Giving Up the Ghost

by Hilary Mantel

  After the rolling was over, I was allowed to fall from the examination table, and urinate. When we got back to St. George’s, after another hour in a taxi, Della lollopped out of the cab and I followed gingerly, setting my slippered feet on the pavement. The porters shouted “Whoa, Della! Whay-hay, ducks!” “Bin Tootin,” she bawled. “That’s our gel,” the porters bawled back. They ran out a wheelchair and looked at me expectantly. I’m not getting in that, I said, don’t be ridiculous; I’ve run halfway round south London in my dressing gown.

  But you have to, they said, aghast. There’s no two ways about it. We can’t have you walking; what a notion! It’s more than our job’s worth.

  Della was singing now, her attention elsewhere. Oh, if it’s your jobs, I said. I wouldn’t like to get you sacked. That’s the way! they said. I sank into the wheelchair for the ride up to the ward.

  As Christmas approached, the ward emptied. The cheerful women went home, sterilized, healed, still grumbling. A husband brought a suitcase for a young wife who had been caught in the early stages of cervical cancer—cured, she thought, she hoped. In bed she had looked like a ten-year-old boy, buttoned up inside a sensible warm top, her pale hair tousled, her sharp face peaky. Now when the bed curtain swept back she stood straight and slim in three-inch heels, her angles encased in careful, beautiful clothes, which fitted her so exactly that you knew they had been made, by or for her; the precise hemline, the loose wool coat with its calibrated swing. She shook her head, and her thick blond bob, precision-cut, settled into place, grazing her shoulder pads; she picked up her burnished leather bag, and stepped out into the rest of her life.

  London emptied. The traffic stilled at Hyde Park Corner. A young woman remained in an opposite bed, six months pregnant, her face mottled with fever; she had a kidney infection and was, in the ward’s parlance, “poorly.” When the antibiotics began to work she sat up and looked about her with misty, Celtic eyes; her dark hair filmed the white pillow.

  When the kidney girl sat up, it was already the eve of my surgery. No one had agreed yet on the nature of my problem. My husband had been told that, in the event that the growths were malignant, he should expect my death. I had not been given the message, but I didn’t really need it. I stubbornly believed in my own diagnosis. If I was right, I would survive.

  Many hours after dark, the carol singers came. I was in the bathroom at the time, standing with my back to the dark mirror. I had begun to feel, not afraid but very lonely; I had given way to self-pity, and tears were springing out of my eyes when they piped up with “Once in Royal David’s City.” I stood till it was over, leaning against the wall. Then I heard a woman say, in a sweet bossy voice, “Perhaps you would care to choose a carol, dear?” And Kirsty laughed: a long peal, like glad tidings. They had swooped on Kirsty because she was in the first bed they came to; they had handed her a hymn book, and when I shot out of the bathroom she was holding it as if it were hot, and her laughter was the sound of her incredulity. I took the book from her; she darted a grateful glance. I flicked the pages over, and asked for “God Rest You Merry, Gentlemen.” The singers complied, though they looked a bit disappointed at such an old-fashioned choice. But I was thinking of our surgeons, coming tomorrow to cut me up; it was the last thing they would do, before going home to their families to carve the Christmas fowl.

  After the singers had gone Kirsty fell into a dead sleep. I sat on the end of the kidney girl’s bed and we smoked a cigarette. “Ladies, back to bed!” the staff cried. I was the only one up, but they made me plural because they didn’t care to confront me. Eventually I kissed the kidney girl goodnight, stroking back her dark hair; there was no one else to do it. I shuffled across to my own bed and edged myself beneath the covers. The mound of my abdomen was almost as big as kidney girl’s pregnancy, and they still hadn’t sorted out pain relief. They gave me a sleeping pill, but it would have taken a mallet to knock me out. I was not afraid, but my brain was active.

  In the silence of the night, toward two o’clock, came an African woman in trouble, rocking her head from side to side, on a stretcher which had taken on the aspect of a bier. Two men, their faces stricken, walked behind her. The cold had given them an ashy hue, and they carried woolen hats, which they wrung between their hands.

  I was brought up as a Christian, in so far as a Catholic may be so called. (My grandmother thought you didn’t want to be reading the Bible, she thought it was a Protestant book.) Christians are given, for their psychic support, the model of a man dying in extreme agony. As Catholics we were encouraged in my childhood to follow the “Stations of the Cross,” praying certain prayers at each depiction of the stages of Christ’s Passion. We were taught to be thankful that, whatever was in store for us, it wasn’t crucifixion: unless we were a missionary or really unlucky.

  As a Catholic, you were taught to contemplate your last end. You were encouraged to rehearse, in advance, your own death: with its accompanying agonies of mind and body, and (I found this a homely touch) your friends and relations hovering about your bed.

  It is true that the “Litany for a Happy Death” didn’t form part of the prayers I was taught in school. But at eight or nine years old, bored with the unvarying form of Holy Mass, and in despair of hearing a good sermon, I used to thumb through to the back of the prayer book.

  “O Lord Jesus, God of goodness and Father of mercies, I draw nigh to thee with a contrite and humble heart; to Thee I recommend the last hour of my life, and that judgement which awaits me afterwards.”

  “When my feet, benumbed with death, shall admonish me that my mortal course is drawing to an end, Merciful Jesus, have mercy on me.”

  “When my hands, cold and trembling, shall no longer be able to clasp the crucifix, and, against my will shall let it fall on my bed of suffering, Merciful Jesus, have mercy on me.”

  “When my eyes, dim and troubled at the approach of death, shall fix themselves on Thee, my last and only support, Merciful Jesus, have mercy on me.”

  “When my lips, pale and trembling, shall pronounce for the last time Thine adorable name, Merciful Jesus, have mercy on me.”

  I take death as serious and proximate, I always have. But recently, when a doctor asked for my family history, I had to knock him back on every score. No heart disease. No strokes. No cancer: except for Grandad, and he was a smoker. No reason, in fact (I said this wonderingly, raising my face), no reason, it seems, we should ever die.

  But the litany tells us we will, and how it will look:

  “When my face, pale and livid, shall inspire the beholders with pity and dismay; when my hair, bathed in the sweat of death, and stiffening on my head, shall forebode my approaching end, Merciful Jesus, have mercy on me.”

  “When mine ears, soon to be forever shut to the discourse of men, shall be open to hear the irrevocable decree, which is to fix my doom for all eternity, Merciful Jesus, have mercy on me.”

  “When my imagination, agitated by dreadful specters—” but no, perhaps I have agitated you enough. I admire particularly the phrase about the hair stiffening on the head. This road to dissolution, the good Catholic was encouraged to walk regularly, following Christ to Calvary. Saint Peter, we were taught, was crucified upside down; this was more merciful for him, since he would have lost consciousness. I was told this three times during my high-school education, by the same woman, and each time in my mind I rehearsed her solemn upending, as if she were a geometrical figure that I had been asked to envisage in some other position. I think she believed Peter had got off lightly.

  “When the last tear, the forerunner of my dissolution, shall drop from mine eyes, receive it as a sacrifice of expiation for my sins; grant that I may expire the victim of penance, and in that dreadful moment, Merciful Jesus, have mercy on me.”

  Note that excellent semicolon. People ask how I learned to write. That’s where I learned it.

  The whole of a Catholic life is lived in the shadow of the happy death—as if your life were to be enacted thr
ough a silvered, speckled mirror, ancient and flattering.

  La la la. Ma ma ma. December 1979: I felt the urge to leave a note by my bed: if I wake up a vegetable, put me in a stew.

  When I was half-awake, a day later, they came to tell me what they had done. After a general anesthetic, you dip in and out of consciousness: sitting up and smiling, you may be the picture of alertness, but your attention has faded. They should have told me again, I think, when I was properly awake. They should have told me once or twice. They should have written me a letter, they should have written me an essay or maybe a small book.

  Certain things were over for me now. I sensed it would not be easy to shore up my collapsing marriage. When women apes have their wombs removed, and are returned by keepers to the community, their mates sense it, and desert them. It is a fact of base biology; there is little kindness in the animal kingdom, and I had been down there with the animals, grunting and bleeding on the porter’s trolley. There would be no daughter, no Catriona; not that I could claim I had wanted her too hard; at twenty-seven I hadn’t ever tried to have a baby. We seemed fine as we were, the two of us. “The children of lovers are orphans,” said Robert Louis Stevenson. That would have been a sad fate for her, little Miss Cat. She would never be born now, and we were no longer lovers.

  I was missing a few bits of me, besides my womb and ovaries, my reproductive apparatus. A few lengths of bowel: but you’ve plenty to spare.

  Do you know what worries me most about this memoir? That I’m always the smart one. Always the one with the last word. Always the one with the heartless quip, the derisive bon mot.

  But now I had to reckon with this: I hadn’t been smart at all. Like a cretin, like some dumb little angel, I had believed what I was told. I believed that the pains which ran through my body each month were part of the burden of womanhood. I didn’t say to my doctors, by the way, my menstrual periods are agony. I thought they would say, get away, you, little Miss Neverwell! And when I had, timidly, approached the topic, they’d said robustly, whoah, now, you don’t want to worry! Period pains? That’ll clear up, my dear, after you have your first baby. Just you wait and see!

  I was brought up as a Catholic and it’s not easy to throw over the faith. I believed that, short of crucifixion, you shouldn’t really complain.

  I was quickly out of bed. I tried to persuade the surgeons to let me go early, but they wouldn’t. One of the girls on the ward had got a makeup kit for Christmas, and told me to help myself to it. I thought we should have our faces on, to meet 1980, so though I wasn’t very upright, because of my stitches, I painted us, young and old. Even Elsie, who was eighty-three, blushed beneath her blusher when I held up the hand mirror so she could see my work. “Look at me,” she said, “Is that me? I’ve never worn rouge!”

  For the rest of us, I painted deep kohl eyes, and ruby lips. The senior registrar came in, and caught me crouching over my patient. “Oh, you girls,” he said, laughing. He walked away, chuckling to himself: another bunch of happy punters.

  Oh, you girls! What are you like?

  The incision ran up the midline of my body, slashed from pubic bone to navel.

  About four months later, after repeated courses of penicillin had got me over the infections that I had contracted while in the hospital, I returned to Botswana, to my ailing marriage, my house, my dogs and cats. I am going to be better now, I said, I am going to be different. I went back to the GP who had been treating me, or failing to treat me: downtown, the dusty consulting room under the eucalyptus trees. I found it hard to talk; I thought I had nothing to be ashamed of, but somehow I felt ashamed, and I was not sure how confidential was my consultation; secrets did seem to leak, in this small bush town. I told him about the surgery, shuffling my feet. “So,” I said, “you see, in the end, it turned out there wasn’t much to be done, by the stage I’d reached. It turned out a bit of a catastrophe.”

  “Oh well,” he said. He shuffled his own sandaled feet under his desk. “There’s one good thing, anyway. Now you won’t have to worry about birth prevention.”

  I had been, until Christmas, a woman who thought she had a choice. I was twenty-seven and I thought I could have a baby, even if I didn’t want one, even if my husband didn’t; I was free in the matter, there were possibilities. Now I was not free and the possibilities were closed off. Biology was destiny. Neglect—my own, and that of the medical profession—had taken away my choices. Now my body was not my own. It was a thing done to, a thing operated on. I was twenty-seven and an old woman, all at once. I had undergone what is called a “surgical menopause” or what textbooks of the time called “female castration.” I was a eunuch, then? Castration is a punishment; what was my crime? It used to be fashionable to call endometriosis “the career woman’s disease”: the implication being, there now, you callous bitch, see what you get if you put off breeding and put your own ambitions first. I was no good for breeding, so what was I good for? Who was I at all? My hormonal circuits were busted, my endocrinology was shot to pieces. I was old while I was young, I was an ape, I was a blot on the page, I was a nothing, zilch. The publisher had turned down my French Revolution book. It seemed I couldn’t even write. But come now—let’s break open the champagne! At least I won’t have to worry about birth prevention!

  There are times in life when you are justified in punching someone in the face. But I didn’t react. I knew it was for the doctor to direct the blow, and me to absorb it. Sometimes one takes a little pride in endurance of this kind. At that stage, it was all that was left.

  When I left St. George’s Hospital, I imagined that aspects of my past had been excised, cut cleanly away. My long scar would knit and the memory of the pain would fade. For a time I went to and fro, between England and Africa, and in the end I tried to put down roots in the colder climate, and make my way alone. But by 1982 I was sick again, pain slicing through my vital organs and leaving me breathless in public places, leaning against a grimy wall at Euston Station, or clinging like a derelict to a park bench. My skin turned gray, and my weight began to fall, so that one day, when I saw myself sideways through a mirror, I shocked myself: I looked like one of those beaten dogs that the RSPCA used to photograph, with bones sticking through the hide. I hadn’t known that the endometriosis could come back.

  Though it is true that radical surgery is usually a cure for the condition, it is also the case that it is difficult to eradicate every misplaced cell, to pick off those minute guerrilla fighters waging a long war in the obscure cavities of the body. The hormone estrogen, like fresh supplies and matériel, allows the guerrillas to flourish. I didn’t know that then. If I didn’t take estrogen replacement, I had been told, my bones would crumble. How much to take? No one seemed to know. Trial and error, I was told breezily. Take enough so that you don’t get the symptoms of the menopause.

  Soon I was suffering almost continuous pain. Ignorant doctors whom I encountered told me the disease could not return. The pain was the pull of scar tissue, adhesions, or if it wasn’t that, then once again I was imagining things. This should have made me angry, but I was too fragile and worn to react as I should. There was little information available to the public, no support groups in those days. When I found a doctor who believed in my problem and was prepared to treat me, my reaction was only gratitude.

  The treatment was drugs now, hormones. The first weeks were tough. On a summer’s day, wrapped in a big quilt, my teeth chattered as they had in Africa when I had contracted dysentery. But the tropical infection had left me light and hollow; now, I seemed to be gaining flesh. I entered treatment weighing something over seven and a half stone. By the end of nine months, which was the usual duration of the course, the pain was no better, but my bodyweight had increased by over 50 percent and was rising.

  When I gained the first stone or two, I didn’t really mind. If you are secure in one aspect of your appearance—and there had never been anything to quibble about, with my shape—you don’t mind small changes, they don’t
seem threatening, and in fact they give you a chance to alter your style. I’d always been afraid of showing my arms, in case people thought I was from the Third World and gave me a donation; and my upper ribs, I’d always thought, looked somewhat tubercular. It was good that I looked healthier; I was tired of people asking what was wrong with me, and giving me those dirty looks that very thin women get all the time. I’d even been turned down for a job, by a broad-beamed horse-faced woman who said I looked weak: other jobs had been barred to me as soon as my medical record was discovered. It was a bit like going back to the 1970s. In those days, interviewers looked sourly at me because I was married, and looked fertile; so why didn’t they like me any better, now I was on my own and incapable of childbearing?