Unbeknownst to Emily Atkins, across town in the Royal Victoria Hospital Cardiology Unit, Eban Winston Barnard was having to face up to more hard truths.
Mr Ashook Khan had travelled from the interior-landscaped gardens and Japanese fountains of his private clinic in Malone Road and was slumming it for two of his scheduled days a week with the NHS proletariat.
“You seem a little agitated Mr Barnard… are you under any stress at the moment?”
Eban had to stop himself from laughing out loud.
‘Stress’ wouldn’t begin to approach; couldn’t begin to describe how he had been feeling.
But he’d had enough professions of his circumstances and his angst to do him a lifetime and he wasn’t about to engage this balding, dapper, rotund consultant with any more of it.
“You mean other than from having to attend here this morning?” he quipped.
“Quite so… quite so…”
The doctor’s mobile phone buzzed on vibrate. He looked at it quickly. “Excuse me, I have to take this.”
Mr Khan proceeded to speak Gujarati in an animated fashion whilst Eban looked around the room and wondered why the senior physicians always called themselves ‘Mr’ instead of ‘Dr’, like they had nothing to prove.
Mr Khan ended the call, smiled and reassumed what he imagined constituted his bedside manner.
“Can you slip off your jacket, please, and I will take your blood pressure.”
He did so and sighed. “160 over 85… that is not good for someone like you.”
“Someone like me?”
“Do you smoke Mr Barnard?”
“No…” said Eban, lying through his stained teeth. “Well, I did… but I gave up.”
“And when you were smoking… how many a day?” asked Mr Khan, wrinkling his nose at the smell of cigarette smoke permeating Eban’s clothes.
“About twenty a day.”
“I see… I see,” he said, flipping through a file in front of him. “I have here the results of your stress test… not very good I’m afraid.”
“Well, yeah… I’m a little out of condition.”
“Oh dear me, no… that’s not what this is about I’m afraid.”
Eban thought to himself, Here it comes. The moment that every middle-aged man with no health history to speak of dreads.
“I’ve never had a stay in hospital overnight in my life!” he blurted out, realising how foolish and irrelevant that sounded.
“Unfortunately that is about to change,” said Mr Khan. “I am reading that you suffer from angina. Your left arm, the left side of your face… no?”
“Maybe… sometimes,” said Eban unsure, defensive.
The door opened behind him and a porter stood there with a wheelchair.
“I have arranged as a matter of some urgency for you to undergo an angiogram. This is a short, non-invasive procedure that will determine the extent of the narrowing of your arteries and how advanced your heart disease has become.”
Mr Khan was inviting Eban to climb into the wheelchair.
“The nurse will bring you back here afterwards and we can discuss the results and how we shall proceed.”
Eban weakly complied.
As he was pushed down corridors full of men, women and children sat atop trolleys and gurneys awaiting attention, he struggled to take in what Mr Khan had said, and the speed of events unfolding.
“Just keep your feet on the footrests,” was all the porter said as he weaved his way in and out of a semi-bedlam.
Through A&E, with the wails of people in pain and shock, and the whiff of diarrhoea.
Through X-ray, where broken individuals hobbled and hopped around on crutches and in slings. Down to theatre, with its Do Not Enter red-lit admonishments, swinging double doors and irrefutable, antiseptic, clinical finality.
Here he was given a relaxant, told to get undressed and to put on the gown provided.
Then to lie down on the trolley and wait.
Everyone was very nice.
The surgeon on duty – speaking from behind his green surgical mask – explained what was going to happen in some unnerving detail.
“An area of skin in the right groin will be cleaned and shaved. This is to allow access to the arteries through which we will access your heart arteries. We’ve given you a local anaesthetic to numb the skin over this blood vessel. After that you will feel very little discomfort. A tube is placed into the blood vessel of the groin. It carries the dye directly to the blood vessels of your heart, which we can see on the X-ray screen. You can choose to look at the pictures if you wish. At different times you may be asked to take a deep breath and to hold it for a few seconds while the camera moves around you. At the end of the test it’s quite normal to feel warm and flushed when some dye is pumped in by machine. This lasts about five or ten seconds and may be associated with the feeling that you are emptying your bladder… please try not to do that though.”
Eban heard himself laugh, a little manically.
As he could only see the man’s eyes, he was unsure if it was meant to be a joke.
*
The procedure itself was over with quite quickly, and after a short wait to ensure the wound had closed to the nurse’s satisfaction, a porter arrived, and worryingly quipped, “I hope you’ve brought your pyjamas.”
Eban was returned forthwith to Mr Khan.
“That wasn’t so bad… was it?” The physician had changed from his dark suit into a white medical coat. Eban was unsure whether this signified anything.
“Well… not for you maybe…”
Mr Khan didn’t laugh.
Eban reflected on his penchant for making impromptu quips at inappropriate times.
A number of X-rays of Eban’s heart were pinned to an illuminated wall screen.
He had looked once at the pumping organ during the procedure but couldn’t maintain his gaze.
It was just too unsettling to see your own beating heart up there on the screen, pulsing and pushing dye and blood around the tributaries, deltas and inlets of the muscle.
He had thought about the stripped-bare tree in the back garden below his window, with its delicate ecosystem of branches that would grow new leaves in the spring.
He had thought about aerial maps he has seen of the Mississippi Delta and the Florida Everglades. How the streams and rivulets of water somehow found their way unerringly into the Gulf of Mexico. The Ganges. The Amazon. The Nile. They all found their way home.
And he wondered about his own circulatory system.
How he had ignored it, fucked with it, disrespected it. And how life had countered in this most severe of natural disasters.
“Not good I’m afraid,”’ intoned Mr Khan. “Not a laughing matter at all in fact.”
“I didn’t mean to seem—”
“This is how things will proceed.” Mr Khan had adopted a more officious and formal manner now.
“Under certain circumstances we could try an angioplasty technique. This inflates a small balloon to open the artery. The procedure is much like the one you just went through… but with more risk. We might also have looked at inserting a stent… this is a wire mesh tube which remains in the vessel, keeping the plaque pushed outwards.”
Eban nodded to convey measured and considered understanding of the information being imparted, but beads of sweat were popping out like orbs on his forehead.
“However,” continued Mr Khan, “in your case I don’t believe that we have the luxury of these approaches…”
“Luxury?” said Eban. It seemed a strange choice of word.
“Indeed no… we are looking here at advanced disease affecting three of your vessels, and so I am recommending an immediate cabbage.” Mr Khan looked at him gravely.
Eban was unsure he had heard properly. “You want me to eat cabbage?” he asked, incredulous.
Mr Khan sat on the side of his desk and laughed.
His belly wobbled somewhat over the top of his waistband.
Eban didn’t see the funny side.
He wondered about the man’s appetite for food cooked in ghee, and felt like asking him if he’d taken his own fucking examination.
“Oh dear me… no… no,” he chuckled. “If only it were that easy…”
“You did say ‘cabbage’?”
“Yes… forgive me: Coronary Artery Bypass Grafting; CABG – in your case triple bypass surgery. We are going to take a saphenous vein from your thigh and lower leg and—”
“Whoa, whoa… you mean open heart surgery!” blurted Eban.
“Quite. Given your profile I am recommending that this take place as soon as possible. The sooner the better in fact. Could you go home and collect some toiletries, pyjamas and a dressing gown and return here?”
Eban was horrified. “What?! No, no… don’t I get time to think about all of this?”
Mr Khan seemed bemused. “There is usually a waiting list. Up to six months, but if it’s life-threatening we make an exception for—”
“Back up! Back up a minute!”
“Alright then… I can probably have you booked in for this weekend. In the meantime you should be careful not to exert yourself and avoid stressful situations.”
He took out his prescription pad. “I am writing you a prescription for blood thinners, blood pressure tablets and cholesterol-lowering statins. You should have this filled and begin the course immediately.”
Eban was in shock. “You’re kidding.”
“Unfortunately no. Please check at admissions on your way out and they will inform you of protocols and take details of your next of kin.”
“But I don’t have—”
“The operation is routine but a major one and you will require a prolonged recovery period, so I suggest that you make arrangements to be absent from work and for post-surgery care.”
“This weekend?”
“That’s correct.”
“Four days from now?”
Mr Khan was sensing denial. “You are in a high-risk category Mr Barnard. You should not be walking around. Talk it over with your wife.”
Mr Khan’s mobile phone buzzed on vibrate again. “Excuse me, I have to take this.”
Eban watched the man become engaged in a fairly heated conversation with someone on the other end.
Whilst he could not understand what the cardiologist was saying, he was sure he registered the terms ‘Audi’ and ‘A5 Series’.
The man’s head moved in the manner common amongst those from his subcontinent of origin. It tilted from side to side in little arcs and seemed to wobble like some toy dogs Eban had seen in the back of cars.
Eban felt that he needed to get outside, get away from the hospital if he was to begin to percolate the information just imparted to him.
In fact, what he needed more than anything else was a cigarette.
He rose unsteadily to his feet and found the door.
Mr Khan continued his phone conversation, but on noticing Eban make to leave the room, held up a hand in an attempt to have him stay.
Eban ignored him and left.
The last words he recognised in English were “bloody bluetooth!”
*
He passed the busy admissions area, ignoring the instruction to register his intention to return as an inpatient later in the week.
He felt lightheaded and strangely elated, but with an undertow of awful dread just below this that was somehow being kept in check for the moment.
Then a sadness welled up in him and his eyes filled with tears.
It was not the awfulness of the news that he had just received, or the prospect of his chest cavity being split open and his heart artificially stopped.
It was in the reminder of his isolation.
That he must face this ordeal alone.
Brother Alex… Joe Breslin… those awful memories… they had been his constant companions for so long it seemed.
Where were they now when he needed them?
Next of kin? Post-surgery care? Talk it over with your wife? That’s a laugh!
In the short walk into the open air, he had become intimately apprised of his heart’s behaviour in a way he’d never previously experienced.
Of its every beat.
Its frequency and rhythm.
He was painstakingly watchful, listening for any indication that each beat would be his last. Anticipating the seizure that would strike him down.
He would rather it happened here with all these people around.
If he died alone…
…in some stairwell…
…or public toilet….
…how sad was that?
If a tree falls in the forest… he thought.
The sky seemed darker than it had been for the time of day.
Something about the clocks going back… or forward. He could never remember.
The rain drifted in fine sheets. Donegal rain. Down from the north-west. Mizzle. The kind that somehow penetrated your outer garments and seeped in, leaving what seemed like a marrow-deep residue.
He was half-considering the idea of abandoning himself to the fates.
Walking away.
Pretending like all of this had never happened.
Just keep on keeping on… waiting for the big one.
Should I make a will? he thought, and then laughed aloud at the thought.
His Ulster Bank account held the princely sum of £635.
His books, DVDs, records… who would want them?
One thought pushed itself to the front of his mind.
It had been there more or less constantly since his session with the HET.
I have to speak with Joe Breslin.
He was sure of it. To explain? To apologise? He didn’t know.
Justice for Joe.
It had a ring to it that any self-respecting human rights campaigner would have loved.
A man’s wasted life summed up in a slogan.
He thought briefly of proposing to Emily, and noticed that he was grinning widely to himself.
It occurred to him that his reason had temporarily been misplaced.
Mild hysteria might not be far behind.
It’s in the lap of the gods, he thought to himself, and immediately began to hum some song of the same name. “Whoa, whoa, la, la, la… whoa!”
He heard it escape his lips.
He sang it aloud.
He saw an elderly man in a dressing gown and slippers – on a Zimmer frame, supported by a relative – draw level with him.
Some smokers standing outside the hospital’s sliding doors.
An ambulance crew unloading a patient.
All gave Eban a curious look.
He sniggered to himself and sang louder.
“It’s in the lap of the gods… Whoa, whoa, la, la, la… whoa!”