by Tim Parks
In His Image
MY PARENTS HAD two overriding concerns in their children’s regard: our spiritual welfare and social position. To have brought into existence souls destined for eternal damnation would be a catastrophe. We must be steeped in the Christian story. We would sin, naturally enough, but we would always be wise enough to repent and stay on course for paradise. At school our achievements would guarantee us a position among the diligent middle classes, or with any luck the free professions. As far as our bodies were concerned, what mattered was that they be respectable. We must be tidily dressed, our hair tidily cut, our hands, necks, mouths and fingernails tolerably clean. As long as one scraped the mud off one’s shoes afterwards, sport was an acceptable way of letting off steam, but not important in itself. The fact that I was captain of the school football team was not important. If I scored a winning goal it was not a cause for congratulation. That my brother would never be able to participate in sports, never be able to run or jump, was thus no great loss. A well-knotted tie was important. And clean shoes. Keeping your shirt tucked in, your hair combed. We must not use obscenities or blasphemies. We must not masturbate. Not that the word ‘masturbate’ was ever uttered. There was a fear of words like that and of the shared knowledge implied when two people used them. We must not ‘touch ourselves’. We knew where. I remember my embarrassed amusement when the Harley Street urologist (he who ‘cured’ my prostatitis) told me, ‘You must climax, every day, Mr Parks. If not with your wife,’ he coughed, ‘then alone.’ Primates, he explained, climaxed many times every day. In evolutionary terms, we were programmed to keep the prostate busy and its sperm on the move. ‘To avoid congestion in the prostatic ducts,’ he assured me.
‘You little monkeys!’ had been my mother’s indulgent protest when we did something mildly improper. She did not believe in evolution. To be seen slipping one’s hands in one’s pants elicited a more flustered and aggressive response; to the point that I sometimes wonder whether the anxiety and repression that surrounded adolescent stirrings was not responsible for putting the first strains on my prostate. Was the little organ supposed to shoot its load or not? I would start to indulge, begin to enjoy, hear my mother’s anxious voice, stop. But all this is the merest speculation and I’ve no desire to blame my parents. They cared for us as much as parents can. The fact is that the whole society was, still is, unsure as to what our relation with our bodies should be.
The human body was the temple of God, my father explained, and made in His image. But this did not mean we should worship the beautiful bodies on show in magazines and cinema (actually, there were no magazines in the vicarage and I went to the cinema only once before age eleven, to see Sink the Bismarck). What it meant was that the body must be kept pure otherwise we would be offending God; being made in His image was a cause for caution, not celebration. Ugly, ungainly people were also made in God’s image; if they washed and dressed properly and stood up straight, they were as respectable as anyone else.
At school the body featured in biology lessons. It was made up of bones, organs, muscles and tendons that could be shown in diagrams. A list of names must be inserted in the right places below the diagrams. Trapezius. Biceps brachii. Deltoids, flexors, abdominal transversals. These basic anatomical elements were nourished by a network of arteries and veins which likewise lent itself to two-dimensional representation and simple, quiz-like challenges. A day’s swotting guaranteed you eighty out of a hundred in the end-of-term biology exam.
But as the years passed and the diagrams grew more coloured and intricate, accompanied by chemical formulas and names that were hard to spell, it became clear that only the most assiduous and determined among us had any chance of understanding this prodigious machine with its lymph nodes and cell structures, its proteins and mucous membranes. At no point were we invited to compare our own bodies with the diagrams we studied. Phenomenally complex it might be, but the body was still only a mechanism, an object of study. The body wasn’t us. Which was why it was fine, once you’d grasped the basics, to leave deeper understanding to the experts, the same way you do with cars and computers and central heating systems. Only a handful of us would pursue biology beyond O level. If ever something were to go wrong with the body that you personally happened to be in, these were the people who would fix it for you.
My wife phoned me at the office to say the blood and urine results had arrived in the mail and I went out on the river in my kayak. I refused to be anxious. In winter I use a light slalom kayak. Sometimes I paddle three bridges up the river and surf on a wave in the rapid by Ponte Pietra, the old Roman Bridge. This inevitably becomes a form of exhibitionism. Tourists standing at the parapet take photos of the city. They point their cameras down at the surfing canoeist, no doubt wondering if you will hit a rock or capsize. They want a memorable snap. If you make the effort to force the boat up the rapid and under the bridge to the other side, they applaud when you climb the last rush. They aren’t discerning enough to appreciate that you are only a moderately competent paddler. Certainly they won’t be thinking you have a prostate problem.
Or I practise threading the slalom gates at the bridge near the club. There was a canoeing move which obsessed me, had obsessed me for a long time, because although I knew perfectly well in my head how it worked, I could only rarely do it. One of the slalom gates is placed just inside the eddy that forms downstream of a bridge pillar. You have to pass from the main flow to the milling eddy and turn the canoe so that it heads upstream through the gate. To do this efficiently you must drop the downstream thigh as you cross from stream to eddy while swivelling your trunk round and digging the paddle deep on the upstream side. If you get the coordination right, the tail of the canoe slides down into the water of the eddy, the nose rears up, and the boat rotates on the spot. Well performed, it is an elegant, effortless move.
I never got the coordination right. Not true. I got it right sometimes; let’s say, just often enough to keep trying. But I never really learned it. My body got it, or didn’t get it, at random, as if it were a question of throwing six on a dice.
Why? I can ride a bicycle. I can ski. It seemed to be a problem with right–left coordination. I am very left-footed and though I write with my right hand, I catch a ball with my left. Could I have been, in society’s general eagerness for conformity, a suppressed left-hander? Does the sort of tension generated by such suppression produce restless, worrisome, dissatisfied individuals who pester urologists? Why is the body such a mystery and why is the mind so frustrated in its dealings with it, as if faced with an equation that won’t come out? A situation not unlike the mind’s perplexity before some works of art. These are futile trains of thought. Yet I seem condemned to entertain them.
For example, when I set out from my office for a coffee of a morning I often pass a moustachioed man in his seventies who walks with a stick, dresses in a double-breasted suit and invariably sports a white cowboy hat, this in a drab, working-class district of Verona. One day, as we drew close to each other in the street, this debonair pensioner stopped and rather peremptorily announced: ‘For God’s sake, young man, stand up straight!’
I raised my head to look at him. We had never spoken before. He was comically erect, chest puffed out, chin held high, white moustache waxed, a veteran on parade. The stick was a rifle, the tropical suit a uniform, neatly creased; the hat brim was absolutely horizontal.
‘Stand up straight,’ he repeated, as if genuinely irritated by my bowed shoulders. Then, swinging his stick, he strode on.
I was disturbed, but not angry. He had called me ‘young’ after all, and it was true that my shoulders were bowed. This goes with the writer’s profession. Other people had commented on it. At least I don’t have Leopardi’s scoliosis, I told myself. I wondered if the poet’s scoliosis and his urinary problems were linked. And for many weeks I continued to imagine that if by some miracle I could stand up straight, naturally, without forcing myself, and not only stand but walk upright, at ease, my
neck free from tension, my head high, then I would be entirely healthy. My problems would dissolve. And the same would be true, I told myself, if I could do that elegant turn in my canoe; to do that turn every time, with nonchalance, moving from the fast-flowing water to the still and out again, would be to be healed.
Illness, I realised then, like love, or hate, draws everything to itself, turns everything into itself. Whatever I thought about came back to that: my condition.
At home, the envelope was the official kind with a transparent window and the address beneath. I sat on the sofa. It was not unlike, I thought, receiving a formal communication from a lawyer clarifying something as personal and intimate as one’s relationship with one’s wife. For better or worse, richer or poorer, I was about to get some hard information about that enigma, my body.
It was a biology test too far.
P-Colesterolo totale
P-Trigliceridi
P-urea
P-creatinina
P-bilirubina totale
I had no real idea what these words signified. Or what that P was about. Even the units of measure were alien to me. Mmol/L. µmol/L.
There were fifty or so entries, forty of them for the blood, the others for urine: Linfociti, monociti, eosinofili, basofili. Urobilinogeno, corpi chetonici.
What did I know about these things, my body parts? Nothing. The only thing a layman could understand on the printout was that my pee was officially ‘straw yellow’.
Fortunately, beside each entry, in parentheses, there was a range of values considered within the norm. My eye went directly to Sr-PSA totale. Again, I have no idea what PSA stands for, but I do know that a high PSA is associated with prostate cancer. It was the last entry but one and the acceptable range was 0-4.00 µg/L. Mine was 0.31.
‘Heavens, you’re healthy!’ Carlo laughed when I read him the results on the phone. ‘No blood in the urine, incredibly low PSA, no infections; all as expected.’
As I put the receiver down Rita was anxious to know what the verdict was.
‘It seems I’m fine.’
Our friend Larry, she kindly reminded me, had died exactly forty-eight hours after a battery of tests had told him he was in perfect health.
Urodynamics
IN BREATH: A Decision, the book that talks about Bernhard’s pleurisy and tuberculosis, the ‘decision’ is his resolve to leave the hospital without permission and consider himself cured. He would have nothing more to do with the medical profession. Thus he declared his control over his own destiny.
On the other hand he could only do that because he was feeling well enough.
I too was planning to make a decision, but only after I had the results of all the medical tests. Then my decision, most likely, would be acquiescence to necessity, to that ‘official version’ of my condition I had read about so long ago. At the same time, I still hoped the pains would evaporate. I was still playing with my diet.
The blood and urine tests had excluded two possible explanations: prostate cancer and stones. So, the enlarged-prostate diagnosis became more feasible and the TURP operation was a step nearer. The man with the funny hat and frightening surgical instruments was waiting for me.
The so-called urodynamic test, which I did after a morning’s teaching in Milan the following week, pointed in the same direction. This test was actually rather fun. You pee into a funnel and the urine swills down into a device that measures volume released per second. The results are then expressed as a graph showing flow rate over time of urination.
I drank as much water as I could an hour or so before the test, in the hope that this would improve my performance. It’s curious how one does these tests to establish firm facts, yet still tries to get the best result. To cheat almost. Obviously there is something virile about a copious, vigorously splashing pee, and I did not want to seem too pathetic. It crossed my mind that pulling back the foreskin entirely, which compresses the urethra a little and intensifies the jet, might alter the results further in my favour. Then I reflected that this was like putting your thumb over the mouth of the garden hose to get the water to reach the bushes behind the flowerbed. The jet looks better and goes further, but the flow rate is the same.
Standing in a curtained-off cubicle, then, I produced my melancholy, rather lengthy and intermittent pee into the white plastic funnel, while, at the other side of the room, a clever needle traced a tormented, broken-peaked zigzag onto a roll of moving graph paper. As soon as I had zipped up, the young, rather handsomely moustachioed doctor who was supervising tore off my Alpine-arc result and, by way of explanation, sketched over it the trajectory of a normal person: the line he drew showed a smooth pinnacle of healthy urinary performance.
Looking at the two curves, the one vertiginously graceful, the other stunted and stuttering, I was aware that the graphs were telling me something I had actually known for a long time. Perhaps a year before, my son and I had been preparing for a kayaking trip together in Austria. Before getting in the car, we both took a pee in the two loos on the first floor of our house and, being two men alone, we didn’t close the doors. What I heard then – a brief Niagara thundering around the tiled walls, preceded and also followed by the tinkling stop–start of my own silted trickle – was the acoustic and far more felt equivalent of the superimposed urodynamic graphs. Now, I knew the same thing in a colder way, with numbers.
Voiding time 68 seconds
Flow time 66 seconds
Time to max flow 19 seconds
Max flow rate 11.4 ml/s
Average flow rate 6.7 ml/s
Voided volume 447 ml.
Wonderful, as Samuel Beckett’s Molloy remarks after counting his farts for 24 hours, how mathematics helps you to know yourself! I placed the superimposed graphs in the medical file I’d been advised to keep. The sight of the healthy curve did not cheer me the way the sound of my son’s explosive performance had.
‘I’ve seen worse,’ Carlo smiled when I showed him my piece of paper in the hospital cafeteria.
‘So,’ I asked, ‘diagnosis confirmed?’
‘It could still be the bladder sphincter rather than the prostate.’ A normal sphincter, he said, opened almost to the diameter of this doughnut – we contemplated the soggy, sugar-coated ring he had ordered – whereas mine might only be opening – what? – to this: he pointed to the fifty-cent coins he had placed on the counter.
‘That would explain it.’
As he ate and talked, wiping jam from his lips, his eye glancing round at the bodies of pretty nurses, I became aware that despite my miserable urinary performance I was enjoying a faint sense of superiority. Whatever my problems, I was trim and slim, at fifty-one, whereas Carlo, who could hardly be more than forty, was a good twenty kilos overweight and growing jowly. Every time I saw him, he was eating: a doughnut, a sandwich, a pizza. The nurses, I decided, were much more likely to look at me, especially if I managed to straighten my shoulders a little.
In the car driving home I smiled at this vanity, but revelled in it none the less. It was true that my body and I weren’t the best of friends these days; we hardly communicated except through pain. All the same, the flesh could not help but testify to my impressive strength of character: I wasn’t eating jam doughnuts mid-morning. I had self-control.
Thus one might be cheered, I reflected, to find oneself cutting a figure, so to speak, on the operating table.
Later still, Velázquez came to mind again. I was standing at the computer and as I lifted a cup of tea to my lips, my hand trembled. Was it really possible, I immediately wondered, that the boy and man in the painting at Apsley House could hold that water so perfectly still as they passed it from hand to hand? Would a glass in the streets of Seville really have been so crystal clear? Shouldn’t the painter rather have shown the two of them spilling a few drops from a more clouded glass? Everything else in the picture seemed so authentic. And was there a link, perhaps, it even occurred to me, between this no doubt deliberate anomaly and the more fam
ous one in the same painter’s nude Venus where the lovely woman with her back to us has a cherub hold a mirror so she can gaze at her face; only, given that we see her face in the mirror, she wouldn’t have been seeing herself at all, but us, or rather Velázquez.
Both pictures, I thought, calling them up on Google, seemed to have to do with looking, with bodies and minds; and at the centre of both, focusing our attention and tying our mental activity to that of the figures in the painting, were deceptive images of glass and transparency. Why were the boy and the waterseller looking neither at each other nor at the water, yet apparently communing through it?
I went back and forth between the paintings. The exchange of water would have been a commercial transaction – the waterseller sells – but it didn’t look commercial. It was rapt, or meditative, as Venus and her cherub were rapt. But the real question was: why had I – quite absurdly – started to think of the dark fig at the bottom of the glass as the prostate, the prostate in a state of perfect health, but only thus because beautifully submerged in that transparent, strangely mental water? The water was more beautiful because of the fig, and the fig was darkly perfect because of the water.
I get angry with myself when my mind meanders in this oddball fashion. This is the merest self-referential vagary, I muttered. Crotch-gazing. Probably any picture would have set it off. You should give up writing books, I told myself, and accept straight journalistic commissions that would force you to think more purposefully.
On returning home, I opened a letter with the results of the so-called three-day urine cytology test and discovered that they had found pre-cancerous cells in my bladder.
Deterritorialisation