At the junction with the Wrynose Pass road, she halted, the right-hand indicator light blinking in the mist, and took a quick, furtive nip from the whisky bottle, observed only by a lone, lost sheep. The roads were so narrow she needed a three-point turn to swing right. If she could intercept him, she would say: stop this nonsense now. Right now. We are going to a hotel. You are going to get warm and we’ll discuss where to go from here. She turned. The road she had just traveled had been extremely narrow and this one was only a fraction wider. But it led upwards in what she thought to be the right direction. The radio reception faded in and out. Just before it subsided altogether into a hissing silence, she caught a crackly weather forecast: something about storm fronts and the Irish Sea and warnings of something too indistinct to decipher. Her cell phone in its cradle had not picked up a signal for hours. She almost began to miss the Honda Civics and Ford Fiestas with their aging cargoes of pensioners in putty-colored parkas and tweed hats. The mist wrapped itself around the car with feline stealth. She had an eerie sense of weightlessness, as if she could not quite tell whether the car was going uphill or downhill. One moment there would be a clear, steep upward gradient, then the road would even out or descend. Eva Kimberly switched on the fog lamps but they seemed to make no difference. The more she progressed, the more impenetrable the grubby wall of cotton wool ahead of her seemed to become, and there were no landmarks. The paved road simply gave way to ragged green grass and gray shapes that might have been boulders or sheep. She sensed rather than saw a steep drop-off to her left, where the mist seemed to swirl as in a cauldron. The windshield wiper slid back and forth but it was not clear whether it was up against rain or simply the mist condensing onto the car. At one point, to the right, she thought she saw a small obelisk, a sculpted geometric intrusion into this higgledy-piggledy, barely seen jumble of rock and grass and patches of bracken as dull as old, dry tea leaves. But if it had been there, it was soon gone. Was she climbing or descending? Did the pass attack its summit in one solid, uphill grind or meander, choosing between ups and downs? Now she seemed to be descending, sharply, the big car running away from her so that she scuffed the tires on roadside rocks as she struggled to find a lower gear. She stamped so hard on the brakes that the ABS system kicked in, too late to prevent the rear of the car from swinging wide, crashing into a rock on the roadside with a brief howl of metal and a tinkling of glass from the brake and indicator lights. She thought of halting to inspect the damage, but the car still seemed to be running smoothly. There was no ominous grating of steel on rubber. The road ran quickly, clearly downhill now. She peered through the windscreen. Had there been a signpost, off to the left? There was not supposed to be a signpost, but her road map was small-scale and did not show every road beyond the highways. She swerved to cross a bridge. Was there supposed to be a bridge? But the narrow lane ahead of her was climbing again, so perhaps she was still on track in this strange, alien land. In Africa, the mists burned off, the rains were ferocious but soon vented their rage. They did not cling like this. They did not settle in for the duration so that you could never imagine sunlight or warmth again. The storms announced themselves with great thunderheads building white and gray into a blue sky. Sometimes, in the cloying heat before the rains, the very earth would part to release a subterranean army of flying ants that broke to the surface and knew instantly to fly on gossamer wings, whole squadrons and legions of them that people leapt at to catch and fry. But not here. Here the earth was dead, denying all bounty.
The road leveled and she pulled over onto the squelchy grass, careful to leave two wheels safely on the tarred road. She stepped forth into the mist, lighting yet another cigarette, pulling the thick sheepskin coat around her. She glanced at her watch—a gift from him in gold and steel. The rear of the car, just on the passenger side corner, was a mess: dented, scraped metal and fragments of orange and red plastic, all that was left of the brake and indicator lights. A bare bulb in a shiny, silver surround blinked on and off where she had signaled her intention to pull over, a lonesome beacon summoning no one. The hours had run away since lunchtime and finally she admitted she was lost, not simply geographically, but as if the land that had nurtured him denied her, mocked her with its contempt for the outsider, the alien. The air was liquid, seeping into her hair, her eyebrows, lacquering her coat with a silver veneer of droplets. If she waited long enough, surely the clouds would part, lift. She scanned the map. Clearly enough she could see now that there were two passes, not one. The one called Wrynose—where he would camp—was the first. Another—called Hardknott—was the second. She would bet good money she stood now on the second. What point was there now in the grand romantic gesture? What point had there been in the first place? How could anyone expect to revive a passion born in sunlight on the soaked fells? In a bivouac tent, for God’s sake. Why had she wasted her time?
She charted a long, onward route that would end in a civilized hotel suite, a deep bath and room service dinner. Without Joe Shelby, who had brought her here. From the map, she could see she would be late arriving but that did not matter: he had booked the suite with a credit card reinforced with a faxed confirmation. She would call ahead once the mountains released her into cell-phone-signal country. There was no doubting now where she was. The road ran on ahead through places with typically impenetrable names—Boot and Eskdale Green, Gosforth and Egremont, Cleator Moor and Cockermouth—fat chance of that, Joe Shelby, she thought, and sniggered—Braithwaite and Keswick. Once resolved, she restarted the car, spinning the wheels in the grass as she pulled back onto the narrow paved road, nudging down below the cloud line and, after some confusion and false starts in an area of small lanes around Santon Bridge and Plumgarth, she hit the A595 highway, heading up north. Somewhere around the notorious Sellafield nuclear power station—which looked about as appropriate in these wild parts as an elephant in a flower bed, a turd in a punchbowl, a bull in a china shop—her cell phone sprang back into life, startling her with its ring-tone.
“You have a message,” a synthetic voice informed her. “To hear your message, press one.” Driving with one hand, she did as bidden, wedging the phone between jaw and shoulder to get her second hand back on the wheel before the car veered over the white centerline. When the message began, her hands tightened on the leather steering wheel and she pulled over to hear it again, to be sure her senses were not deceiving her.
“Hi. It’s me. Jeremy. Just in London for a few days, squaring the punters, meeting the agents. You know. And. Well. Maybe this is the wrong thing. Time. You know, to be calling. You tell me, Evie. But I just wondered if you’d like lunch. Or a cup of coffee. Walk in the park. Anything, really. Best behavior, of course. No tears. If I could just see you. Just for a moment. I’m at Brown’s. Remember? You see—”
The message died after its allocated moment in wireless ether.
Jeremy. Dear Jeremy. Timing never was your strong suit. But you have learned something about it now.
Chapter Nine
ROCHESTER, MINNESOTA. JULY 2000
Rochester, Minnesota, is a town that lives on undiagnosed and frequently terminal illness. In winter the snowdrifts scud across the highway and the all-year residents stay indoors or huddle over shot glasses in half-lit bars showing football games on television sets mounted high in the corners. In summer, only the sport changes. More than just about any place on earth, its population is heavily weighted towards the medical profession because this is the home of the Mayo Clinic. Even the hotels in Rochester, Minnesota, are linked to this great institution by covered walkways that run above the streets, as if the sick are already at one remove from terrestrial life—not exactly knocking on heaven’s door, but not too far from it either. At most times of the day, you will find the cavernous central hall buzzing with patients on their way from one appointment to the next, some clutching urine samples hidden in paper bags like a drunk’s liquor bottle, hurrying with the same dedication as children who just won the goldfish at the fun fair and
are taking it home in its plastic globe. Most people of a certain means who have been seriously sick know of the Mayo Clinic. Along with the laboratories and consulting rooms associated with London’s Harley Street, it is held to be the world’s preeminent diagnostic center, where maladies that have baffled the rest of the medical profession may ultimately be resolved. Look around, as you walk through the halls and corridors and consulting rooms, and you will not see anyone who is not gravely, bafflingly ill—except of course the nurses and physicians. And even medical doctors who have been unable to cure themselves gravitate here to seek the truth from more specialized colleagues. Within the medical profession it is held to resemble a conveyor belt along which its paying clients are subjected to all the necessary tests and examinations. At the end of the conveyor belt is a desk where you pay your bill and receive a diagnosis offering hope or despair. The complex has ministered to kings and presidents, and there are share-dealing companies where you can sell your stock to pay your bill or, as appropriate to the diagnosis, realign your portfolio for the purposes of avoiding estate duties. Looked at from a cynical viewpoint, you could say that its clanking magnetic resonance imagers, its humming laboratories are simply a vast cash register, an alchemy that turns sickness into wealth and sometimes health. But, from a benign perspective, this place is the final salvation, the last hope for a miracle cure. If the experts here can’t cure you, then you may as well start to think seriously about your relationship with—or acknowledgment of—a Divine Being, and your attitude to the mortality you never quite believed you shared with the rest of the human race.
Joe Shelby flew in via Kennedy and O’Hare, lugging a tote bag filled with books he had never had time to catch up on: Baudelaire and Wordsworth, Dylan Thomas and Eliot. The cabdriver from the Rochester airport, he noticed, did not inquire as to his business: maybe the limp told the story: another invalid, another inscrutable case that, hopefully, was not contagious. Joe Shelby checked in at an anonymous, restful hotel and braced himself for his first appointment by seeking out normal people—people, that is to say, normal enough to belly up to steel-topped bars behind a crumpled pile of dollar bills to be bartered for booze and baseball games on the TV.
The normal people, of course, realized that he was not normal: he did not wear normal tartan shirts and took his wallet from a bush jacket whose cartridge pockets contained expensive German pens topped with distinctive white stars. He spoke in a strange, limey accent and he walked kind of weird. When he paid for his drinks, or drank his drinks, or just toyed with the glass as he stared at a point a thousand miles beyond the bartender’s mirrored display of half-empty bottles, gazing past his own reflection, he did so with his right hand. His left arm hung vertically and if he wanted to move it, he would swing his shoulder to induce movement into the motionless limb. Obviously a patient, a transient, not worth a nodding acquaintance in response to his murmured greetings. After two or three whiskies, Joe Shelby began to acknowledge that, somewhere along the line, he had crossed an invisible frontier whose visa requirement was physical disability; he had become one of the outcasts that people stare at surreptitiously on the sidewalk to see if they have a clubfoot or some metal apparatus from infant poliomyelitis. He knew, of course, that his heart beat true with two-fisted testosterone, just as most men in their late thirties know they are seventeen years old and always will be. But to others he already belonged to that different land of Zimmer frames and wheelchairs, whose denizens are obliged to confront the angry, impotent codes of their condition—the immobility of multiple sclerosis or the shakes of Parkinson’s disease, the wasted muscles and clawed hands of any number of neuropathies. It was a world that, in their heart of hearts, most whole people wished not to see, turned away from, or, in some historical eras such as Nazi Germany, sought outright to banish, exterminate. Unwittingly, without seeking membership, he had joined a club whose codes and premises lay in hospices and medical waiting rooms, MRI tunnels and physicians’ illegible notes, hospital wards and undertakers’ offices. His selection of poetry books revealed new meanings. His fellow citizens were not the drinkers at the bar. They were the patients at the clinic—mon semblable, mon frere: Baudelaire, he recalled, had written those words in the introductory poem of Les Fleurs du Mal, the flowers of evil, but he had been describing the brotherhood of ennui. T. S. Eliot had borrowed the same lines in “The Waste Land” to evoke the fraternity of those whom death had undone: “A crowd flowed over London Bridge, so many, I had not thought death had undone so many . . . to where St. Mary Woolnoth kept the hours/With a dead sound on the final stroke of nine.” Here, in Rochester, Joe Shelby was invited to join the brotherhood of those whose bodies had undone them, who awaited death to undo everything they had ever prayed for. It was an invitation, he was discovering, that came without an RSVP—the rest of the world, the healthy people, replied on your behalf.
“And, when we breathe, death descends into our lungs, an invisible river, with mute cries.”—Charles Baudelaire.
—
For a little over four days, Joe Shelby underwent his initiation. He gave of his blood, drawn deep red like a dark Pinot Noir from the crook of his arm, he provided urine samples after fasting with various stipulations about whether the liquid should be from midflow or some other stage of expulsion. He became expert at pissing, fasting. He hated his fellow patients because they mirrored the reality he did not wish to see in himself. He contrived, in one examination room, to secure an advance peek of the seven-inch needle that was inserted into his spine to draw fluid to establish protein levels, seek out evidence of cranial malfunction. And wished he hadn’t. The clanging, thumping tunnel of the MRI scan was old hat to him now; as an invalid, he was a pro. He knew well enough where the electromyographic experts would place their needles in the reduced flesh of his left biceps, in the triceps and the brachial plexus. He understood the way they measured the impulses from the central nervous system of the brain and spine and out to the peripheries, running like messengers to distant outposts along pathways of neurons and axons, sparking synapses as they hurtled briskly and purposefully at 250 mph. He knew the questions the machines were asking. How quickly did the couriers run? Did they encounter obstacles on the way, conduction blocks that showed the system to be disrupted by rotten cells, torn myelin, neurotransmitters that failed to make the leap between neurons and axons? On small green, glowing screens, his nervous system was translated into jagged peaks and deep troughs, lines to be printed out on long screeds of paper, as at the supermarket checkout after a particularly expensive shop. When the needles were inserted into his biceps, his forearms, his shoulders and hands, he could see them leap and twitch with involuntary movements that had never been there. Watching the men and women in white watching him, he realized that what they saw was a web of billions of nerves of different kinds that ran systems and reactions, a spider’s gossamer of strands branching out from the anterior horn cells of his spine, relaying impulses to far-flung toes and fingers. When they examined him, he knew they would follow the prescribed rituals of their profession, checking for muscle tone and weakness, reflexes and spasms. Just as in his profession there was always a basic set of questions to be answered in even the briefest of articles—who, why, how, when, where and often how much?—so, too, the neurologists followed their set route of inquiry: the questions, first, about the onset of the disease and the symptoms, the extent to which he smoked cigarettes and drank alcohol (raised eyebrows, usually, at this stage: that much? Really?). Were his parents alive? No. What had they died of? Cancer. Had he been sick before? Not really, unless you count odd encounters with malaria, bilharzia. Bilharzia? Mmm. Had he been sick as a child? No. Did he have allergies? Only to doctors’ bills—just joking. No. Had he ever had syphilis, poliomyelitis, been exposed to AIDS? No, no and maybe—these days, who could tell? In Africa, who could cast the first stone?
And only after this interrogation did they request that he strip to his boxers. Then they would require him to perch on an exa
mination table and just look at him with the vaguely disconnected air of someone who has come into a gallery to escape a wet afternoon, taking only a passing interest in the sculptures. He knew they were looking for the telltale signs of wasting in the muscle, quivers which they called fasciculation. They would ask him to relax his arm and leg and then jiggle or turn them to discover whether the muscle tone had turned spastic or flaccid. They would test his strength, in his fingers and wrists, at the biceps and triceps, the shoulders, legs, ankles, toes, making him pull or push against their counterpressure. His left arm, predictably, scored worst: he could not even lift it into position to pull against them, and they logged a zero or a one on a scale of five for those whose limbs could not even overcome gravity. They spread his fingers and closed them with their own. Cock your wrist and don’t let me move it down. He had been here before, in Harley Street and regarded himself as a quick study: now they would run a sharp object along the soles of his feet: and they obliged, interrogating his body, requiring it to provide answers to two lines of questioning: anatomical and pathological. By combining their simple tests in certain sequences, they could establish first of all the location of the disruption to his nervous system, then its nature. That, at least, was the theory. It was true, Joe Shelby figured, that for all the expensive scans, analyses, electrical testing, their art came down to the traditional magic of observation and the exclusion of options, the narrowing of choices. They worked with a feather and a pin, medieval totems. They peered from the outer skein of his being into the unseeable nexus within. Ultimately, they made their guesses on the basis of irreducible assumptions and that was the route to diagnosis. It may have been science, but a good part of it was intuition, experience, the institutional buildup of wisdom from observing thousands of people whose systems had crumbled.
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