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  The good news about the hip operations was that they were allowed to hurt. Ansell was clear about that. The pain from my epiphyses had been unauthorised. The medical authorities had not accepted its bonafides. It didn’t meet their standards, and they threw it out of court.

  Of course pain is unreal, and naturally it’s easier to be sure of this when the pain is someone else’s, but I felt it was a little presumptuous of medical science to be so selective, to single out my knee-pangs as bogus with such confidence. Now, though, I was going to have some respectable pain, licensed pain, pain that could hold its head up and have its docket stamped, its credentials accepted by the British Medical Assocation.

  Ansell didn’t use the word ‘pain’, not out of squeamishness but professional exactness. The phrase she used was ‘a certain amount of discomfort’. This would be alleviated briefly with Pethidine and then with Panasorb. Pethidine a strong jamming signal blocking the reception of pain, Panasorb a soothing background hum in the nervous system. Ansell was optimistic, telling me that for the operation to be successful all I needed was a little muscle. And thanks in part to my childhood GP’s advice on flexing the quadriceps, that’s exactly what I had. I had a little muscle. Bless you, Dr Duckett! Bless your isometric cotton socks.

  Physiotherapy, to take place before the operations as well as after, would help to build that little muscle up into a rather more competent bundle of fibres, able to fling my new hip all over the shop, or at least to steer me around nimbly enough.

  Artificial hips – arthroplasties – were more or less new technology in those days. Spare parts for the human body! Running repairs. The stuff of science fiction, like the moon landing that hadn’t happened yet, like the automatic doors that still haven’t. Nowadays everyone’s auntie has had hip replacements, but back then people didn’t even call them that. Nobody said that I was going to have hip replacements. I was going to have ‘McKee pins’.

  The idea of mending joints goes back quite a long way. The challenge for those who set themselves to repair nature’s failings (above all for the benefit of arthritic patients) has always been to come up with a material that was compatible with human tissue, but strong enough to stand up to the great forces brought to bear on the hip joint. Early candidates included gold, magnesium and zinc, muscles, fat, and pig bladder. None of these cut the mustard. A home-made joint is a tall order.

  McKee’s breakthrough came while he was tinkering with cars and motorbikes. He thought it was a shame that you couldn’t simply replace components in the body that wore out or broke, and he wondered if it might not in fact be possible. His was an engineering perspective, and he set out to solve a medical problem in those terms.

  The first operations to install McKee pins were done at the Norwich and Norfolk hospital in the 1950s, but it was years after that before they became anything like routine, and then only in certain cases, rather extreme ones like mine By the time I came to be a possible candidate for the pins, only a few hundred operations had been done. It was still a big step.

  The new hip joint would be metal on metal. Partly plastic joints were being installed by Sir John Charnley, but they were still experimental. Metal on metal was tested and predictable. Metal on metal joints had been shown to work well and would last for literally years.

  Nothing ages more quickly than progress in medicine. Soon this year’s startling new technique resembles nothing so much as a blood-caked saw from two centuries back.

  Up to the arseholes in bliss

  Mum had her worries and I had mine. Mum was worried about the operations, though she wasn’t worrying as an ex-nurse, but as a practising needlewoman. She knew from Dorothy Foot’s sewing circle and the skills which she had developed there that sewing three pieces together was always tricky. Two was a doddle, and four not much harder. But three was no joke, whatever the material, whether it was corduroy or human tissue. In the case of actual surgery, a neat piece of darning wouldn’t just be a matter of wanting things to look nicely finished off – it would be about securing a strong supply of blood to every part. Arthroplasties weren’t plain sailing and they weren’t plain sewing.

  I wasn’t worried about the surgery in store for me so much as the nursing. I would be lying motionless in bed for considerable periods of time. It wasn’t the return to childhood confinement that I feared, though it would certainly test that elusive thing, my illusion of making progress in life. It wasn’t even my hips that I was worried about – there was no worldly oracle I trusted more than Ansell – but my bottom. I dreaded a return to CRX conditions of bottom-wiping. My worry could be summed up with a quartet of terrible words: Standard Hospital Bedpan Procedure. In my days of bed rest, Mum had been there to attend to me, Mum who was a dab hand with a kidney dish, but she wouldn’t be on duty now. Besides, I was a teenager now, too old to be babied in that way, but not ready for the psychic sandpaper of having my tender parts wiped by someone for whom it was the most degrading part of an unrewarding job.

  In the end Mum made enquiries. It turned out that the bedbound life was going to be much less of an ordeal in the 1960s than it had been before. Hospitals were better equipped now. There were special mattresses made in three sections. All the nurse had to do was slide out the middle section and place a bedpan underneath. Bob’s your uncle and Fanny’s your aunt! I would be in heaven, comparatively speaking.

  In heaven there is to be no weeping, and presumably no wiping of arses. There isn’t much literature about the after-life of bottoms, but there’s enough. As Rabelais describes the virtuous dead in the Elysian Fields they’re up to the arseholes in bliss, since they enjoy the great privilege of wiping themselves on the necks of live white geese, whose softness (in Sir Thomas Urquhart’s version) imparts a sensible heat to the nockhole. Something to look forward to, unless you’re a goose.

  I was moved from Vulcan School to Wexham Park Hospital, Slough, in an ambulance, which wasn’t strictly necessary. There was no emergency (this wasn’t appendicitis chapter two). If I could survive expeditions in the school’s jolting bus then I needed no special cosseting. I enjoyed the ride, though, and managed not to pester the ambulance men for treats or special attention. One of the school matrons, Mrs Buchanan, came with me, just to be a bit of company, a link from the old life to the new, and we had a rare old chat, mainly about books.

  For the next year (and more) I would be studying independently, and I had no end of reading lists, including one given me by the English teacher Mr Latham. Mrs Buchanan had her own enthusiasms, and she passed them on. There’s no sweeter contagion than a recommended book. She was mad for a writer called J. D. Salinger, whose books had wonderful, ridiculous titles like For Esmé with Love and Squalor and The Catcher in the Rye. Salinger was right up her street, she said, and she thought he might be right up mine as well.

  Tom Dooley

  There were no white geese at Wexham Park Hospital to warm the nockholes of the patients, but there was a different sort of exotic creature, something I had rarely seen before in my career as a patient: a male nurse. He was called (can he have been called?) Jack Juggernaut, and he was from Mauritius. Perhaps it was a workplace nickname, or a warping by lazy English tongues of a name considered unpronounceable. The name conveyed his strength, but missed his delicacy. He was certainly strong. Dad was no weakling, with or without jungle training, but my standard of male power was the motorcycle policeman who had once carried me to my seat at the Royal Tournament on an expedition from Vulcan School. He was simply steel. Jack Juggernaut was not – there was a litheness and ease about him. He was also gorgeous in his white smock. Mauritius rhymes with delicious. It could have been horrible to watch that perfect body moving through the halls of the sick, but actually it was glorious. Envy was not a possible response. Wonder carried the day unchallenged. Jack Juggernaut had an enormous dark fruity voice and smelled of vanilla ice cream. Sometimes when he spoke he seemed to hit the resonating frequency of human bones – at least of bones like mine. He was on my wave-
length.

  Male nurses were a small minority. I assume that I was assigned one to save me the embarrassment which goes with being ministered to intimately by the sex not yours. Of course in my case it caused much more embarrassment than it saved, but in a different key. I wanked myself silly in an effort to keep my fascination with him discreet. Then I could enjoy the sensation of being bathed by this god without causing scandal.

  It fell to Jack Juggernaut to shave my groin on the morning of the first operation. I thought I was well insured against arousal, but the touch of his hand summoned up an excitement from the far side of fatigue. He wasn’t at all offended by what was offered him, saying sweetly, ‘You’ve got high blood pressure, haven’t you? You’ve got the horn and no mistake. You’ve got the high blood pressure in your Tom Dooley! Never seen such high blood pressure!’

  I was mortified. Mortified mainly because I had been shy and slow on the uptake. This wasn’t the first time he had used such phrases. Often enough he had said, ‘I need someone to raise my blood pressure,’ only I hadn’t caught the sexual implication. He had been flirting all along. I’d failed to pick up masses of innuendo, cubic tons of the stuff, and now I’d missed my chances. I’d taken out my frustration on poor Tom Dooley, when perhaps there had been other ways to proceed.

  Too late. Now I was going to be immobilised for months while I learned to sort-of-walk all over again, and I had wasted my freedom while I had it. After the operation everything would be different. Flirting would be out of the question when I was back on bloody bed rest. It’s not that flirting necessarily leads to anything else, but the whole enterprise is a washout when there’s no possibility of going any further. I had been served up delicious Mauritius on a plate and I hadn’t even noticed. As the anæsthetics started to take hold I said goodbye to the illusion of consciousness in a state of weary bafflement, as if I was shutting the door on a stray dog that wouldn’t leave me alone.

  Mystical matiness

  While my blood filled up with absence I thought of the only time Jack Juggernaut had actually held me in his arms. Since anæsthetics is (let’s hope) a science and not just a series of wild guesses, my weight had to be assessed. It isn’t just boxers and jockeys who must ritually be weighed before the big event.

  Ever since I had become ill this was an indirect process, since I couldn’t stand up on the scales, and supporting me would falsify the results. So now Jack Juggernaut weighed himself, then stood on the scales again with me in his arms, decorously wrapped in a sheet. My weight, of course, was the difference between the two readings.

  I enjoyed the idea that my weight was a cosmic unknown, almost on a par with π, not to be apprehended directly but deducible by calculation. I savoured those few seconds in Jack’s arms, though I tried to keep my blood pressure low. The body heat blazed through the smock he wore, and I was blissfully cooked in his mystical matiness. This was a perfect moment and would have remained so, even if Jack had a fit of the Aztecs immediately afterwards, tearing my heart out with his large warm hand and throwing it down the sacrificial steps.

  There’s never a photographer around when you want one, is there? I wouldn’t have minded having that moment recorded. A single radiant image to outweigh all the pictures taken of me in hospital over the years. Somewhere in the offices of CRX in Taplow there was a photographic archive documenting the scanty progress of my generation of Still’s Disease patients, effectively a rogues’ gallery, showing our every deviation from normal posture and shapeliness. We were habitual offenders, backsliders, recidivists, stubbornly attached to the mistakes our bodies made.

  I don’t remember exactly what I weighed in those days. Not very much, but certainly more than Edith Piaf, since as everyone knows sparrows’ bones are hollow and extremely light. And mine are not.

  To fabricate the morning

  The moment I woke up after the operation I knew something was wrong. Of course, ‘waking up’ misdescribes what happens after anæsthesia, or any other condition of absence. The world disappears every time we go to sleep, and the ego has to build it from scratch every time, to fabricate the morning. But the world as I reconstituted it in a side ward after the operation wasn’t up to the usual standards of realism. Everything was askew and wired up wrong. As I became more aware of what my body was telling me, its messages made less sense rather than more. I wasn’t in ‘a certain amount of discomfort’. That wasn’t it at all. I was in stark pain, not the suburbs of agony but the main square, in carnival.

  I couldn’t understand what was happening. It was wrong for me to be having pain on this scale, but that wasn’t the half of it: the pain was in the wrong place. The ‘certain amount of discomfort’ was scheduled for the left hip, but neither of my hips felt any different from the way it had before.

  My throat was a different matter, scraped and swollen. It was in torment. When I tried to swallow I almost fainted. I could only think they’d done a throat replacement by mistake. They must have installed an artificial throat, a McKee gullet. Metal on metal. Those brilliant engineers had found nothing better to do than ram a motorcycle exhaust down my throat, still hot from the racetrack.

  Everybody knows the scare stories, the scandals of botching. The sweet kidney yanked instead of the rank one, the innocent toes lopped and the guilty spared. Now it had happened to me. I coughed, and clots of blood came up.

  Even a newly installed artificial throat should by rights be less painful than this. Perhaps they didn’t have the right size in stock, so they made do with what they had, which was far too big to fit the throat space available. The Extra-Large. Then it must have jammed, so they leaned on it until the metal tube forced a passage. They’d gone to work on my throat the way a clumsy burglar forces a lock.

  I was rising and falling through layers of dreaming, shunning the surface where the air was so raw but then fearing that I’d drown if I went down too far.

  I even dreamed that Judy Brisby, my Vulcan nemesis, matron of monstrosity, had tracked me down at my most vulnerable, sneaking into theatre while I was unconscious and going back to her old tricks of force-feeding. With no pilchards to hand she had made do with a kitchen funnel, and forced broken glass down it.

  Force-feeding was of course one of the techniques used on hunger-strikers such as the suffragettes, a form of torture supposedly acceptable because the alternative was starving to death. In my chemical sleep I had been mistaken for a suffragette, when I didn’t even want the vote.

  These were all good guesses, though I coudn’t quite work it out for myself. Previous invasions of my body (appendectomy and so on) had been made under cover of gas. My body was used to that insidious process and raised no objection. I breathed in without protest the fumes of oblivion. Unconsciousness is how we describe it when the body recedes and the Self consults itself in privacy.

  This time, though, the approach had been different. The protocols of anæsthesia had changed. This time the somniferous chemical came in through a vein and not the lungs, and my body didn’t like that one bit. It retaliated and it sulked. This body passed a vote of no confidence. My throat closed up and I quickly turned blue.

  Then there was dismay in theatre. They had to do something fast, but the emergency procedure wasn’t obvious or easy. It’s a technical point of anæsthesia – if something goes wrong when you’re using gas you can just pump it out, and pump oxygen back in, clearing the fumes. You can’t do that with an allergen which is already in the bloodstream. You can’t just suck it out, any more than you can make a cup of coffee black when you’ve already poured in the milk. So when something goes wrong after you’ve administered something intravenous it’s action stations. If not panic stations.

  Desperate measures were called for, desperate and damaging. The theatre staff had to keep my throat open no matter what. They assaulted me to do it, jamming a laryngoscope down my throat.

  A throat lined with barbed wire

  In a way, though, I conspired with those who hurt me. For years I had imp
osed myself on the world by the firmness of my sentence structure. I didn’t let anyone take me for a child, though my size might excuse that delusion. Now this successful insistence on adult status worked against me, and I suffered for it. I had managed to persuade the hospital staff that they were dealing with an adult, but the throat they needed to penetrate if they were going to save me was, indeed, child-sized. An adult tube wouldn’t go in. There were no child-sized tubes in the theatre. They made do with what they had. They forced the adult laryngoscope down my closed throat, and they brought me back as best they could. With the same fused old hips I’d gone to sleep with, plus a throat newly lined with barbed wire.

  All this I learned from Jack Juggernaut in tiny instalments, gradually building up a coherent story. The first thing he said gave only the most general impression. It sounded in his basso croon like something from an ancient blues song: ‘Little man, they’ve done you wrong.’ I didn’t like being called little, but man more than made up for that.

  I didn’t know whether I wanted to be held and not let go, or never touched again. Jack told me my mother was on her way, and I tried to remember that she was really an obstacle to any further independence, but it was too much of an effort. The last thing I wanted to be was someone who cried for his Mummy when things went wrong, but for the time being that was what I was.

  When Mum turned up to comfort me, saying, ‘What have they done to you, my poor boy?’, she was dragging Audrey with her, redfaced and raging.

  The way Mum looked was a bit of a shock. She had taken the scissors to her long hair. Short hair had been fashionable for some time, but it had never been her style. We would all take a while to get used to it, even after she had tidied it up a bit.