The house surgeon was a blonde, tender-skinned young woman, with irises of so pale a blue, set in such wide, weary whites, they looked almost grey. Her hair was drawn back, but wisps of it escaped at her temples and forehead, and formed a kind of soft, irregular frame for her face. It gave a certain pathos to the earnestness of her expression. Fatigue had flattened the skin against her cheekbones and left bruises under her eyes; her voice sounded effortful and distant. She told me she had been up all night. Now, at 7.30 a.m., there I lay, in a cubicle just off the casualty ward, having been turned out of the ambulance onto a high, hard wheeled stretcher. More work.

It was 35 years since I had last been a patient in a hospital. I had been admitted then after a car accident. This admission seemed to me almost as revolutionary or cataclysmic as the last. More than twelve hours before, at a meeting, I had begun to feel pain across my stomach and the lower part of my chest; severe enough pain to make for a bizarre discontinuity between the voices of the committee members, my inner preoccupations, and what I hoped was my wholly unrevealing demeanour. As for what followed, perhaps I can best convey the feeling of it by saying that during the small hours of the morning I became convinced that a cord or organ which should have lain horizontally somewhere in my chest had become twisted into a figure of eight, and that if only I knew how, possibly if I retched violently enough, I would be able to flip it back into position, and make it lie flat again. Then the pain and sickness would stop and I would be able to sleep.

Well, the trick was beyond me. Everything was beyond me: control, escape, comprehension. Nevertheless, when my wife did finally rouse a doctor from his bed to come to mine, towards dawn, I felt a kind of perverse relief at seeing how alarmed he was by my condition. At least I wasn’t making a fuss about nothing! The ambulance he summoned came after a brief delay. Wrapped in the traditional red blanket I was carried downstairs swiftly and with great deftness. It was too early in the morning for any of the neighbours to be looking on, which was something to be grateful for. On the way to the hospital, in the throbbing room-like interior of the vehicle, the man sitting with me asked what I did for a living. I told him I taught English at a college. ‘Oh, then I better speak proper,’ he said, sitting up smartly, with a mock attempt at an upper-class accent.

The next four days and nights passed in disorderly fashion. They left intense but fitful memories. The impossibility (because of a familiar pain) of continuing to lie on my left side; and the impossibility (because of the fear of a new pain) of turning over on my right. Waking at some unknown hour to find a West Indian staff nurse standing at the bedside, gazing down at me, and hearing her whisper: ‘I frightened you.’ My wish to tell her that nothing could have been further from the truth – how could I have been frightened by so intent and concerned a presence as the first thing I was conscious of? – and my utter inability to bring out a single word of this complicated thought. A corner of sullen sky hanging between straining concrete beams. Its sullenness turning to grimness as each day wore on. The intolerable smell of food at meal times in the ward. The smell of rain, brought in on the hair and shoulders of visitors, though not a drop of it could be seen on the windows. Getting to know by sight, by the touch of my free hand, by the touch of my tongue, by the weight and heat of it at all hours, the plastic splint on which my arm with the drip-needle in it was bound. Time passing, at night especially, even more slowly than on a long plane flight (and hardly less noisily, because of the roar of the air-conditioning vents in the ceiling), so that a thirty-minute leap of the hands of the watch was a victory, something achieved against the odds, which brought nearer landfall or daybreak. Spells of sleep induced by yellow, ovoid pills, each spell ending with the convulsive sensation of being flung backwards into waking, as if into a wall. The dehydration of my lips and tongue, and the sense of their growing bigger and bigger with every hour that passed. A day of high fever during which I had no control whatever over the verbose, boring madman in my skull, who endlessly lectured me in pompously editorialising fashion on subjects I know nothing about: Britain’s relations with the Common Market, the industrialisation of Tsarist Russia, the nature of the alphabet.

Still, some time during the third day the sign reading ‘Nil by Mouth’ above the bed was replaced by one that said ‘Clear Fluids Only’. I found myself turning over without really thinking about it beforehand. My blood pressure was no longer being measured so frequently; nervous medical students came less often to take blood samples from my inner arm. (‘Don’t let sister see I’ve spilled some blood on the sheet,’ one of them said, hastily covering up the tell-tale blobs with the blanket. ‘I was afraid you’d be an old woman with fallen veins,’ said another.) The fever withdrew or shrank to a single seed of darkness in the pit of my brain. The drip was put on a mobile stand, and I was encouraged to wander about the ward, rolling my life-support system with me, like an astronaut on the Moon. I was able to stand by the window at nightfall, looking at a bank of dark, bruised red in the west, under which the buildings of London lay in black heaps: all of which had an extraordinary resemblance to coals in a grate casting their glow above them.

By this time the other people in the room had become known as rather more than vague presences. There was Mr C____, whose ragged but elaborately orchestrated snores were such a torment to me. There was bantam-cock Mr B____ (‘in fashion’) and his greying coiffure, stiff with grease, who was desperately impatient to learn the results of a biopsy. There was Mr G____, another more subdued or philosophical attender on a biopsy result, whose fur-bedecked and perfumed wife chirped and clucked at him in cosy-sounding Polish every evening. There was the nameless, elderly Portuguese who suffered from a urinary complaint, and who would sit all day in an armchair, with an array of disposal ‘bottles’ on a table in front of him; these he was always shuffling and rearranging like chess-men, every now and again surreptitiously burying one under the blankets in his lap and then returning it to its place in the parade above. Some of the nurses I had got to know by name (Sarah, Penelope); to some I gave names of my own (Princess Anne, the Asian Flu); most of them remained as anonymous to me as I was to them. At all times I was conscious of being the object of their professional concern, and, occasionally, of something stranger, their professional tenderness. Only at the rarest moments, however, was any sense of my individuality reflected back on to me from their regard.

But for anyone in the hospital to complain of the ‘impersonality’ of the treatment he received would be as absurd as for him to feel aggrieved because the car he buys from a showroom was not manufactured especially for him. Impersonality was not the drawback of the treatment: it was its very condition – that without which it could neither have been conceived nor efficaciously administered. This was not only a function of the size of the institution and of the rapidity of its turnover of patients. It was an essential feature of the medical technology which the system had both developed and been shaped by. If the young houseman who had admitted me and her senior registrar were able to tell me, even before I had left the casualty ward, that I was suffering from a severe attack of pancreatitis, this was not because of their knowledge of my individual medical history, or because they possessed some intuitive, diagnostic skill which had led them to the truth. It was because a numbered sample of my blood had been sent for urgent analysis to the appropriate department of the hospital; within thirty minutes the machines and computers there had (fortunately for me) made certain unequivocal readings which had been sent back to the casualty ward. The doctors had then known how to proceed. That both of them had spoken sympathetically and reassuringly to me on my arrival had meant a great deal to me: but even their self-assurance was in large part derived from the fact that they knew they were parts of a system much larger than themselves.

However, the system did have a haphazard workhouse or almshouse side to its activities whose existence I would never have suspected beforehand. Subsequent, or consequential, periods in the hospital were to make this even plainer to me. On this occasion, for bureaucratic reasons which were never explained, I was suddenly transferred from the ward I was in to another three storeys higher. The room I was put in this time contained two long-stay patients – residents, rather – who were always wandering around; the ward as a whole was untidier and seemed to be run in a more disorganised fashion than the last, perhaps because it was almost wholly staffed by freelance nurses from various agencies, whose attachment to the hospital, its routines and their own duties seemed looser than in the ward below. But it was the presence of Roger and John, the two residents mentioned above, which accounted for most of the noise and disorder in the room itself. They also introduced a kind of comedy that was quite inseparable from the pathos of the position they were in.

Roger, as I shall call him, a man in his mid-fifties, had had a stroke many months before; like other permanent inhabitants of the hospital, he was kept in the ward simply because there was nowhere else for him to go. He must have been an imposing man once. He was tall and portly, with a protruding jaw and a fleshy nose to match it; he had a deep voice and a positively lordly accent. None of these advantages was of any use to him now. He walked with two sticks, goose-stepping with one foot and dragging the other, while leaning backward at an angle of about fifteen or twenty degrees from the vertical. He spent some of his time sitting in a throne-like chair at one end of the room, from which he could watch everything that was going on; he also used to station himself next to the sister’s desk at the centre of the ward, again with an expression of deep, inspectorial attentiveness to what was passing before him. Every now and again, however, he would take off, and there would be a noisy but unalarmed flap among the nurses. ‘Where’s Roger?’ one would hear them cry. ‘What’s happened to Roger?’ Then they would find him in one of the adjacent wards, or in the foyer outside (weeks later I was to see him scrutinising the proceedings in a ward many floors below the one he inhabited), and they would ceremoniously escort him back to his room, with a different set of cries and giggles. ‘You are a naughty boy, Roger. What do you think you’re up to?’

They washed him, they shaved him, they helped him to eat, and once, when he seized hold of the bottom of one of his escorts, they smacked him, squealing with excitement at this unexpected sign of life. For the most part Roger remained silent, the creaking of his walk back and forth excepted, but occasionally he made kindly, patronising remarks to the people around him. ‘You carry on,’ he told me once, when I looked up from doing nothing at all on his entry into the room; and then, as if to palliate any impression of discourtesy this instruction might have made: ‘I have some work to do.’ The voice and manner were perfect. He spoke with such conviction an eavesdropper could never have known how utterly without substance was what he had just said. Another time he asked me if I had met his sister when she had ‘paid a call’. I said no. ‘Pity,’ he said. ‘You would have enjoyed her company.’

Sullen, moustached, long-haired John, thirty or more years younger than Roger, came from the other end of the social scale. Whatever his family did, however, they had earned enough out of it to equip their ailing son with huge bowls of the most expensive-looking fruit, numerous bottles of different kinds of soft drink, a three-deck cassette tape-player, and a portable television set which was parked on a table next to his bed. These last two he played loudly and alternately until I asked a nurse to tell him to turn them down. She received the request ill-humouredly, but did what I asked; with even greater ill-humour John then donned a pair of earphones. The sound still leaked through, but it was not as overpowering as before. Everything he said was uttered in a tone of aggression and resentment; all his movements were designed to secure the attention of everyone within range. He invariably wore a pair of hospital-issue pyjamas and a polka-dotted, maroon dressing-gown. The garments were shed for his wash morning and evening, and the body then revealed was a pallid, mole-spotted, shoulderless, unmuscled affair. But one would not have known that anything was wrong with him had his stomach not been supported by a girdle of whitish panels and straps.

He had been in the hospital for three months or more, waiting to have an operation for what he described as ‘water on the stomach’. Though ‘bed rest’ (and a salt-free diet) had been ordered, he would never spend more than half an hour on his bed during the day without getting up and darting off on some self-invented errand: to the shop on the ground floor, from which he would come back laden with an assortment of comestibles; to the sister’s desk; to one of the other wards; to have a smoke in the ‘day-room’, where another, larger television set boomed and roared away at all hours. He also had a kind of girlfriend, who was herself a patient, apparently, but who was not even obliged, as he was, to wear pyjamas. She was always coming and going, sometimes accompanied by her acolyte: yet another fully-clothed demipatient, a boy of about fourteen, who seemed to go about in a trance of pride at the adult company he was keeping. The three of them frequently went into a huddle around John’s bed before starting up in search of some excitement.

The biggest excitement of all during my stay in the room was the great take-away curry scandal. On what turned out to be (for the time being, anyway) my last night in the hospital, John came in with his girlfriend at about 10 p.m. This was after I had swallowed the more or less obligatory sleeping pills which were distributed every night. He and she whispered together for a while; then the girl left. In the half-darkened room John proceeded to take out of his locker some underclothes, a sweater adorned with the motto and coat of arms of Chicago University, a pair of jeans and a pair of sneakers. He put these on hastily, with an air of great furtiveness. At the door he scanned the corridor to the right and left, before slipping away. Hours later I was conscious of his returning, undressing, and getting into bed. By morning it was clear that trouble was afoot. The nurses who woke us up did so without cheery words. To John they did not speak at all. He lay on his bed with his head under the pillow. This did not stop the Filipino girl who wheeled in the tea-trolley from yelling at him, ‘Wait until sister come!’ – to which John responded with a writhe that sent his head yet deeper under the pillow. When the sister did finally come, she glanced perfunctorily around the room at the rest of us, before advancing on John’s bed. She pulled the pillow away from his ear, and, jabbing her finger at him with each phrase, pronounced her sentence: ‘You are not to get out of this bed, you are not even to go to the toilet, a bottle and a bed-pan will be given to you, the curtain will be drawn, and you will stay behind it until doctor comes.’

The curtains were drawn around John’s bed, and she left the room. Dead silence. Roger, who had already taken up his position on his throne, gazed at the shrouded corner of the room with his steadfast, empty stare. The man in the bed nearest to me, a bespectacled sufferer from gall-bladder disease, shrugged and I did likewise. Presently the canteen staff proffered John his breakfast through the curtains. It was refused with a single yelp. Silence again. At last the senior registrar came on her round. She was a tall, small-faced, olive-complexioned woman, with dark hair severely cropped and (usually) a rather frank and thoughtful manner. On this particular morning she revealed a feline streak to her character. When the curtains around his bed were drawn back, and the full length of John was once again revealed to view, she approached him quietly. ‘Well, John,’ she asked, ‘did you enjoy your take-away curry last night?’

She waited a long time for an answer. None was forthcoming. So, eventually, she assumed one. ‘No? What a pity, when you went to so much trouble to get it.’

After another long silence, during which John stared up at her and she stared down at him, she changed her tack abruptly. ‘You’re a waste of time,’ she told him. ‘You’re a waste of money. You’re a waste of our patience. You’re not worth bothering about. We keep you here because we want to make you better, and what do you do? – you run out at night to the nearest curry house!’

‘I just had chicken and chips,’ John interjected feebly.

The remark was ignored. ‘So what do you want us to do with you? Kick you out? Nothing would give me greater pleasure. Restrain you physically? ... You try one more trick like that, and not only will we not do the operation on you, I’ll see to it that you’re never let into this hospital again. Is that clear?’ There was no answer from John. So she repeated the question; and repeated it yet again: until he finally answered in a muffled voice, yes it was clear. ‘Right. Now you lie on that bed until I give you permission to get up from it.’

Whereupon she left the room. Two nurses remained behind and swathed John in a white blanket: not physically restraining him in the sense that he could not have undone their work, but nevertheless making as good a job as they could of turning him into a mummy. John lay passively on his back throughout this process. Once the nurses had left the room he began cursing at the ceiling. ‘Fucking doctor. Fucking nurses. Fucking hospital. Fucking doctor ...’ The litany went on for a while. Then he started crying.

He was still wrapped up, but silently so, by the time I left the hospital a few hours later. I was supposed to have stayed there for another couple of days before going through the first of a series of tests to establish the underlying causes of the attack. It subsequently became clear that I had been suffering, without knowing it, from gall-bladder disease: but only on my fourth admission to the hospital was the offending organ finally plucked out. Anyway, once the idea of getting out of the place for the next two days had occurred to me, I could not rest until I had secured the doctors’ agreement to it. Thus my ejection from the hospital on this occasion had something of the suddenness of my entry into it. The last person I spoke to was John’s girlfriend, who came running up to me in the foyer on the ground floor, and who wanted me to tell her everything that had happened that morning. She knew and I knew that she was the one who had put him up to the escapade; she told me that the hospital staff had learned about it because an off-duty doctor had seen the pair of them leaving the curry house. And now? Scared and thrilled, she wanted to know above all if she was also going to get into trouble.

On that boarding-school note I was out of the building and travelling across the Heath on an ordinary, wanly sunlit autumn morning. The untreated air was so cool I felt I should sip at it rather than simply breathe it in. Everything outside the car window looked astonishingly frail and random: leaves hanging on by their very fingertips to the twigs above them; trees in purple, russet and yellow masses, each one wrapped in a faint mist, as a sleeping man might be wrapped in his own breath; subdued, defenceless stretches of trodden grass. After the rectilinearity of the surfaces in the hospital, it was impossible not to be overwhelmed by the irregularity and profusion of the growth that was visible everywhere: the infinite gradations of its colour, the variety of its textures, its sideways saggings and downward flutterings, its upward strivings and spreadings. Yet how provisional it all appeared to be; how uncertain the hold that any of it had on itself.

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