Her fellow abortionee was opposite me, a tow-headed sixteen-year-old on her second termination. We hopped from bed to bed, Kirsty and I, sitting each at the foot of the other. She told me about her life. She went out to dance and to shoplift a little and if anyone looked at the boy she happened to be with she would belt them around the head; isn’t that right, she said, and we agreed that yes, it was the only thing to do. More perplexed than malicious, she called the nurses by whistling for them; she didn’t understand their genteel nursy euphemisms, and when they handed her a flask and asked her to pass water she came across to ask if I knew what the fuck they were talking about.
Kirsty was taken to theater to have her termination; believing that she had no chance of looking after her body, of regulating her future fertility, the surgeon fitted an IUD while she was under anesthetic. But then the device fell out, one night when she was in the bathroom; she hemorrhaged, fainted with shock, and cracked her head open on the washbasin. Her life, you felt, would always be like this—the handing out of attrition, without regard to justice; fate would overreact to an ungoverned temper and the impulses of a generous heart. She had adopted me on my first day on the ward; I wasn’t, she thought, getting my due. Until some time after I was admitted, the nurses could not manage to get a doctor up to the ward to organize pain relief for me. The strong pills I had brought with me were taken away, and I was given a Panadol, an over-thecounter remedy for everyday discomfort. A hot bath was promoted as the remedy for my pain; I laughed. That first night, I lay on the bed, my knees drawn up. Kirsty shouted at the nurses. “Look at her, look at her,” she roared. “Give her sumfin.” And they did—a rare opportunity—they told me it was my turn to push around the cocoa trolley. My turn, though I’d only just arrived! So I rolled off the bed and did it. “Cocoa? Horlicks? Sugar with that?” I was not quite able to stand up straight: some inflamed growth inside me was bending me at the waist, pulling my abdomen, knotted with pain, down toward my knees. Silliness, I suspect, had set in; some endocrinological compassion-center was flooding my brain with substances that suggested nothing now mattered very much.
I had been admitted without any certain diagnosis. The professor in charge of gynecology had, in a civil way for which I remain grateful, found me a bed at short notice. Provided I didn’t mind being in hospital for Christmas, he said, they could have me in about the twentieth and operate before the feast. I had felt bleak, on the journey down the motorway—not afraid, but feeling in a childish way that there was nothing to look forward to. After two Christmases in Africa, when I’d missed my family badly, this was not what I had planned. When the professor had examined me at Outpatients, a week or two earlier, I’d bled everywhere, onto his latex hands and the sheet beneath me. I thought he’d have been hardened to that, but he said, “I am afraid I am hurting you. I am sorry. I will stop now.” I would have liked it if curiosity would have propelled him onward: pushing into the unseen, smoking meat of my body, and finding out its truth.
How can I write this, I wonder? I am a woman with a delicate mouth; I say nothing gross. I can write it, it seems; perhaps because I can pretend it is somebody else, bleeding on the table.
But at the time, I came to the vertical, sickly swaying. I mopped myself up and got into my clothes. I sat in a chair: black vinyl, splayed legs, the ridge of its back hard against my spine. You say you think it’s endometriosis, he said. There’s a good chance you’re right. But he didn’t look a happy man. Could it be anything else? I asked. How we conspire, not to speak the word “cancer.” His eyes slid away. Oh well, he said, if not endometriosis, then pelvic inflammatory disease, it is a thing to consider. I said, no I don’t think so really. He nodded. He didn’t think so, either. He said by the way, is it, should I, am I speaking to Doctor McEwen? I looked up to see if he was being sarcastic. No, I said, I’m not a doctor, why would you think that? Only, he said, your terminology is precise. Ah well, I thought. If only you knew me: conscientious, with a mind for detail. Little Miss Neverwell had graduated at last.
Endometriosis is a gynecological condition with a dazzling variety of systemic effects. It is not rare, though mercifully it is rare for the disease to run on, unrecognized, for as long as it did in me, and it is rare for it to do such damage. Because of the number of symptoms it throws up it is sometimes hard to diagnose. It is always hard to diagnose, for a doctor who doesn’t listen and doesn’t look. It is comparatively easy if you are the patient, and get into your hands a good textbook with a comprehensive account of its effects.
A few months earlier—in the remoteness of my small town on the fringes of the bush—I had thought, once again: enough’s enough. My doctor (his dusty downtown surgery darkened by eucalyptus trees) seemed disinclined to investigate, though happy to prescribe me stronger and stronger pain relief. Whatever he gave me (and however much alcohol I knocked back to accompany it), the pain grew over the top. So one day I went up to the capital, to the university library, and combed through the medical books. I found a textbook of surgery, with a female figure, her organs clearly depicted, and black lines—like the long pins with which they used to stick witches—striking through her hips and rib cage, carrying a name for each organ. For each organ, there was a pain, and of each pain, I had a sample.
I learned next how the disease process worked. The endometrium is the lining of the womb. It is made of special cells which shed each month by bleeding. In endometriosis, these cells are found in other parts of the body. (How they get there is a matter of dispute.) Typically, they are found in the pelvis, in the bladder, the bowel. More rarely, they are found in the chest wall, the heart, the head. Wherever they are found, they obey their essential nature and bleed. Scar tissue is formed, in the body’s inner spaces and small cavities. It builds up. It presses on nerves and causes pain, sometimes at distant sites. The scar tissue forms an evil stitching which attaches one organ to another. Infertility is a distinct possibility, as the organs of the pelvis are ensnared and tugged out of shape. Endometriosis in the intestines makes you vomit and gives you pains in the gut. Pressure in the pelvis makes your back ache, your legs ache. You are too tired to move. The pain, which in the early stages invades you when you menstruate, begins to take over your whole month. Lately I had known days of my life when everything hurt, everything from my collar bone down to my knees. But hey! There was nothing wrong with my ankles. My feet were performing nicely. And I could still think, and depress the typewriter keys. Stop complaining! I thought. Look where complaining gets you! In the madhouse.
Along with endometriosis goes, not infrequently, a hormonal disarrangement which shows itself as a severe premenstrual syndrome. In my case, it manifested in the prodromal aura of migraine headaches. Migraine, I had to learn, was not just a sick headache. It was a series of linked neurological phenomena of remarkable diversity. It was within the migraine aura that my words came out wrong, that the door disappeared into a black space: it was within the aura that I heard the dull hum and the muttering on the left-hand side of my head. Migraine stirred the air in dull shifts and eddies, charged it with invisible presences and the echoes of strangers’ voices; it gave me morbid visions, like visitations, premonitions of dissolution. For a time, when I was eight years old, my field of vision was filled with a constant, moving backdrop of tiny skulls. As a student, I had told Dr. G. about them, in a burst of frightened confidence. “Black on a white ground, skulls skulls skulls, the size of my little fingernail, unrolling,” I said. “Unrolling, like a satanist’s wallpaper.” Dr. G. smiled a wintery smile. “Ah well,” he said. At this stage, I was only a neurotic, not the full-fledged madwoman I would become when he upped my dosage. “Ah well.” His voice was soothing. “We all have our little metaphysical fancies.”
Nineteen seventy-nine: I must admit that the very act of climbing into the hospital bed had brought me a kind of relief. I could stop pretending to be well. The odd thing, though, as I had already observed, was that the staff were inclined to treat the patients as malin
gerers. We could see them huddled at their nurses’ station, flicking through our notes and discussing our body parts. Young girls with flaky cervixes were probably no better than they should be, and anything in the pelvic inflammatory line attested to a vibrant sex life. Pregnant women weren’t sick, women wanting abortions weren’t sick, and as for the sterilization brigade, they should probably be up and scrubbing the latrines. (That wouldn’t have come amiss.) And as for me—I soon got a jolly diagnosis. The senior registrar examined me and thought I was pregnant. He winked at me. That’s a baby in there, he said, confidently patting my swollen abdomen. He ran off to get a fetal heart monitor.
But there was no baby. Not Catriona, not Modestine: not anyone, only the ghost of my own heartbeat, amplified to the outside world. Oh well, the registrar said. Looks like I was wrong, eh?
The houseman came, to take a history. He was very new and young, with a starter mustache, which could be studied bristle by bristle; some bristles stuck out at a right angle to his skin. I kept my eye on it, and the movements of his mouth. You are very young, he said, and I am going to ask the professor, yes yes (he got up his resolve), I am going to talk to the professor, I am going to ask him if he can make a neat low incision, so that afterward, you will be able to wear a bikini. He looked almost tearful. I nodded. I knew he would not be able to effect this, but I liked it that he cared so much. It is strange, to expose your soft girlish body to a man of your own age, who has not yet acquired dispassion but wears a white coat. In fact, I said, I never wear a bikini because I am too—I wanted to say, modest. But what modesty was left? I’d had more gynecologists than I’d had lovers; alien fists in my guts. I said, you see, I am too white for a bikini. Too pale. I burn. Of course, he said. But all the same. He got up, flustered, his clipboard almost spilling his notes. At the bed’s end, he turned and smiled, and winked at me.
Two days after I was admitted I needed to have an ultrasonic scan. For this I needed to cross London. St. George’s Hospital at Hyde Park Corner was in its last weeks of occupation; it was gaunt, grubby, and nearly empty. My ward was almost the last to be kept open, I was told, and for the high-tech stuff I needed to go to the new St. George’s at Tooting. I expected them to bring my clothes up the ward, but I was told, no, you have to go in your dressing gown, that’s how patients go.
The only such garment I owned, myself, was a black satin wrap with a plunging neckline. But before I had been admitted to hospital my kind, practical cousin Beryl had said that she didn’t think it would do, and lent me a green velour item, cozy and modest, that came to my ankles and buttoned up to the neck. I was very glad of it, when told I was to go by taxi to Tooting. They would organize the taxi, they said, no worries. Oh, I said to myself, I don’t have to go out on the street and whistle for it? And, they said, they’d send someone to escort me.
Before I began the journey, I was to drink as much water as I could possibly bear to drink, to distend my bladder, which was a good thing for a reason nobody explained. In a way, you didn’t want to ask. What if they didn’t know? There was a trade-off in ignorance going on. They told me nothing, and I didn’t ask questions in case I was shocked by finding how much they didn’t know. I waited, sitting on my bed, pensively swigging from a hospital tumbler.
“Here’s Della!” somebody shouted.
“Hello, hello!” Della shouted back. She rolled in like an Oscar candidate, like the belle of the ball. “Wha-ay, Della!” rose the shout. Della whooped back. I know a character, when I see one. And oh god, how a character shrinks my flesh with dread. I took one final sip of water.
Della was a Jamaican auxiliary, in her fifties or sixties. She was very wide, so that you felt you couldn’t quite see around her. People must feel that about me, nowadays, but I don’t think I block the light like Della did. She had a broad forehead and she glowered. She reminded me of a bison; not a bad thing, really, because as a child I liked the bisons at the zoo; they would stand near the fence, breathing bulkily, while you wormed your finger through the netting and scratched the expanse of sparse hair between their ears. But depend upon it: once on the open range, they could charge you down.
It was Della who was my promised escort to Tooting. They brought a wheelchair up to the ward. “To take you to the taxi,” they said. But I said (maybe I just thought) I can walk, you know that, you make me walk, last night you invited me to operate the cocoa trolley … But they were insistent. They said it was a rule.
I was wheeled to the entrance and packed into a taxi with my bison. “Wotcha, Della!” said the porters at the main door (or some other vile mock-cockney exclamation). Della had, I suppose, been given a letter to hand to someone at the other end, but she didn’t seem to know why we were going to Tooting together, regarding it with levity and as a kind of holiday treat. She hollered back to the porters, “Ray, what! Gwine Tootin, see yer, wot?”
The door slammed. We inched forward into the traffic of Hyde Park Corner. The driver kept his glass screen closed. But chat ran out of Della, chat chat chat. Who was I and why there, for what? I replied, a steady even flow of answers, censored against self-pity, censored against the personal, my face turning again and again to the taxi window. It took a long time, that journey, through the midday traffic, inching south, crossing the Thames. I have never come to terms with London as a city, but I like to look at it silently, from taxi windows, and appreciate it for what it is, and for how it makes me feel provincial. On this day I felt possessed by the idea that I might not see it again. Even two days in the enclosure of a hospital ward changes your vision, and the buildings to me seemed distant and heroic, like the buildings of a dream city. I felt emotional, but couldn’t put a name to my emotion. My bladder, which had been attacked by the disease process, had swollen obediently, and already I had a pain: a new sort of pain, quite a change really. Della was talking, loosely, fluently. I was replying to everything she said. Then she began a new story. My mind rejoined her. She told me about her youngest daughter, only eighteen, who had gone into hospital five years ago to have an operation on her hand. “Just a little swellin’.” Della insisted. “I told her, don’t you bother about that. Would she listen? Would she listen? Ho no!”
I swiveled from the window. For much of the journey till now I hadn’t known what Della was talking about, but surely this was something I could understand? And how did it go, I asked, for your daughter, did it work out all right, did they fix her up? Ho no! Della said. It all went wrong when they put her under. She’s, like, a vegetable now. She got her brain destroyed. Vegetable’s what they call it.
She spoke dispassionately, as if she were talking about a Martian. The law student in me was sick, but not entirely dead. In almost any circumstance, I would have leaned forward—conscientious, mind for detail—and said, you had a claim for negligence, did you get a good solicitor? I would have been slow to censure Delta, for bringing up such a gloomy precedent, and considered that in fact she might have done me a favor: it gave me something other than my pains to think about. Did the hospital admit liability, and what damages did you get? Five years, I thought—five years, the case could still be enmeshed in the system. Only part of my mind flinched from what she had told me. The other part was about to ask her for the figures, for the dates. I was about to speak.
But then Della did a terrible thing. She let her head sag forward and her jowls hang, and she imitated her daughter’s speech. “She goes, Ma, Ma, Ma. La, la, la. That’s all she can do.” Della protruded her tongue. She grunted. “Ma, ma, ma. La, la, la.” She lolled her head on her thick neck. “Ma, ma, la, la.” At length, after time for consideration, Della put her tongue back in.
We traveled the rest of the journey in silence. The taxi driver put us down at the wrong entrance. Della seemed to know where we ought to be, and we set off together, she with unclouded brow, as if rolling across the grassy plains, me in my dressing gown and bare feet in slippers: bending a little over my pain, as if I were brooding. I had come from the heat of Africa, at the
hottest time of year, and we were in December. In fairness, I must say, it was neither raining nor snowing. It was one of those days so near the end of the year that it won’t put the effort in: only a stray sullen flake drifted down, out of a sullen sky.
I had worked in a hospital, at one stage in my career, and understood medical signposts, so I wasn’t happy with Della’s choice of destination. But she insisted. She kept charging, her bison head down; I had to follow her. I wanted to crouch down, on the gravel path, and urinate beneath my skirts, like Marie Antoinette on the way to execution; it is a sad detail of that sad life, which in my manuscript about the Revolution I had thought long and hard about suppressing, but had not. Della led me to the liver unit, where people thirty years my senior were standing in line. They were waiting for scans, it was true, but special ones, peculiar to them. They were yellow, bloated people, who resembled each other, who seemed to have joined the same family. None of them spoke to me. They just looked. They were stooped, like me. They held their abdomens draped over their forearms, holding up their own swags of flesh: like debutantes scooping up their trains to nip out of Buckingham Palace after their presentation.
A nurse shook his head at Della. He pointed. We backed off, away from the yellow people. I looked into the moons of their faces and they looked back at me, tolerant, indifferent perhaps. We set off again, me and Della, out of the liver unit and into the open air, up the gravel walks and down. The cold was raw and wet, like a salt bath. When I got to the right place, they were expecting me. Perhaps they had been expecting me for the last hour, but they didn’t criticize. A technician, kindly but dispassionate, slicked jelly onto my abdomen. It reminded me of Swarfega, a product with which the men in my life degreased their hands after tampering with a car engine. Perhaps the hospital could fix me, with some plastic padding? The technician loomed above me and rolled me with a roller. Lifting my head, I saw the pictures on the screen. It didn’t look sensible, it didn’t look reasonable, and perhaps he didn’t think so either. But he was helpful in pointing out the salient features. “Nice full bladder,” he said, “I expect you can’t wait to get rid of that.” He showed me the blossoming growths around my ovaries. For the first and last time, I saw my womb, with two black strokes, like skilled calligraphy, marking it out: a neat diacritical mark in a language I would never learn to speak.