by Will Self
‘I want you to shadow me while I do the ward round.’ Busner guided me by placing his palm on my shoulder. We both nodded to Jane Bowen, who had forgotten us already and fallen into conversation with a nurse. Busner stashed his bursting briefcase behind the nurses’ station, after extracting from it with difficulty a clipboard and some sheets of blank paper. We walked side by side down the short corridor that led to the entrance to the two wards. For some reason Busner and I were unwilling to precede one another, and as a result people coming in the other direction had to crush up against the walls to get around us. We were like a teenage couple – desperate to avoid any break in contact that might let in indifference.
The dormitories were laid out in a series of bays, four beds in each bay and four bays to the dormitory. Each bay was about the size of an average room, the beds laid out so as to provide the maximum surrounding space for each occupant to turn into their own private space. Some of the patients had stuck photographs and posters up on the walls with masking tape, some had placed knick-knacks on the shelves, and others had done nothing and lay on their beds, motionless, like ascetics or prisoners.
Busner kept up a commentary for my benefit as we stopped and consulted with each patient. The first one we came to was a pop-eyed man in his mid-thirties. He was wearing a decrepit Burton suit which was worn to a shine at knee and elbow. He was sitting on the easy chair by his bed and staring straight ahead. His shoulder-length hair was scraped down from a severe central parting. His eyes weren’t just popping, they were half out of their sockets, resembling ping-pong balls with the pupils painted on to them like black spots.
‘Clive is prone to bouts of mania, aren’t you, Clive?’
‘Good morning, Dr Busner.’
‘How are you feeling, Clive?’
‘Fine, thank you, Doctor.’
‘Any problems with your medication? You’ll be leaving us soon, won’t you?’
‘In answer to your first question, no. In answer to your second, yes.’
‘Clive likes everything to be stated clearly, don’t you, Clive?’
At the time I thought Busner was being sarcastic. In fact – as I realised later – this wasn’t the case. If anything, Busner was being solicitous. He knew that Clive liked to expatiate on his attitudes and methods; Busner was providing him with the opportunity.
‘You’re staring very fixedly at the opposite wall, Clive, would you like to tell Misha why this is?’
I followed his line of sight; he was looking at a poster which showed two furry little kittens both dangling by their paws from the handle of a straw basket. The slogan underneath in curly script proclaimed, ‘Faith isn’t Faith until it’s all you’re hanging on to.’
‘The kitten is powerful.’ Clive smiled enigmatically and pointed with a dirt-rimmed nail, ‘That kitten holds in its paws the balance, the egg of creation and more.’ Having pronounced he lapsed back into a rigid silence. Busner and I left him.
Although there were only thirty or so patients on the ward they soon resolved themselves, not into names or individuals, but into distinct groups. Busner’s catchment area for his ward was an L-shaped zone that extended from the hospital in one dog-leg into the very centre of the city. The hospital pulled in its sustenance from every conceivable level of society. But on Ward 9 insanity had proved a great leveller. A refugee sometimes seems to have no class. The English depend on class, to the extent that whenever two English people meet, they spend nano-seconds in high-speed calculation. Every nuance of accent, every detail of apparel, every implication of vocabulary, is analysed to produce the final formula. This in turn provides the coordinates that will locate the individual and determine the Attitude. The patients on Ward 9 had distanced themselves from this. They could not be gauged in such a fashion. Instead, I divided them up mentally into the following groups: thinnie-pukies, junkies, sads, schizes and maniacs. The first four groups were all represented about equally, whilst the fifth group was definitely in the ascendant; there were lots of maniacs on Ward 9 and by maniacs I mean not the culturally popular homicidal maniac, but his distant herbivorous cousin, hyper, rather than homicidal, and manic, rather than maniacal.
As Tom had already characterised himself earlier that morning, hypermanic types are lecturers; extramural, al fresco professors, who, like increasingly undulant or syncopated Wittgensteins, address the world at large on a patchwork syllabus made up of Kabbalah, astrology, tarot, numerology and Bible (specifically Revelation) study. They are sad-mad, they know they are ill, they have periods of conformity, but they are always somehow out of joint.
‘Art therapy is very popular here, Misha.’ Busner detained me in the vestibule between the two wards. ‘We can’t keep the patients sufficiently occupied, they have treatment sessions of various kinds in the mornings, but in the afternoons you’ll be all they have to look forward to. Sometimes we can arrange an outing of some kind, or a friend or relative will be allowed to take them out on the Heath, but otherwise they’re cooped up here in a fuddled daze.’
We went on into the women’s dormitory. Here things seemed, at first, different. On the men’s dormitory Busner and I had spoken with a few isolated individuals, backed off into their individual bays. But here the patients seemed to be associating with one another. They reclined on beds chatting, or sat round the formica-topped tables which formed a central reservation.
A skeleton with long, lush hair rocked on a bed in the bay to our right, an obscenely large catheter protruding out of her lolly-stick arm. Busner took me in under tow and introduced us.
‘Hilary isn’t that keen on eating – or at least she is sometimes, but she doesn’t really like the nutritional side-effects of food. Hilary, this is Misha Gurney, he’s our new art therapist.’ Hilary stopped rocking and gave me a level smile from underneath neatly coiffed chestnut bangs.
‘Hello. I’ll look forward to this afternoon. I like to paint, I like watercolours. These are some of mine.’ She gestured towards the wall at the head of the bed, where an area about a foot square was tiled with tiny watercolours, terribly painfully precise little paintings – all portraits, apparently of young women. Busner wandered off, but I remained and walked to the head of the bed, so that I could examine the pictures thoroughly. They had been executed with a fanatical attention to the detail of make-up and hair which made them almost grotesque. Hilary and I sat sideways to each other. With her neck canted around so that she could face me, Hilary’s greaseproof-paper skin stretched, until I could see the twisted, knotted coils of tendon and artery that lay within.
‘They’re very good. Who are all these people?’
‘They’re my friends. I paint them from photographs.’
‘Your pictures are very detailed. How do you manage it?’
‘Oh, I have special pens and brushes. I’ll show you later.’
I left Hilary and went over to where Busner was sitting at one of the tables in the central area of the dormitory.
‘Has Hilary been telling you about her friends?’
‘Yes …’
‘Hilary doesn’t have any friends, as such. She cuts pictures of models out of advertisements in magazines, then she paints over them. She’s been in and out of this ward for the past three years. Every time she comes in she looks like she does now. She’s so close to death we have to put her on a drip. She’s usually completely demented; the amino acids have been leeched out of her brain. After she’s been on the drip for a while we transfer her to a tight regime of supervised eating based on a punishment/reward system, and at the same time she undergoes an intensive course of psychotherapy with Jane Bowen. Jane is very much the expert on eating disorders. After six weeks to two months Hilary is back to a healthy weight and eating sensibly. She’ll leave and we can predict her return usually to within the day – some four months later.’
‘I thought a lot of anorexics and bulimics grew out of it?’
‘To some extent, but there’s always a hard core and at the moment it seems to be
growing. These long-term anorexics are different, they’re placid, resigned and apparently unconscious of any motivation. The temporaries tend to be wilful, obstinate and obviously powerfully neurotic. These hard-cores, like Hilary, could almost be psychologically blameless. Some of them even have fairly stable relationships. They’re at a loss to explain what comes over them, it seems to be somehow external, imposed from elsewhere.’
I should have been paying attention to what Busner was saying, but I couldn’t concentrate. For a start there was the strangeness of the situation – I’d only ever spent isolated periods of a few minutes on psychiatric wards before. I had known what to expect in broad terms, but it was the relentlessness of the ambience that was beginning to get to me. There was something cloacal about the atmosphere in the women’s ward. None of the patients seemed to have bothered to dress, they sat here and there talking, wearing combinations of night and day clothes. There was a preponderance of brushed cotton. I sensed damp, and smelt oatmeal, porridge, canteen; indefinable, closed-in odours.
I could walk away from the tonsured idiot on the Heath, but inside Ward 9 I was trapped. And these people weren’t pretending. They weren’t closet neurotics or posing eccentrics, Bohemians. They were the real thing. Real loss of equilibrium, real confusion, real sadness, that wells up from inside like an unstaunchable flow of blood from a severed artery. I felt my gorge rising. I felt my forehead, it was sandpaper-dry. Busner was neglecting me and talking to a pneumatic nurse. The nurses on Ward 9 didn’t wear a uniform as such, rather they affected various items of medical garb: tunics, coats and smocks, nameplates and watches pinned at the breast. This nurse had a man’s Ingersoll attached by a safety-pin to her jacket lapel. She had blonde baby curls, bee-stung lips and the creamy, slightly spongy complexion that invariably goes with acrid coital sweats. I forced myself to listen to what they were saying, and fought down nausea with concentration.
‘Take her out to the optician then, Mimi, if she has to go.’
‘Oh, she does, Zack, she can barely see a yard in front of herself. She can’t be expected to deal with reality if she can’t see it.’ The voluptuous Mimi was squidged on to the corner of the table. Behind her stood a short woman in her thirties with the hydrocephalic brow and oblique domed crop of an intelligent child. She stared at me with sightless eyes.
‘Rachel shouldn’t really be off the ward, considering the medication she’s on.’
‘But Zack, it’s a walk down to the parade, ten minutes at most. Give her a break.’
‘Oh, all right.’
‘Come on then, Rachel, get your coat on.’ Rachel bounced away into one of the bays. Mimi lifted herself off the edge of the table and winked at me in a languid way.
‘Come on, Misha, we’ve got an admission for you to see. I’ll leave you at the front desk. Anthony Valuam will pick you up and take you down to casualty.’ We walked out of the women’s dormitory and back to the association area. Tom, my friend from the earlier part of the morning, was back behind the nurses’ station, reading his dog-eared Penguin. Busner despatched me to wait with him by giving me a gentle shove in the small of my back, then he crooked his finger at a scrofulous youth in a tattered sharkskin suit who sat smoking and disappeared with him towards his office. Tom put down his book and treated me to another little conspiratorial exchange.
‘Has the good doctor given you a little tour?’
‘We’ve been round the ward, yes.’
‘Beginning to catch on yet?’
‘What do you mean?’
‘Well, who did you get introduced to? No, don’t tell me. Let me guess. You talked to Clive and then you saw a lot of other male patients quite quickly until you ended up scrutinising Hilary’s watercolours.’
‘Err … yes.’
‘And did Zack come out with his catch-phrase?’
‘Yes, when we were talking to Jane Bowen.’
‘Thought so. He’s so predictable. That’s one of the truly therapeutic aspects of this place, the unfailing regularity of Dr Busner. What are you doing now?’
‘I’m meant to be going down to casualty to sit in on an admission with a Dr Valuam.’
‘Tony, yeah. Well, he’s my kind of a shrink, not like Dr B; more practical like, more chemical.’
A door opened to the right of the nurses’ station which I hadn’t noticed before. A very short man came out of it and with neat movements locked it behind him, using a key that was on an extremely large gaoler’s bunch. He turned to face me. He was a funny little specimen. He had wispy fair hair teased ineffectually around his bare scalp. It wasn’t as if he was going bald, it was more as if he’d never grown any hair to begin with. This impression was supported by the watery blue eyes, and the nose and chin which were soft and seemingly boneless. He wore a stiff blue synthetic suit of Seventies cut and vinyl shoes.
‘You must be Misha Gurney. I’m Anthony Valuam.’ His handshake was twisted and rubberised, like holding a retort clamp in a laboratory, but his voice was absurdly mellow and basso. A voice-over rather than a real voice. His foetal face registered and then dismissed my surprise; he must have been used to it. Tom was stifling an obvious giggle behind his paperback. Valuam ignored him and I followed suit. We walked off down the short corridor to the lift. Valuam launched into an introduction.
‘It’s very unusual to have an admission through casualty at this time of day. On this ward we deal almost exclusively with referrals, but we know this particular young man and there are very good reasons why he should be treated on Ward 9.’
‘And they are …?’
‘I don’t wish to be enigmatic, but you’ll see.’
Valuam fell silent. We waited for the lift, which arrived and slid open and closed and then dropped us down through the hospital to casualty, which was situated in the first sub-basement. The lift stopped on every floor, to take on and drop passengers.
The architects, interior designers and colour consultants who had made the hospital were not insensitive to the difficulties posed by such a project, they had earnestly striven to make this vast, labyrinthine structure seem habitable and human in scale. To this end each floor had been given slightly different wall and floor coverings, slightly different-shaped neon strip-light covers, slightly different concrete cornicing, slightly different steel ventilation-unit housings and slightly different colourings: virology an emphatic pale blue, urology a teasing (but tasteful) green, surgery and cardiology a resilient pink and so on. At each floor the patients and their orderlies were also different colours. The faces and hands of the patients as they were transferred from ward to ward, on steel trolleys, in wheelchairs as heavy as siege engines, were stained with disease, as vividly as a pickled specimen injected with dye.
The orderlies were violently offhand; they manhandled the patients into the lifts like awkward, fifty-kilo bags of Spanish onions. Then they stood menacingly in the corners, lowering over their livid charges, their temples pulsing with insulting health. Occasionally a patient would be wheeled into the lift who was clearly the wrong colour for the direction we were headed in (this was evident as soon as the lift reached the next floor) and the orderly would back the chair or table out of the lift again, the faces of both porter and cargo registering careful weariness at the prospect of another purgatorial wait.
We reached the sub-basement. Valuam turned to the left outside of the lift and led me along the corridor. Down here the colour scheme was a muted beige. The persistent susurration of the air-conditioning was louder than on the ninth floor and was backed up by a deeper throb of generators. The industrial ambience was further underscored by the pieces of equipment which stood at intervals along the corridor, their steel rods, rubber wheels, plastic cylinders and dependent ganglia of electric wiring betrayed no utility.
The beige-tiled floor was scarred with dirty wheel tracks. We whipped past doors with cryptic signs on them: ‘Hal-G Cupboard’, ‘Ex-Offex.Con’, ‘Broom Station’. The corridor now petered out into a series of partitioned wal
kways which Valuam picked his way through with complete assurance. We entered a wide area, although the ceiling here was no higher than in the corridor. On either side were soft-sided booths, curtained off with beige plastic sheeting. The beige lights overhead subsonically wittered. We passed stooped personnel – health miners who laboured here with heavy equipment to extract the diseased seam. They were directed by taller foremen, recognisable by their white coats, worn like flapping parodies. Valuam turned to the right, to the left, to the left again. In the unnatural light I felt terribly sensitive as we passed booths where figures lay humped in pain. I felt the tearing, cutting and mashing of tissue and bone like an electrified cottonwool pad clamped across my mouth and nose.
At length Valuam reached the right booth. He swept aside the curtain. A youth of twenty or twenty-one cowered in a plastic scoop chair at the back of the oblong curtained area. On the left a fiercely preserved woman leant against the edge of the examination couch. On the right stood a wheeled aluminium table. Laid out on it were tissues, a kidney dish of tongue depressors, and a strip of disposable hypodermics wound out of a dispenser box.
Valuam pushed a sickly yellow sharps disposal bin to one side with his blue foot and pulled out another plastic chair. He stretched and shook hands with the woman, who murmured ‘Anthony’. Valuam sat down facing the youth and untucked his clipboard from the crook of his arm. It was left for me to lean awkwardly in the opening, looming over the gathering like a malevolent interloper. I was conspicuously ignored.
