“When he tried later on to piece his recollections together, he learnt a great deal about himself from what other people told him. He had mixed up incidents and explained events as due to circumstances which existed only in his imagination.” – Crime and Punishment, Fyodor Dostoevsky.
The waiting room was good, as far as these things go. The hospital was a new one, maybe a year or so old, and everything in it, bar the people, seemed just as new. Chairs of all shapes and sizes, firm and soft and high and angled and reclined, some modicum of comfort for every type of ailment or disorder, all laid out in neat rows on gleaming plastic not-wood. There was wood panelling softening the harsh lines of walls and whiteness, soft blue colours masking the clinical efficiency hidden behind the low desk.
Everyone was astonishingly helpful. I was asked several times by passing nurses if I wanted to go into a room and lie down. Every time, I shook my head to clear the fog, muttered something noncommittal. The chairs were fine.
They weren’t fine, but at least there was no risk of me passing out when I was sitting.
A television was mounted on the wall. When I had walked in hours before, clutching my precious letter, my golden ticket to a date with a surgeon, it had been off. The room had been busy, then, full of people coughing or limping, leaning on canes and frames. The TV had been switched to the news, broadcasting out the standard half-hour rotations of the same content for ordinary people having their breakfast, preparing to leave their houses and set off on the morning commute. I listened the first time through, then tuned out the following six.
There were a few hugs at that point, from family members who’d accompanied their loved ones into the waiting area. Nurses were shooing out the clinically unnecessary. This was no place for the healthy.
Having had my hugs and said my goodbyes at the hospital door, I just watched the pairs before they were separated, trying to guess which one was the patient and which one was the relative. I lost more times than I would have expected.
The room fell silent, apart from the strained enthusiasm of the newsreaders as they cut to a correspondent in a Midlands factory for a fifth time. People shuffled and made themselves comfortable in their seats, getting themselves ready for the long haul.
I pulled out the book I’d brought with me adjusted the back cushion keeping me ramrod straight in my chair, and tried to ignore the tingling pain dripping down my leg.
We can at least make a decent guess at the evolutionary necessity of pain. It’s the simplest, most elegantly vulgar basis of decision making. Pain is so central to the human experience that entire schools of philosophy have been founded on the moral necessity of minimising it.
That is, pain exists to tell us what we should and shouldn’t do, what stresses the biological framework that hauls our consciousness around can and cannot be made to bear. If it hurts, continuing with it’s probably a bad idea, or something’s already wrong and you need to be aware of your limitations. Pain is a spectacularly efficient warning and informational system.
But what if it goes wrong? What if, for some reason, the pain isn’t helpful or informational or avoidable, but is instead just there? Always there, in some shape, taking forms and characters, bulging or aching or tingling or stabbing. And there’s nothing you can do to fix it, nothing you can do to make the pain stop, nothing that your body’s telling to avoid or take care of.
Then it becomes crushing. It dominates your life, dictating what you can and can’t do. The grinding, constant pressure of being in pain, the animalistic urge to minimise that pain becomes your whole existence. Everything becomes framed in terms of how much pain, whether it’ll make things worse, whether it’s worth spending the next day in writhing agony instead of the usual distracting discomfort. Nothing is real but the pain.
5 o’clock in the morning is utterly dark, even in early April. I lay face down in the gloom, feeling the stiffness in my back, thankful for the calm down my right leg. Face stuffed into a pillow, I waited.
After an arbitrary half-hour had passed, it was time to get up. I showered with care, knowing that within a few hours my unconscious, prostrate body would be at the mercy of someone with an array of extremely sharp instruments. Having been on the other end of the patient/health professional divide, I didn’t want to give the person with the scalpels any reason to take offence.
When I got out of the shower, I rushed over to check my watch. Still only five to six. I grabbed a glass and filled it with water, taking care to sip it, savouring my breakfast.
Apparently, anaesthesia makes your body unable to perform normal functions like swallowing or breathing. During some surgical procedures, a patient is kept alive thanks to a breathing tube inserted into their airways. Moreover, if there’s anything in the patient’s stomach, they’re unable to keep it there. To minimise the risk of anything coming back up the oesophagus and going into the lungs, you’re told not to eat anything after midnight the night before your surgery, and confine yourself to one small glass of water before six a.m. on the morning of the procedure.
All of which meant that I got a front row seat to watch my dad having breakfast while I tried to calm my stomach. Half an hour stretched languidly out in the dawn. I sat there and tried not to salivate. Still, it was worth it if my back would finally get fixed.
When we left, the roads were totally empty. Apparently nobody commutes at 6.30 in the morning. Dawn was creeping over the horizon.
I lounged back in a car seat for the first time in months. I luxuriated there, comfortable in the knowledge that there wouldn’t be any lingering after effects the next day, because it was getting fixed in a few short hours.
Then the nerve pain jangled its way down my leg and I straightened again, back into the rigid pose I’d been adopting for months.
Any attempt to describe pain after the fact inevitably suffers from the decay of memory. Any effort to recall what pain was actually like, what the sensation felt like, is doomed to fail. Your brain purposely forgets the awfulness and so we come up with all sorts of jarring language, metaphors and images to try and explain the sheer helplessness.
So I could say that, at its worst moments, it was like acid was dripping down my spine, flowing through my veins, spreading out through my capillaries to stab at every cell of my flesh.
Or I could just say that it really fucking hurt all the damn time. Both are equally useful.
The human spine is a complex structure. A basic explanation is that it consists of alternating disks of bone and cartilage stacked atop one another to create a column. This makes it flexible, as opposed to a single solid bone. The spine surrounds and protects the spinal cord, a bundle of nerves and other bits and pieces that runs all the way down the back from the brain and which makes up the main transmission system for instructions and messages from the brain to other parts of the body.
The opposite is true, as well. For example, pain signals go from the affected area to the brain through the spinal cord.
So when, as happened to me, one of those disks of cartilage pops out of place and pressing on the spinal cord, some mixed signals can occur. To put it extremely mildly.
To reframe it in medical terms, I had a prolapsed disk, causing acute sciatica. That is, the disk inflaming my spinal cord caused the nerves all the way down one leg to send pain signals back to my brain. Thus the dripping acid.
One of the many unfortunate things about something like this is that, after a certain point, it doesn’t go away naturally. If the disk hasn’t slid back into place on its own within the first few weeks, it’s irretrievably pinched and trapped between the adjoining vertebrae (bone disks). Surgery is the only resort; someone cuts you open and snips off a miniscule portion of the offending disk, allowing it to slide back into place.
The pain serves absolutely no purpose.
Clinical staff started appearing and calling out names. People shuffled through the waiting room to the large double door that some scrubbed stranger was holding open for them. They would pick up their bags of belongings and limp or stagger through and disappear into some half-glimpsed white space.
Some reappeared. Others didn’t. The waiting area gradually emptied to a handful of stalwarts. I was sitting, trying to read, but glancing up every time the door opened. I’d been there for a couple of hours already. Then my name was called and I did the same as everyone else. I unfolded myself from the contortion that was the closest thing I could get to comfort while sitting down, stuffed my book and cushion in my bag to nestle alongside my toothbrush, pyjamas and dressing gown, and ached my way over to the smiling woman in a lab coat who had asked for me.
We went into a new area, all clean white and harsh lighting. Bays were hidden behind drawn curtains. We passed an open one; an empty bed was encircled by a battery of instruments and implements. The clinical side of things.
Some of the patients I’d seen waiting earlier were now sitting in a smaller waiting area in backless gowns, the sort of ridiculous touch I’d thought was only a cliché on TV programmes. I was ushered into my own empty booth and the curtain pulled behind me.
The doctor explained the procedure in full and went over the risks involved. Apparently, there was a not insignificant chance that something could go catastrophically wrong and I’d end up paralysed or dead. Less than one percent, but the risk is there when someone’s fiddling around with sharp objects near your spinal cord.
I joked weakly that it was a bit late to get cold feet and signed my consent form.
After answering a few questions, the doctor passed me onto a nurse, in a different, identical curtained bay. I tried to remember my medical history for a questionnaire and managed to come up with my only prior experience with anaesthetic. About ten years earlier, I’d been put under for about ten minutes to get my broken nose dunted with a hammer and rammed back into its proper position. This gem of an anecdote didn’t seem to excite anything beyond a tick in a different box to the rest of my answers. Back issues aside, I was completely fit and healthy.
Which is exactly what I told the anaesthetist when she came in after the nurse to ask exactly the same questions. And the assisting anaesthetist, when she came in after that. Not diabetic, no allergies, no previous major surgery, no energy-leeching slugs camped on my brain, no xenomorphs poised to burst from my chest, otherwise fit and healthy.
Not that that’s a complaint. Health professionals taking issues seriously was something I hadn’t seen much of in my last visit to the hospital. The fanatically caring attitude of the staff was underlined when the nurse who’d asked the first set of questions came back and talked me through everything that was going to happen now that I was effectively ready.
Apparently, there were two other patients going in for procedures with my surgeon before me, so I could expect another few hours wait. The image that came into my head at that point of a blood soaked butcher bellowing “NEXT!” as an assistant lugs a hacked corpse away into the shadows was entirely my own imagination. Or evidence that I read too many fantasy novels. The anaesthetist sounded like she planned to do a little more than hand me a bottle of whisky and something to bite down on.
And so I was ushered back out to the now much emptier waiting area. My stomach rumbled. I twisted myself into a seating position, pulled out my book, and read the same sentence ten times. I thought about food.
Curing your own salmon seems like a bit of a waste of time. Sure, it’s always nice to make something of your own, to feel that measure of achievement and satisfaction that comes in the creation of a tangible thing. I’m writing thousands of words into the empty void, after all. I can’t talk.
But taking a whole side of salmon and just covering it in stuff, then leaving it. There’s not process there, no creation of something new. All you’re doing is slowing entropy. Staving off decay for a while longer.
Smoked salmon as a reminder of the fundamental fleeting folly of existence is a bit much as a metaphor, even for me.
So, watching a TV chef lather his salmon in salt and clingfilm it, none of those thoughts crossed my mind. There were accompaniments to the salmon, beetroot or lettuce or something. Something thematically Scottish. The chef was somewhere up in the North East of Scotland, exploring the UK for different regional foods and specialities.
He was in a distillery garden, in the shining sun, in dappled shade, thick hands massaging salt into a slab of pink flesh. And there were some other things he was doing, assembling salad and sampling whisky and going to raspberry fields and laughing with a big bluff moustache wearing a polo shirt. I can’t really remember any of it, though. Aside from the salmon.
There had already been another cooking show, a trio of scared looking youngin’s sweating under the steely gaze of a “mentor” before serving up a meal to two other extravagantly blazered chefs. One managed to underbake his chocolate fondants and they collapsed into a gooey mush as soon as they were removed from their moulds. Fondon’ts, one might say, if one had a terrible sense of humour.
At some point earlier, the TV had been switched off after a nurse evidently got annoyed with it. He wandered out and announced to the three of us still sitting there whether anyone was still watching the TV. Everyone obediently shook their heads and the newsreaders disappeared as anonymously as they had been there.
Raskolnikov feverishly wandered St. Petersburg, searching for some meaning, acting randomly, in a trance of guilt and self-recrimination and uncertainty, oscillating wildly between determination and despair and hope and dejection and a crushing sense of transgression. In my book.
Some old boy asked for the TV to be switched back on again. He was probably in for a hip replacement or the like, what with it being an orthopaedics ward. A newspaper lay abandoned on his lap. No-one had come in to say goodbye to him.
I’d left my dad at the door, saying that it was pointless for him to come in with me. It was, since all that I’d be doing would be sitting waiting, and he had to go to work. A hasty hug was scrambled out between us in the aisle of the car.
I meandered my way through the enormous, echoing spaces of the vast new hospital. Signs were everywhere, big official ones marking departments and wards and lifts. The office I was supposed to report to was signposted by a printed out piece of paper blu-tacked to the wall.
I regretted not bringing more with me to do. Other people were there, each for surgery, being shuffled off to their different departments and areas once the system had been notified of their presence. I was the youngest by about twenty years. I squirmed in my seat, uncomfortable and awkward and nervous. And in pain.
The gown, when I finally got to it, was ridiculous. I had been called in, finally, about one thirty. The same nurse who’d asked me all the questions called me back to the other side of the door. He told me I’d have to get changed and leave my stuff with him; it’d be transferred up to my ward once I was in recovery. And he handed me a neatly folded bundle of cloth, told me to remove everything and put on the stuff he’d just handed me.
I asked about my glasses and was commanded to take them off and put them in my bag along with everything else.
There was a small changing area that I was ushered into, like the booths where you try on clothes in a shop, except with more mobility aids. There was even a full-length mirror on the wall. I giggled at the idea for a second, checked to see whether the bags under my eyes needed touching up. Then I stripped down and looked at the pile of clothes I’d been given.
There was a pair of-
No, that’d overly charitable. There were two pieces of what seemed like thick tissue paper, shaped like triangles, held together at a couple of points with string to leave three gaps. I guessed they were supposed to resemble pants and struggled my way into them. They were too small and too big, ballooning and gripping. I kept thinking I was going to tear them pulling the unyielding string over my huge arse.
It looked disconcertingly like I was wearing a large, translucent nappy.
Then on with the shower cap made of the same filmy skein of fabric. And the gown, open and flapping at the back, which was when I discovered exactly what the mirror was for. Straps or ties or whatever hung off the gown like ribbons, flapping as I spun and twisted and tried to find ways to connect them. After spending an embarrassingly long time trying to tie up my own damn gown, I gave up and sheepishly pulled the door open again. The nurse was sitting there waiting. He spun me around without speaking and tied everything properly.
Looking at my bare feet, he asked if I had any slippers with me as I stuffed my things into my bag. I shook my head, and was handed a pair of foam soles with more string to secure them to my feet.
He lifted my bag and asked me to follow him down a clean, unmarked hallway. It was the same direction as back to the waiting room.
Then we went through another set of double doors and purple highlights were there, more beds encircled by curtains and ports and taps and instruments. It was strange, the purple. Random panels on the wall, cutting through the whiteness, softening metal cans of gas.
The nurse motioned me towards a bed and told me to get in and lie down. He went and spoke to another couple of nurses at the desk in the middle of the place, a long corridor that seemed to take turns and stretch on away, around. I heard my name. My number.
There was a sign above my bed. I was D5, for the moment.
I lay back and closed my eyes. There seemed nothing else to be done, at the moment anyway. I lay and savoured the tingling, jangling, jarring sensation crackling its way down my leg. It’d be gone soon.
There was a muted buzz of conversation around the place. A few snorts of laughter. Two people sitting behind the desk were talking to one another. I lay back and tried to think of all the things I would do once my back was fixed.
Someone approached and I opened my eyes. It was the anaesthetist again. She’d changed from the suit she’d been wearing before into an anonymous set of green scrubs. The heavy framed, fashionable glasses seemed out of place somehow, personality in the procedure.
What’s your name, your date of birth, your identification number, she asked, grabbing at my wristband. What are you in here for? I blurted out the answers, trying to remember the string of digits. Having answered to her satisfaction, she made a note on her clipboard and explained that we were just waiting for the theatre to be readied.
She left, and I was on my own again, staring at the ceiling for a bit. One of the nurses from the desk came and gave me another pillow to prop my head up properly.
Another person arrived, the assisting anaesthetist this time. She asked the same questions, got the same answers. She made another notation, made some cheery remark, and left.
Then another nurse came by, another clipboard, the same questions. I was still the same person, with the same problem. I knew what bit of me was to get chopped up and what wasn’t, and now it’d been triple checked. The possibility of waking up without a leg due to some catastrophic misunderstanding had heretofore not occurred to me.
I was reassured that it would just be a bit longer and that we were just waiting, and then the last attendant withdrew. I closed my eyes again and went back to staring at the blackness. God, I was tired. They might not need to knock me out. Lack of food and water and sleep seemed to be doing that job pretty well.
A voice drifted in to my consciousness, someone asking the same questions of another patient. Name, date of birth, ID number, procedure. Then another voice said something in a language I didn’t recognise, imitated the questioning tone. There was a reply in the same language. The answers didn’t need to be translated.
“OK, we’re just waiting for the theatre now, so we’re done here,” said what I assume was a nurse, uncertain of herself. “Could you tell him that?”
“Yeah, sure,” replied the interpreter, then a few words in whatever language it was made their way to the patient. There was no acknowledgement, or none that I heard.
“Since that’s everything, can I go and get some lunch?” the interpreter asked. “Because I’ve been waiting here with him since morning, and I’m starving. I can tell him where I’m going, and I’ll be able to find out what ward he’s in from the front desk after the operation, right?”
“Umm, let me check,” answered the nurse. There was a murmured conference with a colleague at the desk then “Yeah, that’ll be fine. We’ll take him from here, there’s a nice café on the second floor, and you’ll be able to find out where he is once the operation’s done.”
“Cool, thanks.” The interpreter then apparently explained everything to his charge and took his leave. The patient didn’t object. Everyone left him alone.
There was quiet on the ward again as I strained to stay awake. I felt the pain in my leg holding me conscious. For once, it was welcome.
A door opened and a few pairs of feet made their way squeaking past me, to the bed next to me. Someone said something about the theatre being ready. Then she said it louder and slower, putting on her most reassuring voice, and the noise of someone being wheeled away, uncomprehending, passed where I lay.
I don’t know how long I lay there. Time had been flexible, malleable, for a while now, stretching into incremental infinitude and snapping back into great rushes all day. All the time in the world, then everything happened at once.
It was a while, though. Enough time for me to mentally note down the other patient, store it away in my memory. Try and work out what language it had been. I guessed Urdu, knowing that I had no idea and no way of checking.
Some more time passed. Maybe Pashto.
I listened to the quiet chatter of the nurses behind the desk. When I’d been put into the bed, when my foam slippers had been taken from me after the twenty pace walk, the rails at the side had been raised and locked. I was penned in, laying there, nothing to do and nothing to care about.
Eventually, someone approached me. I jerked my eyes open, and saw the whole anaesthetic crew gathered round my bed. We were ready, it seemed.
And so it was said. The two of them took a grip of my bed, either side, and strode off down hallways, turning corners and through swinging automatic doors and held-open manual ones, more corridors, slaloming through the colour spectrum, a whiteshift.
Then we were through another set of double doors and in a corridor that was also a room, a set of doors at either end to come and go. More nozzles and pipes and instruments sprouted from the walls. A blood pressure machine was wheeled over and one of the staff strapped it round my arm and on my finger, another reached into my gown and began sticking electrodes and wires to my skin.
Sorry, I muttered, trying to roll around and give them the easiest access. Wires twisted from my chest to a beeping machine. The anaesthetist started talking, making small chatter about what I did and who I was and what her son was up to as she uncapped a venomous looking needle.
Just a little sting, I was assured, and she slid it into my wrist. Nothing, damn, everyone’s so dehydrated at this time of day that it’s impossible to find a vein. Maybe try a little lower down the hand. So anyway, yes, my son’s just about to go on a trip to Asia and he’s really excited.
It’s OK, you can lie flat now, we’ve got them all attached.
Ah, there we go, that’s it. OK, we’re going to give you a painkiller and then something to relax your muscles, alright? This’ll probably feel pretty good, this first one.
She inserted a needle into the cap feeding into my wrist and pressed a dose of something into my bloodstream.
And this one is to relax your muscles and knock you out, OK? This’ll probably sting a bit, but think of where you’d like to wake up. Just close your eyes and think of where you’re waking up, think of that place. She placed a large plunger full of thick, white liquid against my wrist and slowly pushed all of it into my arm.
Ice was in my vein, spreading into the capillaries, firing its way up my arm, inside my flesh, in the core of my forearm, my elbow, my bicep.
Count backwards from ten and we-
I looked around blearily at the same purple panels, the same desk, the same ward as I’d just been in. I blinked. It took a lot of effort.
There were two nurses around my bed. Things happened. Were said. Maybe one of them asked if I was in pain, whether I could use a bit more pain medication. I nodded. Didn’t speak, I think. Maybe.
He slotted another ampoule into the cap on my wrist and poured another hit of morphine into my bloodstream. There was feeling in my back, discomfort, aching, something new. Perhaps.
The older nurse, the one who’d spoken, explained that the other was a student, watching and assisting him. I nodded again, turned to look at her. She was young, and pretty. I tried to crack a winning smile, because of course that made sense. I was a fucking catch. I think I drooled a little.
There was something said about the surgeon coming to see me. I nodded again. Some water was found for me and I sipped a little, felt it soak into my gums, my palate, the inside of my cheeks. There was nothing left to swallow.
Then the surgeon marched over, short and businesslike and brusque. He grabbed my hand and shook it with a nod. I stared glassily at him and tried to focus. I still didn’t have my glasses, after all. I asked him how it went. He said it went well, that there’d been a lot of pressure there that they’d managed to relieve. Maybe something about liquid spurting out when they opened it up, I dunno.
The image of a little fountain of cerebrospinal fluid hitting this man in the eye might have made me snort with laughter.
Job done, patient attended to, he marched off. Places to be, people to chop up. No time for questions with the fixed.
The senior nurse explained what was going to happen now. I’d be wheeled to a recovery ward and spend the night there, get out the next morning. My things would all be there, in my bag. I nodded again.
They began to wheel me off, again swift and businesslike. They would slow down when we came to a bump, though, ease me over it and apologise. I was lying on a six inch long open wound at the base of my spine but it was cool. The world drifted past.
We must have taken a lift or something. Must have got to the recovery ward by some means. But then I was there, in my own room, individual rooms were a feature of this new hospital, I remembered, being disconnected from all the things that were sticking out of me. There must have been a lift, but even now, I’ve no idea.
The bars on the side of my bed were finally lowered. The recovery area nurses left and one of the ward nurses came in and said some things to me. Probably. Wrote some things up on a whiteboard about whether I could eat solids or not.
While the first ward nurse was fussing with me, doing things – maybe a blood pressure reading? – another came in and asked if I wanted a sandwich. Cheese and tomato was the menu for dinner tonight apparently. I’d rocked up I the ward after formal dinner hours, so that was that.
The first nurse filled my big jug of water and admonished me to drink plenty, and the other nurse reappeared with the promised sandwich. Another glass of water and I managed to swallow something this time, croaked a thanks to the nurses.
They left and I ripped open the sandwich. I shoved it into my mouth lying flat, felt it hit my stomach. I covered myself in crumbs, then scooped them all up and ate them too.
My parents arrived to see me. They hugged me, awkwardly, whilst I lay there unmoving, grinning like a loon. They sat and listened to my babble, put up with my vacant silences as thoughts bubbled to the surface of the tar pit in my mind. My dad went to the shop to get me something to eat after discovering that all I’d eaten in twenty four hours was a cheese and tomato sandwich.
I was put on a phone to various people, assuring them I was fantastic and that everything had gone swimmingly and that I still had all my limbs and that I’d be getting out tomorrow.
My parents still stayed, long after it was reasonably time for them to leave. They stayed and did nothing and read and chatted to one another and watched me spill water down my front as I tried to form coherent sentences. They stayed and we sat in silence.
I felt nothing in my leg. A calm nothing. I didn’t weep. There wasn’t nearly enough water in my body for that.
Eventually, my parents had to leave. It was starting to get dark, the ward staff had been in to get more readings a couple of times and given them glares, and so they picked up their things and reluctantly edged out. My dad was wearing the suit he’d been in when he’d dropped me off.
There was a TV, so I switched it on and squinted at the bright lights. Inhaled the extra food. It got to a time when I felt tired, exhausted even. I eased out of the bed, trembling, stumbling, over to the bathroom with my toothbrush and toothpaste. Held the mobility handrails with a desperate grasping claw. Shuffled back to my bed and lowered myself into it, sighing with relief and breathlessness.
I didn’t sleep much that night, but it wasn’t because I was in pain. I wasn’t in pain. I was flying. I couldn’t sleep because it was the first time I’d tried to sleep on my back in two years.
Top image stolen from anteriorhipreview.com
 That would be Crime and Punishment, hence the quote at the top. That, and this blog trades in showy pretension.