I left for the Hospital. Driving a car before the streets have begun to smell and while there is still pink in the sky is a pleasure. Some women lick their lips when they see a significant car in their mirror, women with coats like troika rugs on the passenger seat beside them, and red nails, and dogs like wigs.
There were seagulls in Hyde Park and deserted groups of green deckchairs. There was an air of recuperation, London treating itself gently before a new day. Cities, more than the country, hold crevices for the irrational to gain a hold, but London was showing a bland face where the spores could not, at any rate in this clear dawn, settle. I wondered how the child with the new part in his heart was. I looked forward to seeing him and his family. At least I was blameless in their respect. No one could accuse me of manipulation save in its literal and curative sense.
The flower man in Belgrave Square had put away his ugly blooms. No more guilty husbands till nightfall.
When I arrived at the Hospital, their flower counter was just opening. We do not encourage visitors to bring flowers. They occupy nurses and vases. Those flowers we do sell are serviceable. Some are not real. They last, are undemanding of maintenance, and do not rot down. Sometimes when I see a patient presented with one of these sterile bouquets, I see through his flesh to the pacemaker or to the plastic valve or reinforced nylon aorta and, according to my mood, I feel gratitude or fear on account of these miraculous or intrusive inorganic spare parts. Like the husband who sees his new bride remove wig, nails, padded brassíre, I begin to wonder whether in the end I shall be left not with a living body but with a machine, a pump and some tubes.
I like to arrive early at the Hospital. Any who have died in the night have been taken away in false-bottomed stretchers, the new batch of nurses take over, once again in love with the job, full of tea and bread and jam; the Hospital is winning. The dark adversaries are at bay.
Hospital life is absorbing; it may debilitate you in the end. To care is impossible, not to care is impossible. Those patients who stay for a long time come to live by hospital time. They quaver for their supper at tea-time, they need the circumscription, they are dependent upon the hectoring way of the nurses. They are afraid of the violent profligacy of choice in the well world. They live in a valetudinarian, half-lit world where all decisions are taken by another. They are children, with no need to pubesce. To believe in the hospital is essential for the patient or he will not mend. Not to believe too much in the hospital is essential for the patient, or he will not adapt to the bright day his well body should now be fit to inhabit.
And then there are the mages. That is myself, and my fellow consultants. Not all have my newspaper notoriety, though the men who give babies to the childless are worshipped in this way. This is understandable; it is after all primitive magic as well as microscopic science of life which builds and shelters these new lives. Those of my colleagues who are given this type of adulation are touched and troubled by it. What they do is misdescribed, made misleading and to them couples come for whom the hope of hope is not even to be hoped for. They come from Anchorage, from Lima, from Dunblane. I have been lucky. My surgery is not arcane and has little of magic, though the heart is like the moon in our minds, and even more so in the shrunken mind of the narrow-vocabulary papers. The moon is made of green cheese, the heart of soft-centred chocolates in red velvet. The moon is for June, to spoon under at the prompting of the heart. The moon takes all women in its tidal tug, the heart has all the best lines. When the first foot was set in the dust of the moon, its silvery disc, the lozenge of love, was not pulverised. Minds baulked at the conclusion of literal events. The first transplanted heart, tucked in by the archetype of all heart-throb surgeons, did not hurt the romance of the idea of heart. It is a soft pump of muscle, but do you not wear it, with no incongruity, upon your sleeve? Does your heart not come into your mouth when you see the whore’s heart cut out by her brother? Heroes are great-hearted, hearts are for lovers, knaves, tarts and queens. The heart has its reasons; it is a lonely hunter. All life returns there repeatedly, and at the end, having reddled the blue gallon of blood for the last time, the great heart breaks.
The heart is an emblem we understand. It is proof love need not be literate. So the meaty seat of my professional endeavour is rich in metaphors. It stands for all we beat for against the tide of what is sure. To consider all this in the servicing or repair of a faulty heart would be as rash as to drive a space rocket on champagne and a driving licence. Professional men must not reflect too much; we delegate this to our universities. The trick of living is to travel light, and too much thought will put wings on your cap perhaps, but set your ankles in stone. If lawyers gave to law the equal balance its practice and philosophy require, no judgement would ever be made. Draco’s bloody stylus would still, ineffably slowly, be approaching the set wax. Seeing illness, sooner or later, we must act, and thought, the instigator of action, is also its great enemy.
I am a man of thought become a man of action.
Hospitals, then. Most people will tell you, as though revealing something quite exclusive about themselves, that they hate hospitals. I love them. Hospital was for me what university had not been. I at last was able to leave home. My parents would not have understood my leaving home while I was at university in London, so I cycled daily from Bayswater to Bloomsbury and took my meals with my mother and father. My first hospital was in Buckingham; even my mother realised that this would make it impossible to share our evenings and our food. It came just in time, for me. My mother had begun to ask about girls. I think she was relieved enough that there were none, in case I should be distracted from my work. Perhaps she imagined that I did all the courting I needed in the refectory or lecture hall. In fact I went to the cinema once a week with a dark medical student named Douglas Hardiman, who wore the same jersey for four years during which it grew tighter over his belly. His flesh raged. Once inside the cinema, we would separate. Douglas would look about till he saw a girl as nearly alone as possible. If there was no single girl, he sat next to anyone female whose flank was undefended. After the film, there would be either Douglas alone and with a story of sally and rebuff, or Douglas with a girl who might even accompany us on a subsequent trip to the cinema. They would not last longer than this, on account of Douglas’s approach, which was an impassive but violent molestation, his face staring ahead at the screen, his hands working like a person trying to get inside a corpse for warmth in a snowstorm. Outside of the cinema, as far as I could see, he could not look at his victims. He was compelled to talk, and to talk about medicine. He was drawn to discuss all that, in the early 1960s, was not pertinent to the wooing of girls. He would glaze over in cafés – the Rumble Tum, the Digest, the Tom Tom – and give monologues on lesions or fluke. The clear beauty of the function of the eye, or articulation of the hand, became in Douglas’s mouth meat and juice and gore. ‘Ooh, isn’t he morbid?’ these girls would say to me, hoping to stir into action the dishy friend of the mad boy talking carnage in the warm coffee-steam. But I liked these cinema outings because I could do what he was doing, in a stealthy way, with boys. Where he paddled and dipped and unhooked, I stared and tested and occasionally found my eye met. Assignations were made, and one afternoon I discovered that there was an end and a means to them which was neither lonely nor procreative. I never wanted to stop. I do not know whether Douglas knew. I was mooning, desiring and not daring to pursue; Douglas even followed the plots of the films, so simply physical was his quest.
My first hospital brought my first happy sex. In the white laundry, among slapping towels, tents of sheet, eight osier chariots full of dirty white linen, and the rolling surge of industrial washing machines, the slippery floor gritty with fragrant blue Daz and my eyes stung with bleach, I embraced and was embraced. I was old to be learning, and my joy was great. The smell of hospitals, which is fearful to many, is mysterious and delicious to me. The hospital was the first world beyond my family. It was disciplined and self-contained; the first insti
tution discovered after the family is laid down for nostalgia, and the glamour and function of hospital are blended for me into something for which I feel what could almost be called patriotism. Their glamour offers me something resembling that which hotels offer the homeless rich.
As I grew into a real doctor, then specialised and became a consultant and at length a recognised plumber of the heart, so I became more dependent yet on my hospitals, though no longer dependent on them for love. I could not be. My success had stripped me of the anonymity which had made things easy before. I was not tempted either to try to find my first paradise again. Just as public school boys move on to their clubs, I moved on, without losing the tingle of danger and indulgence I had enjoyed. In Turkish baths, in plain tiled lavatories, I remember the sluices and laundries in which I had first been happy.
The hospital where I have been for some years now was built as a small foundling hospital. It has grown four times; once, when a philanthropist commissioned Norman Shaw to add to its modest single block. He added long windows set in a tall façade of stone; pendant from each window is a small false gallery, faced with tiles, in eggy blues, greens and sunlight yellow. There are twelve windows and each set of tiles depicts a different illness, succoured by men and women dressed in long green robes, much as we appear, in fact, though the intention is pre-Raphaelite. Conspicuously absent are heart-disease and cancer and the new Pink Death. Brain-fever and tuberculosis are there, and infant death. No cure for that, but the panel parallel shows a slim woman with a furled armful which may be a baby though it looks like a small adult, standing up as present and correct as the Bambino. At the upper corners of each of these glossy tablets is a tile showing a snake bandaging a meaty iris stem, the flower signifying the Trinity. This part of the Hospital is called the Trinity Wing, which makes me think of a wounded dove – a Holy Ghost – winged, as it flies over, by a bad shot. I enjoy Christian iconography; it is like roadsigns, an attempt to find a language which will show all nations the way, without taking into account that what is St Mark to one man is a bored old lion to another.
The next two additions were made in the 1960s. They are buttressed with spindly steel and their surface is hubbled and the yellow of coarse sand. The buttresses are as awkward as the legs of drinking giraffes. None of the windows in this part of the hospital is without its niggling draught. Inside, the optimism of that decade has allowed the architects to waste a great deal of space. There is a wide hall with a gorilla-sized mother and child carved from granite. I have not seen less living rock. It feeds out its own cold, which it retains all year, intensifying in winter. The only thing about the sculpture which is on the human scale is held in the hand of the monstrous child. It is a ball, or a fruit. This part of the hospital is where the children are treated, and many of them touch this ball as they come and go, so it is sometimes warm. Single mittens are put there, until they are paired up, or lost again.
The remaining addition to the hospital is ‘my’ part. It adjoins the original building and is devoted to disorders of the heart. It is not large but it is efficient, containing two theatres. Because it is not large, there are not so many corridors, which patients fear. Seen from outside, the building is an upright creamy tube, with a sloped roof, whose window is a single ox-eye. The body of the building is pierced with what look like arrowslits. Artificial light is a constant requirement. We have two generators. The theatre in which I most frequently operate is in the top room. Because of the height and angle of the window, you cannot see out, but I have looked up to see stars from there, and dawn breaking. Every part of this modern cylinder is in use. Insofar as this is possible, there are no corners to contain dirt; unlike most followed-through architectural theories, this does not seem to be foolish and is handsome. It is also appropriate, as the building and my department were endowed by a man whose fortune was made from the manufacture of cleaning agents ‘good at reaching corners’. Only once the patients are mending in health does this cornerlessness present problems. The furniture of convalescence – sofas, chairs, the television – is incongruous in the circular rooms. Occasionally, I wonder whether I should ask Tertius to have one of his designer friends make appropriate, curvilinear, furniture, which I shall give to the hospital. Then I reflect that coin is both circular and more appropriate.
I took the lift up to the ward, having been to the consultants’ room in the main block. I was greeted by many nurses, each busy with something, as though in a diorama of a well-working hospital. I sometimes feel like a performer, with great longueurs between performances, while my juniors ensure that what is real – tests, readings, turning, dredging, wiping, feeding – all go on. They fill time. It is only once the patients are asleep, and the nurses begin to knit and quietly talk about husbands and children, that the truth comes out again. Life is dense with empty space.
The little brown boy was asleep. When I see the very small children with tubes in their noses and arms and sides, they look like puppets on transparent proteinous strings. To mediums, that is what we are. Geneticists know this too, I suppose, as we dance about on our helical threads. The boy was about two, but in that prim bliss of baby sleep he looked younger. His mother appeared to be praying. In fact she was helping a grumpy old man, who had come in from the adults’ ward, with a crossword clue. It was one of those crosswords which are called ‘quick’. The old man was in a dressing-gown with a badge over the breast. The crest was not familiar; it must be that of a chain store. I imagined he had six months left to him of life. He had a vile temper and did not enjoy the visits of his wife. One of the nurses had heard him crying at night. He had told her he did not want to die, he loved life. Each day, he made the newspaper last. He would call the more gullible nurses over on a pretext and then say, ‘Dreadful, isn’t it, shouldn’t be allowed, crying shame,’ and show them the photograph of the naked girl in the paper to make them blush. Then he would scuttle off to the bathroom to shave. He disliked many things, which gave him a sort of firewatcher’s vigilance. That he was currently doing the quick crossword with one of the things he most disliked he had not noticed. He fawned on me, with a menacing servility.
‘The opposite of white, Doc, even I can do that one, that’s another one done. I do not mind telling you this lady is not bad at this at all, are you, love?’
‘Another question right away please, Mr Mallard,’ she said, handing him a squashed paper bag of fried plantain discs. She seemed incurious about the child. I think she felt that as long as she was there, he would be safe. Perhaps she had once momentarily left the bedsides of her other sons, and saw their deaths explained in that.
‘All’s well that ends blank,’ said Mr Mallard.
‘Well,’ said the mother, and I wondered what her house looked like inside and if she let her girls play outside in the street.
‘Eh?’ said Mr Mallard. ‘Too deep for me that one. Not at all bad these sweets. Taste of banana.’ Then, perhaps feeling he had been too nice, a bit womanish, he continued. ‘Bastards, the lot of them. It all began with that star in the East, of course, if we hadn’t of had that we wouldn’t of had years and decades of rule by rag heads, front wheelers, left footers, and how’s your father.’ But for the possession of his pension and his precious ill health, Mr Mallard would have been one of those fierce invertebrate drinkers with red eyes who free associate at bus stops and have scabs on their faces and wet trousers. As it was, he was ill enough to live in hospital, like a rearrested criminal.
‘Sit down and get comfy, Mr Mallard,’ said the mother of the sleeping child. She searched in the bag at her side and brought out a tissue and a Jaffa Cake. The tissue was mauve.
‘Your nose needs a good blow,’ she said, ‘and then you can have a biscuit. You like these don’t you?’ She was speaking to the old man.
It is a mother’s wish, I observed, in my own mother and in all the mothers who come to guard their children in the hospital, to feed her child. While her sleeping boy was having glucose dripped into his vein, this woma
n was feeding Mr Mallard. The baby had eyebrows which met, like a man’s. About the room were people making the best they could of the conditioned air, false lights and dim colours of the hospital. By now it was legitimate visiting time and the tippling of barley water and handing over of gifts from home had begun. It was the nurses’ job to send Mallard out of the children’s ward. They had allowed the mother in her synthetic silks to stay because of ‘the history’, as it is called. She was also a great keener, and this is very bad in hospitals. When they sense hysteria the patients get insubordinate and plot against the staff whom they suddenly see as enemies. We have a room where parents may sleep. On its wall is a crucifix, in tooth-coloured plastic. Christ has a foppish smile and His feet are crossed as though spatted. The hole in His side looks like a buttonhole.
‘Prithee, undo this button,’ I thought. There are those thoughts which are a refrain, which you do not intend to think, yet which you think daily. They are automatic and not especially illuminating. I think of these words when I operate and am close to the distinction between living and not living, just a breath. I also think it just before the act with my boys. But when it seems most pathetic to me is when I am operating on a child. Silly word as button is, it is the right one. It stands for life, and the child’s death leaves a hole you cannot mend. You may stitch it up, but it will always be clear that something has been there, and is now gone, something round and essential for security.
I spent the early part of the afternoon making sure that the theatre and the nurses I required were prepared for that afternoon’s operation. We began at three o’clock and stopped at eight. I like to keep an atmosphere with none of that tension which is shown in hospital-television. I like a sober neutrality; there is a beefiness in my colleagues, especially obstetricians, which is not suitable. Today’s patient was a girl of about Cora’s age. About her wrist was a plastic bangle, which said, steel, Dolores. She had been born with a heart murmur. It had recently worsened. If you have, as I do, an italic hand, you will write in that word murmur exactly what the electrocardiograph does not show when it is registering a murmuring heart. Instead of the regular up and down of the beat, mur, mur, there are pauses.
A Case of Knives Page 8