4

Hairmyres Hospital, January 1948. He had always known it would come to this: the operating theatre where the bright lights always burned, the hard faces around his bed, the indignities and humiliations forced upon him by his treatment, the inevitability of pain. There was no point any longer in deceiving himself. His being there, he now knew, was a logical progression, a working through of decisions he had made long before. He finally acknowledged his illness, confessing it in letters to his friends, admitting he had been foolish in putting off treatment to finish the book.

He was lying flat on his back, looking up at the ceiling. It didn’t seem like a purpose-built operating theatre, more like a large bedroom in a seaside resort, suitably modified. Like all hospitals, he considered this one, despite its relative modernity, to be just another place of torture and death, a sort of antechamber to the tomb. In his boredom, he started counting the white tiles on the walls (it occurred to him that blood was easier to remove from porcelain than from painted walls and floorboards), but in his perpetually tired state he soon lost count. He had the sensation of having counted wall tiles like this before, but when?

For some minutes, which seemed like an hour, he lay there, ignored by the nurses. Entering a hospital, in his experience, meant forfeiting your rights, your identity even, to become a number, a collection of organs to be manipulated as the overseers saw fit. He listened to them discuss what they were about to do to him, behaving as if he weren’t there. Unlike other Greek and Latinate words, medical ones got to the point. There was no hiding the unpleasant meaning of lobotomy or appendectomy, for instance. He certainly didn’t like the sound of the procedure they were about to perform: artificial pneumothorax, which one of the nurses rather ominously mentioned required something called a phrenic crush.

He watched the surgeon – a thickset Scotsman in his mid-forties called Bruce Dick – as he entered the room and began presiding over the white-clad operating theatre staff, who were busying themselves with various dials and instruments. In his day Dick must have resembled a boxer, but his muscles had now begun their inevitable gravitational descent, like a tightly packed sack of potatoes shaken about in a bouncing cart. He had heard somewhere the man was a Catholic and had fought with the Francoists in Spain, but he couldn’t be certain that was true. Anyway, even if he had been a fascist at some stage, there was something about him that was appealing: a gruff pragmatism mixed with an obvious independence of mind that suggested one could have a decent conversation with him, as long as one wasn’t on the operating table. He looked at the walls and suddenly remembered where he had counted tiles before: in the Bethnal Green lockup back in ’31 or ’32, when he had stupidly got himself arrested as research for one of his tramping stories.

Placing him under a local anaesthetic, the surgeon made an incision just above the collarbone on his left-hand side, and peeled back the skin and muscle to expose the phrenic nerve. One of the nurses was holding his head steady, so the only things visible to him were the shiny metal instruments Dick was wielding. The operation had been explained earlier. It was this nerve – in fact there were two, one on each side of the upper torso – that controlled the movements of the diaphragm, and with the left or right side of the diaphragm immobilised, the corresponding lung could rest, drawing in less of the oxygen on which the tubercule bacilli thrived, and without which they would more easily succumb to the body’s natural defences. That was what the medical books said anyway, but to a layman it seemed like a product of the Victorian belief that anything that caused pain and discomfort must somehow do you good.

He realised he was wriggling involuntarily on the table, wondering how they intended to crush this so-called phrenic nerve of his; no one had told him, which he guessed was because the contemplation of it was alarming. There was pain coming, definitely, but from where?

‘Please stay absolutely still,’ said Dick, who he now saw was holding a surgical clamp. ‘And … now!’ the surgeon said, decisively, prodding the clamp inside him and closing it suddenly.

There was an explosion, or what seemed like an explosion. His vision was overcome by a blinding yellow light, which radiated outwards from the point the clamp had been fixed. The pain’s severity left him gasping for air, but it was momentary, the nerve having just been put out of action. It was over. The clamp was removed, and a wave of relief washed over him. He relaxed his body and his involuntary wriggling stopped.

But it wasn’t over. A nurse in a white coat was breaking an ampoule and drawing back the plunger of another syringe, which she placed in a metal kidney dish and offered to the surgeon. Orwell noted, unhappily, that there were more syringes on a bench nearby.

‘This is just another local anaesthetic,’ said Dick, settling his glasses on his nose before pulling back the sheet covering his lower torso and sliding the needle in. Some other new form of pain must be coming.

A tide of numbness started to spread disconcertingly across his middle. As the anaesthetic was doing its job, the nurses turned him onto his right side, wedged a cushion under his pelvis, and placed his left arm over his head – a position that made him feel totally helpless and once again unable to see what was being done to him. Then Dick picked up another syringe. ‘A little deeper this time.’ Orwell winced as it went in.

Immediately that was done, the surgeon began fiddling with yet another instrument. It too was a syringe – one big enough to disconcert a cow or a horse. Its needle was attached by a rubber hose to what looked like a bicycle pump with a pressure gauge attached. It looked savage and straight out of one of the Gothic horror stories he had so loved as a child. This syringe too was slid into him just below the lungs. He felt a stinging somewhere deep inside his abdomen, even with the anaesthetic.

‘There is blood,’ said Dick. ‘Let’s try again.’

He watched with horror as the needle was removed from his side, drained of blood into a dish and once again poked into him, sliding its way deep. A sudden tremor of pain caused his legs to kick out. ‘Pleural cavity breached,’ the surgeon said coolly. ‘No blood this time. Let’s stay in.’

What in God’s name were they doing to him? To have this gruesome machine connected to you, in fact buried deep inside your body, was at once terrifying and humiliating.

Dick began pumping the top of the tube up and down. ‘It’s just nitrogen; nothing to be worried about.’

He felt like a specimen laid on a slab for the surgeon’s sadistic pleasure. ‘Can you please tell me what you are doing?’ he gasped.

‘We are filling your diaphragm with air, which will cause the lung to collapse and remain still and free of oxygen. Best if you don’t talk.’

The knowledge didn’t make him feel any better. The procedure seemed to go on forever. Peering towards his belly, he could see the space between it and his chest, which had sunken on the left side, start to rise like a balloon. All he could do was lie there mute as they continued to work on him.

The nurse, who he assumed was looking at the gauge of the pumping device, read its progress to the surgeon. ‘Fifty … seventy-five … one hundred.’ His eyes turned involuntarily towards the dial. ‘Remain still, please.’ The pumping continued. ‘Two hundred.’

To calm himself he breathed as steadily as he could manage, trying to think of anything other than the terrible thing that was happening to him, but found his mind wandering back to Spain and the electro-shock treatment they had given him to stimulate his larynx after he had been shot.

‘Three hundred.’ It kept going. ‘Four hundred … five hundred.’

‘That will do,’ Dick said. ‘Better not push it.’ He sounded almost disappointed.

The large needle was removed from his side, stinging again as it emerged, and the wound was cleansed with antiseptic and covered with a sticking plaster. Again, a wave of relief washed over him and a sweat broke out on his forehead. Everything was alright; there was to be no more pain.

‘That’s you done for the day, Mr Blair. Nurse, let’s mark down seven-fifty for the next time. Perhaps a thousand subsequently.’

‘For the day?’

‘We shall have to build you up slowly, of course. The nitrogen is absorbed slowly. By your body.’

‘Oh?’

‘Yes, every few days or so to begin with.’

The thought of the giant syringe …

Dick must have been reading his mind. ‘After a while it’s only once a week. Eventually just monthly, if we’re lucky.’

‘For how long?’

‘Weeks, months, Mr Blair. However long it takes. We intend to cure you.’

He writhed under the sheet. Was this what the rest of his treatment – his life – was to consist of: being squeezed dry and filled up again by other people?

‘It gets easier.’

*

During the weeks that followed, he lived in some sort of sleep or stupor as his body tried to adjust to relying on one lung. Periodically he would be wheeled back into the tiled room for what they euphemistically called ‘refills’, where the dial would reach eight hundred, nine hundred and a thousand; how many times it occurred he could hardly remember, and it took all his public school resolve to keep himself from grovelling pathetically and begging for it to stop. Almost daily, white-coated medical staff would take his temperature and his pulse, tap his joints, peer down his throat and remove samples of blood. Between times, he was regularly shaved and his hair was cut. They even removed his teeth and gave him a set of dentures, his natural teeth having succumbed to the relentless assault of the drugs they had given him, and the clenching of his jaws under the intense pain.

He wanted to live, of course, but felt himself governed by some urge to resist all the good they were doing to him, so he could get back to the novel. They assured him that what he needed was complete rest. Sitting up, wriggling around, reaching over to grab fresh sheets of paper, moving his arms up and down to type in his two-fingered fashion – it all deepened his respiration, which encouraged the bacilli. But even after it was explained to him, he felt powerless to resist the compulsion to write. Dick responded by getting the nurses to take away his typewriter, but could see there was no stopping him.

‘Writing with a pen now?’

Orwell, who was so absorbed in his prose that he hadn’t noticed Dick enter the room, looked up and smiled a hello. ‘Actually, one of those new biros. It’s easier to use in bed – no ink bottles – but less pleasant. You have to scratch the ink into the paper rather than writing upon it. Completely different.’ He saw the look of schoolmasterly disapproval on Dick’s face. He should have been flat on his back, but here he was, propped up by pillows like some kind of sultan.

‘Something important?’

‘A review. Pompous book about India. For the Observer.’

‘Do you find it difficult, reviewing books?’

‘It’s a game, really. The idea is to say as much as you can about a book by reading as little of it as possible. Passes the time. And anyway, it pays well. This illness is becoming an expensive habit.’

‘I couldn’t think of anything more difficult than sitting down to write a thousand words.’

‘Oh, it’s easy. Bread and jam. It’s writing novels that kills you.’

Dick took another drag on his cigarette, turning as he saw a Rolls-Royce pulling up to the car space outside the ward.

‘Horrible and exhausting business, a novel,’ Orwell went on. ‘A bit like having a painful illness you just can’t throw.’

‘One could always just stop.’

‘One could always just stop breathing.’

‘Try it, Mr Blair. Put away the pen, listen to the radio for a few months, read, but not too much. You can be cured, if you want to be, but it’s going to take a bit of effort. Perhaps some sacrifices you haven’t been prepared to make yet.’

But the patient just chuckled, as if to say, ‘Not a chance.’

Dick looked at the mess of the room, with the full ashtrays, the piles of books on the floor, the basket filled with discarded paper. He noticed a framed photograph. It showed his patient, seated in front of a set of sagging bookcases, a young boy propped on his lap. Both were caught in a moment of sublime tenderness, the shot being perfectly framed. Dick’s eyes were drawn to the missing buttons on the man’s lapels, suggesting some privation or loss – a dead wife, or maybe just a general lack of care for himself.

‘Tell me, Blair, do you want to live? If not for yourself, then for someone else? Someone who needs you.’

Orwell glanced at the photograph and smiled. ‘Of course I want to live. If I’m not alive, I can’t write.’

‘Couldn’t all that wait a year? Books will still be published in the 1950s.’

‘A year? Now that’s a long time.’

‘So tell me, then, what’s this novel of yours about? What makes it so important and urgent?’

‘They tell me you were in Spain, Mr Dick, on Franco’s side.’ He saw surprise in the surgeon’s eyes.

‘I was younger then.’

‘How do you feel about it now?’

‘Well, I never thought it would lead to Hitler or the war we’ve just had, if that’s what you mean. I did it for Catholic reasons, you see, not political ones. Anyway, I was a doctor. I didn’t go to kill anyone.’

‘I did, with a grenade. Are you still? Catholic, I mean?’

‘Not as much. The war! Are you still a socialist?’

‘More so. Although in a different way. I’m less naive too. That’s one of the things my book is about, you see: the dangers of extremism. Anyone can fall for it.’

‘One of the things? What else?’

He took a moment to order his thoughts. ‘All the things worth saving. You know … democracy, a full belly, the freedom to think and say as you like, the laws of logic, the countryside, the right to love others and not to live alone but in a family … human things.’

‘Time to take a short break from it, Mr Blair. You’ll do a better job when you’re fully recovered.’

‘Oh, I can work just fine on it from here. It’s not like I’m out digging ditches.’

‘Do you understand what tuberculosis is, and how it kills people?’

‘You could say I’m something of an expert. Anyway, I have a good idea for the next one, and you can’t pop the cork when you’ve got another book inside you.’ Orwell turned his eyes to his writing pad.

‘Good day, then,’ Dick said, and left the room.

In the corridor, he summoned the head nurse and instructed her to put Blair’s arm in plaster the following morning. ‘Tell him it’s something to do with that arm pain he’s been suffering, and that it’s caused by the TB spreading to his elbow. I don’t think the man’s prepared to admit how much he has to live for.’

Dick turned to see a man standing at the nurses’ station, holding a box filled with foods that hardly anyone had seen in a decade. It was obvious this was the owner of the Rolls-Royce. ‘David Astor for Mr Orwell,’ the man said, in a soft voice whose fineness was reflected in the clothes he was wearing.

‘You mean Mr Blair, of course,’ Dick said, approaching. ‘Over there.’ He pointed to the room he had just left. ‘Mr Astor, when you’ve finished your visit, would you mind stopping by my office? I’m Mr Blair’s surgeon.’

‘Not at all.’

‘The nurses will direct you.’ They shook hands.

*

Later, Astor sat in Dick’s office, drinking tea. ‘How can I help you, Mr Dick?’

‘As you will have guessed, it’s about Mr Blair – Mr Orwell. I wanted to apprise you of the seriousness of his condition.’

‘Certainly.’

‘Normally I wouldn’t betray the confidence of a patient, but you may be in a position to help.’

‘My discretion is assured, Mr Dick, and I want you to understand from the outset that I will do anything to help my old friend.’

‘Well, his condition is rather more serious than we thought. He had an old lesion – TB – in his right lung. We’ve discovered through X-ray a new cavity in his left lobe.’

‘So, both lungs, not good.’

‘No. He may recover with complete rest. I have to emphasise that means no work, not even writing.’

Astor put down his teacup. ‘My God, I’ve just given him another commission. I thought I was helping him out, keeping up his spirits.’

‘Indeed, perfectly understandable.’

‘I won’t give him any more.’

‘That would help, but there’s actually another way you may be able to assist.’

‘Any way I can.’

‘There’s a new anti-TB drug the Americans are having great success with. It’s not yet available in England. The Medical Research Council is conducting tests, which won’t help us here at Hairmyres, but the drug can be purchased directly from the Americans. Only it takes American dollars, which we don’t have. In fact the Board of Trade wouldn’t permit it even if we had them.’

‘I have an office and funds in New York. Consider it done.’

‘It’s called streptomycin.’ The surgeon handed over a typed note. ‘We’ll need seventy milligrams for a full course of treatment, I think. I’m afraid it will cost around three hundred American dollars.’

‘I shall wire New York.’

‘There’s one other thing. The health ministry may object. They usually put restrictions on imported medicines, especially those under trial. Undue officiousness sometimes gets in the way of sound treatment. But I read the Observer and I assume you know the health minister?’

‘Don’t worry about that. Mr Bevan is one of George’s greatest admirers. Leave it to me.’

The two men shook hands and Astor made to leave. At the doorway he turned and spoke. ‘You have probably worked out by now that Orwell is a highly adamant character and far too principled for his own safety. He won’t accept charity or queue jumping. So I want you to deal directly with me about the amount and cost of the treatment he requires, and generally not tell him too much. Such decisions must under no circumstances be left to him.’