Some time ago while riding the Tube, I came across an advertisement that stood out among the familiar roster of ads for nutritional supplements and blended Tennessee whiskey. This was in the days before the pandemic emptied Tube carriages and transformed indoor public spaces into chambers of contagion. Unfolding across several posters, it went like this: ‘Explore risks that may be common in your family tree.’ ‘See how DNA affects your health.’ ‘Put your worries to test.’
The advertisement was clearly suggesting that the knowledge it sold would be beneficial to the customer, although why and in what ways were questions on which it demurred with an undergraduate essayist’s dictional prudence: not ‘mitigate’ or ‘minimise’ but ‘explore risks’. The claim seemed to be that knowing about one’s genetic predispositions to disease would be inherently good. Knowledge itself would be improving.
Yes, I thought. I could see myself doing that, in the spirit of exploration.
A few years earlier, my aunt died. It was very sudden, no one saw it coming. She was young – about forty – and not manifestly in ill health. One evening she went to bed, and the following morning she was carried downstairs.
In the desultory, strange days that followed, we were told by the pathologist that she had suffered a cerebral event – an aneurysm or a stroke. Afterwards, this was corrected. No, it had in fact been her heart that malfunctioned.
For years afterwards I could never remember whether it was my aunt’s brain or her heart which was defective, and even now I am uncertain. I only remember that there was some initial confusion, now long since resolved, but which is the correct explanation and which the false I continue to forget. I’ve asked my mother countless times to clarify matters, but – and not for any lack of interest on my part or clarity on hers – I do not seem capable of retaining the knowledge. My ignorance on the matter persists in spite, or perhaps because, of the possibility of a genetic link.
Throughout my early twenties I spent a lot of time seeking to acquire knowledge about my body. It was unwell, this much was certain, and the question of how was one to which I applied myself studiously. Of course, I had theories. Looking back, these tended to change quite frequently. My researches required me to enlist the help of doctors. Above all, I sought a scan that would light up every region of my body; that would reveal, clearly and distinctly, what was the matter with it. It is a long story; it went on for some time. Then something happened.
One evening I fell sick. I had a fever, I didn’t sleep. Nevertheless, the following morning I felt fine, and went to work. But that evening the fever came back, this time worse. This cycle continued for a week or two.
At the time, I was an outreach worker. This was in 2012, or possibly 2013, the early days of austerity. It was January. The work involved traipsing the streets of north London to inform its elderly inhabitants of which services remained. I was working under the aegis of a new charity whose main funders were the councils in which it operated (in many ways it was, I’d later come to understand, a roundabout and insidious form of privatisation). I was paid handsomely for this work, but by the hour. What was more, it was seasonal; once temperatures reached double digits, this brief and surprisingly lucrative employment would cease.
I quickly adapted my routine to these new realities. I’d get up, without having slept, and put my bed sheets in the washing machine (time delay: seven hours). Then I’d cycle across the river. I’d walk around the council estates of north London, which were now mostly privatised, and knock on some doors. Then I’d cycle back to Camberwell, move my bed sheets from the washing machine to the dryer, eat dinner, wash up, read something and reinstall the freshly laundered sheets. Then I’d fix myself a drink and sit in bed and wait until, just after 11 p.m. and always before 11.20, the fever began to gather. This proved to be surprisingly sustainable, until one day I collapsed on the stairs.
I took a morning off work to visit my GP. It was an expensive visit from the perspective of earnings potential. As usual, Dr C was patrician and inscrutable. His body had been trained over many years to be semantically neutral, to give nothing away. He nodded as I explained what had happened, and then, as if dismissing everything I’d just said, he said, ‘OK, let’s have a look at you.’ He placed a stethoscope on my back in order to listen to my lungs, placing his other hand against my chest to steady himself. His grip tightened, signifying something. He cleared his throat and composed himself. ‘Did you have any plans today, Mr Rees?’
Dr C instructed me to go to A & E. They would X-ray me today; it would have to be today. I agreed to go straight there. After I left his office, Dr C followed me out into the stairwell and called out, ‘You will go straight there, won’t you, Mr Rees?’
At the hospital I explained all this to the triage nurse. I was careful to leave nothing out, but also to make no embellishments. She nodded sympathetically and drank in every detail: his tightening grip, the atmosphere that hung about the room. His haunted tone as he called out to me across the waiting room. When my narrative was over she handed me a piece of paper and asked me to hand it in at reception. The paper read: ‘Feels unwell.’
Later that day I had an X-ray. True enough, there was a ‘mass’ in my lungs. Certainly, it was of some concern. But it was impossible to say what the mass was (‘an X-ray machine is not a precise instrument, young man’). A long period of waiting followed, interrupted by the women who occasionally appeared to take samples of my blood. I regretted having brought nothing to read.
For many hours I sat there, bookless and bored, until eventually a junior doctor appeared to tell me how things stood. The results that had come back were normal. Others would take longer. It was possible that I had a virus of some sort. That would explain the chest X-ray: it would be a lymph node, that was all. On the other hand, there were reasons to doubt it. My white cell count was normal. One would expect it to be raised. Things did suggest that something more sinister might be going on, but it was too soon to be jumping to conclusions. I wasn’t to worry. I was to go now, get some rest. I was to come back tomorrow, when I would report to the Medical Assessment Centre.
Honestly, this was not unwelcome. In general, the parameters of any medical investigation are determined by the story that one tells about oneself. When one leaves a doctor’s office having been told, after a brief examination, not to worry, that what one had taken to be a concerning symptom is merely one of the ordinary vexations of embodiment – that one is, in a word, healthy – the feeling tends to be reassuring only in the short term. Before long, doubts set in. What if one has failed to give the really essential piece of information? What if the small detail which in the blur of the encounter slipped one’s mind, or which, in embarrassment at one’s paratactic excesses, one deliberately withheld, what if this detail were the truly important thing, the stray thread which would have enabled the doctor to unweave the veil of health and reveal the sick body beneath?
Such, at least, tended to be my experience. In King Lear Cordelia laments, ‘I cannot heave my heart into my mouth.’ She is referring to her inability to give voice to interiority, to perform a private feeling of love. A patient must heave their entire body into their mouth. They must rally the forces of intellect in order to give an account of a body whose nature is independent of their ability to account for it in language but whose fate now depends on that ability. There is always more one can say, and if the patient fails to say the correct thing then any reassuring words uttered by the doctor will be worse than null; they will be a lure. And yet giving a good account of oneself, an account which will convince a doctor that one is worthy of their time, a reliable witness to one’s own body, is also about knowing what not to say. More really isn’t always more. It is a writer’s problem: what to put in, leave out. But the stakes are different.
The Medical Assessment Centre promised deliverance from the usual cycle of relief and regret. It promised that medicine’s investigations into my body would no longer depend upon my skill as a narrator. At the Medical Assessment Centre I would be reduced to a mute object of medical knowledge, anonymous and transparent like an anatomical drawing. The thought delighted me.
When I arrived the next morning at the Medical Assessment Centre, the receptionist, whom I had never met, knew my name. Actually, everyone there seemed to know me. Over the course of that morning people of various professions made reference to my ‘case’.
I changed into a hospital gown. A nurse came to take some blood and, to my surprise, left a cannula in my arm. ‘Oh?’ I said. ‘Don’t worry, Mr Rees,’ she said meaningfully. ‘For your procedure.’ A few minutes later a hospital porter arrived with a wheelchair. ‘All right, Mr Rees, hop in.’ It dawned on me that I might actually be a patient. It was an unlovely realisation that felt nothing at all like vindication. I declined, politely I believe, and said I was perfectly well enough to walk. The porter appeared hurt. He mumbled that he would have to check with the doctor. I nodded that he should do whatever he felt necessary as I gathered my belongings into my rucksack.
The porter returned, bearing no evident resentment, and as we made the short walk to the Imaging Unit he prattled cheerfully about this and that, the weather, his two young children, the extension he was building at his parents’ house. When we arrived, he withdrew quickly so that my delayed and oddly inflected ‘Goodbye’ was addressed to his back as he receded through the double doors.
At the IU, I was injected with a coloured dye that made my asshole dilate and passed several times through a noisy, large machine. It was the moment I’d been waiting for, my dream come true. Afterwards I was told (without the offer of a wheelchair) to retrace my steps to the Medical Assessment Centre. I sat around for an hour or two, time now completely lost to me, although its passing was tortuous, until the kindly, brusque Dr L appeared. ‘Look, it’s going to be a while. Go for a walk, get something to eat. OK?’
Dr L said he’d call me as soon as he had the results. Soon I was sitting in a dimly lit coffee shop holding a book, and after an hour, or some hours, I received the call from Dr L. His voice now sounded completely different, grave, formal, although it was difficult to know what to make of this since he belonged to a class and a generation whose members still possessed a ‘phone voice’.
I sensed that my fate was now known – not yet to me, but to someone. The facts of the matter had come to light; it only remained for them to be conveyed to me. As I stepped out into the street I had a sudden rush of appreciation for ignorance, which I now realised could be something more than a mere deficit. Ignorance could have a reality of its own, it could be a state of plenitude and possibility. It was a state in which I’d have liked to abide a little longer, perhaps indefinitely.
The sky was luminous and white. It was one of those overcast days that give one the appalling sensation of living inside a fluorescent light bulb. I thought about walking in the opposite direction to the hospital, to the Thames, perhaps, or to the City, where I rarely ventured, but whose shadowy and impersonal labyrinth of skyscrapers seemed to offer the very opposite of what lay in store for me at the Medical Assessment Centre. I thought about never returning, taking my chances.
Of course, I walked straight to the hospital. It wasn’t only that a will to knowledge turned out to be the stronger drive. The pleasures of not knowing are necessarily belated. One can always choose not to know. But ignorance, consciously chosen, is nothing at all like innocence.
When I returned, Dr L greeted me at the door. He told me to follow him into a private room, his voice still grave. I sat on the bed, he on the lid of a metal bin marked biowaste. On the computer screen were the results of a CT scan: my body, illuminated. I was surprised to find myself not feeling very anxious. It was not a feeling of calm that came over me, however; only abandonment to the implacable logic of the situation.
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