Der Untergang des Abendlandes

These excerpts are from a regular contributor to the Times Literary Supplement, one of the few great remaining journals in the Anglosphere. The observations I find telling:

… The Filipino nurse looked frightened and ran off to get Leon from Ghana to have another go. I said, “Hello, you must be Leon”, and he stared at me without a word. If it weren’t for putting the needles in, which often goes wrong, causing an alarm to go off, I could easily get used to having a four-hour rest in hospital every other day…
…Nurses no longer wear white, so everyone looks like a cleaner, although some have transparent face guards like welding shields, to protect them from flying spit. The only white members of staff are the cleaners from Romania, including two pretty girls who bring tea and biscuits…

Will there always be an England? Or a non-RoC Canada? The whole piece follows.

FREELANCE
HUGO WILLIAMS
FREELANCE
Published: 3 February 2012
W hen I went to see the NHS counsellor last year he told me that dialysis was “not everything”, which seemed about as cheerful as you could get on the subject. I have now started the treatment and his words remain an aspiration.
Dialysis involves putting two needles into a specially prepared vein-cum-artery (fistula), a process which is the unspoken painful reality of the matter. The anaesthetic cream doesn’t work, nor does the freezer spray. Your degree of pain is governed solely by which nurse you happen to get. I grade them according to their prowess on the needle. Their poor English – “Your name Bill?” (confusion of surname) makes you think their needle technique may also be struggling, but it seems to be hit or miss. My first needling was worse than I could have imagined. One of the needles pierced the side of the fistula, causing the artery to “blow”. The Filipino nurse looked frightened and ran off to get Leon from Ghana to have another go. I said, “Hello, you must be Leon”, and he stared at me without a word. If it weren’t for putting the needles in, which often goes wrong, causing an alarm to go off, I could easily get used to having a four-hour rest in hospital every other day. But needling is all – think piercing a bruise – and taking them out isn’t easy either.
We’re in a ward of about twenty beds, each one attended by its Dalek-like dialyser. Coming out of the machines are transparent tubes full of blood, which bob and twitch in a lifelike manner, until something blocks or clots and the alarm goes off. Occasionally it plays a little classical dance tune which Juan says with a wink is called “Chinese Circus”. There are no chairs. Only cry babies like me are allowed a visitor, who must get a chair from the waiting room and take it back there afterwards. Most of the beds are occupied by African or Asian patients, who seem to share a genetic weakness of the kidneys. Many of them arrive by ambulance, in wheelchairs, and have been doing so for years. They grunt hello to the African or Asian staff. One Buddhalike character sits chanting with his belly out. Another prays quietly. “Here comes the rabbi!” says a tall, hatted, vaguely Orthodox type. My favourite is Davey, a sort of ruined East End dandy with waistcoat and scarf, who hangs his cane on the curtain rail and makes everyone laugh by saying he is going to die today. When his ninety-yearold mother dies, he tells me, he is not going to bother coming any more, i.e. fade away. Have I considered this option myself? I say it’s only my second week. He calls for “a cup of tea from Shangri-La!”. I wish he wouldn’t make everyone laugh when Juan is trying to put the needles into me.
Here the routine is long established, as in a milking shed or abattoir, everyone hooked up to their life-or-death machine. Except for periods of acceleration, things happen slowly, like the slow steps of the staff, coming and going between the handwash, the desk, the glove and apron dispenser and the waste bins where huge armfuls of bloody tubing are dumped after every treatment like the innards of some slaughtered beast. Leon is doing a twelve-hour stint. His trousers trail on the floor and his shoes look like used blotting paper. There is an air of hopelessness about the place, because dialysis is a life-support system, not a cure. If it alleviates symptoms, it produces others, itching, twitching, dizziness, weight loss, constipation, cramps. Dialysis is bad for you: bad for the heart, the bones. It is a kind of false health, like drug addiction; it sluices the system, but the toxins come back the next day: time for another shot.
There is no peace on the ward. One old man coughs with the full force of his vocal cords, as if he is used to being listened to. Another makes strange falsetto cries. A nurse asks him repeatedly not to make his funny noise, but he pays no attention until a male nurse threatens to send him to Accident and Emergency, the ward’s ultimate sanction, also used for truants. Nurses no longer wear white, so everyone looks like a cleaner, although some have transparent face guards like welding shields, to protect them from flying spit. The only white members of staff are the cleaners from Romania, including two pretty girls who bring tea and biscuits.
As the nurses approach your bed, for needling and de-needling, you pray you will get one and not another. Juan might as well be skewering an aubergine. What they all want to know is “Are you still peeing?”. Apparently it dries up. Dialysis is all about your “dry weight”. Water builds up in your system, increasing your blood pressure.
I’ve lost two stone recently, but I have to lose a further litre of water during dialysis today. Dizziness ensues and a vice-like cramp grips my shin, which the machine doesn’t register. I make a falsetto noise of my own.
During the second half of the session I start wondering if my bladder will hold. Two hours is my limit. I ask for a bottle, but they can’t find one. Do I want to be taken off the machine? I say no. A papier mâché bottle is found and the curtains drawn. Leon comes back and takes the bottle, but half an hour later it is found by one of the cleaners, spilled under my bed, as if I have thrown it there. Much public mopping. I have earned my membership of the club.
Towards the end of the session some long-serving inmate shouts for a nurse by name, but she knows his ways. “I am doing something. You are no finish yet.” Everyone must wait to come off his machine, just as he must wait to go on. It can take half an hour. We pack up slowly, dialysis headaches all round, then shuffle out, saluting here and there with a particular dead gesture, like vampire victims. I am on the waiting list for a kidney, but it’s hard to imagine going through all this every other day for the next three years, which is the average waiting time.
My task is to own the illness, to find the good in dialysis, so that it gradually becomes “not everything”. I can see I will have to invent a life, perhaps one in which little bits of present comfort take the place of the longer view on my days off. Every now and then the future presents itself vividly as someone else’s life and I almost laugh at the impossibility of it. No doubt this is why they have a counsellor: to stop you laughing.