Patient

by Ben Watt

  I asked him how it had happened. He said the cause was unknown, but it had probably come on as a result of heavy physical stress and suffering. He said he’d also been given to understand that neuropathy was a symptom of my illness. I asked him how long it would last.

  ‘Difficult to say,’ he said. ‘A month, maybe nine months, maybe more – who knows? Depends on how badly the nerve is burnt out. Steroids might help.’ He was guessing. I sat there for a moment. I told him I was a singer. He sympathized. There was a silence. He wrote his name in blue ink with a fountain pen on to a piece of paper. All consultants use fountain pens. He told me to ring him if things didn’t improve when I was finally discharged.

  I slipped the piece of paper into my dressing-gown pocket and the nurse wheeled me out into the bright waiting-area. Tracey wheeled me to the lift. I walked the last bit. We didn’t say much. There wasn’t much to say.

  Two teenage student nurses are seated at the big table in the middle of the ward filling in their patient-progress forms. I have seen the kind of things they write about me –

  ‘Ben is a well-kempt gentleman and his pain management has gone smoothly this morning.’ ‘Ben sat up and ate a piece of toast this afternoon.’ ‘Ben produced two stools of loose consistency, vomited and partook of light conversation.’

  They look like they could be revising for their GCSEs. It is after lights-out. They are talking in hushed voices.

  ‘Gary gave me a tape after the party. Loadsa music on it. Really good.’

  ‘Oh, tell me. Like what?’

  ‘Well, mainly The Waterboys.’

  ‘Who?’

  ‘The Waterboys. You know that Mike Scott bloke. The hat. “Whole of the Moon”.’

  ‘Oh, yeah, yeah …’course.’

  ‘And then there was this stuff by this other bloke on the other side. Really good. I mean really, really good. Sort of doomy but amazing words.’

  ‘Who’s that then?’

  ‘Never heard of him before. Leonard Cohen.’

  ‘Leonard Cohen. Oh he’s really old. From the sixties.’

  ‘Never is!’

  ‘I’m telling you, he is.’

  ‘How old.’

  ‘Oh, ancient. In his forties. Must be.’

  Occasional parties would be thrown over in the Queen Mary’s nurses home on Saturday nights, largely attended by freshers or end-of-year leavers. Doctors and consultants would get ribbed in the days running up: ‘Gonna strut your stuff, sir?’ ‘Get on down, Dr Brown!’ And from nine until midnight the dull thud of kick-drum and sub-bass would pound quietly across the gardens. The nights would begin with reasonably up-to-the-minute club music but spiral downwards from then on through Abba and The Police until the last half-hour turned into a shapeless free-for-all when strains of oldies would float through the open window behind my bed – ‘Dreadlock Holiday’, ‘Hit Me with Your Rhythm Stick’, ‘Layla’, ‘Y.M.C.A.’

  I watched the younger nurses on St Mark’s come in for the day shift after the weekends. They’d always get in just in time, like at school, scuffling and skidding into the ward for the morning update, leaving their identities at the door – rave DJ, crusty, swot, homebody. Accessories denoted allegiances. Dubplate and twelve-inch shoulder-bag, nose stud, nurses handbook, bicycle clips. Some took to the job like ducks to water, able to submerge their egos beneath their work, or – better – merge them seamlessly into their patient-relationships. For these nurses, nothing ever seemed too much trouble. Kindness and patience seemed to flow naturally. Everyone liked these nurses.

  Others struggled with themselves and seemed to find it hard to give. Their personalities would chafe against the day-to-day mundanity of many jobs – especially the relays back and forth to the sluice with bottles of piss. The irrational behaviour and sometimes wild knee-jerk accusations of neglect from the patients rubbed up badly against their own adolescent intolerance. They had a need to assert themselves. It would manifest itself in little huffs as they turned away from the bed, deliberately clipped and swallowed speech, apathy or bullishness, subtle levels of inappropriate response. I really hated one or two of them some days, and I know they really hated me back some days too.

  The next morning I wanted to walk somewhere. I was becoming more and more mobile as the days went by. I offered to fetch a paper for anyone who wanted one from the shop in reception. Lots of winking and the handing over of small change preceded my departure and, stooped over, I pottered off with my drip-stand and a pocketful of coins. I took my time. It was a trip out after all. I smiled at people in the corridors, kept the lift door open for doctors and patients in wheelchairs, and generally was as charming as I could be in my role as a rather emaciated, bearded Quasimodo.

  Reception was buzzing. I queued behind nurses buying lunch – cheese roll, crisps, Lilt, Snickers – and paused by the huge granary baps stuffed with ham and salad, poppy-seeded subs crammed with egg mayonnaise, crusty baguettes of sliced turkey. Strangely, I didn’t really crave them, in spite of not having eaten properly for weeks, but viewed them with the interest I’d give to arresting museum exhibits.

  I asked for seven newspapers and bottle of Volvic. I got a carrier bag and hung it on my drip-stand and shuffled off. The place was vibrant. I loitered for a couple of minutes just watching. A pregnant woman was crying, her hand held by a little boy in full Batman outfit. He had on the cape, and the black mask with the hood and with the little pointy ears. An old man sat on his own with a walking-frame and a white plastic bag printed with the words ‘I Ran The World’. A girl spilled a tube of Smarties all over the floor and they scattered like ball-bearings. People waited on a line of chairs for prescriptions, and nurses hurtled past as lift doors started to close.

  I took the lift all the way to the seventh floor and got out into the empty corridor and pushed open the doors to the chapel. Tracey told me she had been up there when I was unconscious. She didn’t really know why. Some restlessness. It was lonely and dry and lifeless. Heavy oak panelling lined the room. A huge oil-painting hung above the altar. There was no natural light. The carpet muted my footsteps. I felt my presence wasn’t registered. I stood for a moment, but no thoughts came. I don’t know what I was expecting, but the austerity was suffocating. I took the papers back down to the ward.

  When I got back, a man was cleaning under my bed. The cleaners made the tea and washed the floors. Almost all the women on the staff were black. They wore bright yellow nylon dresses and would clack around in hard wooden sandals, languorous, taking their time. In the mornings one of them would bring fresh jugs of iced water and clean plastic beakers. Hot, weak tea came round with Marie biscuits at around eleven, and again at four. In between, the women mopped floors and changed the waste-paper bags by our beds. They chatted to each other in thick, accented language. The men who swept the floors and damp-wiped the surfaces seemed to be mainly from the eastern Mediterranean – Italian, Cypriot, Turkish, maybe. They wore blue nylon trousers with yellow Marigold washing-up gloves. The man cleaning under my bed had a feather duster.

  ‘Hello,’ I said.

  ‘Hallo.’ He looked surprised.

  ‘How are you?’

  ‘OK.’

  ‘Where do you come from?’

  He paused. ‘Tunisia.’ He stopped dusting for a moment. ‘Harlesden now.’

  ‘Really? How long have you been here?’

  ‘One years.’ He started running his duster over the wall.

  ‘What do you think?’

  ‘OK. Bad food.’

  ‘Oh? What do you eat?’

  ‘Lemons. Lemons and bread.’

  ‘That sounds healthy. I eat this.’ I pointed to my food drip. He smiled.

  ‘I think I like lemons in Tunisia better.’

  ‘Me too.’

  Six

  Two p.m. I am slumped on my bed. I have no strength. I see the same image of the bucket coming up dry again that I saw down in the garden on my first weekend on the Coronary Care Unit. Metal. I feel I have g
ot something metallic in my mouth. Like I have just licked a coin. I started on a new course of oral steroids this morning, and it is a day after the cyclophosphamide. Has something gone wrong? Have the drugs done something bad? I was doing so well. I keep scraping my tongue back and forth under my front teeth to remove an imaginary film. My eyes feel dry and crispy. Dry autumn leaves. I screw them up, trying to get them to moisten. Dry crunched-up leaves. Broken veins and capillaries. Leaf veins. Like the back of a hand with a torch shone through it. I don’t want water. I don’t want to move. If I just lie here my mind will eventually wander and, before I know it, fifteen minutes will have passed and I might feel OK. My gut feels rotten. Trapped pockets of air and gas. A dachshund made by a balloon-twister. My head is an empty box. My thoughts rattle around, dry crumbs in a kitchen drawer.

  Six p.m. I am on a lightly rolling ship. I can’t talk. My stomach slops with bilge-water. My nose is full of nausea. Fumes on a car-deck. Oil. Burnt petrol. My ears hum with the drone of low engines. My eyes are opaque plastic windows, salt-blasted, unclear. Don’t touch me. Deep breath.

  Nine p.m. I am lying on my side. A waste-pipe running into the sea. Effluence. Warm effluence. Backing up. I am concrete. I am corrugated. The daylight has gone. The sea is black. I am spilling. I am trailing along the seabed. I sit up. My stomach lurches and flails like a dropped hosepipe coursing with water. I grope for the grey cardboard bowl under the bed and I throw up. Green bile.

  That night a nurse rolled me over and gave me a Paracetamol suppository to bring my temperature down. I was feeling bad and strange. I asked for extra blankets. I had taken to sleeping on top of my bed, to keep as many layers between me and the plastic undersheet as possible. I pulled a couple of white cotton blankets over me. It was snug. I laid the pillow-rest flat and managed to lie half on my side with my knees up. Sleep came deeply and fitfully.

  I dreamed of weevils and termites, burrowing into trunks of wood, leaving them hollowed and pitted like cork. I was stumbling, kicking over little hillocks and mounds of earth. Hundreds of weevils were running over my slippers. My tubes and lines were trailing through the earth. I tried to hitch them up, but I could see insects already in the necks of the tubes, like wasps climbing into bottles. I tried to shake them out, but they were inside, running up the inside.

  At 6.30 a.m. a nurse took my temperature. It had climbed to 39.1. I rolled back into my pillows and watched breakfast come round. Dry white sliced bread was on the trolley, which meant the toaster was broken again. Cornflakes. Tea. Powdered coffee. At least the milk jug was cold. I missed breakfast a lot. My head felt like the rind of a fruit, juiceless and extracted.

  At eight the surgical team looked concerned. Everyone was aware of the dangers of the latest injection of cyclophosphamide. It had the potential to temporarily leave me with no defences. I was ripe for infection and my temperature was up. Maybe I’d picked something up already. They ordered a course of antibiotics, and a temperature reading every hour.

  By nine it had hit 40. By ten it had climbed to 40.4 – about 105 degrees Fahrenheit. Nurses were gathering round my bed to watch the mercury rise. It was amazing in its frightfulness. I felt shrunken. I lay perfectly still. My head was a skull. My chin rested on my chest. Inside my head I felt the tissue was too small for the space it occupied. If I moved, it seemed to scrape against the surface. Abrasive. Stinging. Like grazing the fleshy part of the arm against a pebble-dashed wall. Twisting my head would bring out little electrical storms across my brow and down my nose and through my sinuses. Tiny lightning strikes. And I was a small creature who had made its home in this skull. Peeping out from the darkness. Tiny eyes like beads. Silent. Quietly scuffling in one of the sockets. I felt rotten in my guts. Nurses drifted in and out of my line of vision, often asking if I was OK. I didn’t want to move my head, so I would just raise the corners of my mouth into a little smile.

  At eleven I sat up and vomited again. As I sat up, my head came away from the pillow like Velcro. I was faint, lightheaded. Two nurses were supporting me. They laid me down again. I closed my eyes. My stomach up to my mouth felt like a soft, hot pipe – pumping, fleshy, too big for my body. The sudden ascent of my temperature was leaving undisguised concern on the faces of the nurses. Two surgeons came back and ordered strong anti-nausea injections. They talked of another possible blockage in my guts from scar tissue or maybe another abscess. They arranged for an ultrasound scan for the following afternoon.

  Paul, the houseman, appeared. More blood tests. Blood cultures were needed for signs of bugs and infection. Nobody really knew what they would find or what was really going on. I was deep into myself by now, insulating my responses, lagging myself against the unfolding crisis. My veins were sluggish and hard to find. Local anaesthetics were injected while Paul jabbed around in my arm. The tiny tube of the butterfly needle would spurt for a moment then stop as the vein failed to respond. He asked how I would feel about an attempt to draw blood from a big vein in my groin. I looked out of the window. I knew it was important. I didn’t know what to say. I said OK. When he went in, it felt like a drawing-pin being forced into a stretched rubber band. The syringe filled instantly. I wanted to be sick.

  I lay there in my dry skull for the rest of the day, dozing, not speaking. Tracey was there. I vomited again a couple more times in spite of the anti-sickness drug. Nurses would ask me if I was hot. I only felt dried out. Like something once damp, now shrivelled. A peach-stone. That night the electric storms started up in my face again. The worst since ITU. My temples buzzed with blood. I could feel my pulse beating all over my body.

  By morning there had been little change. I don’t remember the night passing coherently. Delirious dream landscapes. My temperature was still over 40. I felt crumbly, like parchment paper. Blood cultures had grown nothing. Without firm evidence of an infection, a blockage in the gut was talked about again.

  At 2 p.m. Gert, the porter, collected me for Ultrasound. I was taken down in my bed, past the drawn faces of the X-ray out-patients in their gowns and towelling socks. The doctors tinkered around for twenty minutes, digging the scanner hard under my ribs. I fell asleep on the hard bed in front of them. They carried on scanning, running the scanner like a silent electric razor over and over my belly. The soft lighting. The grey quietness. The astronomy of ultrasound. I woke up. I wanted to stay and be swallowed up by something – another world of non-doing. Time-trapped. They found nothing, and a porter collected me.

  Most of the rest of the afternoon I slept. The results of the ultrasound disappointed the surgeons. A yet undiscovered infection seemed likely again. It was decided my Hickman line should be removed that night, in case bugs were breeding in the warm milky food at the point where the line entered my chest, infecting my blood. A couple of hours later a young surgeon arrived to take the line out.

  The curtains were drawn round. Hickman lines run deep into the chest. The longer they are in place, the harder it is to get them out. The skin tends to grow back around the entry site, binding the tube into the body. A heavy sedative was injected into my arm. My head lolled on the pillow. I went woozy. I thought I was about to be tattooed. A bluebird on my ribcage. And then I opened my eyes. Other patients were drinking hot drinks. But hot drinks don’t come round till late. My chest was burning. I was alone. I looked at my watch. Two hours had passed. A nurse told me Tracey had stayed for a while but had had to go home. The Hickman line was gone and my chest was stitched with a strand of black thread. That night, if I moved, I felt like a hooked fish. The stitch seemed to snag. I had to sleep on my back, half sitting up again.

  The next morning bled lifelessly out of the night before, grey, still, no patterns of sleep or waking. I was living on water only. I day-dreamed. Gentle hallucinations. Terracotta. I was made of terracotta. A clay oven, a brick, water and liquids evaporating off my surface, placed inside a wood fire. My temperature was still high. I lay still for hours. Every time I wanted to pee I had to call a nurse over. I wasn’t allowed a normal uri
ne bottle from the communal sluice. Each time the nurse had to crack open a sterilized plastic jug from a protective wrapper, wearing sterilized surgical gloves to minimize the risk of further infection. Everything I was emitting was being measured, recorded, analysed, tested. Amount, colour, consistency, viscosity, smell.

  Mid-morning brought firm news at last. Something had been grown from my blood cultures. It seemed like I had some kind of blood poisoning – fungal septicaemia.

  Everyone was relieved that there was at least a reason for all this suffering. My weight was plummeting. I’d lost ten pounds in three days. I was down to nine and a half stone. There had been talk a few days ago that I was almost ready to go home, but this latest set-back had distressed everyone. Pharmacy was alerted and a new drug was ordered. A fresh drip was rigged beside my bed in readiness. And when I looked up I thought I saw a sail on a mast and called a nurse over to tell her.

  The new drug, an antifungal bombshell called Fluconazole, was dropped at midday. My body retreated further into itself, pulling back into trenches deep and familiar, leaving me half soundproofed from the hospital boom. I fell into a deep sleep. I dreamt I was draining away, water from an outdoor pool, leaves caught in the net above. And, as the water drained, the pool tiles were more chipped and scarred than anyone had ever imagined, so refracted and softened had they been by the soft lapping of life. I opened my eyes. I saw Tracey. The bedside table. Ribena. A beaker. I closed them again. I was dripping wet, my fever half sweated out, and I felt as though silt and stagnant droplets were on my mattress. A puddle. Midges hovering in a sweat haze over the filmy water. I thought I was by a roadside, beaten up, pushed out of a moving car at speed, face down in the verge of tall, dry grass and then rolling down the bank into the gully until I was face up in the filmy water.