When it’s just him and me, when I’m prodding for the pulse between the bones of his wrist, or strapping the cuff around his wasted arm to take his blood pressure, my own heart races with unspoken words. Sometimes I imagine spitting them, hot and shocking, into his face. Other times, when I’m calm, I want to loom over him and whisper them as an icy draft across his bared skin. Instead I give him his bed bath in silence and focus on the task at hand: I straighten his clenched fingers, watch them retract, tease them out again with my sponge. The right hand is more gnarled and seized than the other and the movement makes him grunt. So I uncurl it again and push my sponge between each arthritic claw, watching him flinch, listening again for the complaint gargling in his lungs. When I roll him over, his weight always surprises me, catching me in the small of the back. It’s as if death, like some silty sediment, is already settling into his hollow bones. When I let go he rolls back neatly into his own shape imprinted on the mattress, the fossil of a grown man.
Some days I can’t manage to turn him on my own. I call Manjit in to help me. She holds him on his side while I wash his back. His skin is almost transparent, so thin you could tear his arse with a broken fingernail. ‘I hope you’ve been manicurrring,’ Manjit says primly, rolling the R’s. She’s hamming up Shona, our nursing director from Dundee. Manjit plays her like Miss Jean Brodie’s evil twin. ‘Now little gels,’ Manjit mimics through taut lips, ‘I like to rrrun a tight shep. There’s no rrroom for slovenly on my watch. I do things by the buke.’
Shona likes to line us all up to inspect our nails as if we’re in boarding school. She comes back to check Manjit’s twice, as if she might have somehow overlooked chipped red nail polish and a forearm of noisy bangles in every colour of the rainbow. ‘Jesus, I reckon she thinks I’m some bloody checkout chick at the Caltex, just off the plane from Delhi,’ Manjit snorts. She does that half-nodding, half-shaking thing with her head, like a Bollywood star. When I laugh he moans softly at the sudden sound. His mouth wrestles with the beginnings of words. ‘Don’t you start,’ I tell him, as I begin the brittle operation of dressing him, grinding my teeth as I slowly thread his arms through his pyjama top.
Manjit smiles and strokes his head. His white hair is thin and wild and innocent as fairy floss above his ears. ‘All right, Mr B. Toni’s nearly done,’ she coos. ‘Then I’ll bring you tea in your crossword mug. If you give me a smile I might even pop in an extra sugar. OK? OK, Mr B?’ He manages an animated gargle. It could mean, ‘That would be lovely, dear.’ Or it could mean, ‘Go to hell, you stupid bitch.’
Manjit doesn’t care either way. Any response is a miracle with the end-stagers. I’ve seen her chase the life in them like some kind of Holy Grail. She’s young. She still has the energy to talk to them as though she expects an answer, touch them as though she remembers who they were. Most of us in Acute have become slack with all that. It’s easy to drop the pretence when you get nothing in return. We’re too busy following Shona’s manual of day-to-day maintenance: the correct method of spoon feeding, bed bathing, turning, strapping in, the temperature and blood-sugar monitoring. In between all that, who has the energy to talk or touch for no reason? No one but Manjit, anyway. Sometimes, not often, but sometimes, she gets the flicker of a brightened eye following her across the room, the locking of fingers around her wrist, a suddenly girlish giggle or snatch of half words, all where there was nothing before. She bites on her brown lips then and her smile is stubborn. She doesn’t tell Shona or the doctors. What do such things mean in a patient who is slowly forgetting how to chew, how to swallow, how to breathe? She looks up when she knows I’m watching. ‘See, Antonella? See?’ She blinks at me, like I’m complicit in her secret, like we’re partners. But I look away.
*
Manjit brings Mr B’s tea in a plastic beaker with a straw in the lid. She has put the plastic beaker inside a mug printed with a blank crossword. When I roll my eyes, she shrugs and says, ‘Well? He likes it in his crossword mug. He drinks more.’ She pushes the straw between his lips and I hear her murmur soft encouragements to him, like a mother to a child. When I wheel in the trolley from the meds room, Manjit says, ‘Someone left him halfway through his bed bath last week. Did you know?’ She catches the drips of tea on his chin with a flannel and doesn’t look at me. ‘Didn’t they, Mr B? Poor thing.’ She puts the mug down and begins to check the names taped to the plastic trays of pills on the trolley. ‘When I found him he had no pyjama top on and a wet sponge on his chest. Blue as ice, he was. God knows how long he’d been like that.’ She doesn’t say anything else as she crosschecks the meds. The discordant ragtime ring of a piano drifts down the corridor as if from some haunted old-time music hall. I imagine the rows of ghosts nodding their grey heads in music therapy. She looks up and searches my eyes carefully, one and then the other. I turn away and take a pill tray from the trolley.
‘Really?’ I say with my back to her. ‘Good job Miss Jean wasn’t on that day, then.’ Manjit stands still for a moment. When I face her, she opens her mouth and inhales as if she might continue the conversation, so I cross over to the next bed and say with a brightness that makes me feel sick, ‘Look, Mrs Porteous, you get a purple one today. Your favourite!’
Maeve, strapped in her bucket chair, does not look up. She cowers bald and wrinkled as a fallen chick. You could almost cup her in your hand and see her heart fluttering under her skin, grey and translucent as her cotton nightdress. I look down at her twisted body in the chair and imagine scooping her up and cradling her across the shiny, disinfected floors, away from the strip lights and out into the fragile morning sun. I might leave her at the base of a tree covered in autumn leaves. Instead I put my fingers in Maeve’s mouth and prise it open, slotting the pills into her like coins. I close her jaw around a beaker of juice and massage her throat.
‘Maeve, my lovely,’ Manjit says. ‘How are you?’ She takes Mrs Porteous’s fingers, veined and blue as old china, and folds them over her own, the colour of tea. ‘She’s uncomfortable today, Toni. Don’t you think?’ She hooks a finger under the old woman’s chin and runs a thumb over the muscles in her jaw, locked grimly as if wrestling some invisible force. Manjit is good at reading the signs: she understands the writhing, chafing hands, the whittling tongues, the rocking and huffing and humming. She can read them like Shona reads medical charts or operations procedures. I’ve taught Manjit these things. At visiting time families seek her out now instead of me to translate the secret language of the demented and dying. Manjit can show them the vacant stare, the slack mouth, the contorted, shaking limbs and retrace for them the father, the uncle, the mother that once was there.
‘Do you think we should speak to the doctor about upping her meds?’ Manjit asks. I busy myself with ordering the little trays of drugs, their Technicolor glory winking through the plastic, making everything else look pasty. ‘Toni?’ Her delicate brown hand is on my own, fat and ruddy as a butcher’s. She wants more than a yes or no.
‘I’m just tired,’ I say. ‘You know what it’s like.’ She doesn’t, of course. She is too young and bright and full of hope to have felt the suffocating panic of the past, the gnaw of old resentments.
*
Sometimes when I’m to feed him his pureed pumpkin or potato I find some small job that needs attention. When I get back to him I take the spoon and stir up the food, making sure it’s completely cold and unpalatable. Then I shovel small balls of it into his mouth and watch him grimace with the effort of swallowing, pulling down his bottom lip with disgust, and with greed because he is hungry. It is exactly how his mouth looked when it was just the two of us in his office, all those afternoons, all those years ago. That same grimace from the effort of landing the cane on my palm, hard and flush along the welt already pulsing there, like a plumped vein; that same tight repugnance beneath his nose as he looked down on me; that same hunger in his eyes as if he couldn’t help himself. I remember the slow-motion walks down the corridor back to class, holding before me that strange object in the shape of my hand, waiting for the blood to blossom from the scars below like some exotic flower he’d just given me. I have to look away, then, away from his mouth smeared with pumpkin, because I have the taste of blood in my own.
*
By the aviary, at the cheap outdoor setting the staff use for their breaks, Manjit and I slip off our shoes in the sun. I curl my toes on the chalky plastic chair and look at my throbbing bunions and chipped toenail polish. Her feet are thin and brown, delicately veined, too beautiful for the bleached industrial paving. ‘Mr B doesn’t like you, Toni,’ she says, tossing the words into the air, like a child teasing. I squint at her mischievous little smile for a moment, then I light a cigarette. ‘He told me.’ She laughs.
‘Yeah, right,’ I say and blow smoke down my nose.
‘No, seriously. He flinches when you walk in the room … and he wets himself. I’m always having to change him after you’ve been near him.’
I scratch at the psoriasis in the folds of skin behind my knee, psoriasis I haven’t had for years, not since I was a kid, not since school. When I look at my fingernails there is blood underneath them.
‘Yeah, well it’s like Pavlov’s dogs, isn’t it?’ I say and toss my ash into the pot of an umbrella tree. ‘Except instead of food, he knows he’s going to get a bed bath or a needle or a mouthful of pills.’ When I see her frown, I add, ‘Poor bastard.’ She smiles wanly as if to say, ‘Don’t treat me like I was born yesterday.’
I grind out my cigarette in the soil of the pot plant and heave myself out of the plastic chair.
‘Just don’t,’ she says. ‘Not on my shift.’
My gut tightens and I reach for the psoriasis again. ‘What?’ I say.
‘Just don’t do that with your cigarettes. It’s revolting.’
*
Shona finds us by the aviary.
‘Mrs Porteous, bed five, has gone.’ She glances briefly at her wristwatch. ‘Twenty-five minutes ago.’ Even announcing death Shona runs a tight ship. She wields her clipboard before her like she’s some auditor for the Grim Reaper. Her lips barely move when she speaks and she blinks with rapid efficiency. ‘Her records show a morphine increase that wasn’t approved by a doctor and a DNR order not signed by the correct family members.’ Shona looks at Manjit’s bare feet and the cigarette stubs in the plant pot. We do not speak. ‘This will have to be revisited in a staff review. You are aware of that?’ We nod simultaneously, like children. Shona flares up, ‘Oh, for God’s sake, Kaur, get some bloody shoes on and see to Mrs Porteous before the family arrive.’ She turns in the doorway to the ward and comes back to lift up Manjit’s fingers, compulsively. Then she shakes her own hand free of them, like she would inconsequential coins or car keys. As she leaves she says with her back to us, ‘And get those earrings out. You’re not at the temple now, Kaur.’
*
When she has gone, Manjit rests her forehead on the table for a few seconds and I hear her breath against the plastic. But when she stands she is sure and elegant, slowly pulling down her hair and coiling it back into its clip in one smooth manoeuvre. She unhooks her earrings and looks at me. I lean sideways to scratch at my knee again but the folds of fat that gather at my waist stop me short. I straighten up and head to the door.
‘Toni,’ she says. She has already shaken off Shona’s bullying and is back on the job. ‘Mrs Porteous’s family wouldn’t sign a Do Not Resuscitate order. Don’t you remember? They said they couldn’t bring themselves to. You were there when I asked them. Remember?’ I shrug and turn to leave. ‘Antonella?’ she says gravely.
‘Yes, Kumari Kaur?’ I tease her. She doesn’t laugh. ‘No idea,’ I say finally. ‘Let Miss Jean worry about it – she’s the one on the power trip.’ Then I say, ‘Don’t take it so personally.’ But my voice sounds lame. I’m thinking of Mr B and wondering whether someone can be destined to hate another person the way others fall in love: irrationally, uncontrollably, obsessively.
*
His family visits on Sunday afternoons. A daughter, mainly. She’s about my age, almost as fat. Sometimes she brings her teenage kids. They hover uncertainly in the aisles, all oversized clothes and open-mouthed absence, as if they too have forgotten who they are and why they are here. The daughter tidies his bedside cabinet and stocks it with Sorbolene and folded white handkerchiefs embroidered with his initials. They get stolen by the cleaning staff or by more mobile patients on walkabout from other wards. Every week she hopefully replaces them, thinking he has used them. It assuages her guilt, this one small service. One week she asks me about them.
‘White handkerchiefs?’ I say. ‘No, I don’t remember seeing any. Perhaps they’re in the laundry.’ I smile at her but all the while I’m sick with the memory of those little starched squares.
*
In the afternoons before the home bell rang he’d send for me. It was always worse at the end of the day, when everyone else had gone. I’d wait in the corner of his office listening to the squeaking of chairs and hurried feet in the corridors, the parting shouts on the other side of the closed door, while he leaned back in his chair, swivelling slightly, the newspaper in his lap pressed into a crisp rectangle around the crossword. He’d mumble the clues to himself as if he was alone and fully engrossed, but I’d already learnt how he liked to tease out the thrill of anticipation. I’d see the tips of his neatly trimmed nails turning white as he squeezed his pencil; watch the way he rolled his thumb excitedly backwards and forwards over the rubber bands he kept lodged around his knuckles; try not to notice the red lines where they cut into the skin on the back of his hand. His desk had the same brutal order to it: the immaculate leather writing set with fountain pen upright to attention; the glass paperweight of Pope Paul always to the left, his two fingers raised in stern benediction; the jar of fiercely sharpened HB pencils always to the right, behind the plaque of thanks from the Rotary Club; and at the very front, the clean line of the cane resting on a folded white handkerchief embroidered with his initials in deep blue thread. I’d wait, tracing the monogram, the letters almost hidden among the loops and curls, and I’d try to guess his middle name from that one clue, as if that single character might unlock the man behind the neat rectangle of newspaper, might make me understand the why and where of it all.
*
His daughter stops bringing the handkerchiefs. It doesn’t matter anymore. I already know his middle name from the Do Not Resuscitate order in his records. She brings him orchids, prearranged in a coloured box with loops of ribbon. After a time, when she is at peace with her decision, when she has grown used to wishing for the end to come, she will bring cheaper flowers wrapped in service-station cellophane and busy herself arranging them in the ward vases. It gives her something to do and shortens the time she must look at him. She will read her book and pat his hand for the twenty minutes it takes to feel her duty is done, and she will not have to look at his crooked jaw, the hollow of his cheeks, the way his tongue worries a rotten molar. And when she is gone, I will skimp on his morphine and give him tea from his crossword mug, as Manjit likes me to. It’s our duty – offering these small pleasures for as long as possible.
‘Thirteen across, seven letters,’ I’ll say. ‘A dish best served cold. Blowed if I know. I bet you know, though, don’t you, Mr B?’ And I will remember the way that Do Not Resuscitate order twitched on my open palm before skating like a dead leaf on a draft, up and up towards the strip lights and down under the filing cabinets.