Dirty Work

by Gabriel Weston

  But still. There is that image. The image of the human form, whatever you choose to call it, is a few feet away from you. The cannula with its flexible tubing is in your hand. There is a softness in the very equipment. The image is grainy. It is an indistinct business. Still, it might seem like just the right time to look away from the ultrasound screen. It may be an opportune moment to miss out on what once appeared to me, on that screen, like the simulacrum of a human being falling to its knees as its life ended, what always shows as a black-and-white image changing and reducing and disappearing from the screen, the proportion of lucency reducing, the presence absenting itself, the overall white darkening to black.

  Sometimes, unavoidably, the tubing will not be enough. Its calibre or bore may be too narrow. You know this has happened when the normal loud suction noise quietens down because something is blocking the end of the tube. It may be necessary to clear this tube, to pull a piece of tissue from its end. I won’t lie and fudge. There is a feeling of shame in this blockage and sorting it out. There is shame in the mechanics of this. I have my italicised freedom. What obstructs the tube may be soft tissue but it is more likely to be an arm or a leg or a piece of spine. The protesters against abortion who stand at their pickets like to show you these parts. They favour the tiny hand for its poignancy. They wave this dead hand at you from their banners. They make it greet you with their own rude accusations. But these images do not belong to them. These images are mine too. The sights I describe are mine even more than theirs because they are part of my reality. And I agree with those angry abortion-haters, that group we call the antis, in this respect alone: that the things I see, and which they flaunt so mischievously, are the saddest sights I have known. Can I not be allowed to tell this truth, so that it is not only in the wrong hands?

  The skull of the foetus at this stage is called the calvarium. From the end of the first trimester onwards it can be hard to remove the calvarium. It may require forceps. Even then, it can be difficult to negotiate it out through the cervix. Because it is round, it slips away from one’s grip. And succeeding in this matter does feel like violence. At medical school, I cut a dead man’s leg off in an anatomy room so that my dissection group could learn the anatomy of the rectum. That felt like violence too. The lab technician said, Come on now. It’s okay. How else are you going to learn? This is like that. Holding heavy forceps, feeling the mixture of give and resistance in the tissue they grasp, with only the instrument between my hands and the dismembering of a foetus: the dismalness of doing this for the first time is dreadful. It also feels like a moral act. You cannot just walk away from a problem. You cannot be a gynaecologist and leave this work to someone else. That is the cowardice. That is what I think.

  I have not done late abortions. I have not yet done late abortions. I have seen them, though. I have been with Frederick when he does them because I have wanted to see if I am ready to do them myself. I feel bad about this. I know that it doesn’t make sense, logically, to separate one kind of life from another. The fact is that it just gets harder to manage as a pregnancy continues.

  These are some of the facts of what I have done. And, as to the feelings, what can I say? I feel sad. I should feel sad, and I do. But as long as there is gentleness and understanding, it is okay. I don’t like parts getting caught in the tube. I don’t like having to grapple with them. But I don’t mind checking, at the end, that they are all there. This is my clinical duty, if I am to avoid the risk of my patient getting an infection, but it is another sort of duty too. I check there is a calvarium, spine, two upper and two lower limbs. Some of my colleagues do not like to assemble them as they would have been in life. I feel the opposite. I feel I want to do this. And I want to pause, and give some kind of reverence to what was, and is no more, a potential life.

  This is what I would tell anyone prepared to listen. I would give them this inkling of the truth. They could read it in this form, so they could stop at any time. And if they did not want to read this, they could just return to where the italics disappeared, to where the prose returned to being safe and upright and not nasty. And the story would work whether or not the italicised section had been read.

  I step back from the door. Suddenly I realise where it is that I need to go. Hitting the main hospital corridor, I follow the sign to the ITU and the HDU. I pick up pace. I don’t think about where my identity card is because I am allowed to be here again. This is my hospital as much as anybody’s. I walk like a doctor with a destination, with none of the shaky tread of my last few visits.

  At the junction of the three main corridors, I glance at the bank of chairs where I sat so recently early one morning. A young Asian woman in a uniform wipes the plastic seats with with a dirty cloth. She looks at me and we smile at each other. I turn left and see the ITU and HDU at the end of the corridor, straight ahead.

  Two people, a man and a woman, stand with their backs to me as I approach my destination, down the long wide corridor. The man is young and holds flowers. The woman has grey hair and clasps his arm. She is slim and elegant. She wears a pink sleeveless anorak. As I advance towards them, I hear the crackle of the HDU intercom and the young man, leaning towards the microphone but keeping his arm where it is, for his companion’s affectionate grip, says, ‘We’re here to see Emily Smith’ in a clear, hopeful voice.

  I reach them and stop. The man and woman turn to face me. I hear the click of the door being unlocked from within. My patient’s husband and mother step together into the High Dependency Unit. I too continue on my way, treading the few remaining paces to the door between the HDU and the ITU, where I stop and knock. I hear what I need to and open the door. I am glad to find that David is alone.

  ACKNOWLEDGEMENTS

  I cannot thank Lara Agnew enough for the hours and hours she has given to this book. I am also very grateful to Lisa Harris, John Parsons, Andrew Amoah, Nick Thomas, Kate Guthrie, Tracey Thomas, Dan Franklin, Claire Conrad, Ander Cohen, Laura Hassan, Neil Ashman, Sam Guglani, John Weston, Sally Weston and Helen Akal.

  This ebook is copyright material and must not be copied, reproduced, transferred, distributed, leased, licensed or publicly performed or used in any way except as specifically permitted in writing by the publishers, as allowed under the terms and conditions under which it was purchased or as strictly permitted by applicable copyright law. Any unauthorized distribution or use of this text may be a direct infringement of the author’s and publisher’s rights and those responsible may be liable in law accordingly.

  Version 1.0

  Epub ISBN 9781448163731

  www.randomhouse.co.uk

  Published by Jonathan Cape 2013

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  Copyright © Gabriel Weston 2013

  Gabriel Weston has asserted her right under the Copyright, Designs and Patents Act 1988 to be identified as the author of this work

  First published in Great Britain in 2013 by

  Jonathan Cape

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  A CIP catalogue record for this book is available from the British Library

  ISBN 9780224091282