by Sarah Moss
‘Let’s look at your parcels,’ I said. ‘Maybe there’s something to cheer you up a bit.’
I was peeling off sticky tape and enthusing to myself while Miriam lay with her eyes closed when I heard the high voice of the Family Liaison Nurse at the nurses’ station. Her footsteps approached. Most of the nurses wear the kind of shoes you’d expect a person to wear for standing and moving round for a thirteen-hour shift, but the others, and the women doctors, make a kind of percussion in the ballet of hospital life. Castanets. The opposite of echolocation. Miriam kept her eyes closed. She had retreated, I thought, she had gone away.
‘Good morning. Miriam, are you not feeling well? A bit wheezy again?’ She looked at me. ‘She’s usually up by now, isn’t she?’
Yes, I thought, she’s usually at school, hanging out with her friends during morning break.
‘She’s well,’ I said. ‘Miriam, Erica asked you a question.’
Allowances, yes, but not rudeness.
Miriam opened her eyes but didn’t look at us. ‘I heard. I’m perfectly well, thank you. Never better.’
Erica nodded. ‘OK. Well, the doctor’s going to talk to your mum and dad in a little while, and then maybe we can make a plan.’
Miriam looked at her. ‘Do you mean he’s going to say I can go home?’
Erica’s eyes widened. Family Liaison Nurse, she should have seen that coming. She’s used, of course, to younger children, less alert children, sicker children. ‘I mean we can start planning for when you will go home. When we all know you’ll be safe there.’
‘When?’
Erica looked at me. ‘When Dr Chalcott and Mum and Dad are all happy with the plan. I know it’s hard but I can’t tell you when, Miriam. This is going to take a bit longer. But it will feel better, won’t it, to have a plan?’
To have a story. A plan is a story about the future.
a room for telling bad news
The Family Liaison Nurse led us past the fish, out of the ward, into the corridor where the air was spiced with the promise of external doors and people in coats and gloves. It did not feel right, for Emma and me to be in each other’s presence and not with Miriam. We’ll look after her, the nurse had said. I hesitated; I had heard children whose parents were not there crying until other parents took charge, and while I knew Miriam wouldn’t cry, she might stop breathing. You can go, Dad, said Mimi, I promise not to die until you come back. I know that she needs to say these words, needs to hold them to our throats like a blade to see if we flinch. I do flinch, which is, it occurs to me, what she hopes to see.
I did not take Emma’s hand. We walked as if we had met so recently that the silence was awkward. You got here all right, then, I might have said. Any plans for Christmas? Erica took us through a waiting room where couples looked up as we passed, ready to hope for news or to resent other people’s movement, and toddlers drooled and sneezed over plastic toys on low plastic tables. She led us down another corridor, narrow so I fell in behind Emma, full of central heating and second-hand air. Doors marked in the NHS font stood half open, showing plastic desks and patterned screens around examining couches. They think that cartoon characters comfort, or perhaps only quiet, children who may be going to die.
The room at the end was octagonal, the windows too high to see through, and it was pink. Old-lady pink, salmon pink; it is dead salmon that are salmon pink. There was a grubby pink plastic sofa and a low plastic table supporting a box of tissues which was among the most sinister things I have ever seen. It was a room for telling bad news, such bad news that the posters about the evils of obesity and smoking were not here. There was no need, really, to tell people anything once you had brought them to that room. Perhaps the idea was that any prognosis would be better than you would come to expect after being left there for fifteen minutes waiting for the consultant, especially in the company of a frightened GP who knew a whole lot more about rare kinds of anaphylaxis than she had done ten days earlier. I told you, Emma said, this isn’t going to go away. There’s no diagnosis that means everything will be OK.
Shut up shut up shut up shut up. I am afraid I put my fingers in my ears. I am afraid I threatened to leave her there and wait in the corridor outside if she said one more word on the subject, if she continued to steal the closing minutes in which I could not know what I very much did not want to know.
We heard footsteps, and Erica’s voice. Erica and Dr Chalcott came in together, as if he needed a henchman for this conversation, someone who could hold us back or pass the tissues. I stopped myself standing up as they came in, bracing myself. Why do all conversations with doctors in hospitals feel like a confrontation? Because they want to get away, because they fear that you will lie on the floor and grab their ankles, claw at their white coats, allow them to drag you along the corridor behind them as you implore them to tell you a story. There was, of course, a clock on the wall of the room for bad news. A clock and nothing else. I saw Emma straighten herself, pull the mask back over her face. Doctor.
her body made a mistake
Dr Chalcott and Erica had come to tell us a story. To tell us a diagnosis, if you prefer, although a diagnosis is a story, brings a story’s promise of safe conduct through time and place to an anticipated ending.
Once upon a time there was a clever girl. She lived with her father and her mother and her little sister, in a town in the centre of England. The town had two fine parks, given to the townspeople by a Victorian entrepreneur turned philanthropist, doubtless in expiation of the kind of sins that end in the ownership of land, but the magnolia flowers there were no less like expensive paper, the roses no less heavy-headed, for that. There was a river where swans glided, where moorhens and ducks presented the town with charming infants in due season, and a canal where wooden boats painted like Christmas tree ornaments lay serenely moored. Perhaps, the townspeople would say on their Sunday walks, perhaps we should buy one of those, perhaps if we lived on a boat we would be happier and more free. Not that there was any reason for unhappiness. Not that they were not already, by any global or historical standard, free.
The girl’s family were not poor, but, like most families, they rarely felt rich. Her mother was a doctor who worked mostly with those in a neighbouring town who were poor and often also unhappy and afraid, and her father made it his work to care for his wife and his two daughters. They lived in a small house where there were more books than bookshelf space, more toys than cupboard space, more coats than coat-hooks, and so they were not always comfortable but they were not unhappy: the man loved his wife and had not, in twenty years, cast a covetous eye on another woman. He loved his daughters and had never in their lives wished that they were different from the way they were, never wanted them in any way muted or diminished. The time would come when he would remember his faith in his girls and be comforted that he had always felt it.
For fifteen years, the family thought they had been blessed with two healthy children. Or perhaps, for fifteen years they had been blessed with two healthy children. The girls began to breathe at birth, within a minute of the cutting of the cord, and went on doing so, day and night, waking and sleeping. Their hearts continued to beat, faster for running, for fear and for joy, and slower for resting and growing. Their mouths received food and drink, their digestive systems took what was good and eliminated what needed elimination, and the girls grew in strength and sense as the seasons passed. They were well. There was nothing wrong. And their parents, who for one reason and another already understood that to have children who are well is to be in a state of grace, knew their blessings. Their luck. Their blind, undeserved good fortune. This is important. They were not complacent, not heading for a fall.
And then one autumn day when the wind was wild in the trees and the last leaves filling the air, the girl ate her lunch at school (pizza which she would later describe, when asked by her doctor, as ‘ersatz’; an apple, later characterised as ‘red and powdery’, and half of her friend’s cereal bar, brand name and i
ngredients forgotten and the subject of extensive research and speculation in the following weeks). After lunch, she and her two friends went out onto the playing fields, where they found it too cold to sit under the trees as they had been doing earlier in the autumn and so walked around, circling the field as they chatted. We talked about the usual stuff, she said later, not that it was relevant, not that anyone really thought that what happened next was caused by conversation. Parents and their comparative iniquities. Boys, and specifically whether Will in 10H returned Charlotte’s interest. Next week’s Geography test. The likely outcome of the next election, what might have motivated or driven a girl of their own age at a neighbouring school to make her way to Syria with the intention of marrying a fundamentalist fighter. We were saying, the girl would report to her doctor, that your generation has pretty much taken our future, that unless we happen to have parents with at least cultural capital and equity in their houses if not actual surplus in the bank, our generation has no reason to expect to have jobs or houses when we grow up however hard we work, so why wouldn’t you bugger off to a war zone if you’re desperate or gullible enough to believe it offers more opportunities; we were saying that if the grown-ups want to stop teenage girls going off to be terrorist brides they should be thinking about what the girls are running away from as well as towards. Stuff like that, we were saying. Yes, her doctor would say, I understand that, and then what happened, Miriam?
Then she took out her phone to show her friends the pictures of her play at the weekend, and then they started taking close-ups of the leaves. They found a drift of skeleton leaves, holly and beech, and became fascinated, dusting off the fragments of loam and soil as if from ancient remains, holding the leaf-bones up to the watery sky, trying black-and-white photos. Playing. The bell rang and they hurried in for Maths, but at the door the girl felt for her phone, which was allowed on school premises only if it remained switched off and in her bag throughout the school day, and thought that she had left it under the trees, on the far side of the field. I’ll catch you up, she said, cover for me if I’m a bit late, and she ran.
And somewhere deep inside the girl’s blood, in her bones, molecules began to tell the wrong story as she ran. They perceived, from somewhere, a threat. Her immune system acted fast, as immune systems need to do. She became, she would think later, profoundly afraid; a ‘sense of impending doom’ is invariably listed as a diagnostic sign although it is also, as she would observe, a reasonable and indeed obvious reaction to the other symptoms, which on this occasion followed in rapid succession. Her skin reddened, her face and then her throat swelled. Her blood left her belly, her lungs and her heart and filled her skin. It became hard to breathe. Her heart-rate accelerated, and went on accelerating. Her blood-pressure fell and went on falling. And then there was no more oxygen for her blood, no more energy for her arms and her legs and then for her guts and at last for her heart and her brain and her movement. Her sight and hearing and then her thoughts and finally her heart ran out of fuel. Her heart’s chambers, its portals, fluttered frantic, struggled, slowed. Stopped.
Once upon a time, her body made a mistake and ended itself. And her doctor did not know why, but he did know that the event, the incident, was likely to happen again. To repeat itself, he said, as if the incident were an agent, the subject of a reflexive verb, capable of eternal motion. As if the story of her dying, of her anaphylaxis, were a form of mutually assured destruction between her blood and the world, a pact that by its nature could not be undone. This is called exercise-induced anaphylaxis, he said, and it means that when Miriam exercises shortly after eating whatever the trigger food turns out to be, or after being stung by a particular insect or taking a particular drug or in some cases feeling cold, her breathing will shut down and then her heart will stop. Usually, he said, there is a cause, usually there is an agent that we eventually identify, but sometimes, especially if it doesn’t happen again, we never know. Sometimes the body keeps its counsel. And sometimes the anaphylaxis is not induced by exercise or any other known cause, and then we call it idiopathic, which means—
I know, I said, it’s the same root as ‘idiot’ or ‘idiolect’, it means we don’t know, it means that sometimes these things just happen. It means that death can occur spontaneously for no reason.
He nodded. One thing I will say, he said, as if he had not said the other things, or had said them involuntarily, one thing I will say, Mr Goldschmidt, is that Miriam was down, she was without oxygen, for quite a while, for several minutes and I know she seems normal so far but sometimes you see changes, sometimes you start to notice things, when someone goes home.
I looked at Emma and saw that she already knew that, had thought of it at the beginning, that there had even been conversations, among medics, when I was not there.
I saw that I had not given her permission to tell me what I did not want to know, and that in refusing I had left her to know it alone.
I was sorry.
But I did not say so.
unforgivable lists
My father came, the first of our magi. He took the train, coming out of the depths of the Cornish winter where the stars shine brutal through the long nights and the rest of the world seems very far away, aborting the Cornish hibernation to hasten along the blood-red coast of Devon, through the sullen marshes of the Somerset Levels, past the strange earthworks and jealously guarded military installations of Wiltshire, into the magnetic field of London and out again, pulling away north, to us. I thought, he said on the phone, I thought I’d get a hotel room by the hospital, give you some kind of base there, be on hand where you don’t have your friends round the corner. Unless I’d be more use at your house? No, I said, you’re right about the hotel. If that’s OK, if you can afford it. I mean, we could help with that, if you like? I am never sure how much money he has. The house, yes, bought with his mother’s legacy, saved, it turned out, for decades because he had never intended to see out his days at any of the communes where he’d spent his adult life, but income? Odd jobs for neighbours, a run of evening classes in woodcraft, a few things on a friend’s stall at the craft market in summer. Enough, apparently, to pay the bills. No, he said, Adam, there is no need.
Miriam slept late again that day. The child in the next bed had had a bad night, pain and crying, and somewhere around 4 a.m. there had been some kind of emergency at the far end of the ward, bells, running feet, urgent talking, a senior voice angry on the phone and the rush and squeak of a bed being rolled away to Intensive Care. I have not seen Intensive Care and do not want to; let there be some bitterness I don’t taste, something left for other people. I wanted coffee but I didn’t want Miriam to wake up alone, to think that I leave her when she sleeps. I needed the bathroom, needed cold water on my face. No-one in a hospital is fully awake and in the world. Hospitals have their own gravitational field, their own atmosphere; you can feel it from the car parks.
I stood by the window, tasting the sourness of my own mouth, aware of my own smell after a night on a plastic chair-bed under a synthetic blanket. It was raining again, and since we had been moved across the ward, Miriam’s priority dropping now she had a diagnosis of sorts and medication, we had a new view. The canopy of the hospital entrance, the end of the police station, an oddly quiet four-lane highway beyond, and office tower-blocks filling the sky. You could watch people approaching the hospital’s maw, see them lower their heads or set their shoulders, and you could see people going away, parents leaving without children. I did not look very often.
I scanned what I could see for organic forms, for leaves or flowers or anything at all that had not been built or dumped by humans. There is always the sky. There was rain. There was moss in the hospital’s gutters and some rosebay willow herb growing out of one of the disused chimneys. I craned further. There were a few dead leaves along the windscreen wipers of one of the cars parked in the named bays for senior managers, passengers betraying a garden at home, another life. Although it was six months since we
had last been there, although all the time my father was in America I never crossed the Tamar, I sickened for Cornwall, for my father’s house, for the gorse and rocks of Bryher Farm and all those years when I did not know that this was going to happen.
It could be worse, I knew that. On the ward, I was surrounded by parents and children for whom it was worse. I leant my head against the cold window and closed my eyes. In the darkness of my head, I made unforgivable lists of parents who might reasonably envy me. Auschwitz, Belsen. The massacre of the innocents. When Yugoslavia came apart, there were villages where people nailed their neighbours’ children to their own front doors. Those whose children’s dying cries were recorded by their murderers. The toddler whom no-one saved from the boys with bricks. The children under falling bombs in places where bombs fall, in the sea in the places where boats sink. At least no-one had deliberately harmed Miriam, no-one had seen her going about in the world and decided to take her body and kill it. Inexcusable, I was inexcusable.
‘Adam?’
Suddenly, Dad.
I found myself in his arms.
For a long time.
He stood back, tipped his head towards Miriam. ‘How is she?’
‘Well. Stable. Very bored.’
‘Out soon?’
‘Once they’ve tested her for reactions to some of the less obvious things. As long as she doesn’t start wheezing again. A few more days.’
He nodded. I didn’t tell him the other bit of the story: once I have been properly trained in CPR, and once we have all been trained to use the adrenaline injections she will need to carry for the rest of her life.