About a month later, and farther north, there was a one-day conference, which was about humanity’s relationship with other species. It was an impassioned affair. A government minister began the day, then a climate scientist gave dire warnings, then came writers and activists, all speaking with urgency about how we have to ‘reconnect with nature’. We have a crisis because we have lost our ability to see the natural world, or find it meaningful. There had been a break- down in reciprocity. Humanity had taken a wrong path, had become destructive and insulated.
The guests spoke from a raised podium with a nineteenth-century stained-glass window behind. Through the window, we, the audience, could see an occasional herring gull glide by, coloured red by the glass. A lunch of local venison was served, then came the afternoon speakers, who suggested that consumerism was a poor substitute for passion or wonder. One told a thrilling story about an encounter with sea-lions, another about a transforming experience with polar bears. It was dramatic in itself, but, he suggested, it carried wider meanings for our relationship with other creatures.
It was wearing on for Christmas. Outside the conference venue the streets were filled with shoppers, and the stained-glass window darkened early.
Perhaps I was still tired from my mother’s death, thinskinned and bad-tempered, but when the day ended with time for questions, I had some turning in my head, though I didn’t raise my hand. About ‘nature,’ mostly, which we were exhorted to reconnect with. What was it, exactly, and where did it reside? I’d felt something at my mother’s bedside, almost an animal presence. Death is nature’s sad necessity, but what when it comes for the children? What are vaccinations for, if not to make a formal disconnection from some of these wondrous other species? And what did we just eat, vegetarians aside? Deer meat, and very nice, too.
The train home was busy, and it broke down briefly, but people were cheerful, considering we were packed close to each other in a metal box on a Highland moor, but the last wolf was shot long ago.
* * *
In the New Year I wrote to Professor Frank Carey, Clinical Consultant in Pathology at Ninewells Hospital in Dundee. I’d met Frank before and knew him as a level-headed and considerate man, tall, with a soft Irish accent, and a good teacher. We were at a similar age and stage in life, with growing children and parents beginning to succumb. If he thought my request was prurient, he didn’t say so. Rather he and his colleagues seemed glad of outside interest in their speciality. Usually people shy away.
I told Frank about the environmentalists’ and writers’ conference, and how the foreshortened definition of ‘nature’ was troubling me. I’d come home grumpy, thinking, ‘It’s not all primroses and otters’. There’s our own intimate, inner natural world, the body’s weird shapes and forms, and sometimes they go awry. There are other species, not dolphins arching clear from the water, but the bacteria that can pull the rug from under us. I asked: please show me what’s going on.
I was gabbling all this as we walked down the gleaming hospital corridors one February morning. Frank reached out to open yet another double door, saying, ‘You know, till now, I’d never really thought of it as “nature”.’ I wondered, as I had at my mother’s bedside, and the conference, if there was a distinction somewhere I had simply failed to understand.
* * *
If pathologists are seen as slightly sinister, it’s because they’re the ones conducting dramatic post-mortems in TV detective shows. But the architecture doesn’t help. The pathology labs were inevitably downstairs, in the lower reaches, the bowels of the building. Their main doors were protected by keypads, a sign announced fiercely that the department was ‘under twenty-four-hour lock-down’. But I was there now. In his small office, Frank found a white lab coat for me, the first time I’d ever worn such a thing, the attire of the scientist, and he suggested we started with surgical specimens, in the ‘cut-up room’. The cut-up room. I drew breath, but after my mother’s death, and all the gentle euphemisms, and that conference, with its reverent talk of far-off polar bears and ‘transforming experiences’, I was actually quite glad to have arrived at a place where a spade was called a spade. Frank said, ‘Are you squeamish?’
The door opened to a soft roar, the ventilation system. The wall opposite the door was all windows, but white blinds were drawn, and electric lights switched on. Tall shelving units held plastic trays and little tubs and boxes, and there were three or four long workbenches. At intervals on the workbenches lay green plastic chopping blocks. Other people, also in white coats, were already at work, standing at the benches, attending to things I couldn’t see. I swore I would use no food similes, no culinary imagery at all, but of course it looked like a school cookery classroom, or ‘domestic science’, as they were pleased to call it then. The atmosphere was serious, but convivial.
Professor Carey led me to his place, then brought a tray of instruments. These he put to the left of the green board. To its right was a sink. In the tray were long tweezers and blunt-ended scissors. He spent a minute fixing a shining, newly sterilised blade onto a handle. Then he went off and at once returned with a grey plastic tub big enough to need carrying in both hands. He opened it and poured into a sink a gallon of liquid.
‘Formaldehyde,’ he said.
‘It doesn’t smell . . .’
‘It’s the ventilation. There’s a very strong downdraught. Formaldehyde is pretty toxic, it wouldn’t do to breathe it or get it on your skin.’
Then he grasped the object inside the tub and laid it on the block.
It was a drowned-looking thing, obviously of the body, big enough to be alarming: about ten inches long, rubbery brownish-pink, with an entourage of fattiness and membranes. I didn’t know what I was looking at, but Frank soon told me it was someone’s colon, or part of one—about a third. A colon is a tube, as you’d suppose, but the surgeon who’d removed it had sealed the lower end, the rectum end, with metal staples, and that end was about the size of a child’s fist. The upper ten inches had been sliced open, so that part lay flat, revealing the inner surface. This surface was pale yellow-brown, and ribbed like a beach at low tide. It was a natural artefact alright, but far from elegant, and if I hadn’t been told I couldn’t have said whether it belonged to an aquarium, a puppet theatre or a bicycle repair shop.
‘When was this taken out?’
Frank glanced at the notes. ‘Two days ago.’
‘So the patient is still upstairs?’
‘She will be, yes. Oh yes.’
* * *
Professor Carey began by turning the colon in his gloved hands, scrutinising and assessing it. He would have to write a ‘macro-report’, describing what he had, its dimensions and such, before it was sliced up. He stretched a piece of translucent membrane between three fingers to show me, and said complimentary things about the surgeon, a beautiful Iranian woman who was pointed out to me later, whose scalpel had carefully followed this membrane, releasing the colon from its context, bringing it to the outside world.
‘The tumour’s down here,’ said Frank, pushing a gloved finger into the colon’s lower end. He prodded around for a moment, then turned the colon inside out, to show me a hard whitish deposit adhering to the colon’s inner wall. It seemed of no more consequence than chewing gum dropped on a pavement, but there it was.
The cutting followed a set procedure. Frank held the colon with one hand and with the long knife took parings from each end, the ‘margins’. In due course these would be examined microscopically. If the tumour was cancerous, and cancer cells were found within a millimetre of the specimen’s margins, there was a chance that cancer cells remained in the patient’s body. These things determined the course of treatment prescribed. Then he sliced the tumour itself into pieces not much bigger than a thumbnail, and laid these in order at the top of his board. Then began the search for lymph nodes.
There’s nothing dainty about the search for lymph nodes. If the cancer had spread from the original tumour, it would have done so
via the lymph system. By examining these lymph nodes under the microscope, he would be able to tell if it had travelled and how far. Frank began carving decisively through the whole colon. As each slice slumped from his blade he dragged it to a clear section of the board and began mashing the fatty surround against the board with his fingertips. I watched as Frank worked, again trying to resist any food similes, but they would come. The pile of sliced colon mounting at the far edge of his board looked like chanterelle mushrooms, the fat squished under his fingers like cottage cheese. It might have been ‘nature’, but there was nothing uplifting about it. Well, we are predators and omnivores, we are meat and made of food, and the colon is part of how our animal bodies deal with food. At one point Frank said, ‘Amazing how much like animals we are. This could be a pig’s colon. We occasionally get veterinary specimens in, just for interest.’
‘It shouldn’t really surprise us . . .’
‘That we’re like animals? No, it shouldn’t. But it still does.’
Lymph nodes feel like lentils or grains of rice; they resist being squashed. They are pale brown. As he found these auguries he laid them out in order. They looked like a row of baby teeth, only more yellow. One lymph node was markedly bigger than the others, which was not a good sign.
When he was satisfied, he tipped the board and scraped the residue of the colon into a polythene bag. The samples of margin and tumour and the lymph nodes went into tiny plastic boxes, ready to be mounted in wax, sliced, stained and prepared for the microscope. And that was that. One person’s disaster, another’s routine.
I kept having to do a mental exercise, every so often, to unhook myself from the colon being cut up in front of me, which was not a beautiful object of contemplation, and consider what it meant. To think upstairs, I mean, to that person lying ill and frightened and anxiously awaiting ‘the results from the lab’. Other people in the room were working on lumps taken from breasts, an appendix. I’d said as much to Frank, about having to make an effort to empathise, and as he’d worked and I watched, we’d talked of people we knew who’d had cancer, even in our own families. The sheer painful ghastly slog of it; the changed landscapes of a life, the unexpected declarations of love.
* * *
A couple of weeks passed before I could again go the pathology labs; the snowdrops faded, the evening light lengthened. A neighbour had asked if we could look after her son for the day, while she went to the funeral of a young colleague who’d died of cancer. This time Professor Carey suggested we look at the next stage, the histology, or examination of cells through the microscope. Today it was a liver. The computer screen in his office was showing a substantial portion of one, with the gall bladder attached. The pictures had been taken after the liver was excised, but before cut-up. The severed edge, about three inches tall, had been cauterised and so was blackened slightly. Tiny threads hung down, where arteries had been tied off. They reminded me of climbers’ gear, abandoned on a rock face. It had been removed, like the colon, because of a tumour—a big one, this time. The tumour bulged out of the liver like a gloved fist.
Professor Carey pointed out these features with his biro, then said, ‘Okay. Tell me if you feel seasick’.
This time he meant seasick, not squeamish. The microscope was a double-headed one which allowed us both to see the same slide, and for one unused to microscopes it was like slipping into a dream. I was admitted to another world, where everything was pink. I was looking down from a great height upon a pink countryside, a landscape. There was an estuary, with a north bank and a south. In the estuary were wing-shaped river islands or sandbanks, as if it was low tide. It was astonishing, a map of the familiar; it was our local river, as seen by a hawk.
‘It’s like the Tay!’ I said. ‘At low tide. With the sandbanks.’
‘I love the names of those sandbanks . . .’ said Professor Carey. ‘Now, we should start with the normal and move to the abnormal . . . let’s look south.’
As though on a magic carpet, we flew to the south side of the estuary, and there Frank showed me how the arrangement of cells was ordered and calm. The sample had been stained with haematoxylin and eosin; organic, commonly used stains which show the nuclei and cytoplasm respectively. Frank could distinguish blues and purples; to my eye all was shades of pink, though I have a poor sense of colour. But it was a bright and pretty bird’s-eye view of an ordered, if unusual land. I saw trails of nuclei, and the cells’ supporting framework of reticulin. I could fancy the reticulin was old field dykes, the marks of a long inhabitation of the land. Here the cells were doing as nature intended, unconsciously getting on with tasks quotidian and wondrous: the filtering and clearing and storing and production.
‘This is healthy tissue. Bear it in mind.’
Then we were swinging north, crossing the river, which was a vein rising into the liver from the intestine. On the river’s north bank, we stopped and hovered over a different kind of place, densely packed, hugger-mugger, all dark dots that seemed too busy for comfort. Frank didn’t have to tell me this was the tumour. Although it was also still, and fixed and a pretty colour, there was an unchancy, frenetic feel to it. There were too many nuclei crammed together and, as Frank pointed out, the ‘architecture’ was improper, the cells’ structures and shapes were slewed, the supporting framework absent.
He said, ‘The good thing is, these are still liver cells; they haven’t been imported from a primary tumour somewhere else. They’re still trying to behave like a liver, but . . .’
He looked quietly for a moment, then said, ‘Cancer was named for the crab, because a cancer tumour sends claws out into the surrounding tissue. It’s one thing we look for in arriving at a diagnosis of cancer: whether the tumour is self-contained, “encapsulated” or whether it’s reaching out with claws. At cut-up I was happier, because it seemed self-contained, but look . . .’
We swooped low, till we were above a feature that crooked from the shore into the river, a bit like a jetty. When the magnification increased, you could see this was also crowded, and made of the same dense tumour tissue. ‘And there is also this.’ Now he focused on one of those areas I’d so delightedly thought of as sandbanks, with their old, suddenly apposite Scots names: the Reckit Lady, the Shair as Daith. There, too, we looked down on the same kind of tissue.
‘So we have some vascular invasion’.
Frank made a note, then said, ‘We had a trainee for a while, and whenever she saw something like this, she’d say, “Aw, what a shame. What a shame.” Now, let me show you something else.’
It all seemed like bad news but I leaned back into the microscope, to be guided by Frank’s trained eye. In the healthy liver, he led me to two tiny dots and increased the magnification. The dots expanded into a double image, what looked like a pair of boxing hares.
‘That’s a cell dividing normally. The chromosomes lined up equally. That cell has been arrested just at that moment in its cycle; this is life. But see here.’
Again we travelled north, over to the tumour, and within its mass Frank found what he wanted at once. It was another dividing cell, but if they were two boxing hares, one hare was hugely bigger than the other, claiming strength and advantage. His report would call them ‘abnormal mitotic figures’—cells dividing wrongly, and too many, and too fast.
I sat back and rubbed my eyes.
‘So that’s that?’ I asked bleakly, meaning, ‘That’s going to kill him?’ The little hook out into the vein, the intimate, crowded island, a mere smear on a glass slide.
Frank sounded surprised. ‘Not at all! He’s in with a good chance. The tumour’s been successfully removed, and you can’t actually make definite predictions from what we’ve seen . . . He’ll have chemotherapy. And the liver regenerates, you know. Though he’s had that large section removed, it’ll be growing back.’
As Frank put the slides away on a tray in their proper order I glanced about his office, resting my eyes. A couple of lab coats on a peg, books and files on a shelf, pathol
ogy textbooks, a child’s drawing, a bicycle helmet, the window screened by a pale blind. ‘Flying’ may have been an illusion, but it was one my body believed, because I was feeling queasy, with all this swooping down and up. Queasy, but cheered.
‘Would you like to see more? You said you were interested in infections. I set aside a couple of infections for you . . .’
‘You’re very kind.’
This time the country beneath was a gorgeous sapphire blue. It had a north-facing shoreline and, a mile or so inland, so to speak, were regularly spaced ovals, end-on to the coast, that might be craters, or even sports stadiums. Frank was describing it to me with his customary quiet level-headedness. He was speaking of ‘columnar structures’ but it took me a while to understand that he meant the ovals; they were sections cut horizontally through columns. These were acid-producing glands; we were in the lining of someone’s stomach.
Between the oval structures were valleys, if you like, fanning down to the shore. Frank wanted to show me something in one of these valleys and I couldn’t find it at first; it took several patient attempts—this microscope didn’t have a cursor device to point at things. It was a very human moment, a collusion of landscape and language when one person tries to guide the other’s gaze across a vista. What vistas I’d seen. River deltas and marshes, peninsulas and atolls. The unseen landscapes within. You might imagine you were privy to the secret of the universe, some mystical union between body and earth, but I dare say it’s to do with our eyes. Hunter-gatherers that we are, adapted to look out over savannahs, into valleys from hillsides. Scale up the absurdly small until it looks like landscape, then we can do business.
Sightlines Page 3
