Teach Us to Sit Still

by Tim Parks

  Trans-Urethral Resection of the Prostate is the gold standard to which other surgeries for Benign Prostatic Hyperplasia are compared. This procedure is performed under general . . .

  Gold standard seemed an odd term to use. But what if my prostatic hyper-whatever wasn’t benign?

  Following surgery, a catheter is used to remove blood or blood clots in the bladder.

  I read through the same information on a dozen sites, then, without thinking, clicked on images. Immediately there was a photo of the grotesquely dilated opening of a penis suckering like a fish’s mouth around a metal tube. I quickly moved the cursor and clicked on a more reassuring pencil sketch. A man in a doctor’s coat and strangely old-fashioned hat was staring into something that looked like a cross between a telescope, a syringe and a gun. About eight inches long, the instrument had little pistol triggers and flexible tubes entering and leaving from above and below. The man had his fingers on the triggers and an eye pressed to an eyepiece; at the other end of the tube was the tip of a penis, lodged in a conical opening. A rigid tube protruded from the instrument, travelled down through the penis, which was unnaturally straight as a result, and penetrated into a shaded area about the size of a squash ball just beyond the scrotum.

  Beneath the image, a caption announced: In TURP, a wire loop is used to cut away pieces of the prostate.

  I remember gazing at this sketch for some time. What struck me about it was the hubris of its clarity. This handsome, clean-shaven young doctor with his curious hat was Renaissance Man exploring the heavens with his telescopes, Enlightenment Man discovering the power of surgical instruments. He saw clearly right inside the body, my body, right into the quick of life, and he made neat, clinical cuts there with the most sophisticated equipment.

  I switched to the Guardian’s football page and read about a game settled by two goals in injury time. I need not decide about this operation just yet, I thought.

  Stupid Pains

  AFTER ALL, NOTHING had been proved. This enlarged-prostate diagnosis was mere conjecture on Carlo’s part. True he was a urologist but we had only spoken as friends. There was a battery of tests I must do. They were complicated and would take time. In a month the problem might be gone, the pains would disappear whence they had come. I had done the right thing to talk to him, but precisely because I had talked to him I could now stop dwelling on it and get on with my life. I would do the tests without thinking about them or what they were for, as if they were the merest annoyance.

  Such was my resolution on New Year’s Day, 2006.

  The pains had different plans. The pains had no intention of returning whence they’d come, wherever that might be. It wasn’t something I had ever thought about. I wasn’t even sure when they’d put in their first appearance. For months I had gone around muttering things like, ‘God, you feel uncomfortable today, Tim,’ or, ‘Oh dear what a bore waiting for this pee to come!’ But without ever telling myself that what I was looking at was an array of interrelated and intensifying symptoms.

  ‘I feel a bit uncomfortable today,’ I would say to my wife to explain why I didn’t want to dig over the garden.

  ‘OK,’ Rita would smile, ‘next week maybe.’

  The word ‘uncomfortable’, I discovered, had something safe about it, something rather comfortable.

  Discomfort is not pain.

  ‘So, how long has this been going on?’ had been Carlo’s first question when finally I found myself talking to him.

  ‘Well, let’s see . . .’

  I frowned. Now I thought about it, I realised that I had been ‘uncomfortable’ for a long time. It might even be a matter of years. Being uncomfortable had become part of being me.

  ‘It’s got worse over the last few months,’ I said.

  I would have to do regular blood and urine tests, he told me. Plus, a urine flow test, a scan of the whole area, a urogram, a three-day urine test, and maybe a cystoscopy. Assuming the results were as he expected, I could look forward to being operated on in April or May. He made a point of never operating on his friends, Carlo said, but he would refer me to a colleague here in Milan, an excellent surgeon.

  Look forward to it? Quite the contrary. In four months the pains would be gone, I hoped.

  The pains intensified. I now found myself having to loosen my trousers when I sat down. Everything was stiff and sore. Waking in the early morning, at five, or five thirty, I couldn’t get back to sleep. There was a lump of hot lava in my belly. I got out of bed, wandered round the house, brewed up a pot of tea and ate some cereal. I knew this would send me running to the bathroom. The pain would then melt away a while and I could go back to sleep.

  Could it be, I phoned Carlo to ask, that the real problem was with the intestine? I had bowel cancer.

  He laughed. ‘No.’

  I felt chastened. I was becoming a hypochondriac, spending all my time thinking about my bodily functions. How absurd to bother people with the details of my bathroom routines! I mustn’t speak to him again, I decided, until all the tests were done. What’s the point of speaking when you’ve arranged to do proper clinical tests? The tests will speak for you. All the same, it was a relief to know that if I went down to eat breakfast at five, I could rely on an immediate trip to the bathroom followed by a release from pain and an hour’s sleep.

  It seemed odd for a prostate condition.

  But is it really true to say that I was thinking too much about these pains? I was often anxious. I did wonder about possible solutions. But on the whole I did everything I could not to dwell on the matter, not to ‘wallow’, as my mother would have put it. And if Carlo or any of the other doctors I would see had ever asked me to describe these various pains carefully, I doubt I would have been able to do so. The fact is that my body was not ordinarily present to me. I was only aware of it when it caught me by surprise, when it interrupted me. Pain was an intrusion into a busy schedule. I didn’t examine it. I didn’t give it time. ‘How can I finish all the stuff I’ve got to do,’ I would fume, ‘if I have to keep dealing with these stupid interruptions?’

  I always referred to the pains as stupid pains, in much the same way as I referred to the noise of roadworks outside my office as a stupid noise. You wouldn’t catch me trying to find out exactly what it was they were doing to the road. No, I shut the window, sat down at the computer and inserted a fresh pair of earplugs. I had recently bought a five-year supply of the best quality earplugs from a mail-order company in the USA. To block out life’s noise.

  All this was automatic, the only sensible reaction, I imagined, to anything that got in the way of a day’s work. So when, finally, I did acknowledge a feeling as pain, real pain, rather than discomfort, it was because it now constituted an interruption of such ferocity it could no longer be ignored. You couldn’t work through it. Even then, the imperative was not to explore the pain, to find out about it, but simply to return to normality as rapidly as possible. A good hot bath, I thought, might be a solution to a deep throb in the perineum. I could read in the bath. I could do some research.

  The pain did not dissolve. Hot water was not a solution. I only remember flying into a fury when Calvino sank in the suds.

  It reached a point where I could no longer sit down at the computer. I needed to stand.

  I set my laptop on top of a bookshelf at chest height and, shifting my weight regularly from one foot to the other, continued with my work.

  After all, Victor Hugo wrote standing up. And Günter Grass, I’ve heard.

  Physical exercise, I decided, might help. We live in the countryside and it’s easy to run. Not that I really liked running. The point of physical exercise, I had always imagined, was to keep your body in shape so it would leave you alone, leave you free to get on with the stuff you have to do, without stupid interruptions. I timed myself over six miles.

  And I went canoeing. The Adige in Verona is not a bad river for paddling up and down. I had a couple of kayaks stored in the canoe club and there was no reason
why I shouldn’t take them out more often. I actually liked canoeing far more than running, but it eats deeper into your schedule. You have to drive into town, you have to change in and out of your kit, you have to hang the kit out to dry afterwards. The advantage is that since canoeing requires more attention than running you don’t worry about the lost time while you’re losing it.

  For a couple of months, then, in the autumn of 2004, I had run and canoed as many as four or five times a week and, so long as I was on the move, exerting myself, the pains did retreat into the background. But only to flare up again as soon as I had taken a shower, often more viciously than before. Considering which, it occurred to me that perhaps all this pounding up and down steep hills and straining my abs to paddle my kayak up the Adige might feasibly be making things worse rather than better. Perhaps the best thing was not to exercise more, but to cut out exercise altogether.

  The thought was attractive. Acting on it, or ceasing to act, I confirmed that physical exercise was neither the problem nor the solution. These pains didn’t care whether I went running or not.

  Diet, my wife insisted. I should look into diet. And I did. Again and again I tried to establish some relationship between the various items of food and drink I customarily consume (I’m a creature of routine) and the various pains that were plaguing me.

  Coffee was an obvious suspect. Cut it out! For a month I went without my ten a.m. cappuccino and two p.m. espresso.

  To no avail.

  Next came alcohol. It’s always the pleasures that have to go. I cut out my evening Scotch. I was surprised how difficult that was. Around ten thirty, I would be overwhelmed by a craving for whisky. Apparently, this modest habit, pursued over many years, had become an addiction. Making myself, on my wife’s advice, a cup of camomile tea, to fill the gap as it were, I was half hoping that my body would rebel and take matters into its own hands; yes, my body, I thought, would start trembling and grow extremely itchy, until, brushing aside my noble resistance, it would walk resolutely to the drinks cabinet and splash out a Scotch.

  I couldn’t wait.

  My body did nothing of the kind. On the contrary, as the days passed, it seemed happier and happier with the camomile. Irritated, I took encouragement from the thought that if the whisky hadn’t agreed with my body as much as I had supposed, there might soon be some improvement in the pain.

  Not so. The pains stayed exactly where they were, or rather moved around exactly as they had previously, and when, after a month or so, I terminated the experiment and poured myself a very ample tumbler of Laphroaig, I actually slept better than I had for some weeks. I had a pain-free night, with the Scotch. Naturally, I repeated the performance the following evening, only to find that everything had returned to normal. Normal discomfort, normal pain, excellent Laphroaig.

  After the whisky I cut out early-evening beer.

  After the early-evening beer, I cut out weekend wine.

  At one point it occurred to me that red meat was the problem.

  It wasn’t.

  By the time I spoke to Carlo, such experiments had become a constant in my life. My diet was a speculative shuffling and reshuffling of a fairly limited pack in the hope of hitting the winning combination that would allow me to get on with my life without pain, without these stupid interruptions.

  Not that I was scientific about it, I didn’t keep records, and more often than not at some official lunch or dinner, or maybe just out with friends, I would forget that I wasn’t supposed to be eating this or drinking that. I’d happily indulge. Afterwards I’d start the experiment again from scratch. Or just drop it altogether.

  Waking to acute pain in the early hours, swinging my legs out of bed to escape the fiery rock in my belly, these dietary experiments seemed extremely important. I must find a solution. But in the evening, relaxing in company, I really didn’t know anything about the old guy who dragged his ball and chain back and forth from the bathroom half a dozen times every night. Or, yes, I did know him, but as a distant acquaintance, an elderly relative. Best forgotten.

  The Waterseller

  HOLDING A TEST tube between my legs and waiting for the pee to come, some words crossed my mind, something I had read about the nineteenth-century Italian poet, Giacomo Leopardi: ‘Reflecting on the subtleties of urination he would be unable to pass water.’ He had to wait until he could ‘steal a moment’s inattention from himself’.

  What a crazy idea this was! All the same, the story stuck. Years after reading the poet’s biography I still remembered the phrase ‘steal a moment’s inattention from himself’.

  It was mid-January, middle of the night; the following morning I had the first clinical tests. Blood and urine. True to form, I had contrived to put them off for two weeks in the hope that the pains would subside: first for a visit to London to see my brother, then for a few days’ skiing and walking in the mountains with my wife and daughters.

  My brother lives in America and I in Italy, but we sometimes get together for a few days in London after the New Year. John is a painter and likes to take me to whatever art shows are on in town. He enjoys expressing provocative opinions in a highly audible voice and I enjoy listening to someone who sees and knows so much more than I do.

  On the second day, between one museum and another, we stopped at Apsley House, the Duke of Wellington’s home, to look, among other things, at Velázquez’s Waterseller of Seville. In exactly the kind of chiaroscuro you get under a portico in summer, an old man in a tattered cloak, the waterseller, passes a brimming glass with a black fig in the bottom to a smartly dressed young boy. It’s a painting I’ve seen half a dozen times and always felt drawn to, but today I was almost shocked by its impact. Those two faces, staring so intently, but neither at each other nor at the water, their two hands, one old, one young, meeting on the stem of the glass, the light in the transparent liquid above the dark fullness of the near invisible fig, they seemed to hold some obscure message for me.

  I asked my brother if there was a story behind the painting. Who was the third guy in the shadow behind the seller and the boy? ‘Just a street scene,’ John said, ‘just a moment in Seville.’ He drew my attention to the water dribbling down the jug in the foreground and began to talk about the kind of paints Velázquez used. There were two other versions of the Waterseller, he said, one in the Uffizi and one in the States somewhere. Gazing at the painting as he spoke, the precious fullness of the glass and its precarious passage between those two hands made me excited and anxious; leaving the museum, it was as if I had had an important dream and needed someone to tell me what it meant.

  On the last day we took a long bus ride out to Finchley where our father had been a clergyman through the 1960s and ’70s. The grand old vicarage we lived in has long since been demolished and replaced with nondescript flats, but the ugly neo-Gothic church is still there. John was enthusiastic, talking a great deal about the past. He seemed at once nostalgic and scandalised. When he was four he had had polio, been close to dying. He has always walked with a heavy limp. Mum and Dad, he said, had never wanted to face up to the enormity of this. They went on singing ‘count your blessings’ as if nothing had happened.

  It was raining and I needed a bathroom. Finding the recreation hall behind the church open, we went in and saw, in the corridor, a black-and-white photograph of Dad in his robes together with a plaque commemorating his many years of service. Harold James Parks, 1920–1980. He had his arms raised to give the blessing. The place smelt of damp. Peeing in a bathroom that hadn’t changed in thirty years, I wondered if maybe my problem had its origin in those childhood days. Had it been passed on to me in a brimming glass? But I wasn’t interested in exploring the past. When I got back to Italy I’d get the tests done, find out what my problem was, have it fixed, then forget it and get on with my life. I’ve always felt critical of my brother for his fixation with the past.

  ‘Remember how Dad used to peel oranges?’ John asked. We were walking into the wind on Finchley High Roa
d.

  Violently, was the answer, tearing into the peel with bitten fingernails.

  ‘He used to take something called Sanatogen, for his nerves.’

  ‘I believe they still sell it.’

  ‘Remember when he confiscated “Let’s Spend the Night Together”?’

  Over drinks in the Tally Ho, we laughed about this. During the night, back in the flat we were in, I peed into a plastic bottle so as not to have to walk through my brother’s room to get to the loo. John is three years older than me but he sleeps the night through. I had no intention of letting him know what state I was in.

  There were the same night-time problems the following week in the flat my wife and I had rented in the mountains of the South Tyrol. I couldn’t help feeling a sense of shame as I slipped in and out of the bathroom trying not to wake Stefi and Lucy, my daughters. How much easier everything would be, it occurred to me, if I lived on my own.

  That was a new thought.

  During the day, while the girls skied, Rita and I walked through the woods on the lower slopes, wrapped up in scarves and hats. We were mostly silent. In my head I was trying to solve a problem with something I was writing; I couldn’t make the plot come out. It was one of those situations where you think and think and nothing budges, not unlike the silent winter streams, choked with ice. Rita complained that I was withdrawn. ‘You’re more and more driven,’ she said. ‘It’s boring.’ The air under the dripping pines was raw. Every time we stopped at a Stube for coffee or lunch, I was aware, sitting on my pains, that things were not getting better.

  For the urine test I had been told to bring a sample of the morning’s first pee, presumably because it’s chemically different from what you pee later; it has had a good few hours to stew in the bladder. But since I was going to the bathroom any number of times during the night and usually took a gulp of water before going back to sleep, in my case a pee at seven a.m. would hardly be like anyone else’s. It would be more diluted.