I hate that we’ve started a year Nicola never saw; that never saw her.
At King’s we settled into a new routine. Guy’s was just round the corner from where I work. Now I had further to go. Leaving at six, I cycled furiously into the wind. Tail lights jammed Camberwell New Road. I always felt late. For some reason that bicycle journey to King’s has left a scar on me. Most of the time, I’m fine. I can work confidently all day, laugh, joke, run meetings, but when I get on my bicycle to go home, I find tears running down my cheeks. A friend, also bereaved, said, ‘It’s because you’re reliving the journey. I used to drive to the hospital. I cry in the car.’
The route soon became familiar: the right turn by a solicitor’s office, the railway bridge, the hospital looming above me. There was a cherry tree that started to come out in the weeks I cycled past. It blossomed and was over by the time Nicola died.
Arriving, I ran up the hospital stairs, washed hands, wrists and thumbs, wrestled into gown and gloves, and spent all evening with her. We watched Scandal, an American series, then fell back on old favourites. We were halfway through Bleak House when they moved her to Intensive Care; I haven’t finished it yet. In the days running up to the transplant Nicola felt well enough, except that the chemo designed to suppress her immune system made her sick. She hadn’t been sick before; it seemed unfair. I listened to her retch in the bathroom, then gargle and come out smiling.
They allowed her out each morning – so long as her counts were high enough. She went for walks in Ruskin Park, and texted me photos of flowers coming out. It was spring. There was a tree she liked to sit under, a copper beech. The first weekend, she showed me the pond and the bandstand with a proprietorial air, and we sat under her beech. Ruskin Park isn’t big; we walked round twice. The hospital chimney glinted in spring sunlight. Some geese had just hatched by the pond, and waddled importantly over tarmac, shaking their yellow fluff. A judo class practised on the bandstand. Down by the allotments, a notice was wired to the fence proclaiming a ‘Community Garden’.
Someone in the nineteenth century had laid the park out. The trees were mature, but everything around them had declined into shabbiness. Weeds choked the formal garden. The horse chestnuts in the avenue were overgrown. It felt like the magic garden in a children’s book, as if it had been closed up for years. We paused under rhododendrons, thick and dark. Parrots shrieked overhead. There was a path through long grass that reminded us of our river walk at Pin Mill.
Some years ago the park had become a hangout for addicts, the nurses told us; now they were trying to clean it up. The boating pond was dry, with long cracks scoring the cement. From the high ground you could see all the way across London: the Shard, the City and Eye, the housing blocks at Loughborough Junction. Nicola and I stood and looked at the view, hand-in-hand. We would never leave London, we’d promised each other years ago: it was our town.
At home I stood on the roof discussing rafters and plywood with the Romanian builder. You could see miles from there as well: Big Ben, the Elephant and Castle. Our bedroom ceiling wept dust. The rot was far worse than we’d feared, but I wanted everything done before Nicola came home.
‘Four to six weeks,’ the consultant had told her. ‘Three weeks would be a record.’
Dr Anand was off the ward, working in the lab, but her colleague, Professor Lake, was brisk, kindly and expert. There was a well-defined protocol to transplants, it turned out, with prescribed doses and timings that seemed slightly military. We were at transplant minus nine, they told us, the day Nicola went in. They didn’t tell us the name of our donor – British, they said, though many came from Germany. It wasn’t a difficult procedure for donors. They simply gave blood, enriched first by stem cells leached from their bone marrow through a course of injections. We’d met one patient who’d been to visit his donor in Düsseldorf. He and his wife had wanted to thank him, he said. The donor had become a family friend. Selfishly, we just longed to get past the transplant and out the other side. We wanted our old lives back.
Transplant minus six. We watched The Durrells at weekends, dreaming of Greece; read Joe’s blog from New York; saved up High Society for Sunday night. It was the closest we could get to our Sunday-night ritual of a TV movie at home. I got used to the shop where I bought Nicola iced tea and newspapers. I learned the twenty-four steps to the first floor, where there was a door marked Cardiac Endoscopy, with an old patient in hospital pink always sitting outside it. The menu at King’s promised much, but the cooking was as bad as ever. Nicola retched into her toilet. I cooked food for her at home and brought it in Tupperware. On Saturdays I pushed a trolley round an unfamiliar supermarket in Camberwell, loading it with biscuits, crackers, processed cheese. At home, the roof was off. I slept downstairs. Each morning, builders tramped through the house, leaving muddy footprints on the carpet. Rot had wormed its way deep into the timbers, we discovered. We stripped back slate to expose papery plywood, blooms of mould. Everything had to be hacked out. Above us the sky was blue and cold. At night the builders spread tarpaulins in case of rain.
The transplant was planned for 26 April. Nurses counted Nicola down through prescribed doses of chemo. They raised bottles to the light, intoning her name as they checked it against their lists, as if we were commencing an ancient rite. On the day itself I left work early and cycled south. The Anthony Nolan Trust, who’d found the donor, sent a card wishing her well. Nicola was excited: this was the treatment that would cure her. I took a photograph of her in bed, smiling.
This morning I scrolled back through photographs of Nicola on my phone: photos of her in Guy’s just after being diagnosed; photos on our weekends at Penshurst Place or Mistley; photos at Blenheim; photos of her in France; pictures of her sitting in bed, with a blue hospital curtain behind her; or curled on the sofa at home; photos of her walking, resting, raising a glass. In all my photographs she’s smiling, her mouth wide and eyes alight with fun. Her headscarf might be askew and her glasses crooked; she looks tired, in some of the pictures, and thin; but illness never robbed Nicola of joy. It never quenched the love she felt for me, for her family and friends, for life. Her eyes, in photographs, are brighter than the eyes of the living. Amused, cheeky, full of affection. Glinting with the joy of these lost moments, a joy she retained while the rest of us grew fearful, while her body rebelled, while disease crept up on her from behind.
At six o’clock the transplant still hadn’t arrived.
‘They come late, sometimes,’ said Jen, the transplant nurse. ‘Don’t worry.’
We worried. We didn’t want any hitches. We’d got this far; now we wanted it over. To lose the day, to become keyed up again for tomorrow, was more than we could bear.
Emails were sent; the transplant was in transit. Evening faded on the brick wall outside Nicola’s window. We watched Scandal and talked, not about the transplant. Guy, the friend who’d been through it, had said it was an anticlimax, ‘just a blood transfusion.’ He got a bad reaction, but they controlled it with drugs. ‘The worst thing,’ he’d written, ‘is the fear.’
At last Jen knocked on the door: the courier had arrived. We watched her set up tubes and cables, call another nurse to double-check her obvs. She bowed over Nicola’s Hickman line, screwed in the connector.
‘There.’
Dark blood filled the tube. A first drip shook the bag, quivering the taut plastic; the timer on the monitor winked. It had begun.
‘I’ll check you in ten minutes.’
We played cards. It would take three-quarters of an hour for the enriched blood to flow into Nicola’s veins, for the ritual in her body to begin as old cells were slaughtered and new ones absorbed. I pictured bees circling in a hive. I knew it wasn’t like that – this was cutting-edge medicine, wizardry that saved lives. Jen popped in and out. Nicola’s temperature stayed flat; it was, indeed, an anticlimax.
But both of us felt exhilarated. This was the cure, the game-changer that would pull her out of cancer’s reach, a lifeboat resc
uing her from the sea. We knew we faced some long and difficult years, but at the end of them lay health, normality. We knew that Nicola’s immune system would be destroyed. For a time she would be naked, exposed. But absorbed by her bone marrow, the new stem cells would start to build ramparts of their own against disease, infection, bacteria.
‘You’ll have to have your childhood vaccinations again,’ Dr Anand had told us. ‘Polio, MMR, that sort of thing.’
We joked how Nicola’s donor would be younger and healthier than her; she would end up a superwoman. To start with, Dr Anand told us, her immune system would be like a child’s. She used a striking phrase: ‘a fledgling’. We’d watched fledglings on the trees in France, blinking at the world, testing new wings. Scrawny and vulnerable, they hunched on branches. When Nicola’s hair had grown back, tufty and irregular, she’d looked a little like a fledgling, blinking as she woke up. Once she’d been elegant, but she stopped dressing smartly when she fell ill. Instead she wore comfortable old trousers, too-large cardigans and T-shirts she stole from my drawer. It was as if she didn’t need elegance anymore.
I think that in illness Nicola became everything she could possibly be. Her bravery, her kindness, her genius for love were all there, all part of her. Dying, they took on a new richness and warmth, like the colours of a painting deepening with the passing of time. I said in the speech I made at her memorial that Nicola was not just more gifted, but had fewer faults than anyone I ever knew. She wasn’t petty, or jealous, defensive or insecure. She wasn’t resentful, moody, anxious or vain. She didn’t know how to hate or carry a grudge. Contentment steadied her. She looked past storms.
Love glowed on the water around her, like light shining from the portholes of a ship. Somehow Nicola forged through trouble, unperturbed. By instinct she dismissed anything negative. She had the intellect to know what mattered, the strength of will to stick to it, the humour to laugh through difficulties. She had the generosity to live for other people, the purity of judgement to know what and whom she loved. All that was there, throughout her life. In illness, her perfections came into focus, lit by a setting sun. Nicola was generous and gleeful, wise and mature. She knew not to complicate illness with fear. She knew how sorrow could house joy.
On transplant night she lay in bed as the blood dripped into her system, eyes already closing. It was late. Jen had stayed on past the end of her shift. It was half past ten by the time she packed the drip away. I kissed Nicola and cycled home. Transplant Day. I was keeping count, at home, of the nights she stayed in hospital, Xs marked on the squared paper of an old notebook. She’d been in nine days; I circled the tenth.
Four to six weeks was the norm, after a bone marrow transplant. Nicola bet she’d be out in three.
‘It’s a waitin’ game,’ Jen had said.
There was nothing for us to do. Professor Lake came round each day. Her team followed behind her like the goslings in Ruskin Park. Blood was drawn daily for tests. Nicola still felt sick; they changed the meds. Joe blogged from Birmingham, Alabama. We couldn’t go out of doors. While nurses changed sheets or checked dressings, I wandered along the ward to a waiting room whose windows surveyed the park. The cleaners went there too, on their breaks, lounged on the blue plastic banquette, made calls in fast-flowing West-African French or slow Jamaican. A television blared daytime game shows. After leaving Nicola each night, I went to supper with friends nearby. I was more scared than I admitted, even to myself – I can see that now. It felt odd sitting at someone’s dinner table without her.
But she was doing well. I’ve got a phone video from 2 May, transplant plus six, of Nicola and I dancing next to the bed. Martha spent weekends with us. We watched Pride and Prejudice, the eighties series with a glowering Colin Firth. Nicola stayed cheerful. Like a top exam student, she seemed to be sailing through transplant with no points lost. She would be one of the lucky ones – she felt no bad reaction, no exhaustion, just the sickness which had started with chemotherapy. I baked rolls and brought them in a blue plastic bag, concocted picnics of supermarket taramasalata and Babybel cheese. We ate them on the end of her bed. She spoke on the phone with Joe in New York. The Trump election was gathering pace; Joe went to a Bernie Saunders rally and heard Bill Clinton speak.
It was a waiting game.
On 4 May I was up in Edinburgh for work. As I landed at City airport I got a text from Nicola, I’ve got news. I called in panic but she wouldn’t tell me what it was.
‘No.’
‘What’s happened?’
‘It isn’t medical.’
Scared, I hurtled down the escalator, ran from platform to platform, leaned over the handlebars of my bike. I made it from the airport to King’s in forty minutes. Nicola was sitting up in bed, grinning. A letter lay open beside her: she’d been offered an OBE for services to the arts. I hugged her through the trailing cables of her drip. The letter was on stiff, yellowish paper, satisfyingly old-fashioned; it looked as if it had been typewritten. We speculated who might have put her up for it. I promised to call the number on the letterhead next day, to say she wouldn’t be able to collect it until autumn at the earliest, even though things were going so well. Nicola had friends who had turned such awards down – Empire? Really? That didn’t even cross her mind. It was an award, it was fun, and her parents would be delighted. She’d rung them already, swearing them to secrecy.
Next, two weeks in, I came in to find Professor Lake standing by Nicola’s bed, beaming. Her white cell counts indicated that the transplant had ‘engrafted’. I pictured the booster of a space rocket cutting in, thrusting it towards terminal velocity. A new star in the sky. There was no sign of any infection.
At home, Adrian finished the roof. He worked all weekend to do it, just in case they let Nicola out.
‘She’ll probably go home on Monday,’ said the junior doctor on duty that weekend. ‘But Professor Lake needs to sign it off.’
I pushed furniture back into place in our bedroom, hoovered the stairs, made the bed, then went round the house spraying taps and doorknobs with disinfectant. I pictured Nicola’s fingers touching light switches, opening the fridge. She would be home soon, and it was still only three weeks since she went in. Transplant had indeed been an anticlimax. We wondered when she would be allowed to go to theatres and cinemas. I texted, My darling love sleep deep and sound. I wish I was there to hold you.
The next morning her obvs showed a temperature, a small one.
Her bones ached, too. Not badly; the doctor thought it might be a reaction to the chemo. Neither of us worried too much. We wanted to break the record for coming home, but we had time in hand; even another week wouldn’t hurt.
But by Wednesday, Nicola’s fifty-first birthday, her temperature was worse. I gave her a Japanese bowl I’d found in a gallery on Marylebone High Street, but she wasn’t as enthusiastic as I’d hoped. She wasn’t feeling well. She was tired, too, more tired than before. And the nurse on duty was bothering her. It was important to take paracetamol early, to stop her temperature spiking, but when Nicola rang to ask for her dose, the nurse took forever to respond.
Professor Lake sent her for a chest scan. It was precautionary, she said, just to make sure nothing worse was going on. We didn’t sense worry among the medical staff. Hadn’t we been told transplant patients went from infection to infection? It was never going to be a straight road. All the same, both of us were disappointed when the next weekend came – four weeks after admission – and Nicola’s temperature was still spiking.
‘We’ll change the antibiotics,’ Professor Lake said. ‘We can try something stronger.’
She spoke about taking out Nicola’s Hickman line, a possible source of bugs. Tests were sent off to the lab, seeking to isolate the strain of infection.
We couldn’t stop thinking of the previous autumn, when a chest infection had landed Nicola in Intensive Care. Now her chest felt tight again. Standing by the machines, taking obvs, the nurses told her to take deep breaths. A new monitor wa
s wheeled into place to track her oxygen. I went in each morning. Good days brought elation. Am awake and feel much more like me, Nicola texted on the 15th. All oxygen, blood pressure etc steady overnight tho I did spike a 39.9 temperature at one point. Have eaten a banana and am practising breathing. Call me when you wake up. I love you. But a few hours later her temperature rose again.
We could tell something was going on inside Nicola’s body, but didn’t know what. Like soldiers trapped on a hilltop, we were being outflanked. Although we didn’t know it, these were the weeks in which death took up residence within her. We saw nothing; our eyes were on infection markers and temperature spikes. We didn’t see – no one could see – the gradual hardening of her lungs; the chaos in her blood; her immune system, panicked by intruders, turning against her own body. The process was as deadly, as impersonal, as an avalanche sliding down a mountain. It was no one’s fault. The human body isn’t a machine, mass-produced. Nervy as a wild animal, high-strung and fragile, each system reacts differently to the same drugs. Nicola’s decline was triggered by forces that were never fully under control, and never could have been.
A week after her birthday they took out the Hickman line. They found pus at the end of it. Everyone hoped we’d traced the infection to its source.
‘I think we’ve turned a corner,’ the weekend doctor said.
Nicola smiled from her bed. She wasn’t getting up anymore. Sickness made her tired; it was easier to stay in pyjamas. She’d given up completely on hospital cooking, whose smell nauseated her. I left the office early to cook her food, but she didn’t have any appetite. Sickness wasn’t a problem in itself – she would get over it as the chemo wore off. But it made her feel weak and demoralised as her temperature rose and fell in the first two weeks of May.
The autumn before, antibiotics had cured her. We waited for the familiar magic to work, for the temperature spikes to become less severe and the infection markers to go down. The doctors adjusted her drugs. It was still less than six weeks since Nicola had gone into hospital. She was still in the ‘normal’ band. Although it was annoying not to be the star patient anymore, there was nothing to worry about. The next weekend we watched Singin’ in the Rain. Hope came and went. On Sunday she had a better day and we breathed a sigh of relief. It felt as if a corner really had been turned. But her fever spiked again that evening.
A Moment of Grace Page 11