by Tim Winton
After that there were always crutches by my parents’ bedroom door, pills on the side table, bandages on the coverlet. Under the bed lay a slippery carpet of X-rays and some days Dad looked as ghostly and indecipherable as them. There were endless doctors’ appointments, visits to this specialist or that therapist. Finally the crutches gave way to the awful walking stick. And then the stick disappeared and he was suddenly plausible again. We had him back.
But now and then during my primary school years, Dad would have to go in for more surgery, and anytime he returned to hospital I felt a chill of panic. That lingering doubt was always there. What if he didn’t come back? What if he came home a stranger again?
As if picking up on my anxiety Mum eventually took me to visit him during one of these sojourns. At the time he was recovering from a bone graft, and that visit is my first memory of the inside of a hospital. I remember being nervous, but the reality was worse than I’d imagined. It was like a descent into the netherworld: the grand entrance, the high desks and hard lights, all those flat, stern faces peering down at me. I shrank against my mother as she led me through a maze of corridors. Nurses’ shoes squawked on the lino. The opaque windows had threads of steel in them, as if the patients were captives. In the long, open ward with its ranks of steel-framed beds, there was a gauntlet of horrors to be traversed before I could see my dad. It seemed there was a price to be paid for visiting.
In the sixties an orthopaedic ward in a big public hospital was a confronting environment for an adult, let alone a child. Visits by children were discouraged. For patients there was no privacy, and even those ghastly curtains the nurses ricked around beds at crucial moments allowed precious little discretion. On that long walk, with coughs and moans and pulleys and pins and plasters at every turn, I felt the first onset of the weird tunnel vision I still get in hospital wards. It was as if I were walking down my own tiny hallway from which the lurid tableau of men in traction and wing-headed matrons were excluded. But what I could not see loomed larger in the mind. Behind the death rattle of curtains I envisaged limbs plastered into gothic contortions, hypodermic needles the size of bike pumps, bandaged heads in which black mouths gaped and pulsed like anemones. With all those horrors, real and imagined, it seemed quite a distance to travel. I pressed so hard to my mother’s leg she could barely walk.
After this ordeal the eventual sight of my dad with tubes snaking from his hip wasn’t quite so bad. Beneath his bed bottles collected a tawny liquid like the juices of a lamb roast. Dad hoisted me up and showed me the plaster and the gruesome antiseptic stains on his skin. He pointed out where the pipes went in. It was gross but it was nothing like the charnel-house I’d just been through. When our time was up I didn’t want to go. I bawled and said I missed him. But the truth was I didn’t want to walk back down that ward.
Years later I saw a movie by Dalton Trumbo that brought all that childhood horror back to the surface. Johnny Got His Gun is about a quadruple amputee, a soldier reduced to a helpless trunk. Blind, deaf and mute, alone with his fevered thoughts, he lies on a bed encased in plaster, just a silent screaming mouth. From the first glimpse this character was like something bursting in from the banished periphery. Trumbo no doubt meant him to be exactly that, a reminder to the culture that boys pay the price for the wars of old men. But to me he was personal: a memory and a nightmare, one of the images that once danced out of bounds beyond the walls of my panicky tunnel vision. Man or boy, whenever I’ve visited someone in hospital a version of that suffering gothic effigy has lurked at the edge of consciousness.
As a family we had our share of waiting-room nights and long days in carparks, at Princess Margaret, King Edward, Osborne Park, and Albany Regional – puncture wounds, fractures, births and miscarriages, episodes of pleurisy, osteomyelitis, asthma and meningitis – yet somehow I managed to avoid admission all the years of childhood. Sometimes it seemed I was paying for this apparent immunity with traumatic visits to others. My infant brother emerging from a coma, his mouth a nest of ulcers. My grandmother writhing and raging after her catastrophic stroke. The day I stumbled into the burns unit by accident. Hospital seemed like a constant presence. But I was only visiting.
And then one morning when I was eighteen I woke up on the inside. Royal Perth Hospital. I had no idea where I was, though, or how I got there. There was a bloke gurgling and moaning beside me. I tried to get up but there was no power in my body; it was like a nasty dream. I tried to speak – to the man in the next bed, to anyone really – but all I could produce was a croak. For a few moments I lay there taking the room in, trying not to panic. Every surface had a ghost. I couldn’t focus my eyes. My roommate sounded as if he were dying. My hair was full of biting insects, my head hurt, my face hurt, my back and legs hurt, my belly felt as if it had been perforated with something blunt. I really needed to piss but I couldn’t get up. I knew I wasn’t paralyzed but I was stuck. I felt ruined. Frightened, angry, I began to cry.
Eventually someone arrived to see what the fuss was about. A glass of orange juice appeared. The drink was cool but it stung my chapped lips and I spilt some down my chest, unable to lift my head sufficiently. Soon afterwards I puked it all back up.
By all accounts I was lucky to be alive. My convulsions were gone but I was still badly concussed and there were ongoing tests on my innards. Those weren’t whiskers on my chin, they were sutures. And the bees in my hair were thousands of fragments of windscreen glass.
The guy next to me died, or was moved elsewhere; it wasn’t clear. Nothing looked right, nothing felt right. If I dropped off I couldn’t tell, when I woke again, whether I was still in the same day. It was like being a very old man, feeble, confused, at the mercy of others. I couldn’t think straight for long but all I could hold onto was the idea of fleeing. Yes, hospital was awful to visit, but it was far worse on the inside.
If you’re an inpatient, acute illness does you the oddest favour; it takes up all mental space and serves as a buffer between you and the institution. Once the worst of the pain and fear have receded, however, your ordeal is not over; it merely changes shape. Of course nothing is more hellish than extreme pain and ungovernable terror, but nobody can prepare you for the challenge of recovery. That’s the long game.
For one thing, unless you’re out of your head on drugs there’s no rest to be had in hospital. When the trolleys aren’t crashing and scraping in the hectic daylight hours – all those drug carts, food wagons, theatre gurneys – the noises they make at night are both sinister and cruelly promising. As you lie awake in the wee hours the squeak of castors in the distance telegraphs the certainty that something is coming, coming, coming. Something better, something awful, some food, some unspeakable procedure. You’re hooked up to machines that whirr and burp and chirp and the same nurses who sternly tell you to get your rest will bellow and gossip outside your door all night. You’re exhausted, and on top of that you feel like a captive, so you’re agitated. Whatever you want is perpetually unavailable: better pain relief, a pillow that hasn’t previously done service as a sandbag, an open window, a view, some news, some better news. The only thing worse than visitors is other patients’ visitors – or no visitors at all.
In hospital you become needy, greedy, callous. While you’ll concede the necessity of tapering off the painkillers, you’ll always find the decline too steep, too sudden. Even knowing how hard it is to be a hospital visitor you glory in showing friends the sutures and staples and you laugh boorishly when they lurch away in horror. Suffering is supposed to be ennobling, but being in hospital could make even a saint cruel and peevish. Perhaps it’s the enclosed world, the infantilizing effect of being confined to your room, ordered to bed – wearing pyjamas, for goodness sake – having baby food served up and sometimes spooned into your mouth.
So many great novels have been set in hospitals. From the paralysis and recriminations of Solzhenitsyn’s cancer victims to the pettiness and moral vacancy of Endo’s lung patients and their doctors, or
the murky circus-world of Kesey’s mental ward, the healing institution harbours the bully, the whiner, the snitch and the cowardly accomplice. Wars and hospitals – it’s a surprise we write about anything else. Hospitals make rich fictional settings because from the inside they are such chillingly plausible worlds unto themselves. They have their own surreal logic, their own absurd governance, their own uncanny weather, and the powerlessness and boredom they induce is hard to match anywhere else but prison or the military.
No wonder so many terminally ill patients prefer to die at home. Perhaps it’s not the prospect of expiring in the company of loved ones and familiar surroundings so much as the thought of being a civilian again, with some command over the immediate environment.
As fate would have it, I married a nurse. I don’t know what that says about me, but there it is. After every shift at Sir Charles Gairdner she brought the ward home with her – in stories, in bruised silences, in the smells and stains of people suffering and dying day in and day out. That was all the hospital I needed in my life, though now and then I relented and met her for lunch in the cafeteria. But I was rotten company, forever distracted, fidgeting, flinching at the clash of trolleys and the sight of patients wheeling their IV stands between tables. My wife worked until a few weeks before our first child was born. It must have been strange for her cancer patients, being ministered to by such a young and hugely pregnant woman, and perhaps no less startling a few months later when she was back at work while still breastfeeding. Once or twice a shift, I drove our son in to Charles Gairdner so she could feed him on her breaks. I spent many hours lurking in the carpark, spooking the security guards as I waited with him for her to emerge from Oncology. When she came rushing out into the fresh air she was as hungry for our baby as he was for her, and as she lay back in the passenger seat with him at her breast, she discreetly kept me up to date with the progress of patients I felt I knew but would never meet. She smelt of antiseptic and sweat and things I didn’t care to guess at and it was odd to be with her in those minutes when she fed our baby, with those strangers struggling and mostly dying a few floors above us.
For five years we lived in the very literal shadow of a major metropolitan hospital. Like all institutions, Fremantle Hospital managed to be bigger than the sum of its parts. It wasn’t just a health facility. At times it was more like a furnace or a power plant. In summer the air around it was thick with screams and sirens and the drone of cooling towers, and in winter its beige mass blocked out the sun. It was a constant, implacable presence. Because we’d just moved from a rural community too small for a pharmacy, let alone a doctor, the proximity of a hospital was supposed to be reassuring, even for the likes of me. After all, we had three small kids now and I’d done more than my share of driving through the roo-infested night to get medical help. I told myself, This is great – really – we can walk across the street to Accident and Emergency.
As it turned out the hospital didn’t just offer safety, it provided a startling amount of free entertainment. It was a 24-hour soap opera. Whether their problems were large, inconsequential or totally imaginary, the people who visited the building functioned in an unrelievedly histrionic register. It seemed as if the hospital brought out something peculiar, something that altered folk from their workaday selves, as if hospital didn’t just license them to behave differently, it required it. And the variety of people a public hospital draws into its orbit hour by hour is hard to credit. In the time it took to get the groceries from the car to the house, you could see a football star, a weeping woman with a painted moustache and too many fingers, and a man with a steel bolt protruding from his forearm.
Fremantle Hospital was not the discrete health campus of the suburbs, set in awesome isolation like a hyper-mall and bounded by a vast moat of carparking. This was the inner city, a neighbourhood of narrow streets and workers’ cottages, and the establishment had long outgrown its original footprint. The old Victorian building was buried amidst hulking modernist slabs. It didn’t just tower over the surrounding streets, it projected outward. And the overspill wasn’t simply physical. With A&E opposite the local primary school, and the new mental health unit directly opposite our house, the hospital dominated the environs. Around a medical precinct some institutional colonization is unavoidable – the nasty signage, the ever-present uniforms and flashing ambulances – but there were occasions when overzealous security guards or high-handed management gave locals like us the feeling we were intruders in our own neighbourhood.
The place had its own microclimate. But it ran to more than just the steaming and the shimmering and the roof-rattling down-draughts. Within a block or two you could feel the atmosphere around it become feverish and the closer you got to the foot of those towers and their yawning electric doors, the more you noticed the vortex of suffering and need that sucked and boiled around you. There was electricity in the air, latent havoc. Within a few moments our street could change from being a circus to a battlefield. With its aura of hope and dread, it was peculiarly volatile, especially at night and on weekends. Negotiating it required vigilance.
On any street in any city, there’s a human story walking past you every moment but it’s usually withheld. In the lee of a hospital the social camouflage slips away, and what’s usually disguised is on display. Where else do people bear their own narratives so openly? Body language is heightened, almost balletic. Patients who step out for a fag by the taxi rank will pace and smoke and weep like actors in a film noir. Down on the forecourt, visitors, frightened relatives and self-admitters exist in a zone well outside their usual reserve. All discretion deserts them, and their basic competencies forsake them, too: they drive as if in a trance, park like rubes who’ve never been at the wheel before. At times they don’t even park, they simply abandon the car across or even in your driveway, keys and all. People literally carry their troubles on the pavement before you: their sick and shrieking child, their disoriented parent, the demon hissing in their ear. From all those sliding doors – the locked ward, the A&E, the palliative unit – the anguished spill onto the street in haunted shifts, dazed by news good, bad or incomprehensible. They stagger into the traffic, they stumble, they faint. At the kerbside shocked and grieving families unravel in public, sometimes erupting in vituperative brawls. I’ve seen people flog each other with cardigans, shoes, bunches of flowers.
The A&E entrance was like the door to a bright-lit hell. On the way home some nights, I crossed the road to avoid it. The sick and wounded came in ambulances, taxis, shopping trolleys. In the small hours of the weekend patients and their supporters beat at the windows, threatened and bashed the staff, or crawled bleeding and intoxicated through the hedges around the ramp, until eventually the hedges were removed. I woke one night to the sound of an outpatient ramming the doors of the mental health unit with his car in a desperate bid for admission. I once stood at an intersection waiting for the light to change as a woman sat in a vehicle a metre away, screaming without pause. She was right beside me at eye level in the passenger seat, flailing and writhing. She gripped the seatbelt with both hands as if it were the only thing preventing her from flying from the car and bursting into flames. Her face bore the clenched solitude of untouchable suffering. It was as palpable as radiant heat. At the wheel the woman’s friend wept. They were 50 metres from help, at the mercy of a single red light that seemed as if it would never relent. Just standing there, healthy and pain-free, I felt ashamed. I wanted to turn away, walk in another direction, but finally the light changed and they were gone.
Sometimes, around the hospital, you see the worst in people. It’s a surprise to sense how quickly your tolerance and fellow feeling are eroded. You can still find some pity in your heart for the woman who regularly defecates in public because you know she’s at the mercy of impulses beyond her control. But for those querulous supplicants whose derangement is entirely recreational you end up feeling only disgust. As you step around the puddles of blood and the shitty nappies and the needle
s and broken glass and the pools of piss of a standard Saturday night in the hospital carpark, it’s hard to spare the emerging wounded much sympathy; you just want them to bugger off and take their squalid fun elsewhere.
Despite all that bad weather, kindness still endured in the lee of our hospital, even if it sometimes took a little concentration to notice it. It was both tonic and lesson to see how strangers comforted one another as they waited to be collected on the forecourt, how they dandled the babies of weary mothers and offered the unexpired time on their parking tickets. The forbearance of nurses and paramedics was remarkable. Beneath their brusque drollery there was great care and courage. Every morning on my way to the office I saw nurses and doctors emerging into the light wearing the long night on their faces and in their scrubs, and I felt frivolous heading off to my safe, dull day’s work.
All the years I lived next door to Fremantle Hospital I barely crossed the threshold. But in time its influence grew too oppressive for me. Like the grey noise of the cooling towers, its grim presence was unceasing. Even my wife admitted that the precinct was wearing at her nerves. We didn’t move far. Still, the distance of just a few streets was telling.
