Diary

Hilary Mantel

At 6 p.m. on a damp late June evening, I look up from my book and see my husband across the room, faint and grey with pain. What to do? It’s Sunday, and whereas until recent years you couldn’t on a British Sunday buy a pound of carrots or see a play, these days you can’t be taken ill, unless you’re prepared for a long and uncertain wait for your GP’s deputising service. Go to A&E? Perhaps it can be avoided. A few weeks ago, he had a similar pain, and an abdominal X-ray showed no cause for alarm. He lies down. The pain ebbs. We spend a restless night, turning and muttering, waiting for Monday when crisis is more convenient.

In the late afternoon he sees his GP. She sends him to hospital with a note. He can hardly stand upright now. Twenty-four hours after that first attack, he is lying white as paper on a trolley in A&E. It is an ordinary evening, quiet enough – no inner-city brawls here in Surrey, no drunks. And yet, within minutes of arrival, you feel you have been rolled in misery and grime. Everyone is frightened, everyone is suffering or watching someone else suffer. There is no privacy, and the panic is polyglot; notices offer interpreters, translators, signers, but in practice the staff just shout. It is an odd idea of ‘emergency’, this. No doctor comes. There is no pain relief. There is no information.

Hours pass. We draw the curtains around ourselves. We hold hands. Our breathing seems to synchronise. There is nothing to say or do. It is not appendicitis, as the GP suggested – the pain is moving to the wrong side. From time to time I push the curtain aside, collar someone. ‘Yes, yes’, they say. ‘Oh, I will.’ ‘Just coming.’ Then they disappear and I never see them again. A pain-killing drip is put up. Ten minutes later it’s taken down. He is rolled off the trolley, taken for X-ray. By now it hurts him to move. I think he might die. All around me, in the cubicles, the past is being folded away, lives collapsed like tents, and journeys beginning to the new camping grounds of sickness, disability, loss of self. In the next bay I hear a man – a son perhaps, himself elderly – talking to an older woman: their voices cultured, civil, tired, the voices of people who’ve had their time. ‘You’ll have to go to residential now,’ he says. ‘To that place we saw. Only for a while. It will be nice. If you come home this time, I can’t be responsible, you see. I’ll have to go to hospital myself. And then where will you be?’

‘I feel well,’ she says, ‘in myself.’

‘Then why do you keep falling over?’

Sadly she says: ‘I don’t know.’

A young doctor comes at last. Probing fingers. ‘Perhaps diverticulitis’, he says. I know what it is – just as well, as no one explains. ‘First you will get antibiotics,’ I whisper. More hours pass. At 11 p.m. they find a bed. A porter and a nurse come to trundle him down an endless corridor. Later I learn the staff call it the Green Mile. I have to hurry to keep pace with the nurse. Can I befriend her? Will she tell me what comes next? Can I even make her look at me? She is young, dumpy and pallid, and recalcitrance runs from her pores. I have already learned this: if you are assertive the staff bristle, if you are gentle and friendly they blank you. I used to work in a hospital myself, so I know about the necessary cushioning of professionalism. But this is not professionalism; it is hostility, and resentment at having to walk the Green Mile late at night, with a woman breathless beside you twisting the wedding ring on her finger. I don’t want much, I don’t want to put her on oath; I want to protect my husband, to know where he’s going so I can find him again and I want to be acknowledged with a human word. Finally, crushingly, she says: ‘This is what we call diverticulitis.’ It is almost irresistible to say, this is what we call a punch in the head. She shrugs. ‘At least, that’s what we’re treating him for.’

On the ward he has to do a quiz. Has he got a hearing aid with him? Does he have a walking frame? Forms must be filled, I know, but here is a middle-aged man fit as a flea, except for this pain which has him running with cold sweat. The doctor who saw him hasn’t written anything up, neither pain relief nor antibiotics, so ‘we’ are not treating him for anything; his torment has just been moved to a new location and the doctor will have to come again. The quiz-mistress takes a stab at our address, Florence Court; Flourence, it comes out. Better not try her on Nightingale.

Half an hour after midnight I am outside, sheltering under the building’s canopy, waiting for a cab home. This wing of the hospital is a shabby 1970s construction which seems to be trying to slough off its skin; everything in it is stained, soured, shedding. A wet darkness slaps against the buildings. Down the hill, headlights creep along the main road. I think the cab is lost, which is more than likely. I have never felt so lonely in my life.

Tuesday, he waits for tests until late into the afternoon. I begin what will soon be my routine; a morning of futile phone calls, 2-4 p.m. on the ward, 6-8 p.m. on the ward, the time in between spent in a waiting area, eyes passing over and over the same paragraph of print. This building contains antenatal and maternity services, with surgical wards sandwiched between. Elderly visitors with drawn faces mingle with rumbustious family parties wielding carnations; the soon-to-be bereaved sail up and down in lifts bobbing with balloons. From my corner, I watch the mothers-to-be limp across the scabby carpets in states of grotesque ripeness. I notice for the first time that some pregnant women don’t expand at the sides, but grow out in front to points. I watch their faces as they manoeuvre themselves through the swing doors. This is not where you would choose to bring your child into the world. Women die here. Investigations have been held, best practice promised, reform all round; this would not comfort me, I think. On a monitor above the rows of seats a soupy film plays on a loop: ‘Nancy is experiencing Braxton Hicks contractions.’ Nancy looks spacey, like a Stepford Wife or cult victim; she has a carefully calibrated skin colour, is neither black nor white. From time to time, shell-shocked fathers carry out newborns, or new mothers thrust through the doors swinging a baby like a bag of groceries. I remember when newborns were tiny and swathed in lacy knitting. These bruisers are ballooning out of their suits. Baseball caps are crushed onto their bald skulls. I have read that infants are getting bigger, and I see it’s true; but I didn’t know they’d look so dangerous.

Tuesday, 7.30 p.m.: the surgeon comes. ‘How are you?’ he asks my husband. ‘Fine’, he says, automatically. The surgeon has seen the scans. He laughs, incredulous. He shakes his head. ‘This is not a small thing.’

The way home from the hospital lies through leafy low-ways, through Betjemanesque back roads, a slanting sun kindling in grassy verges. It is a fine evening but I notice I am very cold. I don’t sleep much. Next day I phone early, to catch the night shift before handover. They tell me he has passed a ‘comfortable’ night. I know from experience there are only three states a hospital patient can be in: ‘comfortable’, ‘poorly’ or ‘dead’, and I am surprised they have not updated the formulations. Then he calls me himself; he is due to go to theatre by 9.30. Later he will tell me how the anaesthetist asked him: ‘Where were you happy? Where would you like to go?’

‘Botswana’, he had said.

‘Right. You’re on your way.’

He thought he looked up at the sky, through a jacaranda tree; that was the last thing he knew.

One of my brothers sits with me while I wait at home for news; I don’t go to the hospital because it is vast and once there I cannot be sure to be in the right part of it to get the news, and yesterday’s experience teaches me that I would be deeply unwelcome. By mid-afternoon, no one has called me. I understand no bulletins are issued from the theatre. But surely the surgery is over? I am wondering not just how he is, but where. I begin to suspect he has gone so far he may never come back. When I phone the unit that claims to expect him, they can tell me nothing. Must be still in theatre, they say; but it’s clear they don’t care, it isn’t their responsibility. Have they just mislaid him? That seems possible. They take my number and say they will tell me if he turns up. By this time I don’t believe a word of it. Five o’clock, an irritable man tells me off: ‘When you phone, you take us away from our patients.’

What do you talk about, in these circumstances? We talk about Cardinal Wolsey, Werner Herzog, Uncle Ebenezer in Kidnapped, my brother’s dislike of cucumber. The surgeon had talked of gross infection, abscesses, adhesions, perforations. But green salad and odd film directors keep us going for quite a while. ‘Fassbinder, he was a nutter,’ my brother says. ‘And I can’t see the point of lettuce, either.’

This is the worst day of my life.

At about 6.30 the phone rings. A firm, friendly voice: a sister in intensive care. As soon as she speaks, something inside me clicks, out of the death groove and into the life groove. ‘If you come right away, you can see him.’

He is now at the other side of the hospital, and we get lost. It is a bewildering place, growing unplanned on a greenfield site. We find sheer walls with windows and no doors, we gape into wards where the bedridden stare back. When we find the intensive care unit the sister, unfussed by our lateness, packages us into plastic aprons. In here there is neither day nor night, but a reverent hush, a reassuring bleeping and hissing of machines. The patient is awake and cracking jokes. We gape down at him, out of breath. We do not tell him, at this stage, about the hours we have passed, their strange texture, how gradually the drip of dismay entered our veins, then fear and desolation. On the way out we say: ‘Let’s head for the main door, so we’ll know how to get in tomorrow.’ But then we have lost the car. ‘You stand here,’ my brother says, ‘and I’ll find it, and then you.’ Lean, loping, he sets off, seemingly in all directions at once. While I stand at the roadside, my husband’s possessions at my feet, I see cars circling, and each time I see one return, the driver’s face behind the glass grows more baffled, desperate, irate. My brother meets a kindly doctor who tries to explain a short cut. ‘You have to go through the little door.’ And what, through the little door, would you find? Perhaps a perfect replica hospital in miniature, with pin-sized patients, with wounds and lesions you need a magnifier to see.

On Thursday I realise I have barely eaten since Monday lunch. I find a good way of feeding myself: peanuts, chocolate raisins from the WRVS shop, tiny increments of nourishment like rewards for performing tricks. For two days in the intensive care unit the sick man is watched every minute of the day and night. He is in no pain. No one could be more attentive or competent than these nurses. I am weak with praising them. As he descends, in a few days, through the hierarchy, from intensive care to high dependency unit, from there to a surgical ward along the Green Mile, the care becomes more perfunctory, the rooms dingier, the staff more flippant and detached. Nuns used to practise something called ‘custody of the eyes’. I see that modern nurses do it too, but for the nun’s downcast gaze they substitute a blinkered stare. It would be natural, coming into a bay of six patients, to cast a glance around in case anybody was about to roll out of bed, or vomit, or die. But these lasses march straight to their goal, whether to perform a procedure, pick up equipment, or write up a chart. If they looked left or right, they might see something that needed doing, something extra. They never, I notice, look at a relative or visitor, but around the edges of them, or above their heads; if these outsiders were acknowledged, they might want something; they might ask a question. I see a senior doctor, alight with irritation, rip into a gaggle of nurses, thrusting papers at them: ‘Who wrote this up? Who is responsible? I want to know.’ The nurses turn their shoulders and simper. They won’t look at him, won’t speak; they just smirk, darting amused glances at each other, until he gives up and steams away.

Money won’t mend this, I think: no redistribution of resources, no policy revamp. This is about people. Is it possible that the failure is not in the healthcare system, but in the education system that has turned these people out? Or is the failure deeper than that? Do the nurses despise the patients (and their relatives) for their neediness? Are they secretly revolted by their work, and taking their revenge by pettiness, by the foot-drag and the eye-roll, the shrug? All week, my struggle is this: not to redirect my anger and distress to the wrong targets. Smiling obdurate patience must, I think, get me somewhere. But what kind of nurse dumps a patient, new to a ward, like a parcel on the nearest bed, without so much as a jug of water? Who ‘forgets’ to give the liquid morphine prescribed, and snaps ‘He’s had his pill!’ when told a patient is in pain? When I was growing up people used to say: ‘Where there’s no sense there’s no feeling.’ I used to think it was a harsh saying, but I see that it’s true. In the last few days much of the suffering I have witnessed and experienced has been caused not by the human body as it snakes towards death on its secret self-destructive paths, but by the blithe stupidity of the individuals I have encountered, and I don’t know whether at the end of this process I, who am emerging whole and not a widow, will not also emerge a worse person, more cynical, more intolerant and more selfish, a woman who only looks out for her own.

This is Wimbledon’s final week. All over the hospital, on flickering TV sets high on wall-brackets, white figures dash to and fro, seemingly in a blizzard. News of Venus Williams’s victory penetrates even the high dependency unit, and is received with apathy. Rain suspends play. My beloved is sicking up green gunk. An old man stuck over with tubes shouts: ‘I’m not right!’

His children stand at the foot of his bed and bellow back at him: ‘Dad, you won’t be right! You’ve had an op!’

‘I’m not right!’

‘In a bit you’ll be right!’

‘I won’t! I’ve had an op!’

The delights of the ordinary ward are still ahead of us. There, everybody yells, working up the noise level; every trolley wheel squeaks, and locker doors, every time they are closed, slam crack crack like twin pistol shots. A tap drips, plink plink plink, cutting through the clatter; I trace it to a dirty washbasin in an alcove behind a bed. Downstairs, in the waiting room, the maternity churn-rate keeps up through the weekend. Nancy, to the accompaniment of warbling muzak, is still experiencing Braxton Hicks contractions. I have established a place for myself, as one does in a library, a nook from which I survey the passing scene and emerge to direct visitors and patients who are hopelessly lost. Once again it is Sunday, 6 p.m. The miniaturised hospital is now lodged in my body, under my heart. I look up and see, rolling from the lifts and across the foyer, the Daily Mail reader’s nightmare. She looks 16, her face peaky, her bare legs twiggy and blue; the light glints on her piercings. She has had her baby, and her loose gown flaps against her body as she propels her Zimmer frame towards the sliding doors. Standing under the canopy, she looks out into the swimming grey-greens of the English summer. With one hand she rubs her Caesarean scar, and with the other slots a cigarette into her mouth. She leans, a figure from myth, the sheeting rain her backdrop: expressionless, she stares into it, a battered Britannia, her smoke blown away by the wind.