Memories of Catriona

Hilary Mantel concludes her memoir

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 backwards and forwards, 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 grey, and my weight began to fall, so that one day, when I saw myself sideways in 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. Oestrogen, like fresh supplies and matériel, allows the guerrillas to flourish. I didn’t know that then. If I didn’t take oestrogen 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 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. When I found a doctor who understood 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 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 per cent 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 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?

At nine stone and size 12, graceful and curvaceous, I got a job. It was quite a menial one, so I got another, for the evenings. One job was in a shop, the other in a bar. The jobs needed a sort of uniform, so I bought some cheap black skirts and white tops. Within a couple of weeks I had grown out of them. My face was round and looked childish; I was becoming like some phenomenal baby who astounds her attendants. When my next appointment with my consultant came, I said: ‘I’m worried because I’m putting on weight so fast.’ She shot me a spiteful glance, from amid her own jowly folds. ‘Now,’ she said, ‘you know what it’s like for the rest of us.’

I found a secondhand shop quite near where I lived; cast-offs from the bored, and the odd designer label. I was determined not to panic, but I stopped eating: what else could I do? My body was staging some kind of revolt: colic, nausea, an inability to keep food inside me. To get out of the house for eight, I had to get up at six. I spent my scarce free time getting my hair done, lifted and teased and curled into a mane, so that I didn’t look as if I had a pin-head on top of my sweetly plump shoulders. I was a size 14 for a while, and people would say: ‘You do look well – been away, have you?’

My ex-husband came back from Africa. He had once told me I was so vain of my waistline that I would starve rather than gain an inch. But how did he know? In the past it had never been an issue. Now I had starved, and still gained five. Not to worry! He took me shopping. I bought some Englishwomen’s dresses, the pretty, floppy kind that go with creamy skin and broad haunches. We got married again. I had warned him by letter that I was fat now, but I knew I was being melodramatic. Size 14 is not fat, not really, it’s just – it’s well. That’s what it is. Well.

I never was a size 16. I shot past it effortlessly. Soon there was nothing in the secondhand shop to fit me; bigger women don’t discard fashions so lightly. The assistants – and hadn’t I been their best customer all summer? – began to give me the smirk, half-commiserating and half-condescending, that would soon become the usual expression of shop girls when I went to get clad. My skin turned grey again, shading to slate-blue as the autumn came on. My legs swelled and ached. Fluid puffed up my eyelids. Some mornings my head looked like a soccer ball. I was glad when my husband’s job took us to Saudi Arabia, where women wear drapery rather than clothes, and where no one knew me, so that no one could stop me in the street to say how well I looked: where, in fact, I was more or less prohibited from going out on the street at all. I could stay indoors, under artificial light, waxing like some strange fungus.

The failure of my drugs had been recognised, and before I left England I was put on a new type. By now I was not so green in judgment. I looked up the side-effects. Weight gain: I’d done that, and I didn’t think there were sizes bigger than 20 – not really, not for people who’d once been thin. Hair falls out. Well, I had plenty of hair. Voice deepens – never mind, I’d always been a squeaker. Spots – harder to put a good face on spots, but never mind, the clued-up woman knows how to cope with a little outbreak. A general virilisation . . . oh, what’s the odds? I’d always wanted to be a bloke.

A few weeks on, I had developed a steroid moon-face. My hair had come out in handfuls. I was deaf, my eyesight was blurred by constant headaches, and my legs were swollen like bolsters. And one morning I sat up in bed, and cried out, like a nude exposed in a comic strip: eek! I clapped my outstretched palms where my breasts had been, and there they weren’t anymore.

Then I had a bit of luck. I needed a prescription: in fact the drugs would have to be sent from England, as they were not available in Saudi Arabia. I swayed, giddy and wincing, into a doctor’s office. Let me name him – why not? His name was Dr Fishlock. He sat up at the sight of me, and asked: ‘What are you taking?’ He fixed me with a keen look, of knowledge and concern. I told him. It confirmed what he had suspected. He knew the drug, he said. He had worked on the trials. It was effective: but but but.

I knew the buts. I was a walking but. A butt of ridicule, in my own eyes; a sad sack enclosing a disease process, no longer an object of respect, or self-respect. He spoke to me kindly, and cut the dose by a third.

Very few doctors understand this: that, somehow, you have to live till you’re cured.

I went home, to the dark, enclosed rooms of our apartment. I cut my dose by a third. Presently I sat down and wrote another book.

The full text of this memoir is only available to subscribers of the London Review of Books.

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