The Night Shift

Lucy is unmoving on a trolley but I am led to a little room. It is cosy here, we are sitting with knees almost touching and there are two doctors. I remember confirmation classes with a Reverend and the tone – resepctful and hesitant – a patch of grass to glance at outside, matches my school memories. The content is something else. The Smiley One prattles on about the impact, the scans (stopped due to her distress), the blood transfusions, the multiple attentions. I learn that objective is to stabilise her. The One Who Will Not Smile All Week and who has been watching me throughout takes his cue as we rise to leave. He says ”You should be aware these are life threatening injuries”. The Smiley One says : ”It is going to be a long night. Who can you get in for you…?”

    Its timing meant she was received by the night shift and for that first week I joined them. As the evening draws down and we turn home, they put out the tea, read a story, pull the curtains and step outside. Through the night they maintain our intricate world, they serve, and they save.
    Bad Place
    The call spoke of a road traffic accident (I noticed, I actually liked, the weighting of the expression, its successive syllables, the way the words built one upon the other) and I have used it ever since to name what happened. Lucy was at a hospital. Could I get there as soon as possible? I said yes of course then realised on that evening I had no car. In a matter of fact tone they offered to send a police car or an ambulance. But – a pause – none was available at this moment. I said I would call a cab. I asked again the same question, the only question and got the same response. She was OK but could I get there as soon as possible. I was being handled within a protocol, I pictured the laminated manual. OK here meant not dead. More would be revealed when we were all in the same place.
    I became very business like. I would need money so I walked briskly to the cash-point. I packed a satchel with phone and charger, writing book and black pens. Whatever came out of the night I had the bell, book and candle of my calling. I changed from shorts and flip-flops, the gear of a warm Brighton evening, into loose fit jeans and a pressed white T-shirt. I put a second T-shirt in the satchel. I choose black leather boots because I wanted to stand firm and tall.
    In the cab I examined the upholstery and asked simple questions of my driver about the roads to Redhill. The ride was affording important practice. Once I had freaked out in a suite in the Beverley Hills Hotel and I had called a kindly American who talked taught me to look at the weave of the sofa, at the skin of my hand resting on the cloth, to bring my awareness to that and that only. I wanted to use the taxi to lift my game. From now on if I would need to take life five minutes at a time. My many different questions were likely to receive the same answer: we don’t know yet. It was time to take up holy orders, time to become an apostle of the present tense.
    Hastened into A&E my first thought was: what’s the fuss? Unscarred, her face showed no sign of impact. I did something intuitively, something I had not done before. I leant over Lucy and rested my head on hers, forehead to forehead, and let her warmth and breath bring me closer and into the moment and beyond the policemen, doctors, firemen, the medical talk, the bustle and the banter. We stay like that for a long while. ‘’Sorry Dad’’ she says at last.
    Lucy is unmoving on a trolley but I am led to a little room. It is cosy here, we are sitting with knees almost touching and there are two doctors. I remember confirmation classes with a Reverend and the tone – respectful and hesitant – a patch of grass to glance at outside, matches my school memories. The content is something else. The Smiley One prattles on about the impact, the scans (stopped due to her distress), the blood transfusions, the multiple attentions. I learn that objective is to stabilise her. The One Who Will Not Smile All Week and who has been watching me throughout takes his cue as we rise to leave. He says ‘’You should be aware these are life threatening injuries’’. The Smiley One says: ‘’It is going to be a long night. Who can you get in for you…?’’
    I go outside and call a man. I need someone who will listen, who has had a near death experience, who has resources I can draw upon, who has my affliction. It occurs to me that I know several such men and a sense of amazement, the thought that I am a man up on his luck, sits jauntily, like a red cherry atop the layer cake of my emotions. I get through and in the car park I say what has to be said. I say I am so frightened. I sob, I shout, and then I sob some more. Then as he did at our first meeting my friend draws my attention to my responsibility in this matter: I am to find the line of hope and hold to it. He suggests that Lucy will tell me how I need to behave and so she does. Lucy soon says: ”Dad – when I look up I don’t want to see any concerned faces, alright?” 
    We move on and up. We ride the lift to ICU. I do things that cause me great difficulty in everyday life. I wait (the first thing you learn is you always have to wait). I sit.  I live with buckets of uncertainty (the second thing you learn is contradictory information arrives every hour). Extraordinarily I do not become impatient or furious. In this intensive place I know how to be. There is no limit to how I will extend myself for my daughter but my job is simply to attend, and to be given the most junior chores – a sponge, a squeeze, a murmur, a smile.
    Dimitry scrolls through the scans of Lucy’s insides. He is from the Russian East. He is the night doctor on ICU. He always works this shift: this night work is his day job.Dimitry tells me and Lucy what he is doing and why. I notice they all do this: they turn and explain but only once. I assume it is the more modern way. Dimitry wants to add another line, a central line that will lie just outside her heart – so injections to that organ can be instantaneous. ’You can stay but many faint. You’re not going to faint on me are you….?’’. It’s a messy job putting the line into her neck, my head lies in front of Lucy’s under an apron. She is squeamish about her neck. Her fear settles mine. A nurse brushes a hand over the sterile surface and Dimitry swears and, OCD like, begins the make-safe procedure from the beginning. I hold my breath. A single MSRA bacterium introduced in this line will do it for my daughter. Dimitry stitches the tubing into the skin of her neck and tells me to fasten up: she may entail a ventilator before the night is out.
    Through the night I reprise my own entry into intensive care. I remember how the odds halve like an origami exercise. Fold once as you enter ICU, fold again as the ventilator takes over your breathing. Time and place are a mash-up. My own identity is blurred, my own voice sounds strange, and not just to me. ‘’Where in South Africa are you and your daughter from?’’ an English night nurse enquires politely.Lucy stabilises. At dawn, in the chairs they provide in which you cannot fall asleep, I fall asleep. I have her hand in mine. We are through to the other side.
    Wrong Place
    Mr. Ram, the consultant goes from the films to her bedside and asks for an account. Astonishing, he says. It fucking freaks me out that he keeps saying ‘’astonishing’’. He has been 28 years in the Health Service and I don’t want to hear astonishment. Mr Ram knows what he does not know: he does not know how to mend her. Mr Ram and three others log roll Lucy and bind her pelvis in a sheet, pulling it tight with their body weights. In Lucy’s cries, in her youth and her beauty, I see the strangulation of the Duchess of Malfi. Outside – in the sane world – Asian doctors have ram raided an airport intent on immolation. The doctors tending Lucy are Asian to a man. I watch with even breath, ready to leap at them.
    I am calm and quiet because I contain a monster which must not be released. I feel nothing for anyone else in this place. I  go nuts when nurses take a break, when a doctor is not there to authorise more meds, but I must tread carefully lest the beast goes berserk. When we are told to stand aside, that the X-Radiation is harmful and when Lucy says it must be harmful to her too, my reasoning shows me its roots. I urge the doctors on because I know that damage will come in later life, decades hence when I am dead. I won’t be here and and I won’t care. Let her recover and outlive me, let me not have to live with that loss. This is about me, me, me and the rest of my bloody life.
    The sheet becomes putrid and the leg wound weeps. She is stable and she stinks. Everyone agrees she should not be lying here but she lies here. The days pass with protestations, exasperations, hand wringing and more sheet winding. The nights hold visitations of a different kind. As the long daylight fades I am returned to the Dennis Wheatley stories I devoured as a child with closed circles, pentagrams and incantations. My friends in Tamil Nadu chalk marks outside their home to propitiate Kali and her followers. I do what I can. I fuss and prepare new cold towels, I steal ice from throat patients, I watch edgily the disappearing light. The morphine is Mephistophelean in the bargain it exacts. The primary pain abates and a nausea, which will not reward retching, demands new medication. The itching begins quietly, an annoying irritation, before her back is arched to point of fracture. The pain of constipation clenches her bowel where she dare not move. Her temperature goes off the scale but the thermometer registers nothing. We are dealing here with a central nervous system in shock and awe of the assault upon it.
    Lucy finds enjoyment, as she has done since she came upon them as a child, in the stories of Richmal Compton. I read tales of William Brown, his dog Jumble, his friends, his difficult family and his naughtiness. White Mischief from another age where grown-ups are dunces who do not see the point of unrestrained play. In his love of tuck and pop and the money he pays for them I find close correspondence with my Ealing childhood in the fifties. We are each transported into another age and in its antique humour and certainties find warmth and relaxation.
    I wonder if Lucy should really be a boy but she is clearly a girl. I see that as the sheets are cast off and I hold her as I have not done since she was an infant. Idly I wonder if that’s a Brazilian or Hollywood that’s growing out (but which is which?).  Her very worst agony comes in defaecation.  We cling to each other as the nurses clean her. Staff repeatedly adjust the sheets for modesty but Lucy waves them away and indicates more cold towels over her breasts and neck and forehead. Exhaustion removes embarrassment, pain dissolves all privacy. We murmur and gather our resources for the next thing but Lucy does so much of it alone. She shakes awake from terrible dreams. How bad are they I ask? They are very bad indeed. ‘’Dad it’s a relief to wake and find myself here’’.
    In my line of living there is much talk of powerlessness.  However we are assured there is one with that power: may we find him now! Well, we’ve found him but we can’t reach him. The man who will deliver us out of this night is called, quite wonderfully, Mr Day. He resides in a Tertiary centre in Tooting, in another Primary Care Trust. That journey of 23 miles will bridge accident and operation, breaking and restoration, trauma and resolution. That journey will take six days.
    We learn Lucy last year’s marks from Sussex: top marks – a first they still call it I am surprised to hear – in her neuroscience module but it is her Anthropology (another first) that sustains her. She tells me of the Inuit woman, put ashore, birthing a child, burying the afterbirth, running with papoose across the headland to catch up with the boat. ‘’Hardcore’’ she says approvingly. Betty assures me ‘’Lucy is the toughest girl I know’’ . A young registrar pops back behind our curtain, he has something to add to his assessment.  He looks sheepish ‘’I can’t believe I am actually saying this but she’s a fighter.  We rarely see that in people of our age’’. Lucy grins. ‘’Dad, what do you think Mum will say when I tell her I had just booked my parachute jump….?’’ 
    Very clever and caring people ask silly questions.  Lucy is often asked: how are you?  Sometimes she gives a cheesy smile with two thumbs turned up weakly.  I like it more when she is honest and says :”Shit”.  She turns her scientific attention to the pain scale.  Asked for between 0 and 10 she considers carefully:…6.9 she decides at that moment.  I do not hear her complain (I complain of course) but I hear her telling a consultant:”I have painkillers and my family.  I am OK”.
    Her Mother and I take up the roles assigned by Lucy. She called me on the night because she didn’t want a fuss. Her mother’s job is to get her repaired. Julie makes a very large fuss indeed and then suddenly Lucy and I are travelling in the ambulance. Lucy is encased in a mould so that nothing moves within her, the ambulance men – Shakespearean in their light relief counterpoint -  reprise the off-days of the Two Ronnies.  The siren is sweet and thrilling as we swish through the countryside, but I am not fooled. Outside Lower Kingsmill I glimpse a sign to Mogador and know that the dark is close by. We are negotiating the travel between worlds and forces conspire still…
    Right Place
    In Tooting they know what to do but I will not let them untie the sheet. My hand has to be loosened. It occurs to me it may be holding me together more than Lucy. ‘’You are in the right place darling’’ repeats the Irish sister. ‘’ We deal with pelvics all the time’’. I am overcome with the noise, the tide of Bangladeshi comforting the Muslim car crash family of four, the lack of room, and the smell. Trauma and Orthopaedics – and Excrement. Does no one else notice?
    I know that it is good that I eat and I walk out onto the streets. I have never been here before but I know I am in London. I was born here. I have lived half my life in this packed, wet, dirty, beautiful city. I know its sooty tang, its particular hustle, its ethnic mix and clamour. But I am not sure I will ever know its extent. And like any real city it will never loose its capacity to surprise. Lucy’s bed is on the fifth floor and even at this elevation my view is huge and aerial. I am amazed – as far as Wembley Arch it’s astonishingly green. This is London, Plant Kingdom. Supervisory cranes tend new buildings sprouting between London trees, rising out of London fields.
    Lucy is taken for the operation and I find things to do. I slip off to sleep and return to the hospital. I pace and ask too many times at the nurses’ station. A camp male orderly explains: ‘’ they often find more things when they open them up’’. He calls down but there is no news and he adds: ‘Mr Day is a perfectionist’’. I like the sound of that. I venture into the restaurant. The serving area is Vegas black with food in pools of light. I pass into the restaurant and I am utterly alone. It is 7:45pm – where is everyone? A light that comes from another sun backlights a wall of frosted glass; machinery whirrs; I am nowhere I recognise. Three hundred empty seats and yet an overwhelming sense of presence. In his brooding poem of where I am today Larkin calls it only The Building because he knows the power of naming, how names condense and capture and pave the way to comprehension.  I don’t think we yet have a name for this thing: it is vast and blank, and watchful – watching where so many are returned, or cross over. I am perhaps in a space station in orbit around Solaris.
    Eleven hours pass and the seventh night comes round and I am in the little room for visitors at the end of the ward and then Mr Day is in front of me, still gowned and says: ‘’She’s OK. She’s going to be OK’’. I say something clumsy, like it was a long operation. Mr Day sees someone in need of a reality check.  He reminds me ‘’she was run over by a lorry’’.
    Mr Day embarks on a detailed account of the procedures. His talk is immensely technical because I suspect this longhand is his shorthand. How else to describe the exactitude of what he has carried out? I try to stay with him, to scribble notes but I give up. She can have babies. The Ilizarov technique will distract the pelvis.  The knee has been rebuilt around a polyaxyl joint. Mr. Day describes how he has repurposed a device intended for the outside of the knee to the inside. ”It’s made of titanium but I clamped the distal section and – he throws his arms wide – applied leverage.’’ ‘’You have all this gear inside the operating theatre? ” I ask. ‘’ Yes! ‘’ he cries ‘’That’s Orthopaedic surgery!’’.
    It’s nearly midnight, he has been operating since 8:00 am. Lucy was his second patient but he is bright eyed and his energy is undimmed. I fumble and flounce in the sea of my gratitude. ”Thank you. She means so much to me, to us all’’. ‘’Of course’’ says Mr Day ‘’ would you like to see her now?’’ This life and death stuff – it’s all in the working day of Mr Day.
    As we pass though the hospital I ask him about his life. He tells me you cannot beat a London Teaching Hospital and I luxuriate in this exclusivity. He tells me the unit is funded for 168 pelvic operations per year (the f-word again), it’s the largest in Europe, and I enjoy the entry to this extra exclusive enclosure. Of his working week one day is research, one day is hips (‘’to stay abreast’’) ”because I don’t want to be doing this’’ – he means Trauma – ”when I am older’’. ‘’But you will be’’ I nearly say out loud. I remember another surgeon in another time in another place. I remember the talk of sea fishing, of foreign travels that never arrived. I remember his last operating list in Chichester, his cutting into carcinomas a month before his own took his life. I remembered my father.
    Lucy is the last one in Recovery. The walls, the ceilings, the floor here as in the ten theatres that feed this chamber are the most beguiling sea green; I think this is the colour of serenity. Lucy is here but she is not here. The nurses say please come over ‘’we don’t want to redo the operation’’. They often say stuff like this – part-jest, part-truth – stuff that totally freaks me out. Lucy is wide eyed but she is seeing nothing that is in this room. She is excited, crying out, hands raised, moving things, pointing at things. I talk to her, telling her she is in the right place, in exactly the right place. Lucy is very scared, she may not be able to get off : ”I must take the pelvic stop!”. We are on board the Nebuchadnezzar but Lucy is Trinity – jacked in to the Matrix, dialing the telephone and the lorry is about to hit.Lucy takes a long time to arrive. I chat with her Anaesthetist who waits for her too. He was the second one on Lucy’s operation (I fancy Mr. Day burning through them, how they fall exhausted by the way). He tells me what Mr. Day told the team at the end. Mr Day said ”I did a really good job on her”. I think I may falling in love with a surgeon.
    Over the next week Lucy revisits the operating theatre most days for skin grafts, for dressing changes. We are greeted as if regulars at a restaurant (‘’ Hullo. I am Alistair, I am your surgeon this evening’’) but the Recovery is never easy for her, it always holds a little terror.
    New Place
    To me it looks like a slipped crucifixion – nails that would hold floorboards puncture her pelvis and are pulled tight in a lattice of ironwork. Lucy regards the protrusion in her gown. ”Ridiculous – they have given me an erection”.
    I stare dazed as I do most days at the letters NHS. Free at the point of need. (I hear so much talk of funding  but no one asks me to pay anything). Ageist at the point of need. (The number of times Lucy’s age is mentioned – ”the tissues are tremendous at her age’’ – whereas in my work I am not allowed this number. Here it is the question that fronts all others and I giggle at the political incorrectness).  Multiracial at the point of need. (At mixed tables in the canteen I see our best kept secret, the repository of our hope as a mixed up nation and our hope for a brave new Britain). Conflicted at the point of need: tetchy, caring, exact, uncertain, slow, frantic (and all at once in the way I feel only in India). Downright bloody amazing at the point of need. And everywhere, all about, if I care to look I am shown the very best way one human being can behave toward another.
    Quitely, that afternoon, Lucy turns to me and says. ”This is the very best time to be alive’’. The ward has no space. There is never an empty bed in Holdsworth. Why is there no let-up? Our species’ ingenuity supplies the answer. We devise new ways to injure each other but, as the sisters tells me, we are getting better at the first hour which they call the golden hour: patients who would have died ten years ago, make it to Holdsworth today. They told me how swiftly and cleverly they had lifted Lucy, how Redhill did exactly what was needed as needed to sustain her.
    Her brothers, supple and tanned, fly in from Bangkok and Benecassim. Her mother and I are standing and as they join us something goes off (has a doctor exploded a bomb?) but there is no noise, rather a muffling. I am suddenly preternaturally aware. I am extending through the building and I know – I know – this has been a place of healing for a very long time. Science we can’t see is at work all around us. The air is thick with it and the mystery of our soft organism. I am on the rolling edge between the known and the unknown and I feel the surge of our knowledge.  These are the days of miracle and wonder. I know exhilaration. It’s the most beautiful feeling.
    I want to cry out. Look! Listen!  In Tooting Bec, hard by Figges Marsh, new things are in the world.  A girl has resisted the crush of heavy metal, in deep crevasses new bone is growing, and a broken family is pulling together.