Patient

by Ben Watt

  He looked at me with soft eyes. I was older now. Thinner. I tried to be natural and smiled as much as I could.

  I never really expected anyone to come. I was always surprised when Tracey said a friend would be along the next day. I felt I must be uninteresting to anyone but myself, and that the sooner I sorted everything out myself and got back to how things used to be the better for everyone. My illness struck me as just a nuisance in many ways, nothing too serious, even when I was aware I was on a ventilator, or on the way up to theatre for the third time in a week, or groggy and lost in the recovery room. I thought a few more days, a quick shower and I would be right as rain. And when I wasn’t fighting back I was strangely calm and resigned. I felt if someone had come up to me and said, ‘I think it’s time to make your will. There is only one drug left we haven’t tried,’ I would have just shrugged and thought, ‘Never mind. Death’s not such a bad prospect, all things considered. What’s everyone making such a fuss about?’

  Eileen, our manager at the time, visited a few times, often with her business partner, John. Eileen had dropped everything and come straight to the hospital when I was first admitted. They had had to be the ones who phoned round and cancelled our summer tour in America, and then I’m sure spent long afternoons sitting opposite each other in their tiny office in Notting Hill asking each other if I’d ever play again, or be able to record, or travel or eat or drink, feeling desperately involved but excluded too. They both came when I was first on ITU. They seemed ill at ease. They brought me little presents. John had been out to Tandy and bought a minicomputer tennis game that ran on a battery. I tried it out a couple of times but I couldn’t work out what was going on. I thought I was still knocking up when the screen flashed up that I’d just lost in straight sets. The screen was really low-resolution and I had to squint. It was exhausting. Five minutes and I was finished. Eileen brought me a copy of Viz. I didn’t dare look at it for fear of laughing and hurting myself. For a while it lived up on the top shelf next to my bed in ITU. I used to look up at its green cover and think about asking one of the nurses to get it down so I could have a peep at one or two of the cartoons, but Johnny Fartpants and Buster Gonads didn’t seem quite appropriate after four small-bowel operations and a room full of people on life-support machines. Once Eileen came on a Sunday and was a different person. She had on denim and a white roll-neck sweater. She sat by the bed. She was much more relaxed and just chatted, letting the afternoon spread out before us all, as though Sunday was a window that looked away from all concerns.

  In many ways, that was how I wanted visitors to be. The most rewarding visits were when people came and didn’t feel they had only half an hour in which to sympathize, adhere to an imagined code of conduct and then get out. I wanted people to stay if I had to have a short test done, wait outside if they felt happier, but then come back and stay a little longer and try to see it as normal and that I was the same. But hospital unnerves people, in the same way that being in the presence of disabled people and old, infirm people unnerves people. The proximity of death and pain is unsettling and embarrassing. The parameters of the appropriate response seem to change, and I watched friends stumbling over their self-consciousness and battling with over- or under-reaction. If I held out a hand I’d see them choking back a tear. If I were quiet for a few minutes they would feel they had overstayed their welcome. If I smiled weakly I’d feel I had inadvertently created a moment of unbearable poignancy. And curiously, because of this, I felt a huge amount of power over them. I realized I could manipulate their emotions, and I was fascinated at their impressionability. It seemed easy to exploit their good intentions and, if I chose, to turn a cough into a dying breath, a goodbye into a last farewell. Their hearts were open books, their eyes wells of sympathy. I surprised myself at the times I contemplated such duplicity – not so cruel as to ever really put it into practice, but cruel enough to consider it.

  I didn’t see much of my half-brothers. They each came a couple of times, but their visits were muted and awkward. I felt the family was being driven into itself by my experience. It is said a crisis can pull a family together, but strangely I thought we were forced apart and I found myself thinking how different we all were, relations as if only by chance, each wrapped up in very different versions of what was happening.

  When I think of us all together I see the old family house. We had the top two floors of an Edwardian house in South London, with my grandmother living on the ground floor. After my grandmother died, my mum and dad rented out the lower flat for a while, but in the end the whole lot was sold. I grew up and lived there until I went to university. Whenever I fly home I look out for it on clear days, banking out of the holding pattern above Heathrow, a figure of eight over Lego London. The south-west suburbs. Richmond Park. The reservoirs. Hammersmith Bridge.

  I always see Christmas. We all ate turkey in the sitting-room. Every available table in the flat was put in the middle of the room and covered in red crepe paper and then surrounded by all the available chairs. Even deck-chairs were fetched from the shed. My grandmother was summoned from downstairs and then, shortly after four o’clock, we all began. Tinsel hung from the huge gilt mirror on the wall. We were all reflected in it. The room seemed packed with people and paper and presents. At the end of lunch one year, my mum, wearing a scarlet and white floppy hat, presented my grandmother with her present from the family. It was a huge cardboard banana box of tinned food. She wouldn’t keep a fridge, and food was always going off in her flat.

  After we’d all watched Morcambe and Wise, my dad slipped away and started playing the piano – ‘Love is Here to Stay’ and ‘We’ll be Together Again’. He always did this. They were the songs he played to my mum when they first met when he had his band at Quaglino’s. The piano was kept in my mum and dad’s bedroom. There wasn’t really anywhere else to keep it. Gradually the family drifted in one by one to listen and sing along quietly. Great-aunt Margery, who taught English in a school in Willesden, was allowed to perform an English pastoral, and my mum sang ‘A Nightingale Sang in Berkeley Square’. Then my dad got back on the stool and hammered out some boogie-woogie with joky lyrics sung by my eldest half-brother, Simon, before climaxing with some loud ragtime to which Helen, my mum’s first husband’s partner, vigorously danced the charleston. We all clapped along and whistled and cheered at this. Nothing could follow Helen’s routine. She often did it. It was her moment, and for several years it was the crowning moment of Christmas. After that the crowd dispersed, leaving Simon playing his own sad compositions in the style of Roy Harper. My half-sister Jennie stayed and listened for a little bit, and my mum, and then the room was empty.

  I didn’t like it when they put someone old and obviously ill in the bed next to me. Tracey said most of the time no one looked more haggard than me and Kevin, but, even so, I always preferred it if I got someone straightforwardly middle-aged and evidently on the mend. If they were too young – and by that I mean my age or younger – it made me think too self-pityingly about myself for my own good, and I would dwell silently and darkly for too long at a time. Too old and I immediately felt uneasy and I constantly seemed to be waiting for them to die or convulse or something. Middle-aged, though, and I felt OK. But they put Pat in next to me all the same.

  Pat was yellow. An oily yellow. He was loud and old. He barked at the nurses, especially the younger ones, which made me jump.

  ‘Bleeaarrgghh!!’ he seemed to say to them.

  He sat in his bed with long, lank, ratty grey hair, unshaven, in piss-stained long johns for two days before he was given clean pyjamas that he didn’t want. He had wild eyes like he’d just seen something bad and it was still in front of him. He had long uncut toenails, perfectly shaped. They were filthy and as sharp as winkle-pickers, and the tips were starting to curl back under his feet. Until he spoke in sentences made up of more than two or three words, I couldn’t place him at all – rich, poor, posh, ordinary. He used to detach the bag from his dripstand when he g
ot up to slouch off for a piss – he wasn’t meant to do this – and then worsen things by holding the bag too low so the blood from his arm would flow down and back up the tube, mixing with the saline halfway, turning the fluids pink like diluted grenadine. It was a gruesome sight. The nurses told him not to, but he would forget the next time he got up and he had to have his line changed in his arm three times in the first two days because of it.

  He went up to theatre a couple of days later and came back looking worse. Still jaundiced, his skin had turned more sulphurous. The days passed and he didn’t look any better. His eyes were duller, and he got quieter and lay stiller. He had been given a catheter up in theatre, and he didn’t try and get up so often.

  He would perk up in the mornings, though, when the papers came round. Every day he asked for the Sporting Life. Of course the paper trolley never had it. He’d try asking for the Racing Post, which was even more unlikely, and then settle for the Daily Express and would pore over the racing pages on and off all morning. He asked one of the nurses to place bets for him a couple of times.

  ‘It’s a Carson double. Can’t fail,’ he barked.

  We all laughed.

  ‘Sorry, Pat,’ she said. ‘I wouldn’t know where to start. Anyway, you don’t want to be throwing your money away now, do you?’

  ‘Look, love. It’s a Cecil horse in the first and a Group winner in the second. Carson’s on top. Take the money.’

  She said no, but then when later in the week a winner and a dual forecast came up trumps on consecutive days, and he started bragging and complaining, one or two of us started to take him seriously and she soft-heartedly took his money for an each-way double at Kempton, and promised to go down to the bookie’s at lunch-time.

  The next day when the paper trolley came round we all got papers and I could sense everyone turning to the racing results first and none of us could believe it when we saw the horses had come in. Pat was crowing and coughing, laughing and spitting, fetching up huge globules of phlegm off his chest in his excitement – which was more than the physios had managed to do in a week.

  ‘Told you. Told you. Pillar to post. Pillar to post.’

  We all waited expectantly for the nurse to arrive for the late shift. At three she waltzed in grinning with the winnings. She was thrilled for him. She said she’d never been in a betting-shop before, and then told him she’d been given a tip for the St Leger if he needed one.

  The girl from the hospital radio came round that evening. She had a pad of paper and was asking patients for requests. They were going to be broadcasting at 8.30, and we were to tune in on our little headsets above our beds. She seemed relaxed, wearing faded Lee jeans and a green sweater. She looked like she’d prefer to play some loud rock ‘n’ roll. From the beds on the other side of the ward I heard the requests.

  ‘Tony Bennett.’

  ‘Sinatra.’

  ‘Anything lovely by Pavarotti.’

  ‘What, love? A tea with two sugars, please, if you’re making it.’

  Somebody asked what else would be on the programme. We were told there would be something from Cats and that there had been quite a push for Glen Miller from Erskine Ward. I was banking on Kevin to ask for something frenzied and punky – a little New York Dolls or maybe some Stiff Little Fingers – but he was asleep. Victor didn’t understand what was going on, which left me. I toyed with asking for something obscure and specific and meaningless, like ‘Mouldy Old Dough’ by Lieutenant Pigeon, but I hadn’t the courage.

  It is the day arranged for my second shot of cyclophosphamide, and Ignatius, a young Spanish student doctor, has been chosen to inject it. My eosinophil count has been creeping up, again signalling continued dangerous over-activity from my immune system. They warned me it might happen. Another chemical hammering should beat it into submission. Nobody has exactly been looking forward to it, though. Ignatius is nervous. The drug is serious. Pharmacy won’t release it without special authority. Two or three consent forms have already been signed by leading doctors. Cyclophosphamide is a cytotoxic drug. Cytotoxic means cell-damaging. It was originally developed to kill malignant cells in cancer treatment, in the hope that they would be more sensitive to it than ordinary cells. In practice it has proved to be highly effective on the white cells connected with immune response, but it has to be carefully measured and monitored as it has the potential to stop all natural cell development in the bone marrow. When used a lot, cyclophosphamide can cause sterility, make hair fall out, and bring on vomiting and nausea by damaging cells in the stomach lining. Ignatius basically has his hands on a small chemical weapon.

  A drip has been rigged up above me with fast-running saline. The drug has to be injected into this river as it enters my arm, to disperse quickly. Neat cyclophosphamide can cause renal failure. The drug is all contained in one needle, but must be injected laboriously over ten minutes with no gaps. It is important it goes to plan. The drip will then stay running all night, filling my system with litre upon litre of water, after which I am expected to pee every twenty minutes for the next day and a half to help flush out the drug’s residue.

  Ignatius takes off his watch and lays it on the bed to read the second hand going round. Steel interlinked strap. He has brown, muscular arms. He slips his thumb into the butt of the needle. He has the shakes. He tells me he has always had them but is adamant about becoming a surgeon. I smile and try to remain casual.

  The drip is turned up full and he slips the needle into the line and starts to depress the plunger. Tracey is there, and Paul, the houseman. We are all quiet and watch. Paul says a few light-hearted words, and then falls quiet again. I try to relax. Ignatius is sweating. His temples are moving. He stops for a moment and flexes his hand. He has got cramp. Four minutes have passed. I close my eyes. The seriousness of the occasion sets my mind racing. I feel the cool water running in my arm.

  Time stretches. I see fells and damp heather and mountain streams, hilltop tarns, Lakeland, baby waterfalls, hydroelectric power stations, fine drizzle, sheep with their fleeces stained red with dye, the reedy turf covered in droppings, scarred and striated valleys, buttresses of rock truncated and shattered into a million bits of scree, and, further down, stepping-stones, stone walls, stone bridges, dappled light, a river so clear and cold I can see boulders on the river-bed, and I want to bend down and cup my hands and drink the fresh water as it flows over my wrists. I see Rydal Water and Windermere and Tracey at the plastic wheel of a tourists motor boat, her hand in her mouth, looking all around her and across the wide water, convinced we will capsize if we are not careful and vigilant. And I see myself as a boy crossing a charred and burning stubble field towards a beach, my dad in front, my mum behind. My mum wears a turquoise towelling dress. Suddenly a lark bolts from the earth at my feet and screams into the sky above my head, singing and singing, a kite in a high wind, and my mum stops and cups her hand across her brow to see it against the bright September light and we all stop in the smouldering field and listen. I can smell the sea coming. And the dead corn. I ask my dad why the field is burning, and he says it is to enrich the soil for next year and that destruction can be for good as well as bad.

  I open my eyes. Paul has gone. Ignatius has finished. He is tidying up. He slips his watch back on and clicks the strap, and then says goodbye. I say thanks, and then look round the ward. Kevin is drinking Coke and pulling at some fruit. Victor pads past forlornly in his pyjamas on his way for a crap.

  I think of cyclophosphamide in my body – a wrecker, a healer, tampering, meddling with the roots of life, like an insecticide washed off fields of crops into the gullies and brooks, bubbling and frothing up like detergent, running into my veins as into rivers, and down through the topsoil and sandy loam, through underground channels and soft, porous rocks like body tissue, to settle at the water-table which feeds my roots. And all I can think is, If and when I recover from all this, in the years ahead, will I be as I remember myself, unbowed, organic and strong? Or will I always be a wea
k strain, in need of shelter, susceptible to the wind and the rain?

  It is said to be quite common for patients to lose their voices temporarily if they have been on a respirator for a time. The throat can become sore, but corrects itself within a couple of days. When, after a week on ITU, I was still croaking and whispering, doctors had started taking note. They encouraged me to try to project, which was pointless, as I was trying. Tracey told me recently that they had told her at the time that my loss of voice was psychosomatic and she was to try to get me to speak. It was a sign that I was hiding in my own illness. It shocked many who came to see me. Not only did I look like Howard Hughes, but I sounded like I was about to pop off at any moment. Richard and Michelle, friends, rang the unit from their holiday in France one morning and the nurses brought the phone over. I didn’t usually take calls, but I was light-headed on drugs and asked for the receiver. I whispered away in a mild haze for a few minutes. Michelle later told me how upsetting it had been.

  After three weeks on St Mark’s and six weeks after my first operation I was finally referred to a throat specialist in the hospital. Things were no better. I was still croaking and rasping. He was holding an out-patients’ clinic on the ground floor. Tracey helped gather up my drips and stands and I was sat in a wheelchair with my notes on my lap. The file was enormous.

  Down at the clinic, it was throbbing with life. I was taken to the front of the queue. People looked at me cautiously. I felt I frightened them. Although we were all in a hospital, I looked too ill. Children were silenced by my presence. Women whispered to their husbands as I passed.

  The consultant sprayed the inside of my throat with a local anaesthetic and pushed my tongue down with a wooden spatula, shaped like a large lolly-stick. Two minutes later he told me flatly one of my vocal chords was paralysed. I paused for a moment. I was stunned. I saw the end of my current life as a singer and the beginning of something even newer than I had been preparing for. I stared at the floor blankly. My voice. It frightened me more than anything else that had happened over the past weeks.