The Iceberg

by Marion Coutts

  There is a machine to do this unpicking and it’s a simple tool from a kit a carpet-layer would use. From where we sit, crossways to the bed bays, we can see that there are only two nurses on duty, the German nurse and the one called Donna. Donna has been at various times the nurse assigned to Tom and the relationship has not been good. She is easily embarrassed, whether by him or by every patient she sees, there is no way of telling. It seems unfortunate, cruel somehow on her that she has elected to be a nurse. Her character might come over better as something else, although I’m not sure where her talents lie. She is readily flustered. Items get dropped: urine, blood samples, swabs.

  Donna is self-conscious about her body in motion as if aware that she does not do the work well. To cover for this she moves slightly too fast, ever exiting the latest incident. She has been known to pretend not to hear. Her hair is distressed and blonde and fixed up at the back with a stabbed mass of Kirby grips. If she could see herself from behind she would not wear her hair like this.

  The choice today is between Donna and the German nurse and whoever is free first will be assigned to Tom. Having watched Donna at work, the idea of her unregulated hands on the hardware to unpin his head makes me hot and weak. I want to cry. I have to stop her.

  Charlie the charge nurse comes in. We saw him once in civvies in the lobby, dressed in battered shades of brown and grey and carrying a plastic bag. He looked like a man in a pub. His face is deeply lined, a current or ex-smoker, and in a bar you would not notice him at all. But on the ward he is the only one worth watching. He is the top steward on the cruise ship and he carries his authority carefully and ever so gently separate from himself, as you would a bowl of water. Casual efficiency is ingrained in his manner. He does not hurry but the ward is his domain and he notices everything in it.

  He is busy. I have to be quick, seize the moment and step in. Tom’s stitches, I say to him, are they going to be done soon? When one of the nurses is ready, yes. No way to finesse this. He must know what she is like. Can I just ask that it is not Donna? He has grey eyes the colour of Herdwick wool and he turns them on me. Yes.

  Charlie is as good as his word. The German nurse takes out the staples very deftly, starting from the bottom, one by one. The bloodied metal brackets clang on to her tray. They look like insects, stuck with matter and bits of hair. In Africa, army ants are sometimes used to do the job of sutures. Here they are simple metal staples. It is no trouble. We wait some more.

  We have started to notice a pattern. There are spaces where we are delivered news. They tend to be spaces rather than actual places: generally improvised, porous, makeshift and vulnerable to intrusion. It seems that the delivering of news, however catastrophic, is not regarded as an endpoint in itself but has the status of a transaction done in the open like a piece of knowledge passed from hand to hand on the way to or from somewhere more pressing. Physical interventions – the removal of the staples – are given a site. Yet beyond a single fit, Tom has no symptoms by which we might know he is ill, so knowledge for us is everything. The disease is invisible, and talking about it is the way we feel its charge. Yet we are never presented with sites that might hold a theoretical explosion or contain its profound impact: the dissolution of the floor, folding in of doors and walls, sudden drops in pressure, the creation of a vacuum, the appearance of a void. So all our news, great and terrible, is imparted in liminal spaces. In between. I can name them: the telephone, a pale green transit room opening out on two sides on to adjoining clinics, a swing door, a tiny office crammed with chairs, computers, files and a shredder. This last had a door that could be shut, so it counts at least as a room.

  After the removal of the staples and a further half hour waiting, this is where Tom and I; Mr K, the surgeon; and Charlie, the charge nurse meet so that Mr K can give us the biopsy results. The room is so small that once we are seated, in order for anyone to leave we all must rise again. The legs of the four swivel chairs are entangled. No one can exit independently, as the chair-mass blocks the door. The window cannot be opened. A large rubbish bin takes up priority space.

  There is no preamble. The biopsy results are as bad as they can be. Grade 4 – glioblastoma multiforme. This is the new name we are given. I hear a short suite of words – aggressive – early – small – encapsulated. Even in the delivery of wholly violent news I notice Mr K’s voice is emollient and slightly hesitant as if to soften the blow, making me think the news might actually be worse in reality even than this. More words are said but the air in the room has fused with the air inside my body, making it difficult for breath to come or go.

  This should not be Mr K’s job. All praise to the surgeon. He is the one with the good hand and as the bad messenger he is not in his element. His manner and words are functional and in no way sweet as the high art of his knife. We who are good at words would be better than him at this but in this foursome we are suddenly wrong-footed. Something new and strange has happened. We are the victims. I don’t know yet what this means but the ground we stand on has gone.

  I have to get out in order to think. The news is the whole matter of the meeting so once it is delivered there is little else to say. We rise as a quartet and for a moment the four of us are locked together in an awkward folk dance of non-specific crossing and shaking of hands, symbolic bows of the head, murmurs of thanks and goodwill. What has just happened? We leave.

  By heart I know that our route entails a series of right angles, starting with a turn left out of the little room. Thereafter we turn right, out of the ward, out of the hospital, out of the square, out. We walk side-by-side, mute and fused by heat and common danger. My eyes are filmed with fluid that doesn’t fall but hangs as a vertical screen. Through it I see the streets are very crowded but I don’t notice anything again until we get to the river.

  1.10

  9 October 2008

  Dear Friends

  The struggle continues. The biopsy showed that Tom’s tumour was malignant. The surgery went very well but he will need a course of radiotherapy, beginning quite soon, and going on for six weeks (that is, going into St Thomas’s each day, for a short blast, for five days each week). Tom is otherwise making a good recovery from the operation. He looks and feels well.

  The next couple of months of treatment are going to be pretty difficult. So we say again, it’s important to us at this time that our friends stay in touch. Please do continue to write, phone, text, email, visit us, and so on.

  With love

  In September, though deaf to all but our own noise, I pick up the sound of the outside world collapsing. The value of money being wiped off the international markets makes no noise in itself. Loss has local impact. But to the accompaniment of smashing glass and metal, chairs hitting pavements from the fifteenth floor and the collective hum of all the air-cons in America, the big ones go down: Lehman Brothers, AIG, Merrill Lynch, Washington Mutual. Conversely the media goes up like a great big helium balloon. They are making up the deficit in talk. What could be more thrilling than the collapse of the financial systems of the West?

  In Clapham after dropping Ev off with a friend I stand on the pavement and stare at a cash machine as if it is a threat. I am there so long someone asks me if I am planning to use it and if not, would I mind moving. My head feels fuzzy and ever so heavy. I would like to rest it on the pavement. I know that our problems are insoluble with money but I wonder if I should be clearing out my bank account.

  I leave my pounds where they are. A dream like a brackish stream is going by. I had assumed, like many of my kind, that we would live happily forever. Our future was moored together. We weren’t going to divorce, that was clear, and we weren’t going to die until we did, in the far distance: old, not without pain but not until a time that made sense, discreetly one before the other or the other way round, leaving a gap, in which whosoever it was who was still living could wonder, drift, mourn, prepare and cease in their turn.

  1.11

  So what did you do when death c
ame to your house?

  We continued in the same way as before.

  What is that, a failure of the imagination? Are you in denial?

  This is not wholly true; we continue in the same way as before but in parenthesis. My thinking has switched its grammar. The present-continuous is its single operational tense. Uncertainty is our present and our future. Unlike an abstract or esoteric linguistic problem to be puzzled over, this has the force of a wholesale conversion experience. You are alive, this is your life becomes You are alive, this is your life. Once the nature of the threat is known the defences are brought out at high speed and within multiples of days they are fully rolled out. As well as the surgeon, Mr K, we are assigned an oncologist, Dr B. We are booked to see the neurologist, Dr H. We meet the chemo nurses and Tom is fitted for a radiotherapy mask. We wait for the regime to begin.

  But the surface of us appears to be very much the same and this is an early stage intimation of a radical marvel – the flicker between the steadiness of the quotidian and the crash-consciousness of its ending. To call it even a flicker is an overstatement. The difference between the two states is imperceptible and total. One mindset cannot be attentive to both in the same moment, yet it must. We are in mortal danger and we fall about laughing at what Ev comes up with. We are forever dropping our guard and picking it up. Dropping and picking up are indivisible. They are the same act. The two states are so fused that the switch is not apparent.

  Everything living bears the fact of its own dissolution. This is a given. But for us it has become tangible. The universe as experienced is not universal. The universe as experienced is personal. It turns its face towards the individual. It presents an individual form. This individual form is ours. All that adheres will be lost.

  Yet there are social and domestic pleasures. And they continue. Decisions that needed to be made two months ago still need making. What shall we eat? Where shall we go this evening? I paint our bedroom, not a pressing decision, but what colour should it be? The job has a clear outline, a beginning and end. It is an act of defiance. I crouch on the floor to paint the skirting and hide my face in cornice and cupboard. Low at the carpet where no one will ever look is a long clean edge of white paint at the join of skirting and wall. The line does not waver. I cut corners but I am experienced and I have a good straight hand. The colour of the wall ends up green or perhaps blue, both shades notoriously difficult to assign but the one I choose is deep and saturated. It will soak up all the sunsets that reach us and retain them hard against the retina like a battery.

  There was always so much to be done. And now there is so much more. As Ev gets older the generalia around him multiplies: baby stuff, friends, park, all kinds of play. Tom coming home from hospital brings oxygen back to the house and Ev is invigorated. We see a lot of friends. They all want to come round to verify his continuing existence. Salute the brain. They are reassured. He is the He of He. I welcome them but when they come it’s true I remain in tension until they go. I am without conversation and without insight. I have occasional flashes of wit but free-floating, not tied to anything and my words come out impetuous and sudden, like a small child’s vomit.

  Tom is mending beautifully from the intrusion into his head and we have a string of gorgeous days. Then, one morning ten days in, he has a violent fit. Somehow, though it seems obvious in retrospect, we were not warned that this might happen. It is more disastrous for me than for him. I get to see it. Though it brings an immediate backwash of physical and mental exhaustion, he recovers himself. I do not. I learn something. Here, we commence. We stand at the beginning.

  Within the shortest span he starts work again. He picks up his regular writing sooner than anyone can believe. He wants to test his brain, to verify and see what it can do. Every week he writes his pieces for the paper and the work is as it was, complex, active, steady as ever. The words are there for him to find. He can organise the way they flow and the language, its style and rhythm, is his. The text is the proof. He writes slower but with great drive and excitement. He was always very good at this. Under pressure he is getting better.

  I am not so mentally well constructed. I am an artist, but making or thinking about making are suddenly out of reach as if they have been confiscated and put away. I do not go to the studio. I no longer understand what the studio is for. What would it be like to be able to think properly? What would it be like to have a thought and set another against it, to make a comparison, formulate an idea? I can’t do this. My thoughts, such as they are, run ahead and back like a dog on a tether, covering always the same ground and beating it down to a dry and useless hardness.

  I cannot imagine Tom not being with us. I try to imagine futures but can feel my imagination slipping even as I summon them. My mouth is dry. There is no grip. This is my brain in rehearsal and I don’t like it. It’s a rough, mean-formed thing, like a maltreated animal gnawing and worrying at its new constraints. What I do not imagine is that this is not happening. I am pragmatic. That would be a waste of time.

  Tom wants to be treated as an organism. Why not? He’s against capitulation in the face of illness, against its distorting power. He will continue as before and fashion it in his image. He is pro-sugar and pro-coffee. Pro-delicious. He is pro his life and the living of it the way he wants to. This is what it means to be an adult. When you have been doing it every day for many years you get used to it. Making decisions. Forming habits. That’s what we do.

  One of the ways in which ideology manifests is in stroppiness. A refusal to bend in the face of a force outside oneself that seems to be winning. What is the better path: to continue to do things on your own terms, to insist on the primacy and habits of the self, or to adapt? Adaptation leads directly by chute into puzzling terrain. Adapt where? Adapt what? You might conceive of taking decisions as a different person, but what person? Strategies, diets, belief-systems, books, thought-programmes, fads and whole environments exist devoted to change and the ‘journey’. It is a self-generated circuit of hell. The Internet is raucous and shouty on all sides about health and its opposite number: pros, cons, pro-cons, pre-cons, dangerous cons, attitudes you never even thought to hold before about subjects you didn’t care about till now. We are bored and instantly sceptical but that’s our style. We don’t think much of choice as it is currently configured. The oncologist, Dr B, is our newest and most clued-up informant and she is careful. She makes precise verbal murmurings only in favour of the evidence-based value of Vitamin C. The NHS recommends a balanced diet. This advice hasn’t moved since 1945, so sound is it. Eat well, all things in moderation. OK. Clear enough. So we eat well and we shade towards generous in the moderation. A large tub of high-strength vitamins finds it way on to our shelf.

  Pills are new. In the bathroom cabinet we have ibuprofen, ancient paracetamol and tickly-cough mixture for a child. Eye drops from years ago. Indigestion tablets. Calpol. Many things are out of date. We have never had need of drugs. Now we have the steroid dexamethasone, the anti-convulsant Epilim and the chemo drug temozolomide. All are taken at home. The drugs are of such great urgency and moment they capsize us. We do not know how to treat high-octane medicine and give it such symbolic reverence that on the first day we fluff it and the dose spills on the floor. The floor is Ev’s domain. He crawls over it, eats toast crumbs from it and picks up dust, rolling it thoughtfully into balls between finger and thumb. My head throbs and my eyes film over as I watch the pills scatter. We are all going to die. I am black with anger. We scrabble to find them, count them back in. I think we have them. Minutes later, something digs into my foot through my sock. It is a small white bead of dexamethasone.

  And did you rise to what the occasion demanded?

  I rose so high, I left my body.

  We discover, or rather I do, that you cannot hold a state of fear for an extended time. Fear is a peak, not a plateau. Shock is a drug and at first it feels pure and elevated, yes. The unreal keeps all exalted. Nothing else matters: we are in a state of grace. />
  But a house can fall down only once and then the dust settles. A train is about to hit and then it does. A wave comes in and sweeps everything away and dead bodies float around in its wash. If you are still alive at this point, you may well die in the aftermath, indeed this seems likely. But terror is a spike. Something else must follow. Terror is followed by less terror, or perhaps – almost inconceivably – by an even worse shock to come. I don’t know what the ebb of fear just below the peak is called. It is not a dilution or a lessening but a complexifying. It bears the realisation of what has just happened plus the understanding of what might follow. It is a solid compound of shock plus duration plus comprehension.

  After an explosion, if you are still conscious when a blast has happened, everything for you does not cease. There is a shift, a gap, between the impact and the first grasp of what remains and what remaining might entail. What has happened to your body, to the air, to familiar shapes or smells, noise or lack of noise, not like anything there was before? This intermediate time, this ebb, or whatever it may call itself, has a long, slow tail. It leaves a moraine of unconsolidated residue and debris behind. And the tail might last as long as your body continues. Something has happened. The new situation is embodied and you are its witness. This is what happens to me.