‘Patient’ – Part Two

Dan Jacobson

Dippy-dippy-dation, my operation:
How many stitches did you have?

Children’s Counting Song

Six weeks after being taken to hospital during a severe attack of pancreatitis, I returned there to have my gall-bladder removed. This is of course a routine surgical procedure (routine for the surgeons, if not for the patients): indeed, a timely newspaper article had informed me that it was ‘the major surgical intervention most commonly carried out in Great Britain’. After several examinations I had been told that the operation would prevent a recurrence of attacks of pancreatitis like the one I had been through: a promise or invitation I was not disposed to reject. Let the reader think of what follows, therefore, as a kind of traveller’s tale: the account of a brief sojourn in a country which is never more than a few minutes or miles away from any of us.

So there I was, having been admitted ‘cold’ on this occasion, lying in bed with a full two and a half days to go through until the operation. In the bed alongside mine was a geriatric patient named Teddy. I did not know, and still do not know, why I was admitted so early: apparently that was the standard procedure. For Teddy there was no going back and forth, no crossing of frontiers, no letters or visitors from that remote kingdom which began just outside the hospital doors. His entire life was spent either on his bed or in a wheelchair. In the mornings the nurses unplugged his catheter and its receptacle; then they took him to the bathroom; then they propped him up in a chair, in his pyjamas and dressing-gown, with a blanket around his knees. They never failed to put his checked cloth cap on his head; occasionally, for a laugh, they put it on back to front. Thus rigged out, he sat through the day: sometimes sleeping, sometimes staring, sometimes shouting (if he managed to catch anyone’s eye) ‘Hoy! Hoy!’ or ‘How about it, then?’ When he opened his mouth three long green teeth showed. ‘Where’s me sandwiches?’ was another favourite cry. The young men in the ward responded to it by giving him bananas and biscuits from their private store; when they gave him a cigarette he promptly began to eat that, too.

Shortly after the cigarette-eating incident I was moved out of Teddy’s room into a specially made-up bed in the ‘high dependency’ section of the ward. This was directly in front of the table where the nurses sat and did their paperwork: it was separated from them only by a low parapet, so that they could see at a glance whether any of the patients needed their attention. Items of emergency and resuscitatory equipment were also kept there, affixed to the walls. At last, after hanging about for two days in a state of useless anticipation, enlivened only by repeated form-filling and examinations by every grade of medical staff and student in the hierarchy, I had been brought up into the front line. Or so I thought. Naturally I was depressed and anxious about what lay ahead, as well as impatient to get to it, to have the next night and morning over. Then I would go into a gulf, an abyss, a place of darkness which was unknowable by definition, and from which I would emerge like another of the bloodless, prostrate, unconscious, white-swathed creatures whom I had seen being wheeled into the ward from the operating theatre. How could one imagine oneself becoming like one of them? How could one not try to do so?

In the pre-dawn darkness, the grim, Aztec-like rituals of preparation began. I ate a breakfast of cornflakes and tea with milk, and bathed in water treated with a special iodoform mixture; my stomach was shaved; a suppository was administered; white, sacrificial garments were given to me – a brief nightgown with tapes that tied at the back, a chef’s hat, little cloth slippers. Just how anxious I was, in going through these procedures, became apparent to me when I noticed that I had begun to treat my body with a special solicitude, as if it already had some deep injury inflicted on it, whereas the truth was that nothing at all had happened, and I was quite as capable of walking out of the hospital as I had been of walking into it, two days before.

Instead I lay in bed in my white nightgown, trying without much success to read a book, or listening as if across a great space to the casual conversation of the nurses on the other side of the parapet, or to the monologue of one of the other patients in the section. The talker was an elderly, elongated man, with exceptionally large feet and hands, whose presence in that room was something of a mystery, since he was well enough to be discharged directly from it, on that very day, into the great world outside. Some of the things he said were rather mysterious too. For instance, he firmly told the huddled, silent heaps of bedclothes who were his only auditors, ‘As far as I’m concerned the Edgware Road is the road north out of London’ – as if any of us had been arguing that it ran south out of London. Some birds flying past the seventh-floor window produced another authoritative ruling from him: ‘They must be rooks, since crows don’t fly that high.’

The hours seemed to go by even more slowly than they had the previous night. Before a patient was taken down to the theatre, I had been told, a ‘pre-med’ was administered, to make him drowsy. Then darkness would supervene. When the staff-nurse finally approached me, well after mid-day, I sat up almost eagerly, to take my medicine like a man. Or rather, like a child. At that point there took place the only ‘mishap’ I have to report, as far as my own treatment is concerned. The nurse had not come to give me my ‘pre-med’: far from it. She had come to tell me that I would not, after all, be operated on that afternoon: indeed, the operation would not take place until the next Monday. (It was then Thursday.) They had miscalculated the time needed in the theatre by the two patients who had preceded me there.

All that apprehension for nothing! All of it to go through again! These last days of strenuous waiting, and these last hours of preparation, utterly without point! The shock of that announcement was in its own way quite as painful as anything I had felt since I had fallen ill; in some respects it was even worse than any of the other pains I had suffered or was still to go through, for it had not come about through an act of nature, as it were, but as a result of human misjudgment and mismanagement. Anger, incredulity, paranoid suspicion (I knew, I’d always known, they were capable of pulling something like this on me; I’d always known I’d be the one they would do it to), shame, impotence, even a tiny, sneaking flicker of relief – it does not take long, no more than a second it seems, for such conflicting and mutually exacerbating emotions to fill one’s breast. To get them to settle down is a more protracted business.

In the end, however, the torment-by-anticlimax I had been put through did produce two incidental benefits. The first was that the wintry weekend I found myself unexpectedly spending at home (two long black nights and three brown days, accompanied throughout by the sound of leaves creeping and crackling in the streets) turned out to be surprisingly enjoyable. The second was that when I did return to the hospital on Sunday, to be prepared all over again for the operation, I felt none of the apprehension I had gone through on the previous occasion. I did not give a damn about anything but getting the whole performance over and done with; I certainly was not going to let them make a fool of me again by investing emotion in it beforehand.

So: into the gulf. Its antechamber was a bare, disorderly-seeming room, with a high ceiling and many parked trolleys to one side; it echoed with clashing noises whose origin I could not determine. For some reason the room reminded me of a large greenhouse or conservatory. In that place, amid those noises, recollection comes to a stop. The anaesthetic was not administered there, I am sure: but I have no memory of anything that followed, until I found myself in the ward, on my back, hung about with, indeed penetrated by, drips and drains and aspirators. It was morning. My throat ached.

Had I slept right through the evening and night, after the operation? It seemed to me that I had. Some time later, however, my wife asked if I did not remember seeing her when I had first been brought back from the recovery room. Then, at once, I did recall seeing her; I remembered the distant, troubled smile on her face, which seemed to rise out of an ocean-like turmoil or heaving going on all around her. That this was a genuine memory, and not merely a response to her suggestion, I know by the fact that in the same moment I remembered something she had not told me: namely, that I had been looking at her over a set of bars which had been put up around my bed. I could even remember the feeling of bitterness and dismay which this piece of apparatus had produced. The last time I had seen such bars they had been around Teddy’s bed. ‘So that’s what they think of me!’ I’d protested inwardly.

Over the next two days I flopped and floundered through a welter of discomfort and weakness as if through an endless, bottomless bog which was, bewilderingly enough, my own body. Nothing worked; nothing could be relied on; whatever was not felt as an intolerable pressure of one kind or another made itself known as an even more alarming absence. Of direct pain, however, I felt remarkably little: indeed, as long as I lay perfectly still I suffered no pain at all. But how could that be managed for more than a few minutes at a time? Every cough, every hiccup, tore through the whole mess like a bullet. Every movement was a reminder of what I would have been going through had it not been for the pain-killing drugs which, in solution with the saline drip above the bed, were constantly being piped into me.

Those drugs, presumably, also piped into me the hallucinations I kept on having or being visited by. They were strangely colourless, plotless, pointless affairs, for all their more-than-dreamlike insistence. Over and over again there gathered around the bed diaphanous, quasi-human figures; they whispered and chirped and clutched me tightly by the wrist or arm or shoulder; usually it was by their grip on me that I would know them to be back, each time. They had no faces, they had no more substance than an insect’s wing, but they did have exceptionally firm fingers. They could stare too, their facelessness notwithstanding. To be conscious that they were not really there, to know that I was awake, that when I looked for them I could see nothing, was never enough to drive them away. A moment later they would return – staring, shuffling, gripping, exchanging the dry crepitations that passed for speech in their washed-out, twilight world. Dreams would have had incomparably greater emotional impact than these visitations; dreams would also have had far more colour and narrative substance. But the phantoms were still at it, days later; once they even got their fingers right inside my jaw, in order to force my head back and hold it there, for what seemed to be a long, long time. Subsequently it occurred to me that these creatures and the activities they went in for might have been some kind of ‘after-image’ of the operation itself, when I had certainly been surrounded by masked, firm-fingered attendants; but that is nothing more than an attempt to make sense of what otherwise would appear to be wholly senseless.

On the third day after the operation I was moved from the high-dependency section to one of the four-bedded rooms into which the rest of the ward was divided. Evidently my recovery up to that stage had been satisfactory; and so it continued to be. In ways that actually seemed to be more mysterious than the pain and discomfort I was going through, an increase of strength came to me, or I came to it, day by day, sometimes even hour by hour, in unpredictable accessions. You feel illness, moment by moment; it is something you are conscious of; your consciousness is the sure sign that you are ill. Recovery, on the other hand, comes by stealth. Each stage precedes your realising that you have passed it. Every day, however short of breath I still was, and however hobbled my step was by that crushed, post-operative crouch which marked off the veterans from the apprehensive newcomers, who now stared at me just as I had stared at my predecessors on my arrival, I could walk a little further; every night I could stretch my legs a little straighter in the bed; eating, drinking and evacuation (the last after a wretched delay) became somewhat less of an ordeal.

Curiously enough, this progress did not appear to be retarded by the depression which accompanied it, and which grew stronger, if anything, as I grew stronger physically. It took the form chiefly of a sense of failure which referred not just to my ailing body, but to myself, to my life, to everything I had ever done or tried to do. It was not that I felt myself to be a failure, because I was there: rather, the truth seemed to be that I was there because I was a failure. The episode, in other words, could not be seen as an intrusion into my life or an interruption of it: it was its epitome. This conviction somehow appeared to be certified by or objectified in the flat, pinkish, four-square walls of the room, its beige, rubberised floor-covering, the plastic Venetian blinds over its windows, the honeycomb light fixture which threw a fluorescent glare into every crevice of the room, or, after lights-out, kept a small blue worm suspended in its grip all night through. That same conviction of failure took another form when I caught a glimpse of myself in a mirror while having my first bath (itself a milestone on the way to recovery): what I saw there was not my face but my father’s, and not just his face but the attentive, listening tilt of his head, the wariness of the movements of his eyes, the habitual expression of unhappiness on his features. So far from those modes of his selfhood having vanished into the grave with him, as I had imagined, I had incorporated and re-created them within myself. Now the moment had come for them to make themselves manifest.

The ironic truth, however, was that all this must have been in its own way a version of appetite, a sign of life. Whatever mental miseries the others in the room were going through, they were not those accompanying the process of recovery. I say that for the starkest of reasons. The others in the room were not recovering. They were dying, all three of them. In the bed across from me there lay a tall, emaciated man, somewhat younger than myself, whom I shall call Harry: he was a terminal cancer patient. In the bed on my right was old Mr K____, a diabetic with high blood pressure, who was slowly drifting away into silence, like an unmoored boat, with only an occasional Yiddish-inflected exclamation of bemused greeting or inquiry to let one know how far he had gone or had still to go. And in the bed diagonally across from me was Mr F____, another elderly man, whose demeanour was quite alert and whose complexion was positively rubicund. However, one Friday lunchtime, when the house-officer going off duty bade him farewell with a hearty, ‘See you on Monday,’ Mr F_____ replied firmly: ‘I hope you won’t.’ ‘Don’t be silly!’ the house-officer brayed at him, in such resonantly public-school tones the words seemed to clatter off the walls like tin cans. ‘What a silly thing to say!’

Later that afternoon Mr F____ had visitors: his wife, who was herself in a wheelchair, and his jerky, tweed-suited, spinster daughter of middle age. They were fussing about him with their gifts of fruit, flowers and Perrier water, when Mr F____ began to groan heavily and to roll about on the bed; a moment later, still groaning, he was on his back and slowly but irresistibly arching his whole body upwards, higher and higher, until it was braced like a bridge between his shoulders and his heels. One could not have believed it possible for so old and plump a man to remain suspended like that, but he managed it. Then he collapsed. Almost immediately, with yet another groan – and somehow the sight was even harder to believe this time than the last – he had begun to arch himself upwards yet again. His wife was frantically wheeling her chair back and forth; the daughter pressed the buzzer, abandoned it, and ran into the corridor for help; both of them were uttering incoherent cries. A nurse came in and the curtains were drawn around the bed. From behind them came more groans, some loud, some like whispers, as well as the voices of mother and daughter pathetically crying, ‘Relax! Just relax!’ as if the man were being fractious or were bringing his sufferings on himself. Finally the relief houseman arrived, on the run. The curtains were drawn back only after Mr F____ had been rendered senseless with a shot of morphine.

The houseman, a neatly combed, good-looking, kind-hearted boy in his early twenties, then had to deal with the wife and daughter. This he did by telling them that Doctor This and Doctor That would be coming to see the patient as soon as they possibly could; they would be out of the theatre at 5 p.m. and they would then attend to him immediately. So the two women started to wait for the arrival of the doctors. They could be heard in the corridors uttering to one another the doctors’ names, the houseman’s included, like talismans; as five o’clock approached they began to ask every passing nurse when the doctors would be coming; Mrs F_____ could be heard talking on the payphone, with a kind of reverential despair, of the imminent arrival of the doctors, as if of the coming of some wonder-working, all-knowing creatures belonging to another race. At about 7 p.m. a whole team of these doctor-saviours did finally appear. ‘Sod it!’ I heard the central one among them exclaiming to his colleagues, as they stood in a group in the corridor. ‘The old bastard’s gone and blocked himself. We’ll have to operate tonight ... ’ He was, needless to say, well out of earshot of Mrs and Miss F____. There was not only irritation in his voice but also exhilaration at the thought of the fatigue and effort that lay ahead, and of his own capacity to do whatever might be demanded of him. Shortly afterwards Mr F____ was wheeled out of the room. The next morning he could be seen in the high-dependency section, with more than the usual amounts of paraphernalia hanging over him, and an oxygen mask affixed to his paper-coloured face. Later that morning I bumped into mother and daughter in the corridor: the younger woman’s expression was worn and red-eyed and quite without hope; the mother’s face looked half the size it had been the previous day. Her eyes sought mine from below, from the wheelchair, with a mixture of shame and mute appeal, as if I too might yet miraculously turn into a source of help. Later still, Mr F____’s son arrived, with his adolescent son in tow: the man stood at the foot of his father’s bed, mopping his eyes and face with a handkerchief; the boy simply gazed with incredulity and fascination at his slumped yet strung-up grandfather. By the time I left hospital, three days on, Mr F____ had not recovered consciousness.

Within an hour of Mr F____’s departure from the room, Mr L____ was wheeled into it. He was in pretty good shape: quite evidently well on the way to recovering from the hernia operation he had been through. He and I used to go on hobbling patrols together, up and down the corridors of the ward. I did not tell him what had happened to his predecessor in the corner of the room he now occupied, and nor did either of the others: Mr K____ because he almost certainly did not know; Harry, the cancer patient, because he did not care. He had enough woes of his own. It was his wife – an Irishwoman with dyed, silver-blonde hair permed into ripples exactly like sea sand after the tide has withdrawn – who told me that he was a terminal case. She had also said that he did not know it. But I think he did. The more I saw of him the more convinced I became that he had no expectation of ever getting out of the place. One of the ways in which this showed, strangely enough, was in the sweetness of his behaviour to the nurses, compared to the harshness with which he treated his wife. Nothing she did pleased him: not the food or newspapers or changes of pyjamas she brought him, or the length of her visits, or the subjects she chose to speak about. For her he had snarls and curses (‘stupid bitch’, ‘silly cow’); for the nurses, on whom he was now dependent during all the hours she was away, he had only humble beseechings and coos of thanks. (Though he did once or twice complain about them to me.) At regular intervals he received quantities of sedatives and painkillers: small, red capsules which clattered in the plastic container in which they were given to him, orange and yellow syrups, the occasional shot from a hypodermic needle. These enabled him to drowse some of the hours away, either lying on his bed or sitting in an armchair. When he was awake he never looked out of the window, read a newspaper, went to the day-room to watch television, or listened to the radio through the headphones hanging above each bed. He had given them up, together with the world outside which they represented.

In the evenings, after the nurse had made up his bed for the night, he always lay on top of the bedclothes, his feet presented to mine. The evening cafard would settle down on the ward. Nothing to do now until some kind of unconsciousness would intervene at an uncertain hour of the night. Nothing to look forward to but the arrival of the drugs trolley ninety minutes ahead. The corridors of the ward, and the vestibule outside, where the lifts have been coming and going all day, deserted. The voice of the television set in the day-room muted at last. Harry lies stretched out, head twisted, mouth open, eyes closed, beak nose to one side, hands on chest – a medieval figure of emaciation and suffering. When he closes his mouth his face is hardly recognisable as a face: it is more like a bag with a single deep crease across it. To look at such a man, at such a moment, is to realise that it is precisely our extraordinary powers of recovery which compel us to suffer and to struggle so greatly before we die. If the struggle goes on intensely enough, or for long enough, however, it begins to look not like a struggle for life but a struggle for death – as if that is the real prize or reward the victor has been seeking and will, after sufficient effort, be granted.

Nothing is more difficult to recall, once an experience of hospital life is over, than the sense you have had, while it endured, of its universality. There is no escape from it: not merely no escape for you, there, at that particular moment, but no escape for anyone else either. Everyone has to go through with it: if not now, later; if not in this way, then some other; if not once only, right at the end, then many times and right at the end as well. In a country like England, at any rate, only those who die suddenly or far from all help are spared. To be in the grip of this awareness is like being in the direct presence of birth and death; in comparison, everything we ordinarily busy ourselves with seems to shrivel away, to reveal as if for ever its frailty and futility. Now we can see from what beginnings our lives have emerged and to what end they are remorselessly moving; now we can judge truthfully the value, or lack of value, of everything that lies between. Surely, we think, such an understanding will never desert us.

But it does. It has to. That is the condition of our being able to engage once more with the preoccupations, habits, routines and prepossessions of all kinds of which our lives are for the most part made up. And from that perspective, from within the realm of the safe and the quotidian (or of everything that conspires to assure us of its safety and everydayness), it is the previous certainties that seem diseased: not a permanent revelation but a symptom merely.

Well, since we do not choose to adopt the one view or the other, but have them both forced on us, they must both contain their own kind of truth. To re-create the one truth from the perspective of the other: that is the task.

Thirteen days after I had been admitted to Teddy’s room, and a mere seven days after the operation, the surgeon told me I could go home. Like everyone else to whom such a discharge – or parole rather – is given, I took my luck and cleared out as quickly as I could.