The Creaking Door
On my first evening in intensive care, the elderly Indian woman in the bed opposite me died. The curtain had been pulled around her bed for an hour or so; then the family began to arrive and it was clear what had happened. I couldn’t keep track of everyone – young children, teenagers, their parents, grandparents, cousins, uncles and aunts. They came and went from behind the curtain, most of them fiddling with mobile phones, and it did not seem as though there could be room for them all in the cramped space around the bed. Then, later on, there were prayers, singing and chanting, which went on for hours and kept me awake. At some point in the night they must have moved the body, because when I woke up the curtain was drawn back and the bed was empty and newly made up. By lunchtime there was someone else in it, a tall, wiry Rastafarian who lay on top of the sheets wearing only orange hospital pyjama bottoms and his knitted Rasta cap. He talked loudly and cheerfully to friends on his phone, telling them where he was. Somewhere along the line he had lost his wallet and keys and was trying to track them down. There was a girlfriend, too. ‘Be strong, girl,’ he said to her several times, ‘be strong.’ Every so often he was given oxygen through a face mask but otherwise he did not seem very ill.
From time to time the hospital priest walked through the ward, and I felt that he was trying to catch my eye. I did not take this as friendliness. He had a beatific, supercilious smile, as if he knew something I did not, which seemed quite possible. As he glided slowly between the beds, dressed entirely in black except for the bright white strip of his clerical collar, I saw something sinister in him, a predator amongst the vulnerable, an emissary of Death. I looked away. I did not want to give him the satisfaction. Just to look at him, I thought, might be a kind of curse for a sick person.
It had seemed like a bad case of flu. I had been in bed at home for a week, taking paracetamol and aspirin every four hours, trying to keep my fluids up. There was a pain in my right side that felt like a pulled muscle, perhaps from vomiting awkwardly over the side of the bed on the first night of the illness. I rang a GP friend who said I should see a doctor if I didn’t improve in a few days. My wife was frustrated with me. Our five-year-old and four-month-old needed her more than I did. ‘Sometimes you just have to man up,’ she said. On the seventh night I told her to call an ambulance. ‘Am I going to be OK?’ I asked the doctor in A and E. ‘You’re in the right place,’ he said.
In intensive care I was given an oxygen mask that strapped over my mouth and nose. They put me on fluid, painkiller and antibiotic drips, and took blood and sputum samples. An X-ray showed both my lungs were black with infection and the tests confirmed the diagnosis – pneumococcal pneumonia. My lungs were failing and my blood was starved of oxygen. There was a huddle of doctors on a ward round and one of them was a friend of mine. This was so strange that it might have been a hallucination. It was her first day on the ward and I was very happy to see her. She came back later and told me, off the record, ‘You’ll be fine. You’ll be out of here in a couple of days.’
My memory of the next few days is sketchy. My wife came and went. My parents arrived. I told my Mum, ‘Intensive Care is very intense.’ I laboured on with the mask, but the oxygen level in my blood stayed low. I remember a conversation with a consultant. I told him I couldn’t cope with the mask anymore, I was exhausted and desperate. He said, ‘Well, the other option would be to sedate you.’ If he explained what this would involve, I don’t remember it. I don’t think he mentioned the word ‘coma’. ‘Please,’ I said, ‘I can’t cope.’
On my fourth day in hospital they put me into a medically induced coma. The coma was necessary – I found this out later – so that they could insert a breathing tube down my throat and ventilate me properly. A non-sedated person will not tolerate this, would choke on the tube.
The antibiotics did not work and my condition did not stabilize. I was diagnosed with severe sepsis – a whole-body inflammatory state – and then, a few days later, Acute Respiratory Distress Syndrome, the lungs’ extreme reaction to an infection. The alveoli inflame, then collapse, the lungs harden and the oxygen saturation in the blood drops rapidly. Even if treated, ARDS has a 50 per cent mortality rate. Wikipedia says: ‘as loss of aeration progresses, the end tidal volume eventually grows to a level incompatible with life’.
I was kept in the coma for twenty-two days. The breathing tube down my throat pumped 100 per cent oxygen into my lungs. An intravenous line in my neck delivered up to eight different drugs at one time. The drugs themselves hung in bags – like swollen fruit, as my wife described them later – from metal stands next to the bed. Drugs to treat the infection, drugs for sedation and paralysis, drugs to keep my heart going despite the sedating and paralysing drugs, drugs to drain excess fluid. There was a feeding tube up my nose and down into my stomach, and saline and electrolyte drips into my arms. Every thirty minutes another line took blood out of my arm to be sent away for testing. I had a catheter in my penis, another in my anus, five sticky pads on my chest to monitor my heart and a clip, like a clothes peg, on my finger that shone an infrared light through my blood to measure the oxygen saturation.
Keeping me going, maintaining me, was a mass, an industrial effort. I had one dedicated nurse at all times, changing lines, drugs and drips and piss and shit bags, checking and adjusting settings, rolling me to prevent bed sores and to shift the fluid that built up in my lungs, responding to the alarms that went off every few minutes when my heart rate, blood pressure, oxygen levels or temperature went outside acceptable parameters, and recording it all every half hour on an A1 chart on a lectern at the foot of the bed. In the mornings they came round in packs, sometimes seven or eight of them: intensive-care consultants, lung specialists, drug specialists, ventilation specialists, blood specialists, anaesthetists, senior nurses, the intensive-care matron. My own nurse would update them and a daily plan was recorded on the chart. At the end of every day a document, sometimes ten pages long, was produced which included lab reports on my sputum, faeces, urine and blood. It noted whether or not the daily plan had been achieved, whether or not my dignity had been maintained, whether or not I had been washed or shaved. It recorded all the visitors and phone calls I received – if ‘received’ is the right word.
My wife and brother learned to read the data, the mass of it my body was producing. They watched the monitors on the machines, read the chart at the end of the bed and analysed the information that came back from the labs: the oxygen level in my blood, blood pressure, pulse, temperature, white and red blood-cell counts, antibodies, immune-system markers, the graph patterns of my breathing. When they weren’t in the hospital, they rang up for the latest readings and to find out whether I had had a good or a bad night. ‘Don’t get hung up on the numbers,’ one of the consultants said, but they did.
My wife and brother knew all the nurses and doctors. My wife wept on several of them, my brother had a crush on another. They interrogated the consultants when they came round and had meetings with them in their offices. They had their favourites and the ones they didn’t care for. There was one – Dr Death they called him – who always seemed to have bad news and wouldn’t meet their eye. His prognosis for me was grim. The best-case scenario was six months in intensive care, a year or more off work, oxygen tanks at home, perhaps permanent invalidity. ‘Do not,’ he said, ‘expect back the same person who went into hospital.’ My wife preferred another doctor, a ponytailed young South African – Dr Feelgood. He eulogized my strength, my capacity to survive.
After ten days the oxygen saturation in my blood had not stabilized and I was moved to an oscillator, a machine that provided a different, more aggressive form of ventilation. The oscillator holds the brittle lungs open while air is pumped in and out, and the whole body vibrates with the force of it. A cooling blanket with freezing air pumped through it was laid over me to keep my raging temperature down. I was bloated with fluid, my whole body swollen up so that I was almost unrecognizable. ‘Fat Tom,’ a friend said to my wife after she had been in to see me.
These were, I am told, the worst, the most dangerous days. This was when there was a box on a trolley by the side of the bed with a sellotaped sign, ‘Emergency Lung Drain Kit’, which my wife said looked alarmingly basic. The consultants discussed moving me to another London hospital where I could be given Extracorporeal Membrane Oxygenation, in which blood is passed out of the body and through a machine that puts in oxygen and takes out carbon dioxide. It is the final throw of the dice. In the end, they decided it was too risky to move me. There were family summits and conversations about what would happen after my death. My wife checked the mortgage cover, my life insurance and death-in-service payout from work. Everyone drank a lot of wine. My Dad wrote in his diary – the consultants had suggested everyone keep one – ‘Lunch in Pizza Express. Food mediocre.’ My Mum noted, ‘Chelsea win Champions League (Didier Drogba, extra time penalty).’ My wife recorded a conversation with my father-in-law during which she said, of me, ‘He’s going, Dad.’
This was when they brought my five-year-old daughter in to see me. They explained it to me months later, when I went back for an outpatient’s appointment. ‘If there is a loss,’ the consultant said, ‘research shows that children do better if they have had a chance to see the sick parent.’ When she came in, my daughter patted the cooling blanket tentatively and called me ‘pipe-man’. She was not visibly upset, but the next day, at school, she drew a picture and wrote underneath, ‘I am sad Mummy.’
Dr Death told my wife and brother that I was ‘the sickest man in London right now, and maybe the whole country’. They both wrote this down. It was not, everyone agreed, a helpful thing to say – baseless and melodramatic. Surely there were people somewhere actually on the point of death, who in fact did die. I could not be sicker than that. But when, instead of dying, I got better, I liked the way it made me sound notorious – the Sickest Man in London – and I held on to it as a badge of honour.
Twenty-two days. I have thought quite a bit about this strange, lost time. I would like to have a photo of me then, in my coma, visual evidence of my presence in the world, some connection back to myself. There is no photo – no one was thinking about photos – but I have a mental image. I see myself from above, at an angle, as if my consciousness has floated free of my body and up to the ceiling. My normal physical systems have been elaborated, outsourced, into circuits of wires, tubes and technology. I am either host or parasite, or perhaps cyborg. I look down and wonder at what, if any, level my mind is functioning. To what, if any, degree I am sensitive to the external world – the lights and noise of the ward, the nurses and doctors treating me, my family and friends reading to me and holding my hand.
After seventeen days in the coma, I began to get better. My oxygen saturation stabilized, the infection retreated and I was moved from the oscillator back to a normal ventilator. On the twenty-third day they gave me a tracheostomy so that the breathing tube could be passed directly through my throat rather than my mouth. Then they began to reduce the sedation.
I can’t remember the moment I woke up. As with so much of this, I have to rely on other people to fill in the gaps. My wife was there. My eyes opened, huge, black diamorphine-dilated pupils. I tried to smile and lift my arms. I seemed happy and very high, but a few hours later, after my wife had left, I became confused, paranoid. I asked my nurse, John, to show me his ID. I tried to rip out the lines on my arms. They put white cotton mittens like boxing gloves on my hands to stop me but still I thrashed at them and tried to fight the nurses with my puny, wasted arms and legs. I begged to see or speak to my wife and demanded to be moved to another hospital where the staff were not trying to kill me. That evening they re-sedated me. This was the beginning of a new phase.
Intensive Care Unit Delirium or Psychosis affects around a third of patients who stay longer than a few days in intensive care. It is caused by illness, medication, the withdrawing of medication, sleep deprivation, the distress of people in the other beds, the starkly lit, noisy, relentless and alien environment of the ward itself, or all of these things together. Massive doses of diamorphine had kept me in the coma – when I came back for a visit months later, a nurse told me she had never given anyone more than she had given me, a fact I am stupidly proud of – and now I was coming off it.
I was strapped into a dentist’s chair in a seaside hotel. Around the room, a kind of bar or casino, there were others strapped into chairs. I did not want to be there but had come anyway, and knew something was going to happen, something half thrilling, half terrible. The young, attractive woman who strapped me in and reclined the chair smiled and talked reassuringly to me, but I knew she was wicked. The room, with its flashing lights and red and white leather, had the gaudy, nightmarish feel of an amusement arcade, of twisted fun, of sexual pleasure and threat – and the chair was part of some hellish fairground ride. I wanted to leave but the woman was leaning over me, strapping me tighter, urging me to relax and submit. On the side of the chair there was a lever with a red knob at the top, like the arm of a fruit machine. All the time I was waiting for her to speak the words I seemed to dread but also long for, an offer with no possibility of refusal. ‘Time for another suction, Tom?’ she said, and then she would reach up and pull down the lever. Later, I would come to in the street, wrecked and wretched, and start trying to find my way back to the hotel.
The Face Project was a company contracted by the hospital to carry out cutting-edge therapeutic work with recovering patients. Their treatment centre, attached to the hospital, was bright and modern, and the staff were all young, hyper-cheerful and efficient, casually dressed in jeans, trainers and yellow Face Project T-shirts. The whole place – not to mention the name – projected the freshness and zeal of an internet start-up, or a cult. I was taken to a series of seminar rooms where patients were given iPads and seated in a circle. One of the T-shirted staff led us through a series of psychodynamic exercises that were designed to revive and sharpen our mental functioning, but which I did not understand and could not get the hang of. I asked the staff lots of questions – what exactly was the relationship between the Face Project and the hospital? When would I be going back to intensive care? – but they ignored them or changed the subject. They seemed distracted now, a little brusque. Eventually I was alone, lying on a bed in a small room where I could touch all four walls by stretching out my arms. No one had been to see me for some time but I had no means of leaving. I noticed that the walls stopped about six feet from the floor and if I sat up in the bed I could see over them. What had impressed me as a sophisticated labyrinth of offices and high-tech treatment rooms was suddenly revealed as a few roughly partitioned cubicles within one drab and not very large space. All of the other cubicles were now abandoned.
‘Sundowning’ sounds benign – tranquil, poetic, a little druggy perhaps. In intensive care, however, it describes a pattern whereby patients suffering from delirium become more agitated at night, a kind of grim descent into greater fear and delusion. This seems to fit a metaphysical rather than medical logic – night-time is the time for spooks and ghosts, witches and demons, and for terror. Even in normal, everyday life, it is harder to stay sane in the middle of the night. I am told that one night during my own delirium, every time my nurse approached me or our eyes met, I mouthed (I could not speak), deadly serious, ‘You’re trying to kill me.’ In the morning, just as she was finishing her shift, demoralized, I woke from a doze with no memory of the night. ‘Hello,’ I said, brightly, ‘how are you?’
Traumatic, dystopian, apocalyptic, paranoid fantasies of vulnerability or victimization – my delirium was part pure dreaming invention, part elaboration of actual circumstances. I travelled with family to a reunion with friends at their home in backwoods America, where they were living squalidly in broken-down huts, barely above the breadline. My oldest friend, who had long since gone AWOL with his wife and child, arrived too, but, nursing a grudge no one had known about, blew himself up in front of us. Then I was somewhere in Europe, in the middle of a riot or a revolution. Everything was on fire. I was a kind of celebrity, famous for some act of protest, and was taken to see the dead and injured.
In intensive care there was a tall, very thin nurse with tight curly hair and a strong German accent and one night I was alone with her in what seemed to be a deserted theatre. She sat opposite me a few feet away and I begged to be allowed to call my family, as she had promised. She said there was no time now, that the show was about to start and I was needed. Apparently, I told my wife: ‘I’m exhausted. There’s a show on the first floor and they are expecting me to perform.’
On Fridays the staff and patients of the intensive care ward decamped to a hotel in Kent, an arrangement that seemed plausible to my delirious mind. Upstairs, where my bed was, there were tables piled with old sewing machines and behind a curtain in one corner, a Thai family eating their dinner. I was uneasy about the place, aware of some scandal attached to it, but my wife and father-in-law reassured me and promised they would be back in the morning. I was being looked after by Lily, the most beautiful of the nurses, but I could not settle. I wanted to call my wife but Lily told me she would be driving and wouldn’t answer the phone. One of the other nurses came over with a needle – they wanted to give me an injection to help calm me down. There were several nurses around me and I began to struggle. I didn’t believe they were real nurses and I appealed to other people in the hotel to help me, but none of them did. There was no doubt now that this place was malign, a conspiracy of sadists, and Lily was the ringleader, the most corrupt because the most beautiful. I fought them but they held me down and injected me. Then Lily climbed on top of me and raped me. The baby was born moments later, in a gush of blood, and I knew that they had won.
I was being weaned from diamorphine to methadone – enormous syringes of green liquid – and spent days drifting in and out of groggy, confused sleep. I could not keep track of time. I stared at the clock on the wall but could not decide which hand was which, or what they meant anyway. I could not remember who had been to see me or when, or what they had said. I asked for my phone back and sent incomprehensible text messages to my wife in the middle of the night. The tracheostomy tube on my neck fell out whenever I moved my head and I had to bang the side of the bed as hard as I could until a nurse came to fix it back in. Every few hours a nurse would put a tube down my throat to suck out the phlegm, mucus and blood that I could not bring up myself.
I could not speak. There was a small balloon or ‘cuff’ inside my throat, which created a seal and prevented the air being pumped in via the tracheostomy from escaping through my mouth. When the cuff was up no air could travel across my vocal cords. I communicated by pointing: to my mouth for ice chips to suck (which was all I was allowed), to my forehead for a wet cloth to cool me down, and, now that the catheter had been removed from my anus, to my arse for a cardboard bedpan to shit in. I used a mangled sign language or mouthed the words I could not say out loud. I had a small whiteboard but my handwriting usually let me down. My brother said it was painful to watch me labouring over each letter, producing only minute, unrecognizable, runic figures.
Later on they started to lower the cuff so that I could speak for a few minutes at a time. I said to my wife, ‘I’m very concerned about myself’. I rubbed my thumb and forefinger together and said, ‘This’ – meaning intensive care – ‘is expensive, this is going to cost us a lot of money.’ On another occasion, my wife came in with a friend and I kissed and cuddled them so much that they were embarrassed. When my wife went out to the toilet I tried to climb out of bed. I pointed to the window and mouthed to our friend. ‘Let’s go,’ I said to her, ‘let’s get out of here.’
As the methadone dose was reduced, I was awake more during the day, and time began to pass extremely slowly. At night, I often found it hard to sleep at all. Oral medication was given at 10 p.m. – in my case a sleeping tablet, an anti-anxiety drug to ease withdrawal from methadone and, quaintly it seemed to me, two paracetamol. Eventually, at eleven, they dimmed the lights and the ward took on the eerie, subdued feel of a plane at night, of machines still working towards a destination. There was the steady churning and beeping of ventilators and dialysis machines and the lights of their displays gave out a soft, almost benign glow. The consultants, porters and visitors were gone but the nurses moved around the beds, just as before, turning off the alarms that broke the hush every few minutes. From time to time a new patient was brought in and there was a buzz of activity around them while lines and tubes were inserted, bloods taken. Some patients seemed to sleep all day and all night, others hardly at all. When I looked around there was always someone, eyes wide open, staring at the ceiling. Then, at 5 a.m., the lights were turned back on and the nurses woke everyone up – everyone who could be woken up – and started to wash us in our beds.
I was doing well – everyone said so. Each morning when the consultants came around they told me how much better I looked, what great progress I was making. Nurses I didn’t know but who seemed to know me called out ‘Looking good today’ as they went past. It happened so often, so reliably, that it began to ring a little hollow. Then I noticed they were saying the same things to the other patients around me, and just as often: how much better they looked this week than they did the week before. I knew that not all of these people were getting better, some were getting worse, and some, eventually, died. But I still believed them when they told me I was looking better. I acknowledged the compliments, smiled and said, yes, I was feeling pretty good; I wanted to believe.
After seven weeks in intensive care I was strong enough to be taken to the bathroom in a wheelchair to use a real toilet – rather than a shit pipe, a bedpan, or a commode – and I saw myself in the mirror for the first time since I had arrived in hospital. It seemed that my appearance had been a secret everyone had been keeping from me, and with good reason. The nurses, or at least the series of male ones who had looked after me in the previous few days, had been taking my presentation and cleanliness seriously. My hair was large, freshly washed, combed out and pressed into an unwilling side parting, though I had told them I never brushed it myself. I was ultra clean shaven. Perhaps this was all an effort to counteract or obscure the bare facts, but the effect was the opposite. I was gaunt in the extreme. My neck and arms were stalks, my teeth dark yellow, cheeks pallid and hollow, and the hospital pyjamas, in Guantánamo Bay orange, flapped off me. My eyes were dark and black-ringed, pupils vastly dilated from the drugs, brimming over, as my wife said they had been since they woke me up. I stared back at myself rather tragically. I felt and looked extremely ridiculous, a sort of perfumed and coiffured corpse, and the thought occurred to me that – assuming at least some of the compliments I had been given were sincere – if this is what I look like now, what can I have looked like before?
In the bed next to me, a few feet away on my right-hand side, was Robert. He came in sometime after I was put into the coma and was still there when I was discharged from intensive care, a few weeks later. He was young, younger than me, probably still in his twenties, chunkily built. Like me, he was ventilated via a tracheostomy, but he was on dialysis as well. Like me, he was sometimes helped out of his bed and into the chair next to it. He could just about talk to the nurses, often making them laugh, but not loudly enough for me to hear what he said. Along the inside of his right arm several words were tattooed in elaborate gothic lettering, but again I could not make them out. He often took photos of himself with his phone and at the time this seemed strange to me. His parents and a sister came in most days. His mother, as thin and haggard as anyone I had ever seen, would say hello to me. His father, silent and deeply uncomfortable, hovered at the end of the bed and went out regularly to smoke. For some reason it seemed clear to me that father and son did not get on. Our beds faced the same way, in parallel, and there were machines and tables and half-drawn curtains between us so I rarely saw Robert’s face or made eye contact. But one day, when he was in his chair and I was in mine, he smiled and raised his thumb to me, and I raised mine back.
I could see Dennis much more clearly, though he was farther away. He was diagonally across the ward from me, our beds perpendicular, and I watched everything that went on around him, which was a lot. He had long dreadlocks, which were tied loosely behind his head, and an oxygen mask was strapped over his mouth and nose. The bed sheets were always drawn up to his neck and underneath them his body made no shape and never moved. He lay with the bed almost flat out for most of every day, usually asleep. At times they raised him up, the oxygen mask was unstrapped, and he drank cartons of iced tea through a straw. He had a constant stream of guests, more than anyone else in the ward. His boyfriend was there all the time during visiting hours, holding Dennis’s hand and talking to him, and then others came in groups of two or three or four. Half his visitors were glamorous black women – his family, I assumed – and the other half were gay white men. One day, encouraged by the thumbs-up from Robert, I nodded at Dennis and he – very slightly, reluctantly I thought – nodded back. His large dark eyes stared out from his otherwise lifeless body and I tried to guess at his state of mind.
I had become, or so I felt, a kind of celebrity patient. I was the erstwhile Sickest Man in London. I had come back from the dead, the void, the abyss. And now I was the longest-serving patient on the ward, an old hand, an intensive-care veteran. I was enjoying myself, I had a kind of status. The project to make me feel good about myself seemed to have succeeded.
I began to get visits from medical and nursing students who needed a case study for projects they were working on. There were several posh and polite young men, dressed in the uniform of aspiring consultants: pale chinos, brown leather shoes, shirts tucked in but tie-less, sensible hair. I imagined them rowing, or playing hockey. One medical student I had seen around the ward for a few days asked if she could talk to me about my ‘experiences’. She drew the curtains around the bed, sat down and leaned in towards me. Her name was Sarah-Jane, she had a lot of freckles, and her first question was, ‘How does it feel to know you nearly died?’ It was as well she had not been to see me while I was still delirious: she would have gone straight into my nightmares. Her question did not seem very medical, but it tapped into my vanity. I had been lying awake a lot at night and was in a philosophical mood. I said, ‘You’re very direct, aren’t you?’
I cried a lot for myself, a pure self-pity, which I felt I was entitled to, at least for a while. I thought of my daughter coming to see me, the psychologist asking her questions about how she felt. I was very tender, I could cry in an instant. But it was a sweet kind of melancholy, like thinking about your own funeral and all the people who would come and be sad, and it was not so far from elation, elation that I had survived and was going to be OK. Before all this my mother-in-law had called me the Creaking Door, because, she said, ‘there is always something a little bit wrong with you but you will probably go on forever’. I liked this because it was vivid and because it attributed to me, I thought, a kind of strength and resolve, like an Indian chief – Sitting Bull, Standing Bear, Crazy Horse, Creaking Door.
Sometimes, when a bed near me became empty overnight or while I was asleep during the day, it was hard to know which way that person had gone – to better health and another ward, or to death. In the same way that the doctors and nurses did not volunteer information about other patients’ illness, no one told you when someone died. They were trying to protect you from the full knowledge, the proximity of death; it could only bring you down. I did not ask, either. Perhaps I sensed the same thing and was trying to protect myself. But occasionally it was very clear. Towards the end of my stay, at the other end of the ward, six or seven beds away, was a teenage girl who had been in a car crash. She was there only a few days and I knew it was serious because the curtains were always drawn around her bed. I never saw her myself, not when she was brought in and not when they took her away. The night she died, there was a sudden rush of activity around her bed, doctors and nurses coming and going urgently from behind the curtain. It was quieter for a while and then the family arrived. I picked out the likely parents, a teenage brother, an uncle and aunt perhaps. They filed in behind the curtain and five minutes or so later filed out. Once they had gone the nurses went to work again. At some point I must have dozed off, and when I woke up the curtains were drawn back. The bed was empty and there was just a single nurse left, tucking in fresh sheets for the next patient. I asked my nurse about it. She said, ‘It’s the young ones that are hard to take.’
After fifty-one days in intensive care I was in a hurry to get out. I felt I had seen too much, more than was healthy. The general ward was a stepping stone towards getting out of hospital altogether, but when I got there I found it was dispiriting in a profound way that intensive care was not. Everyone had warned me about this. I had even been given a booklet about it, ‘Leaving Critical Care’. I was put in a bed at the end of a small ward of old men. It smelt as hospitals are supposed to, sour, of food and piss and bleach. Instead of a nurse dedicated to me, they only came from time to time, to give me pills or check my blood pressure, or if I buzzed. My questions went unanswered. Here the battle against illness had little drama and no glamour. Looking around the ward, the stakes suddenly seemed very low. Old age was brutal, wretched, unheroic, a remorseless stripping away and hollowing out.
The man in the bed opposite me in the new ward introduced himself rather formally as Peter Maxwell, though I quickly came to think of him as Peter Not-very-well. We talked a fair bit, an ongoing and often repetitive conversation that ebbed and flowed throughout the day in between sleeps and meal times and our visitors. He was an extremely nice man, though chronically gloomy. He did not know how old he was and was vague about why he was in hospital. He had not brought his contact lenses with him because he knew he would lose them, and so he could barely see. Once he mistook my brother for my wife. He was often confused. On my first day in the ward I watched him stand at the sink between our beds and clean his teeth for a full twenty minutes. Several times a day he asked me, ‘How is your pain now, Tom?’ and I explained that I was not really in any pain, I was recovering from pneumonia. I asked him how he was feeling. ‘Well,’ he said and smiled grimly, ‘it’s all over for me now. I’m useless, I can’t do anything. I’m just a burden to my poor daughter.’ He apologized to everyone constantly – to the nurses when he asked for anything, to me when he hadn’t heard something I said, to his family for everything. ‘I’m not complaining,’ he said, ‘I’ve had my time.’ We went through this several times a day and it began to oppress me. ‘I’m not complaining,’ he said, ‘it’s not about me anymore. How is your pain now, Tom?’
Before I left hospital one of the doctors from intensive care, an Ecuadorian guy, came to see me. I asked him about Robert, the man who had been in the bed next to me there. I was curious about him, and slightly competitive too. Outside intensive care I felt liberated to ask things I would not have asked before. The doctor hesitated. ‘He didn’t do so well,’ he told me, and looked uncomfortable even saying this. It was an awkward, gentle way of putting it, but still it took the wind out of me. Then he told me the rest. It turned out we had not been in the same situation at all, Robert and I. He had cystic fibrosis and had been waiting for a lung transplant that never came. He had been ill his whole life, in and out of hospital, would have expected to die young, if not this time then the next or the one after that, and the staff in intensive care all knew him from before. The doctor had heard that Robert had been married but his wife had left him because she wanted to have a baby and he was infertile, as almost all men with cystic fibrosis are. It was a lot to take in, a lot of pain, and I brooded on Robert. I had not known him at all but we had been in adjacent beds for weeks and I remembered our thumbs-up. This was all the communication we could manage, what we were reduced to, but it did not seem like nothing.
Once I was out of hospital I had a lot of visitors, a relentless stream of everyone I knew. People often came with flowers, cards, presents and cakes. I went through the whole story countless times, and I learned to talk easily about my near-death experience, enjoying the extremity of it. I wanted to talk about it and was frustrated when someone didn’t seem to be engaged, was distracted by their children or mine, or brought up another subject. I had been to the edge, as far as anyone could go, stared into the abyss and then come back. I had not seen a light but still I felt that I possessed a kind of secret knowledge that meant I was worth hearing. After this I need never feel insecure about the depth or profundity of my human experience. I had been given a moral, emotional and spiritual trump card.
At other times, however, I did not feel equal to my visitors’ expectations, or what I believed to be their expectations. So much thought and concern had been expended upon me. I had dominated the headlines for weeks, been the subject of conversations to the very furthest reaches of my acquaintance. People had lit candles in churches, chanted, abandoned work and holidays, decided to be nicer to their partners, given up smoking. Now I felt I somehow needed to be more than myself to justify it all. I wondered if they went away somehow disappointed.
A year later, there is only one physical legacy that I am aware of, the healed-up tracheostomy scar nestling at the base of my throat. I stroke this with my finger when I am working or reading or watching television – the soft, shiny, slightly raised, pinkish baby skin – a new mannerism, a tic, a nervous habit.
Several people have asked me the standard question: have I done anything crazy since I came out of hospital, something reckless, something I have always dreamed of doing? I have not quit my job, left my wife, got religion, gone potholing, taken up pottery or bought a fast car. But I might not be entirely the same. One friend claimed that I am 10 per cent better than I was before I was ill, and seemed to mean it in the most general sense – a 10 per cent improved person. My wife jokes that they – the doctors and nurses – re-wired me when I was comatose. In the few months after getting out I fixed the central heating, took the U-bend off a sink and unblocked it, and changed a flat tyre on the car – all tasks previously beyond me. I seem also, counter-intuitively, to have been cured of a chronic, if not very acute, hypochondria, the habit of thinking of myself as physically compromised – the Creaking Door. All my feeble creaking has fled in shame before this substantial, mortal event, or else it has been drowned out by the revelation of my ultimate resilience, my capacity for survival. I am still, I think, a year later, on a bit of a high. Some of the sense of celebrity, grandiosity, remains. I still feel, sometimes, that my survival has given everyone else a lift, that I am emblematic of everyone’s hopes for a happy outcome, a walking affirmation of life.
Around, underneath, and beyond the high there is, however, from time to time, faintly, a feeling that I do not remember from before, a deep undermining, an existential fracturing. It arrives, strangely, just after moments of happiness: a bleak awareness of the intolerably thin line between things working out and things not; of the futility and ridiculousness of any activity against the size and length and depth of the void. It feels innocent now, quite manageable, easily dismissed. But perhaps one day, perhaps slowly or perhaps suddenly, like an incubated infection, it might rise up, spread out, and encompass everything.
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