The Screaming Gynaecologist

Jenny Diski

After waiting that long week for the results of my post-chemo scan, the answer to the hovering question about the effect it had on the tumour in my lung and the affected lymph nodes was much the same as most eagerly awaited answers to important questions. Inconclusive. As I’m learning to expect, nothing very decisive has resulted from the treatment. After three cycles of chemotherapy, the tumour has shrunk a little, but, onc doc said swiftly, it was small to start with. The lymph nodes too have decreased a little in size. There was neither excitement nor disappointment in his manner. It may be that he has the same air of studied neutrality in his everyday life, when eating a delicious meal or going over the top on a rollercoaster. Or, more likely, it is for work purposes alone, in order to prevent over-excitement or crashing disappointment in patients with unrealistically high hopes or fears. I imagine that his ‘but the tumour was small to start with’ was intended to prevent disappointment at the seeming slightness of its reduction: a small reduction in a small tumour is not to be sneezed at. It seems I am to think that the cancer that can be seen hasn’t got worse, indeed it has improved, and if I were the right sort of character I could take heart from that. To me, being the sort of character I am, it means I’ve got cancer (‘So what took you so long to arrive?’), and I won’t not have cancer, but as the doc said at our first appointment, a certain amount of time can be added to my life by the treatment (two to three years instead of perhaps 14 months) before the symptoms begin and the dying process starts. I smiled and said ‘that’s good’ in a way that I hoped showed I hadn’t got any unrealistic hopes up, and that I was grateful for his, the nurses’ and the radiographers’ efforts. The team. And, of course, I am grateful. I try to feel grateful.

As far as I understand it, the main problem is with the spreading of the cancer via my lymph nodes – this is what happens most commonly with lung cancer – to brain, to bone, who knows where? When I asked, the onc doc said that they hadn’t seen any new cancer sites, but they couldn’t know if there were cancers too small yet for the scan to pick up. ‘We can only see what we can see with the instruments we’ve got.’ I assume that the cancer spreading minutely through my body, like microscopic pig iron in diminutive goods trains, is the reason, even with treatment, that my life expectancy is still only a fairly abbreviated two to three years. It’s a travelling cancer sending its cells here and there so that only when they have taken root and grown can they be seen, by which time, I imagine, new invisible seeds will have been planted elsewhere. Etcetera. Still, if onc doc’s super cool is not just professional and he maintains his chill when hurtling down Kingda Ka, the world’s highest rollercoaster, then I might be wrong and I should rejoice at least somewhat in the diminishment of the visible cancer cells. Anyway (I’m working hard on attitude here), it must be better than the tumour staying as it was or getting worse. So, as planned, the radiotherapy has begun. First the measurements and then the daily dose. Each treatment, twenty minutes of zapping. A month of treatments, Monday to Friday with weekends off, throughout November. (Here comes Melville: ‘Whenever it is a damp, drizzly November in my soul; whenever I find myself involuntarily pausing before coffin warehouses …’)

There is a sense of things going to plan, but no magic. There’s nothing to be done except wait while the medics keep everything as contained as possible with radiation, and see whether, three months after the end of radiotherapy, the tumour has reduced, and, more important, if the cancer has spread and grown visible. There was no new mention of that original two-to-three year prognosis if I had treatment. I didn’t ask, because I was fairly sure from his manner and what he didn’t say, that the prognosis hadn’t improved, even if it hadn’t got worse. In other words, I will continue to live with uncertainty and my inability to do anything about it, the condition I’ve been trying to wriggle away from all my life.

It’s absurd to complain about the uncertainty of life expectancy – we’re all just a breath away from the end of our lives – but it’s especially absurd from someone in their late sixties. For almost a year before the diagnosis, I’d been plagued by thoughts of the possible not-so-far-in-the-future depletions of body and mind of one of us, me or the Poet. The future played out, in my mind, with each of us having innumerable strokes, serial heart attacks or one of the other less decisive but nonetheless disabling illnesses of old age. Turn and turn about I’d have in my mind one of us debilitated or dead, then the other. The urgent question was: which would I prefer, to be the carer or the sufferer? The dead or the survivor? How long before one or other of us could no longer live in our two-storied house with its steep stairs? When might it be necessary for one of us to be looked after by professionals in a care home? We’ve lived together more or less for sixteen years. Sixteen years ago, the future still seemed a long time ahead, even if to our young selves back in our thirties, either of us in our fifties and now sixties would have seemed as old as we could imagine without picturing mobility aids and incontinence pads. Getting myself to imagine us as our young selves might imagine us was enough of a jolt to make the mind accept the present not at all terrible reality of time and the body.

But within a moment of accepting the reality, I returned to its consequences, which is to say the deteriorated future of our ageing bodies and minds. The fact was that the depredations of old age were no longer so far ahead that they could be dismissed as ‘sometime in the future’. The fear, as my late fifties turned into my early sixties, grew to become a fear of certainty, rather than uncertainty. I wouldn’t say I preferred the certainty, but I knew at least where I was. Then to have the diagnosis of cancer dropped into my model of the future, to be told that with an effort I might live for another two or three years brought back the uncertainty, so that both conditions, fact and speculation, each at their most unpleasant, now existed side by side, as equals. Can I learn to live with certain uncertainty, or uncertain certainty? I know that so many other people live with exactly that, from illness or poverty or war, but that thought doesn’t help. I’m no better at tolerating unresolvable uncertainty than I was when I was fifteen and going to live with a perfect stranger while receiving letters from my former chums, inmates of the Lady Chichester Hospital, cheering my good fortune and wondering how I was getting on in my new life.

I was getting on as anyone of my age might, given my previous circumstances and the fact that I had been taken on, sight unseen, for I didn’t know how long, as a house guest, or a foster child. Not all that well. I had lived with strangers before. I had been sent to a foster home while my mother had a catatonic breakdown and was in Friern Barnet, and later to a children’s home, where we took walks in crocodile formation along a coastal pathway above the surf, as social services tried to sort my mother out with social security and a bedsitting-room, while getting me admitted to St Christopher’s. After that, when I was 12, an over-zealous young rabbi – with Humbertian hankerings – sent me several times to stay with his parishioners during school holidays to help out my mother, and to enable him to visit me alone. He only shuffled on his knees across the room to ask if I would kiss him, and when I said ‘no’ never brought it up again except to ask if it had altered my feeling about ‘our religion’. I assured him that it hadn’t and could we please carry on driving to London.

By the time, two or three years later, that I got to Doris’s I knew from experience how you tiptoed around a house that wasn’t yours, fearing the sound of your own footfall, creaking doors or floorboards. I remembered not knowing the household arrangements, when was it OK or too late to get up, did I wait for others to have breakfast or get on with it myself? Was it OK to use this or that bathroom, which things were special to whom? I never knew the rules of each family or group, the systems, what is and isn’t done in other people’s houses and when. I always tried to make myself invisible and inaudible. Doing nothing was best, except that sometimes it turned out people were waiting for you to appear. I tried not to leave footprints, to erase any clues that might show where I had been and what I had done. But always eventually I had to decide to enter and leave rooms, to answer a phone or not, or confront a closed door without knowing if it was the right time to open it. People weren’t unkind, but I was never at home when not at home, which by the time I was 12 no longer existed, though it remained as a pattern, the only pattern of how to get through the day. It never seemed to coincide with other family’s routines and expectations.

Once I stayed for a month with a strict orthodox family and after an intense shabbos ritual of prayers, blessings and a meal, I woke in the night to have a pee and thoughtlessly turned on the hall light. The entire family ran screaming from their rooms, all demanding to know who the culprit was, sensitised even in their sleep to the grave insult to Yahweh that had emanated from their house, if not, it turned out, their blood. Towels and when to change sheets were always a problem. Toothpaste. How much water should you have in a bath? People had remarkably variable depths of bath water. Everything generally was difficult. Using the loo during the day was fraught, having to flush and remind the house of my existence in it. If I were sharing a bedroom, I’d try and find some dark corner of the house to claim as my own, and I tried to keep incidental, accidental encounters with members of the family to a minimum, hovering on the stairs if I heard them moving about in the kitchen, returning swiftly to my room if they were coming in my direction. Which books could I take to read, how much loo paper should I use? Eating with them and going out together were all horrible anxiety traps. Their having me to stay was a charitable deed. A mitzvah. Nor was I subject to the natural forgiveness or generally non-lethal battles between family members. I didn’t understand how rows faded away, leaving no one sulking. I knew though that I couldn’t be a recipient of such forgiveness or such easy healing of wounds. I squeezed myself into invisibility, tightening every muscle in my body, terrified when there were arguments and small dramas that I might be dragged into them. Or I made myself known when I thought I needed to by a theatrically heavy footstep or a cough.

On another occasion, when my mother was stretchered off to Friern and I was sent I don’t know where to stay with I don’t know whom, I remember living briefly with some people who had a collection of coloured glass figures – looking it up, I think Murano glass – and I dropped and smashed one that I picked up. I considered hiding the broken pieces, but the absence on the shelf would have been obvious. I owned up. It would have provoked catastrophe had it happened at my home with my mother. Here, everything was quieter. I could tell that what I’d broken was important, either loved or expensive. There was no hiding the dismay, but there was no shouting or screaming. I was told to be careful and not to touch things in future. I had no idea how to behave in such silent, sorrowful circumstances. When could I leave the room and get myself out of the way? What kind of apology should I make? Should I offer to pay for the piece? But I had no money. I found I didn’t really like the neatness of controlled displeasure. Normally I would have clapped my hands over my ears and locked myself in the bathroom until things calmed down. But here things were calm even when I’d caused a catastrophe.

My first weeks at Doris’s were like that. Having stayed in other people’s homes before didn’t help. (It still doesn’t. I remain awkward and uncertain while staying in other people’s houses.) It was worse, actually, because this wasn’t a holiday and didn’t have an end date, and there was no social worker or rabbi attached to oversee the placement, who could be contacted if there was a problem or my presence was too much of a burden. At Doris’s house, I’d creep down from my top-floor room, past her closed door on the middle floor, to the kitchen for something to eat (did I eat too much?) or another coffee, knowing that no matter how carefully I avoided a creaking stair, or returned the cheese to the fridge, wrapped so it wasn’t obvious that I’d eaten any of it, she would know I was there in the house. It wasn’t just a sense of discomfort at being an interloper, I wanted to be invisible, not to be thought about on my own account. The idea I had was not to be a felt presence, to be a ghost, not to exist except for myself, until some signal said that Doris was ready to acknowledge me, and then I had to act my presence, shape up and be a good guest, however that was. But what signal? I’d have been grateful for a bell or a written timetable. I couldn’t just ease my way into living there, or consider myself to be one of the party of two who would learn how to ‘get used to one another’.

Doris had said clearly and often that I had the freedom of the house. I could eat or drink anything from the fridge and help myself to tea and coffee. I was to treat the place as home. (But hers or mine?) She got up early to work, I’d probably be asleep, but she didn’t like to be interrupted, so I was to ignore her if I met her in the kitchen or on the stairs. (How do you ignore someone in their own house who has given you a home? And my mother had been in charge of etiquette. I knew I wasn’t to ignore people. Speak up and always look people in the eye.) Still, if the door to her bedroom and study was closed then she wasn’t to be bothered. That was almost as good as a bell. She’d answer the phone and anything else that came up I should just use my common sense about. But I didn’t think I had any common sense or none that told me when to override the usual rule of silence. Very occasionally a phone call was for me, and Doris would shout up or down from her landing. I’d rush to take it, excruciated at having interrupted her. We might meet over lunch and chat if she wasn’t, you know, thinking, but how could I know? And she’d generally be around in the late afternoon and make supper in the evening. After supper we’d talk or watch some television (The Wednesday Play, That Was The Week That Was, news, documentaries, old movies) and then head off for the night to our rooms. I found myself freezing when I encountered her, as if trying to implode myself, and I couldn’t stop myself saying ‘thank you’ and sometimes ‘thank you very much for having me’. I picture myself in those weeks as traditionally Japanese: forever trying to make myself smaller, and out of the way, making my bow lower and my thanks outlast their acceptance. I asked what I could do around the house and Doris said, just the normal things. Keep your room tidy and help with the washing up. My room was chaos and I didn’t do the washing up nearly enough. She was giving me an allowance and I should try to keep within it. I rarely did. There was, she said, no need for gratitude, that was silly. She offered the civilised justification: people had helped her at different difficult periods and one day I might be in a position to help someone else. I saw the mutuality of that and I hope I have in some ways, but it’s never consciously been as a return payment to Doris. My need to express gratitude, the insufficiency I felt, was never assuaged by the long view. Gratitude was half of what I felt. The other half was fury and resentment, a leftover from all the chaos before, which in one way or another my parents were incapable of resolving. But also there was a substantial amount of anger at having to be grateful, the gratitude ever increasing, the bill never settled, and made more enraging by Doris’s insistence that I wasn’t to feel it. Also anger at the discomfort I felt trying to live invisibly in an unfamiliar house with someone I didn’t know, at having to relax when I couldn’t, at having to be at home when I wasn’t. I didn’t understand any of that until it began to come clear four years later, in another psychiatric hospital.

Doris’s assurances that we’d get used to each other never cut through the surface of my discomfort. She had a way of offering emotional advice and making declarations of welcome in a distant, throwaway, clipped manner that expressed to me more than anything else her uneasiness with ease. The advice to relax came out like an instruction, similar in tone to telling me not to knock on her door if it was closed. She never seemed to be relaxed with me around. I began to get the impression that the words she spoke and how she actually felt were at odds. It was hard to know which I should attend to. Eventually I learned that they had to be kept separate, and I started to feel that I was in familiar territory, though not familiar in any relaxing sense. I’d come directly from a psychiatric unit, and before that I’d rebounded from father to mother, neither of whose places was anything like any home I’d experienced. It was as if Doris thought she only needed to say ‘relax’, ‘don’t feel grateful’, ‘feel at home’, and it was done. It wasn’t at all clear to me what feeling at home meant within the context of the house rules that kept Doris from being interrupted and given that it wasn’t actually my home. What kind of at home was I to practise? Was I to be myself, the idle-teenager-with-a-bundle-of-anger-and-stored-problems ‘at home’? Or a good-girl-brand-new-without-any-emotional-baggage ‘at home’? The good girl was pretty submerged by then. I could, at best, remain silent and discover what practically I had to do or not do in order not to be a nuisance. So the first weeks went by. During that time I learned shorthand and typing on a part-time course to help me with the job at her friend’s office, and, of course, because it was essential if I wanted to be a journalist, which was what I said I wanted to be to Doris – unable to admit my improbable fantasy of being a novelist to an everyday real writer tapping out short stories that became the collection A Man and Two Women, and writing the script for a TV version of The Habit of Loving.

A couple of weeks after I arrived Doris told me she’d made an appointment for me to see a gynaecologist. She gave me the time and address. I asked what it was for. To fit me for a Dutch cap, she said. The sooner the better. I asked what a Dutch cap was and Doris sighed before sitting us both down at the table to explain. I didn’t want to get pregnant, did I? And it was really no problem using a cap, providing you took responsibility and never, ever had sex without first putting it in. But I hadn’t got a boyfriend. Well, she didn’t think that state of affairs would last long, and there was no harm in being ready. The last thing you need is to be pregnant and have to have an abortion. I tried to imagine having a boyfriend for whom I needed a Dutch cap and how I would manage to put it inside me without him noticing. Being pregnant and abortion flew straight over my head and escaped through the kitchen window. I wondered if the predicted boyfriends were to be brought here to the house I was to make myself at home in, to be entertained sexually, or if I had to find someone with a place of their own.

There was an enormous amount of talk between Doris and her friends around the table, as well as in books and films I was reading and seeing, about the unsatisfactoriness of young people having to sneak about and use dark alleyways to have sex. Sex in dark alleyways and getting pregnant were pretty much one and the same thing. I wondered to myself how late I was allowed to be out, assuming I ever found any friends or knew anywhere to go. There were so many details I needed to know about how to live in this new world, none of which would have arisen with my own family, who had never mentioned the subject of boyfriends, but I never had the courage to ask Doris these very practical questions. Partly this was because I was a teenager with some odd questions to ask of someone who I didn’t know very well, but also because at any hint of a question about how I should behave, Doris would say everything would be all right and wave that arm dismissing my mostly unspoken queries, saying we’d get used to each other and we’d sort things out as and when problems came up.

This alarmed me. It seemed to mean that there had to be actual problems, clashes of expectation and behaviour, in order for me to understand what was wanted. I looked older than my age, and was a quick study. After a few weeks of silence, listening to people talk around the table, after a film, or about a book, I threw in a few acid or ‘insightful’ comments of my own. I turned from an ‘enigmatic child’, as someone called me, to a perfectly timed commentator on what and who went on around me. I acted sophisticated to fit in with these new people, who clearly valued it very highly. I could see I was doing it right. But bad girl though I was, and thought I needed to be if Doris and her friends were to accept me, I was terrified of anyone being angry with me, or of finding me out. I didn’t know what would happen if I was found out, and especially by Doris, a stranger in whose house I was living. The awkward experiences I’d had staying with other suburban bourgeois families on a strictly temporary basis gave me very little idea of how to live as a familiar stranger in this house with Doris, who mocked suburban ways and values, and had such firm opinions about everything from politics and literature to sociology and psychology. And there was still no mention of how long I was to stay there and what would happen next.

I arrived at the gynaecologist’s with time to spare. It was a private practice in a large house, heavily carpeted. I was taken up the stairs by the gynaecologist who came down to collect me. She settled behind her desk and I sat in the chair opposite. What could she do for me? She wore a white coat and was I think in her forties. I said, as Doris told me to, that I had just arrived to live at Mrs Lessing’s house and that she was a friend of one of her, the gynaecologist’s, regular patients, and I had been sent to be fitted for a Dutch cap. Are you having an active sexual relationship? I said I wasn’t, but it was for in case I did. The gynaecologist’s face was a mask of professional inquiry. She drew a file towards her and took up her pen. She wanted my full name. Address. My age. Fifteen. She put the pen down and looked directly at me, as if I’d just walked into the room. What? Fifteen. Fifteen? And then she started to shout. How dare you come to me asking for contraception! You’re under-age. What is that woman doing sending you here? Doesn’t she know it’s against the law to have sex at your age, let alone for me to provide contraception? She’d be struck off. She was boiling and getting out of her chair. I said that it was so I didn’t get pregnant if I did have a sexual relationship. ‘But you’re fifteen!’ she shouted. ‘What are you doing preparing to have a sexual relationship at your age and then coming to me for help?’ She moved around the desk towards me: ‘Get out of here at once.’ I bolted. She actually chased me out of the room, shouting still, and stood at the top of the carpeted staircase to make sure I left. I fled out of the front door and along the street, shaken and embarrassed. I’d come upon a world of professionals on the edge of madness, apparently. I couldn’t understand how Doris didn’t know that the gynae couldn’t give me contraception. When I got back, still shaking, and with an adolescent’s fear of the police being set on me, I told Doris what had happened. She clicked her tongue, irritated. It was too bad, X had been going to her for years and said she was very nice. I said that apparently I was too young to have contraception. Nonsense, Doris said. She wants you to get pregnant and have to have an abortion, does she? I’m sure there’s someone else. I’ll ask Z.

The urgency of my need for contraception was, for all Doris’s explaining the catastrophe of getting pregnant and the terrible world of backstreet abortions, a bit theoretical, it seemed to me. A year before, living in Holland Park with my father, at the age of fourteen, I’d been raped.[*] During my final term at St Christopher’s I’d had a boyfriend who worked on the local paper and lived in Letchworth, but try as he might, it turned out I had seized up or something, because when we tried to have sex on the school playing field in the early hours of the morning, he couldn’t get inside me. He’d been annoyed and said I was frigid. I didn’t know the word. That, apart from moments and shadows as a child – the Humbertian rabbi, and the more or less unconscious behaviour of my parents towards me – had been the extent of my sexual experience until then. I hadn’t the faintest desire, teenager and bad girl that I was, to know about or experience more sex at that point. Doris had made the assumption that a troubled teenage girl would inevitably be sexually active and therefore urgently in need of contraception. But Doris got on the phone and found another, more ‘realistic’ gynaecologist who, this time she checked, was prepared to fit me for a Dutch cap, ‘as soon as possible’. The following week I picked up my prescription from the local chemist. When I got home I opened the box and found a pink plastic oyster shell, which I opened to find a brown and what seemed to me an astonishingly large rubber dome.

You can read the next instalment of Jenny Diski's memoir here (and the first one here).

[*] Jenny Diski wrote about the rape in the LRB of 5 November 2009.