teetered on the rack above us. As the train rumbled through south London suburbs, I knew that the door was closing, once and for all, on Martha’s and Joe’s childhood. Raising children had been the greatest adventure Nicola and I took on together. We never wanted their childhood to end, but of course this moment had to come. If Nicola had never fallen ill, this would still have been a year of change.
At Gatwick, Joe and I had a coffee, joked. He looked so young. He checked passport and money belt; we hugged. On the train I texted, Left Joe x, and kept my face turned to the glass so the other passengers couldn’t see my face.
Two days later, Nicola was home unscathed. Her temperature had dropped again. The flu test was negative.
She went to King’s and reported back on the Transplant Unit: small, clean rooms, friendly staff, a transplant nurse she liked. She signed all the forms, a grisly process where they read out possible downsides and side-effects and made patients sign an agreement. It was like asking prisoners to sign their own warrant of execution. We knew the risks: rejection, Graft versus Host Disease, skin rashes, damaged organs, infection, death. Nicola didn’t talk about them. There was only one path ahead, for us, with cancer lurking to either side, and she stepped boldly onto it, not troubling to look back. My wife’s last gift to me was her own courage.
Two weeks before, we’d booked a weekend away, but cancelled it when Nicola’s temperature rose. We booked again, a hotel in Woodstock, near Blenheim Palace. Driving west, stuck in traffic near Oxford, we remembered weekend breaks we’d taken before. Through the car window we watched trees softening in the early spring. As a child Nicola used to stay with her grandparents in Gloucestershire. We’d both missed the countryside during her illness. Late in life she’d become a gardener. Somehow, without apparent effort, she had learned how to tie roses and prune clematis, how to summon irises, peonies and foxgloves from a flowerbed, conjuring each in turn as if summer, unfolding like music, was her gift to her family. Dressed in faded jeans and flat shoes, she crouched over flowerbeds, with her glasses slipping to the end of her nose, while the binbag beside her filled slowly with weeds. Gardening was something she didn’t share even with me. It was the place Nicola went to be alone.
In Woodstock, wisteria climbed stone walls. The hotel was corporate and depressing. We preferred to visit the palace, its vibrant baroque towers and broken pediments rising above the surrounding trees. Baroque, barroco, comes from the Portuguese word for a flawed pearl. Nicola and I lay on the bed reading magazines. I hugged her, my flawed pearl. The next morning we walked to the lake. Under the waterfall, we didn’t talk about the possibility of her death. Fifty-five per cent of patients, Dr Anand had told us, make it through a bone marrow transplant. There was nothing to say about the alternative; we chose life.
Nicola was due to go into King’s on Sunday evening. They would start treatment straightaway. We left Blenheim after breakfast on Sunday morning and drove quietly home. We both wanted to be brave, but neither felt it. The house seemed empty with Joe gone. Martha was still away in Cambridge. We were quiet but there’s nothing, now, I wish we’d said to each other: in twenty-eight years we’d played love’s every key. Everything ends. Nicola’s suitcase was already packed: headscarves, Kindle, pyjamas. She stuffed toothbrush and make-up into a sponge bag while I made lunch. Neither of us wanted a glass of wine. Our talk was forced. We remembered grey Sundays in the old days, when shops were closed and streets empty, and there was nothing to do but go for a walk or watch an old film. I could feel time unspooling. Two o’clock. She didn’t want coffee.
After a silence, she said, ‘We might as well go.’
So I picked up her case and we walked out of the house. Now, I want to freeze that moment as I locked the door. I want that afternoon back, cold as it was: Nicola quiet beside me, the trees still bare. The hollowness in her voice when she spoke, the way she cleared her throat on the steps.
I started the car, drove slowly down the familiar street where we’d always parked, turned left. We drove south under the plane trees of Camberwell New Road. Traffic grumbled. We found a parking space on a side road opposite the hospital and walked in through the gates.
Men stood on the steps, smoking. Families were leaving as visiting time ended. The hospital was vast, impenetrable, but Nicola knew the way. We walked down a long corridor with ward names marked on wooden boards. The Transplant Unit was buried within another ward. We rang the outer buzzer and waited. I remember a metallic voice from the entryphone: We’ve been expecting you. It was like something from a science fiction movie. Inside, canisters of oxygen lined the corridor. There were no windows; we might have been in a spaceship. The doors to either side were marked INFECTION RISK.
Nicola’s room was on the left, past a further set of doors. It was hot. They’d been sterilising it, the nurse said. She said, sterilisin’, her accent unplaceable. The unit felt hushed; there was none of the cheery clatter of Samaritan. Rolls of protective aprons hung on the wall. Faintly we could hear nurses talking in a side room. It was early evening but the lights were already dimmed. A porter rolled a trolley of dirty plates past Nicola’s open door.
‘I’ll bring you the menu later,’ he said.
We took stock. The usual bed, but the blankets were different. Everything was cleaner, newer than in Samaritan. A black anglepoise hung over the bed like a butler waiting for orders. A fridge perched on a table, muttering quietly to itself.
To one side was a huge shower room. I stacked books on the window sill while Nicola unpacked her sponge bag and folded tops and knickers into the cupboard. The last patient had left their calendar on the pinboard: foals in a field. A television filled the wall opposite the bed.
There was a brick wall a metre from the window. I could barely see sky at all, and we couldn’t hear London. There was no phone reception. Anything could have been going on outside the walls of this place. You could imagine a park, a village, or the shore of an island; a prison yard, a garden, or a deserted city with homes abandoned and
shops boarded up. We felt like convicts or fugitives: like Anne Frank in her attic, or a prisoner in the condemned cell, watching twilight through the bars.
I left Nicola at ten and drove home. The builders were due to start on the house next morning. I texted friends:
Keeping you all in the loop – Nicola was packed off last night to King’s in Camberwell for her bone marrow transplant, with some preliminary chemo to suppress her immune system to the right level. She’ll be in 4–6 weeks. We didn’t get to see many of you in the gap after the last bout, because a minor infection unfortunately hauled her back into Guy’s for a few days – nothing serious. But we did get a lovely weekend in Oxfordshire, photo attached. Meanwhile, all is going well. The room is comfortable, and the doctors fantastic.
This is all very much routine for them, so we hope this is the final leg of a long marathon.
8
It’s New Year’s Day in Rome. Last night we went out with friends. At midnight we stood on the Campidoglio and watched fireworks over the forum. People lit paper balloons with baskets dangling below them, carrying wishes scribbled on scraps of paper. We watched them rise into the air. Dozens of candles, man-made stars, they drifted above us, dipped, and burned out over the ruins. A flock of gulls, disturbed, wheeled over us. I didn’t much want to talk. Walking home we pushed through New Year crowds: lovers and wives, families with children.
In an odd way, coming to Rome has prolonged the strangeness of the year Nicola was ill. Everything here is strange. I open the shutters each morning, and looking to the right, leaning on the cold marble sill, I can count the ruined columns of the Forum. A broken tower rises at the end of our street. In a church nearby are the chains that bound St Peter’s hands. Nothing makes any sense. My wife, my children’s mother, is dead. But at the same time, everything is sharp in my memory: the year we had together; the Snapchats we sent every day; the quiet room in which Nicola died, her forehead warm under my lips.
A Moment of Grace Page 10