Arthur always knew he would be getting a phone-call or someone would be making one about him. Dad phoned about mum. A staff nurse phoned about dad, and now it was Older Brother’s turn. Arthur called him Oboe for short. It was a wind instrument. Oboe’s daughter called during the Sunday afternoon cricket tea interval, and then his son, at one o‘clock the following morning,
‘He’s had a turn for the worse, you’d better come.’
Arthur packed a few things and went. Nothing else mattered. It all gets done whether you’re there or not. Jane stayed with Laura and Kit.
Arthur feared the worst, but after two hours of wondering in the car, he discovered that Oboe was still alive, on life-support.
Rose, Oboe’s wife, told them the story in the intensive care waiting room, ‘He hasn’t been well for a couple of weeks. Slow and breathless. A funny colour. He’s not been sleeping well, dreaming and restless. I insisted he went to the doctor’s on Friday. The doctor was concerned about the mental side of it, but you never know what he was told. We had to get the emergency doctor out eventually, he was so poorly. Once he was on the ward he stopped breathing and so he’s here on intensive care.’
A girl younger than a policeman appeared at the door, ‘You can come through now.’
Rose and Arthur went. Hushed and dim, a single light on Oboe, coupled up to tubes, pipes and machines. The gasping rhythm of the ventilator. The quiet murmur of the night staff. Oboe had been deconstructed and the ghost was missing.
There was nothing they could do. The bad news messengers took a turn at looking at their dad. They all chatted for a bit, tearful. Then Arthur rang Jane and went back to Rose’s to sleep. The following morning Arthur rang work with his apologies. No, he didn’t know how long he would be off. He actually didn’t give a toss whether he ever went back, but he kept that to himself.
He’d gone back to the Health Service after two years off. A career break some would say. Unusual to return after so long away. Not quite a junior but not senior either. An assistant. No career prospects. Clinics only. Take the money and leave on time. No need to butter up the boss. A bit of a comedown some would say. True enough, but Arthur enjoyed trying to help, and it was a reason for getting out of bed. The money was poor, but his, he earned it.
It had been a new speciality to him. New facts and skills. He read, attended meetings, asked help of colleagues, listened closely to the patients, but as with any new project it was slow going. The boss didn’t make an effort to help, nor did he look over Arthur’s shoulder. He just assumed Arthur could manage. Arthur knew his initial enthusiasm would turn to grief and now, four years in, he had no conscience about the work he had left behind.
Arthur had never assumed that any of his juniors could cope. Sound and compassionate supervision was one of the few things he looked back on with pride. Their firm had a reputation and the junior jobs were popular. The boot was now on the other foot.
The occupational health department sent for him within a month of starting. Something to do with the career break. A small round man, neat in a suit, collar and tie sat behind a clean desk. His head was a polished smooth ball with face and spectacles. Two pencils and a fountain pen lay in an orderly row on a pad of A4 paper. The room was bare apart from one library shelf and an eye-test chart.
‘How are you?’ The polished man glanced at Arthur and picked up the pen.
‘Have you an idea why you’re here.’
‘You mentioned in your questionnaire that you’d taken some time off work.’
‘I’m not sure what that has to do with you.’
‘We don’t want you to have similar problems because of something we’ve not done right.’
This was new to Arthur and sounded bollocks. The real reason was to check whether he was up to the job or not. Some paper pusher having a slow day. Who did this guy think he was?
‘I’m not sure what you mean.’
The guy sighed. He’d not put pen to paper yet, ‘We want you to be able to work without feeling ill as a result.’
‘Why should I feel ill?’
‘You might find the work stressful maybe?’
Arthur said nothing and the room was silent for what felt like several minutes. Probably thirty seconds at most. Arthur could barely contain the volcano that was firing up into his chest.
‘I don’t think we’re getting anywhere. Are there any reason why you’re struggling with these questions?’
Only a million you smooth prick thought Arthur, but said nothing. Quite unnerving he knew. It was a skill.
‘I don’t feel we can continue, but my door is always open.’
Arthur stood and left without saying goodbye. He immediately got on the phone to the manager who ran the department where he worked, ‘Did you set the bloke in occupational health on me?’
‘No. What bloke?’
‘Oh, never mind,’ and replaced the receiver. He calmed down in a couple of hours and found something to laugh about within a week. Occupational Health didn’t ask to see him again, but he did get an unusual phone call from the Chairman where he had previously worked, ‘Arthur, I’ve had a letter from a Dr. Rawlinson. Occupational doctor. Wanted to know if you were sound in wind and limb, that sort of thing. Told him you were.’
So the bastard had written without him knowing – what a prick.
Some of the meetings he attended were in the local teaching hospital. The information and training were first rate, but the behaviour of the professor and his senior colleagues was appalling. Arthur had forgotten what they were like – they enjoyed ripping each other’s throats out.
‘I’ve brought this scan, just to check what the radiologist said in his report. It’s a hobby of mine. They often get it wrong.’
‘That sort of scan is not helpful. If you’d read my last paper you’d know.’
‘They’ve been useful to me.’
‘That sort of evidence doesn’t bear scientific scrutiny. You’re just wasting time and money. A final year medical student could’ve told you that.’
Arthur cringed. Other audience members tittered. How could the poor bloke cope after that lashing? But he did. Just sat down and shut up. Others would’ve walked out. He would have walked out. Never to attend again.
The boss sat him down in his office one afternoon. A one-to-one appraisal. Buddy stuff. Call me Harvey. Shirt sleeves, loosened tie. Another fountain pen. A notebook this time. He always wrote stuff in this note book. Arthur’d no idea whether he ever read it. Told Arthur how he thought Arthur was getting on. Then the killer blow that Arthur was waiting for. ‘There is the matter of the letters. Sometimes the direction of treatment is not clear.’
‘Directions come from the top. If you don’t tell me what you want, it’s not easy for me to make it up,’ said Arthur, ‘you’re secretary’s too busy to correct my letters, which aren’t brilliant because my dictating skills haven’t come back fully and sometimes I am at a loss what to do anyway. Particularly with complex patients who really should be seeing the boss.’
Harvey looked into a corner and blew silently.
‘Thanks for the time though,’ said Arthur, ‘and I’m getting well into some of the routine stuff.’ Harvey had tried at least.
Then there were always other rogue staff members. The specialist nurse who thought she was really a consultant. Got what she wanted by telling tales behind backs. The specialised therapist who liked to lord it in team meetings, ‘I saw Mrs. so-and-so recently. She is deteriorating.’ This was followed by litany of signs which Arthur had never heard of. He finished by saying, ‘I think she needs and injection.’
‘Who saw her last in clinic? asked the boss.
‘I did,’ Arthur raised a hand, like a naughty schoolboy.
‘Did you give an injection?
‘I couldn’t find anything to inject.’
The therapist, a thirty something Scot with a chip the size of a mountain, red faced and fidgety, looked across at the specialist nurse, ‘She needs an injection, don’t you think?’ They nodded at each other and the deal was done.
Arthur couldn’t believe his ears. A therapist with attitude and a psychopathic nurse questioning a medic with more than twenty years experience. He remembered the girl. Barely out of her teens with a small family. Wide eyed and alert, regular nightmares and flashbacks. Near death experience in a road crash some twelve months previously. Now losing interest, struggling to get out of bed. She needed and injection like she needed a hole in the head. The boss had been weak, he had been weak.
Arthur did not care what he had left behind at work.
How does anyone manage? Aware of the anytime phone call, knowing he still lived. All of them in limbo, somewhere between life and death. They got a routine going, a semblance of doing something. Start with the journey three times a day there and back. The ritual dancing in the car-park looking for a free space. Took longer than the journey. Could be there for weeks, waiting for someone to leave and go home. A £1 a day mounts up. ‘Have you paid and displayed?’
Switch off your mobiles, no smoking, except outside the main entrance where a rubbish bin should have doubled as an ash-tray. The stone flags were littered with used tabs and squashed medallions of chewing-gum. Rose got stuck here, when the automatic doors wouldn’t open. Arthur remembered the days when doors had handles which you turned, pushed or pulled. Maybe the car-parking fees bought the services of a cleaning company.
Then the long corridors full of modern art, the recently painted mixed building stock, and the flowers and shrubs. Beyond the entrance, Arthur sensed someone had recently made a big effort. Had they had a poor assessment by the inspectors? The gardening department was sound at least. Maybe it was directorate, even a seat on the board.
The Intensive Care entrance was a single door with an intercom, nothing grand, for relatives anyway. Once inside, there were two waiting rooms complete with glossy posters, computer-generated cards in cellophane wrap. When Arthur was ready to read them, in a quiet panic-free moment, he realised they were all the same, at different heights on different walls, catering for tall people, short people, people with eyes in the backs of their heads, and people with short-term memory loss. ‘Switch off the TV when it’s not in use’, ‘Quiet periods are . . .’ It was sort of clear what was intended by the information, but Arthur couldn’t help wondering how something gets used if it’s not switched on and just what the patients did during loud periods. Intensive Care became their second home where they read the paper, did the crossword, drank coffee, ate sandwiches and sat at the bedside.
Oboe was unconscious, out of it. Sheet pulled up to the waist. Ample belly. He wouldn’t know if he was cold, and they took his temperature regularly, didn’t they? Arthur noticed a small bruise over his left eye. They say hearing is the last thing to go. Some of his visitors talked to him, giving him a blow-by-blow account of the day’s events. Others just sat and pondered the TV screens and their wavy lines, the bleeping, the flashing red lights and the hundred and one drips and tubes hung on a gantry over his head, draining somewhere into him, supporting life. Arthur noted how bleeping had become devalued, like an overused word, “nice” or “situation”. Everything bleeped – mobile phones, the car if you left the lights on, the microwave, even the electric cooker. In his day a bleep was a serious alert, pay attention, you need to take urgent action. One evening between hospital visits, back in Rose’s kitchen, Arthur jumped as the microwave sounded off. He looked around, ready for action.
‘It’s only the lasagne, Arthur, not the life-support.’
The first morning after admission, the head honcho took them aside after the ward round. Lots of questions – how long has he been unwell? Gradual or sudden? Yes he’s a heavy smoker, drinks a bit. Yes, he’s been deteriorating for a few months. Yes, it seems to have got worse this last two week or so. Couldn‘t get about during the day and wandered at night. Found out on the road once. The nights were clearly worse. Asleep but sat up, moving, restless, talking, falling out of bed. Rose had to sleeping in the next room. Did he snore? No, but he used to. ‘What’s wrong?’ asked Rose. Oboe had a big heart, waterlogged lungs, low oxygen in his blood. ‘We think he might have a snoring disease; we had one in just last week.’ Somehow Arthur didn’t think so – probably the guy’s hobby horse, needs to get real, stay with the mundane. ‘Can we see you again? Can we make an appointment?’ asked Rose. He slid away.
Dominic, a young fresh faced lad, seemed to be on top of things. Arthur worked out he’d been qualified five years. A specialist registrar. Dominic popped a camera down Oboe’s windpipe and discovered pneumonia. No white blood cells or other evidence that Oboe was putting up a fight. “Immune-compromised” – “run-down’ in lay terms or simply given up.
They couldn’t get in the ward at next visiting. Oboe was having a brain scan. ‘What’s that for?’ asked Rose. The nurses weren’t sure. Dominic said it was a routine investigation in cases of confusion. Did we know if he’d hit his head? No, we didn’t. ‘Anything could have happened,’ said Rose.
The days melted down into getting ready to go to the hospital, being there and coming home. Except the nights. Rose and Arthur were alone, resting, and catching up, trying to make some sense. Things talked about that were never talked about at all those christmases and birthdays and barbequeues.
Arthur was aware of some of the story. Aware of Oboe falling out with his life, his family and friends and his disappointment with how things were. Apparent boredom and rudeness. He’d been a grumpy codger for a while, but Rose said he’d moved on to no enjoyment in anything. Stood and looked out of the window, talked to himself. He was the only one who really understood. Nothing got expressed openly, all body language and short sharp testiness. He’d a couple of friends. Rose was amazed they still were. Drinking and smoking large. Rose knew this had changed his physical health. A time-bomb.
Arthur recalled their early life. The war years between them, a gap that might have shortened as they grew older. Dressed in the same things, but clearly different. Arthur skinny with wiry curly hair. Oboe massive by comparison, the bright first son with a mountain of expectations sitting on his shoulders. William, Willie, their father had angry and violent episodes. Oboe had to make himself scarce on many occasions. Too fond of answering back with a clever remark. Arthur had spent hours with Larkin imagining what life for his dad would have been like. Newlywed and, hard to believe, starry-eyed in the late thirties. Proud when Oboe arrived. Overseas forever in a war torn world. Love letters. How he missed his family. Then back to earth, no job, Mary and Oboe joined at the hip. Disappointed would have been a mild description. Crushed was more like. Then two steps forward and one back. A job, a mortgage and a younger brother for Oboe. Death of his mum and a sister living over the brush. And the black dog. Days in bed with tummy ache. Duodenal ulcer the doctor said. Gave up smoking. Tins and tins of horrid white powder that didn’t quite mix with water. And the fits of violence. He wanted so much for the family, desperate that his sons should have a better chance.
The answer was in the levels. Qualifications that he’d never had. Oboe went off to grammar school and took the levels a year early and was away off to Oxbridge before Arthur had taken the eleven plus. He’d no memory of how Oboe coped at home. Kept himself at it and out of the way was Arthur’s best guess. A good degree followed by postgrad, a university teaching post on the north west coast, Rose and two children. Now this. Arthur realised he didn’t know his older brother at all. A late midlife wobble. Was his university career a success? Had he achieved what he’d expected? You never asked questions. Either he knew everything there was to know and gave you the answer as if anyone should know it. Belittling that easily kept people at bay. Or you never asked because you knew he wouldn’t tell you.
Arthur’d to follow on. The same or different? Vulnerable and so wanted to please. Had to get out from under that long shadow. There was no future in soccer and cricket. Willie wouldn’t have it. Must be the levels. Started well enough with entry to grammar school. Good results in the first two years, and then he lost the plot. He learned the other lessons well enough. The ‘them and us’ lessons. Willie and Blodwen had never had much, solid labour and mistrustful of those that seemed well off. Don’t trust anyone with a posh accent. Never did a solid days work in their lives. Run things from the golf club. Big cars. Think they own the roads. A daily mantra, along with the sarcasm, ‘Bout time you knew your work as well as the adverts.’ It was strange. Willie didn’t like or trust them, but he’d wanted Arthur to become one.
Rose talked about her early life. A farmer’s eldest daughter from rural Lancashire. The Bolton twang was just there. Buses to school. Teacher training. Met Oboe when he began his university post. A disappointment to the family for moving away. Expected to marry locally, and keep the farm going, expand maybe, have a large family. Become another mother earth. Her sister had and that’s what hurt. Dad had died and mum had her favourites. Beyond the family, teaching had been her life and it defined her. She demanded obedience, but was generous…………………………..
Going out for a drink with oboes best mate.
Rose and Arthur did not talk about Oboe dying. Instead they wondered what was going to happen when he woke up? Would he appreciate being resuscitated? He wasn’t there to give consent. How would he adjust to being alive?
Black humour was another way of coping. As long as he still lived.
‘He’s pinker than he’s been for years.’
‘He’ll have a massive hangover when he wakes up.’
‘What’s this f….. thing in my mouth? Jees, my throat’s like the bottom of a parrot’s cage.’
‘We could put a cigar in the ventilator and pour some scotch in one of his drips.’
‘Let’s move the furniture round in his room and decorate. Well we couldn’t wait for you, dad, you been asleep for so long. You remember you were worried about your seventieth birthday? Well don’t. You know seven year old Johnathon, your grandson. He’s in college now.’
‘Intensive Care should have its own car-park, after all there’s only eight beds and it is the most important ward in the hospital. We should have a special badge too, a uniform, separate dining-room.’
‘Do you think so?’
‘Well our own chip-shop anyway.’
Oboe kept cocking his wrist and kinking the blood pressure tube. The resultant bleep had an insistent bass rhythm. I wonder, thought Arthur, let’s listen for a tenor beep, maybe the ventilator. If we want the melody we will need something with a little flexibility. We’ll train your breathing Oboe. Could have a whole orchestra in here if we worked on it.
Dominic told them the results from the brain scan. There was an old small crack in the bone over one ear. The brain underneath looked damaged, but not new. Did they know how this had happened? No. That night Rose told Arthur that Oboe had been in a fight. She didn’t know when or who with as Oboe wouldn’t talk about it. Couple of losers he said. The police had attended, but he wouldn’t go to hospital. But, one of his pals had been with him and made a positive identification. One of his ex-schoolboys always looking for bother. The police were prosecuting. Apparently Oboe had made one of his bright remarks and got a clout round the ear for his trouble.
A vicar visited, a benign man with a smile and a beard.
‘I do a ward round.’
‘Yes course you do.’
He somehow craned his neck and pulled a strange face when Rose said she was Oboe’s wife. Arthur wondered if he had wind, but he said it was part of his way of asking a question. How were they coping? He got wind again when Rose said she was fine. Arthur said a sense of humour helped. The England cricket team will need some this winter in Australia. The vicar was away then on familiar ground, back at Trent Bridge. Rose told him her husband wasn’t religious. He said a prayer anyway, it was his job after all.
No dull moments on intensive care. A regular turnover of patients, victims, inmates, whatever the collective noun is for the institutionalised.
Cristabel, a dotty old lady, alive and kicking, bruised and voluble, unsteady and muddled, went off on walks. ‘How did you get out of bed?’ Cristabel’s nurse couldn’t believe the umpteenth escape. Cristabel was there because attempts to find a bed in the hospital had failed. The nurses seemed used to it. Arthur labelled the Cristabel’s of this world the houdini syndrome. They could escape from anywhere, around and over cot sides, over the bed head, defying gravity and logic. Limbo dancing.
Another man was spark out in the next bed. The following morning he looked perfectly well without computer aids. Overdose said Arthur. Diabetic said Rose, ‘I heard the nurse.’ Intensive Care is for ventilation, yet there was a guy there who was breathing on his own. They eventually found out why. Staff needed him for the telly and Liverpool’s champion’s league game against Valencia. Liverpool lost 2-0.
The staff members were institutionalised as well. The nurses were in blue, the doctors in green, the patients in skin and white, the vicar and head honcho in collar and tie.
Arthur met a fellow former student on the corridor, manicured, groomed and pin-striped, every inch the consultant physician and medical director. Once a piss-artist, he was now a comfortable member of the establishment, complete with a “good” merit award. The rugby team they both played for back in the early seventies was going down the tubes. He’d just stepped down as president. ‘I’m only hanging on til I’m sixty to get the best financial deal. What are you doing here?”
‘Brother’s on Intensive Care.’
He walked away down the corridor, appearing important with important people to meet. Arthur was neither.
They performed a tracheostomy on the afternoon of day five, routine in cases requiring long periods of ventilation. Oboe was much lighter, starting to cough and move about. Chocolate coloured crap came up off the chest. His eyes opened and he recognised Rose and Arthur. The ghost had returned. Rose and Arthur smiled. The staff did too.
Arthur had to get back to work at some time, and needed to assess when. Day six was audit day for the top brass. A nurse reassured them, yes, we’ll make sure they know and someone will see you. Head honcho arrived and discussed the problems in front of Oboe, who was now fairly with it. Everything’s going well, liver and lungs are fine, just the heart and a struggle to combat infection. He slid round the answers as to when will the ventilation stop, how long will he need to be on Intensive Care.
‘I have appointments,’ said Arthur.
‘Keep them,’ he said without hesitation. So he could be direct about some things. Rose and Arthur didn’t take to him, but there again he wasn’t there to be liked. ‘We’re going to stop the sedation and let him wake up,’ and he walked off.
After six days and ten hours Oboe woke despite enough drugs to sedate a large mammal, and the first hurdle was over. He wasn’t going to die that week. Arthur noted with a touch of bitterness that it was the family’s first medical success.
Oboe’s eyes fixed on Rose, like a baby bonding with mum. What’s the matter? he asked. Well, everything, but Rose explained in simple terms and repeated it several times.