Self Harm in Eight Easy Steps

“The first cut won't hurt at all; The second only makes you wonder.”

Duel

[NB. I wrote the below blog entry well over a decade ago, and in the current climate of angst and desolation I felt it merited a cautious re-post. If you are suffering, please know that you are not alone.]

Some time in the late nineties I saw a young man on a bus. He was sitting, I was standing next to him: looking down, I could clearly see a series of cuts along his arm that could not have happened by accident. More significantly I saw the flinch, the unease, with which he registered the fact that I had noticed. I went away wondering what would drive a person to do such a thing. I found it creepy, unsettling (notwithstanding the pathologically morbid cast of my mind); yet here I am ten years on, with a lot more scars (less neat, more random than his) and a much angrier flinch. On another occasion I found myself in conversation with someone who disapproved of pharmacological relief and instead advocated the avenue of self-harm. The relative merits of cutting and drugs to ease ennui - we both insisted that our chosen method, if done cleanly and carefully, posed no harm at all, but neither could be persuaded to the other's point of view.

So what has happened in the intervening years for me to augment the transient respite of drugs with the equally addictive hobby of making myself bleed?

During a later bout of depression (2002/3) I began to experiment with alternative therapies (the NHS having failed to provide any workable recourse). Shoplifting was one outlet, but even that soon proved insufficient. I would try pressing a sharp chef's knife against the flesh of my arm. I must have thought that the simple pressure of a sharp edge against flesh would be sufficient - but human skin is tougher than you'd think. I called to mind how hard it sometimes was to cut a piece of raw steak or chicken, and what I was doing to myself was not even cutting, it was simply pushing the edge of a blade against me, and thinking that alone would break the skin. Sure it left indentations, marks in the arm that might look like old scars to some, but which soon healed and faded. The actual act of cutting - of drawing a blade across my flesh and not just pushing it against it - was a challenge to which I could not rise. Was it the anticipation of pain? The fear that I might cut too deep? Or the all-pervasive intellectual arrogance that I was above such things, that my scars would and must be forever hidden, that I could not submit to the stigma of physical self-harm? True, there is something speciously admirable in psychological self-destruction, a faux-heroic stoicism in the grim resilience to emotional despair.

Therein lies the rub: depression is a hidden disease. How many times, when I had felt hollow, in despair, how many times had people commented how well I looked? Sure there are physical symptoms of depression – the tiredness, the appetite loss and nausea, the insomnia… But essentially it is an illness that others cannot see. I am here talking about non-psychotic depression, rather than the manic variety. Furthermore my depression is not only non-psychotic (so alas I must always be responsible for my actions) but also endogenous: i.e. it originates from within (as an aspect of one’s personality) as opposed to reactive depression (which as the name suggests arises as a reaction to external events). The diagnosis most typically applied to me is dysthymia (literally ‘bad mind’): dysthymia is characterised as a ‘mood disorder’ which is on the one hand ‘less disabling’ than major clinical depression, but on the other hand is ‘longer lasting’.

Therein lies another rub. It is a quiet, restless, desolate condition. It tends to be refractory (antidepressants rarely have more than a temporary placebo effect), and while the day-to-day symptoms may indeed be relatively mild, the cumulative effect is soul-destroying. Given the absence of any workable ‘cure’ or lasting relief (and perhaps the fact that dysthymia is taken less seriously?), the suicide rate is higher than it is for those suffering from supposed ‘major’ depression. Even when my suicidal ideation was at its most demonstrative (summer 2001), my hapless NHS shrink had to concede that I was painfully rational, indeed she affirmed (somewhat rashly?) that ‘rational suicide’ was now recognised in the psychiatric community. During a later bout of depression (2003-2004) I was once again identified as a high suicide risk; this time, however, I had made no overt statement of intent, and I did not actually discover that I had been branded a high suicide risk until long after the event… This begs the question: why, if health professionals had deemed me liable to kill myself, were they doing nothing about it?

So here I am, with a pathologically low mood that resists medical and psychiatric treatment. By their inaction the powers-that-be had conceded that suicide is the logical outcome of this mood disorder. Such helplessness, such frustration, makes me angry. While I had hitherto found the means to express this anger in an at least occasionally constructive (writing) but often subversive (shoplifting, narcotics/tranquillisers) manner, it finally came to pass that I needed to express my rage in a directly demonstrative way. My initial acts of self harm were borne out of anger (I deliberately smashed a glass, and used the pieces on myself); a few months later and I am able to slit my skin as a matter of course, while feeling perfectly calm and composed. I actually went out of my way to keep busy (at least by the standards of my stolid social life), but even when I would lurch home from London in the early hours of a Saturday morning the longing gnawed at me: it was almost a treat, to come home, put the kettle on, and round off the night with a slice to the back of the arm.

In order to understand what I do, I have considered the various ‘explanations’ as to why people self-harm, and the degree to which they apply to me. In admirable homage to my perennial refusal to be pigeonholed or stripped of a single shred of stubborn egoism, for a long while I resisted sheltering under the ‘self harm’ label. What I was doing was not harming myself: it was saving myself. Perhaps it is for this reason that the term ‘self-injury’ is preferred by some to ‘self-harm’. I did not even like the more specialised term ‘cutter’: somehow despite my demand for linguistic precision I did not quite believe that slicing myself till I bled was the same as ‘cutting’.

So, in no particular order…

1. Pain displacement – “whatever gets you through the day”

The oldest known painkiller: inflict an alternative, controlled pain to take away the focus from the pain one cannot control. In the case of emotional/psychological pain, the infliction of a physical injury externalises the pain and makes it more palpably ‘real’, and therefore easier to cope with/explain.

This is, to my mind, a perfectly rational act. I was therefore stoked into more than customary indignation when I read the following statement on a website that (one would think) really ought to know better: “Some find it difficult to give up the behaviour despite realising that it could be life-threatening and is not rational.” Leaving aside how poorly written that sentence is, who the fuck are they (the BBC) to make such crass generalisations? If someone goes for a few drinks to let off steam after a stressful day, are they berated for acting irrationally? Yes, in the strictest terms of logic the correct solution would be to avoid stressful incidents in the first place, but sadly we cannot all exist in a cocoon. The problem with people who make such patronising judgments as that quoted above is that they are unable to address the fact that for some of us self-harm is a perfectly safe and effective (and thereby perfectly rational) means to relieve pain and anxiety that would otherwise cripple us. Furthermore, where do we draw the line when defining self-harm? Some would say that digging one’s nails in one’s flesh to compose oneself is an act of self-harm. Or biting one’s lip? Or pulling one’s hair? What about smoking? Is there any other habit more pernicious to one’s health, and yet which people continue to undertake for the momentary relief it brings, even while it kills them? Yes, stimulant and hallucinogenic drugs are also damaging to the health; however alcohol, sedatives and narcotics, taken sensibly, aren’t going to do much harm to the average user.

2. Sublimation - Manipulation

A variant of the above, when the pain/stress experienced is a result of someone else’s actions (or lack thereof: being sidelined or snubbed can wreak cumulatively catastrophic psychological damage). For whatever legal or moral reasons, it is inadvisable to take out one’s pain on the source of one’s annoyance: i.e. I might want to take a shard of glass to someone else’s wrists, and the only means to overcome this anger is to inflict the revenge on myself. Cutting oneself to register the pain another person has caused is not necessarily a conscious punishment of that person (and it could be that the cause of one’s aggravation would be quite untroubled to think they had incited an act of self harm). However in some cases people do self-harm to provoke a reaction (or manipulate a response) and to punish the person they hold responsible. I once had a boyfriend who was a reformed cutter; the only occasion on which he relapsed occurred when his (Evangelical Christian) parents objected to him seeing me. By cutting himself (and so posing the threat of cutting himself further) he ‘persuaded’ them to reconsider. It would however be dangerous (and offensive) to assume that someone who self harms does so with the intention of manipulating others. As my experience of bleeding progressed I did begin to use it as a means of venting the frustration other people had caused me; it would however be inaccurate (albeit tempting) to blame (or praise) any one person directly for my cutting. Most self-harmers go to great lengths to conceal their habit: I always wear long sleeves in public (in the tiresome event of me living to see another summer, I will have to review this procedure). Other self-harmers may invent a cover story to explain their injuries; I wonder that people so easily believed that I could accidentally sustain cuts across my arm from clearing up a broken glass. Incidentally, those who did see through my fib were soon to confirm that ignorance was the safest bet. Thus is manipulated the very perception of truth.

3. Dissociation – Affirmation

My first counsellor had worked extensively with prisoners, and took no time at all in identifying my predilection for psychological self-harm. We touched on the issue of physical self-harm: she (wrongly at the time, but as it turned out oddly prophetic) opined that I was anorexic, before commenting that many prisoners turn to physical self-harm precisely to remind themselves that they are still alive, that they can still feel, that they do have some power. And so it now is with me: in a world that is dull, apathetic, numb and unfulfilling, what better way to prove myself than by demonstrating, quite literally, that there is still blood thundering through my veins? Anhedonia (literally the absence of pleasure) is a key symptom of dysthymia, which is not to say that all sufferers who experience emotional emptiness turn instinctively to harming themselves simply to satisfy the need for any sensation.

My own initial experience of cutting was borne of rage (point 1), but latterly I am more likely to incise my arm as a diversion from boredom than a displacement of pain.

4. Perfectionism

The perfectionist’s mindset is predisposed towards the fulfilment of unachievable goals, an ‘all or nothing’ stubbornness and hypersensitivity. The perfectionist often rubbishes his or her achievements and abilities, in the belief that he/she should do better (perfectionism can therefore parallel self-loathing, below). This self-undermining is often a subconscious act, and the perfectionist who is critical of his/her self will often be enraged if someone else casts them in a negative light (“I am the biggest hypocrite […] heaven forbid I be criticised/ heaven forbid I be ignored” as Alanis puts it in One).

In pathological cases, any failure to attain one’s idealised potential must necessarily be punished, i.e. the threat of self-harm is used as a deterrent from erring from one’s course. Perfectionists may also gravitate towards relationships with ‘damaged’ individuals (drug users, or indeed self-harmers) in the vain (in both senses) belief that they can redeem/improve the damaged goods. Suffice to say, damaged individuals are spectacularly ill-suited to any such relationship (“You only build me up to tear me down,” in the inestimable words of that other great poet of the subconscious, Smokey Robinson). When the perfectionist begins to infer that his or her protégée stubbornly prefers ignorance to enlightenment, a crisis ensues. This generally goes two ways: a reaction against the chosen one for failing to live up to its promise (thereby requiring (2) sublimation); and a reaction against oneself for the folly of placing hope and faith in the resolutely unworthy object (thereby leading to the below).

5. Self-loathing

In tandem with the above… when perfection (however unrealistic) is not achieved, a state of self-loathing is effected. Imperfection must be punished, else what was the point in seeking something better? Due to the compulsive nature of self-harm, one who is predisposed towards perfectionism can easily be led (however subconsciously) to sabotage his/her self, in order to bring about the frustration and disappointment that will provoke another episode of self-harm.

Despite the prevalent psychiatric tendency to misdiagnose self-loathing as a derivative of low self-esteem, it should be stressed that self-loathing is technically quite distinct from self-pity. The latter is passive, attention-seeking, defeatist. Self-loathing is active (self destruction as opposed to weary surrender), defiant, and above all secretive. As philosophers and psychologists have argued for centuries, hate is an emotional passion (unlike contempt, which is an intellectual judgment [as Schopenhauer tells us]). The object of one’s hate is elevated by virtue of its capacity to command such hate: self-loathing is therefore a covert assurance that one’s self is worthy of being hated, rather than pitied or ignored or (most damaging of all) rejected.

I once summed this up in one of my novelistic fragments: “What he detested in others he shaped and honed in himself, the consciousness of hypocrisy adding a thrilling kick of humiliation to his mortal self-loathing. What was undignified melodrama in any other was measured self-possession in himself.”

Even now I find myself conflicted by my status as a cutter. As my counsellor admiringly concedes, I know precisely what I’m doing, and why I’m doing it, each time I cut myself. By means of easy casuistry I therefore argue that what I am doing is an act of power, a demonstration of my resolve to test myself and change my state of mind. Ergo, I am quite distinct from the hysterical teenager who self harms helplessly and recklessly (I won’t belabour the point, but I have become aware of people who cut so thoughtlessly that they pay no heed when their wounds go septic). Such people are (to my haughty mind) quite weak and contemptible. In summary, even as an acknowledged self-harmer I choose to separate myself from anyone else who might fall under that label.

6. Nihilism

In additional to its function as an alleviator of pain (both physical and emotional) and numbness/boredom, self-harm can also express a profound intellectual despair. The trait of self-loathing as discussed above can also be a sublimation of a chronic dissatisfaction with external situations (not least for the thwarted perfectionist). For example, it may be perfectly natural to hate the world, the frailty and folly of the human condition, the hypocrisy of society and the parasitic nature of human conduct. However when faced with such feelings of revulsion and despair at everything around you, it is unfeasible to express these feelings constructively: the world hardly cares whether you like it or not. But we are each of us a part of this world: harming ourselves is a safe and steady outlet, a mocking statement of the worthlessness of our and every existence. It is true that some people have expressed their dissatisfaction with the human condition by engaging in killing sprees, but such behaviour is a trifle vulgar, nay American.

I suspect that nihilists are the most likely to be rational suicides (despite Dostoyevsky’s attempt in The Devils to depict atheist suicide as vainglorious folly): if it can be rationally deduced that our existence is fundamentally meaningless, and that whatever meaning we do place upon it is a sociological construct, it follows that the world will not be affected by a single life or death. In terms of our function in society we are all eminently replaceable. In personal terms we may well mean the world to someone, but this is of course subjective, and thereby irrational… Why should I stay alive simply to spare other people’s feelings? What sort of life is it, existing purely for another’s sake, never living for oneself? On the flip side of nihilism is the true self-denial of religious piety. Here too we find people who self harm, whether it be ascetic hermits who half-starve, or pompous clerics with a hair shirt or girdle of spikes beneath their robes. It’s funny how people who self harm from spiritual guilt have tended to be considered admirable, self-sacrificing specimens, while those who injure themselves for any other reason are deemed mentally ill. Clearly it’s the other way round.

7. Thrill-seeking

It has been posited (in a commendable if transparent effort at flattering my ill-concealed intellectual arrogance) that I clearly possess the imagination and insight to find a “less scarring” form of self-expression. This crucially fails to acknowledge that scarring is part of the pay-off: I do not simply wish to feel pain, but to see it too and know that it is real. The mood-altering adrenalin rush, the thrill of breaking the taboo, the wilful damage to one’s physical self… The seeking out of self-destructive, socially proscribed activities has proven to be a far more effective antidepressant than any chemical. Even the ultimate pharmacological taboo heroin was a disappointment compared to the mood-enhancing thrills of shoplifting and self-harm. As an aside, I do wonder whether I had the misfortune to be supplied with inferior goods on the few occasions I went dragon chasing – or had years of steady sedative use dulled the brain to the impact of a wrap of cheap smack?

In addition to relieving anxiety/anger/numbness, self-injury also triggers the release of endorphins in the brain. To be honest I doubt I do myself sufficient physical injury to trigger such a response; however I can flatter myself that I do. So much in life requires us to deceive ourselves in order to be happy… but I can rest content that I have never been reduced to the pitiful self-delusion of the theist.

It goes without saying that behaviour characterised by the seeking of thrills can (rightly or wrongly) become allied to a craving for attention. Some may wish to provoke a crisis, which, however uncomfortable (a shoplifter being arrested, for instance), provides at least a passing resolution. While for most practitioners self harm is a secret punishment/reward, some may be overtly exhibitionistic: Russell Brand writes openly of glassing himself. If we think of the stereotypes of self-harming individuals, such as moody teenage Goths, we can almost envisage scars as a badge of honour. Even today some people will assert that smoking makes them look ‘cool’: why should cutting be any different?

8. Practice makes perfect

My first reaction to Heath Ledger’s death spoke volumes, and unsettled even me: I envied him. People go to great lengths to explain that there is no correlation between self-harm and suicidal ideation, and indeed the majority of self-harmers neither kill themselves nor harbour any wish to do so (to quote the faux-wisdom of wikipedia: “The person who self-injures is not usually seeking to end his or her own life; it has been suggested instead that he or she is using self-injury as a coping mechanism to relieve emotional pain or discomfort”).

However it must be noted that some people who self harm do graduate towards a more permanent method of self-destruction.

From my own experience I can testify that I am already sufficiently resistant to the pain of slicing flesh, already seduced by the invidious well-being that derives from watching blood seep and thicken down the hairs of my arm. If I can cut myself without flinching (where once I had to grit my teeth and steel myself with vodka and a sedative before I could inflict so much as a scratch), what will I do next? Sometimes I tell myself it is fortunate that I live ten minutes walk from a major hospital, and if I do carve a little too deep, it won't be too hard to seek medical attention… unless of course I cut too deep by design.

When asked by my GP whether my intentions were tending towards suicide, I replied that I was always careful not to cut near arteries, which of course sidestepped his actual question. Sure I have no immediate intention to extinguish my existence, but the longing, the fascination, the stark sense of relief surrounding suicide: these are always present, always nagging and consoling by turns.

Addenda

I have omitted the potential 9^th trigger for self-harm: in the middle ages it was de rigeur for well-to-do Europeans to bleed themselves on a regular basis, to ensure that they maintained the healthy pallor appropriate to their standing. It is only in recent times that a bronzed/tanned complexion has been construed as healthy or attractive (we know from Renaissance literature that ‘sunburnt’ is a euphemism for ‘ugly’).

I also abjure that other (perhaps more popular) trigger, sexual masochism. Is it considered self-harm if someone wills another into flogging, slapping, or cutting them? I would say no, given that examples 1-8 are all typically solitary pursuits, and the relief gained from cutting is no more sexual than the relief one gains from drink, drugs, or a walk in the park (unless of course you’re George Michael). Certainly some people who derive a thrill from sado-masochism may also self harm privately, for non-sexual reasons. It would however be wrong to assume that there is overall a tenable correlation between the two.

Influenza

Influenza

“A physician is not angry at the intemperance of a mad patient,

nor does he take it ill to be railed at by a man in fever.

Just so should a wise man treat all mankind, as a physician does his patient,

and look upon them only as sick and extravagant.”

Lucius Annaeus Seneca

[NB. Back in the days when another, thankfully less virulent virus was running its course around the world, I contracted swine flu. Below is an account of my ordeal. It suffices to say that swine flu was sufficiently awful, so I am grateful to have avoided covid-19 thus far. In light of the current crisis, I thought it might be useful to re-post this tale.]

I. Incubation

It was the summer of 2009. I had always been churlishly disinclined towards anything so exhibitionistic as ‘panic’: the growing public alarm at the prospective swine flu pandemic met with my typical cold and tight-lipped disapproval. I had been at Singapore airport at the time of the bird-flu hysteria, and had tutted at all the poor fools scampering around in their ineffectual face masks. The scaremongering surrounding bird flu had been conclusively proven to be bogus, and I was thus ill-disposed to humour the breathless threats of swine flu. So people were dying – bah, people die of ‘common’ flu, and a million other things besides. If people stopped dying – then would be a time to worry.

I was particularly incensed by the blind condescension of the public health proclamations: call me fastidious, but I was already in the habit of washing my hands more than once a day, and of throwing away used tissues (did some people collect them, perchance, and dry them on radiators for later re-use?). Perhaps the government feels it incumbent to assume that general standards of hygiene are not much improved since the age of typhoid and cholera; or indeed that people in general are stupid (predictably there is no argument from me on that score).

As the spread of the contagion grew more tangible, I took the time to note the supposed symptoms (in my guise of Health & Safety Officer, I am obliged to feign a little interest). Like TB, depression, and apparently syphilis, flu may be deemed one of the Great Imitators, insofar as its numerous symptoms are easily mistaken for something completely different (how often do we hear the term ‘flu-like symptoms’ used to describe any undefined malady?). Indeed on any given day I could feasibly present with half a dozen supposed symptoms of swine flu: headache, tiredness, nausea, loss of appetite, aches, and general malaise. Such of course are equally symptomatic of melancholia, and as such are as commonplace as waking and breathing and scowling.

When I noted that my headache was persisting for a fortnight, I began to suspect that this was a more than ordinary malady. Back in my heyday of weekly migraines, I did study the surrounding subject, and drew meagre consolation from reading of numerous cases of chronic headache lasting several years. Thankfully the introduction of temazepam into my diet has drastically curtailed my disposition for the sick headache (now two or three a year, rather than 50), but the mild variety of the headache remains a frequent visitor.

But I digress. My two-week headache had quite outstayed its welcome; given the supposedly short incubation period of influenza, it was safe to say that the mal de tête was not in itself an indicator of the flu. Furthermore, I had been in contact with no known contagious vermin, indeed I had been more brutishly unsociable than usual.

By week two of the recalcitrant headache I also had a temperature. I did not deem it a fever (my benchmark being the festering frenzy of my succeeding root canal/urinary tract infections last year, of which I have written with sordid glee). Given that a fever and/or sudden cough are the two key signifiers of swine flu, I grew warier of my gradual accumulation of symptoms, but not to the extent that I feared for my life. My temperature was still ‘hot’ but not quite feverish. By the Wednesday I was decidedly out of sorts, more so than usual for a mid-week malaise. I deposited myself in bed by 9pm (rarely am I a-bed much before midnight).

II. Manifestation

When I awoke it was no longer a playful fancy that I was harbouring the dread disease. My brow was flushed, I had the energy of a broken-backed sloth, and I ticked more than enough boxes for the NHS Direct swine flu diagnostics to condemn me as a suspected patient. And yet (I told myself, clearly already convulsed in the sticky embrace of delirium) I must go to work, for no one else was around to open up the office. One might argue that it was a tad reckless of me to shamble onto public transport when at the height of contagiousness, but I could always reason that I was merely returning the favour: given that I had been in contact with no confirmed carriers, and had not received any ricin-flavoured missives in the post, it was my conclusion that some scabby mongrel on a bus, or perhaps a phlegm-fingered checkout assistant at Tesco, had contaminated my noble sanctum.

I did not linger long at work – long enough to communicate electronically with the rabble to the effect that I was plague-stricken (which of course I could have done from home), and to hand over my suitably sterilised keys to the only poor soul who was in that day.

I retired to bed with Britney and Girls Aloud. I was not tired enough to sleep: who indeed could sleep when such enticing sirens were caressing the ear with their gorgeous melodies? I then changed tack and reclined to the bittersweet indulgence of Burt Bacharach. There can be no setback in life that the music of BB cannot ameliorate. Unfortunately it proved too efficacious, insofar as my mood was lightened as by the lambent flame of dawn, and I felt more than capable of getting out of bed and bouncing around (not literally, I hasten to add).

By early evening the sense of sickness doubled back on me. My body ached abominably. My ribs, my shoulder blades, my midriff, my thighs, my upper arms, all vied to crush me with a senseless pain. At least a bruise or a broken bone has good reason to hurt, but why should pain enshroud a body for no obvious cause?

NHS Direct, or whichever offshoot thereof now cares for swine flu, had earlier that day deemed my malady insufficiently grievous to warrant Tamiflu. Such is the beauty of the automated online system that it was perilously easy for me to re-enter my details and tick all the right boxes to ensure an approval of antivirals. That was easy, notwithstanding having to write down the epic authorisation code. What was more troublesome was getting hold of the actual drugs. Yes, it was now gone 17:30, but there is a local out-of-hours pharmacy on the list of Tamiflu providers. Armed with proof of her ID, proof of mine (my passport), and my authorisation code, my expeditiously appointed ‘flu friend’ (my mum) was still unable to obtain my drugs. They would be ready to collect in the morning, apparently. I was too weary to solicit detailed reasons, although it did little for my faith in the health service (if it is vital to begin a course of antivirals as soon as symptoms develop, then making someone wait another day for said medication is surely not a very helpful procedure).

III. Isolation

And so began in earnest my quarantine from the human race. I will not waste valuable paragraph space in declaring that, under other circumstances, I would scornfully welcome any such avoidance of social contact. Such was the unsettling effect of my (suspected) diagnosis that I soon discarded any sense of one-upmanship; there was a frisson of fear – people had died of this – and the accompanying acknowledgment that for all my Weltschmerz, I was not in fact ready to be extinguished.

The next morning did bring Tamiflu, and the realisation that ‘flu-like symptoms’ is not simply a euphemism for feeling like shit. The one saving grace of aching all over is that one does not focus on any specific pain, although I rapidly concluded that if this creaking bodily discomfort is a precursor of old age, I should very gladly spill my heart’s blood sooner rather than later.

And what of Tamiflu? I have been asked if it helped, and can offer only vague observations. It does not promise to cure influenza, merely to detain the virus from spreading further in the body (hence the importance of taking it straight away and not losing a day – oh wait…). I cannot say that my symptoms worsened once I began the course, although I could shrug and say that only coma and death would have been worse than the way I then felt. I cannot reasonably say that my symptoms improved once I began the course. I did experience initial nausea, but given that nausea is equally a symptom of the disease as of the cure, and that furthermore I have a touch of nausea on most days, I did not permit it to alarm me.

But what of the fatigue? Just as a migraine is not simply a bad headache, so now did I realise that flu is not just a bad cold. Indeed other than a slight cough I had no real symptoms of the classic head cold. Flu inveigles itself far deeper into one’s core. I freely admit to laziness – I celebrate it. I love to crown a lazy weekend afternoon with a little nap. Laziness is a choice, an indulgence; brain-sapping, muscle-sapping tiredness is not. Much as one who has never experienced depression cannot fathom the true hopelessness of the void, one who has never been floored by fatigue cannot imagine its paralysing weakness. On one occasion I dragged myself to the kitchen to make some tea and toast; the simple necessity of standing up for more than a few seconds, and the negligible manual effort of preparing a little sustenance, was so shattering that I then had to go back to bed. As I write this, it seems pathetic and laughable; at the time I was going out of my mind. Now, it seems monstrous that I permitted such a lapse into invalidity, but I actually did reach a stage of such whimpering self-denial that I felt incapable even of putting on a CD or DVD, so onerous was the concentration demanded, so unflinching was my sickly certainty that I could not be entertained.

Such was my prevailing sense of stagnation that I could not even muse on such idle themes as why Americans insist on calling paracetamol ‘acetomenophin’ (neither exactly flows off the tongue – could they not call it something catchy?). By the Tuesday – the day I finished the course of Tamiflu and so by rights should have felt some improvement – I had strayed into the most dangerous stage of any affliction: self-pity. On day one, the faint prospect that I could be dead in days played on my mind, but only as a teasing possibility (the way that the realisation of unlikely but statistically feasible death during a routine operation might flicker in one’s thoughts). By day five the sheer physical enfeeblement distressed me: if walking a few steps made me feel sick, what else was there to do but wallow in the cess-pool of lethargy?

A sick person has inalienable rights to feel sorry for him or herself – no nauseous sense of martyrdom or saintly acceptance of suffering for me. There is though a nebulous line between misery and self-pity. Harking back to my past experiences, even when I was finding blood and pus in my urine, and seething with near-hallucinatory fever, I did not entirely lose my sense of humour. Now however I could not look at my torments and smirk wryly, knowing they would pass and I would be a wiser man for them. I took no joy from my usual mordant Facebook posts and irreverent emails from friends. There was no consolation in cynicism – I really was unwell!

IV. Remission

In my greater than usual discomposure, I began to think of my isolation as a leper-like quarantine, yet here I am, capable of bouts of ferocious unsociability. Of course when a life of hermit-like reclusion is voluntary it can be a means to attain a freedom from the world and its invidious obligations. When house-arrest is thrust upon you to contain you from the world, it is a little less salutary (though to be fair, I had so little strength I wonder if I could actually have descended two flights of stairs).

By the close of the week my spirits had mustered themselves into some form of resistance, if only to preserve me from spending another afternoon groaning on the sofa in front of Channel 4’s afternoon film (yes, the 1959 Journey To The Center [sic] Of The Earth does not get any better). The aches and pains lessened, to the extent that I could stand up for long enough to make a sandwich. I could concentrate for long enough to read.

I could even see the light at the end of the proverbial tunnel, and actually see the real light of day, for one is no longer considered contagious on completion of a course of Tamiflu – with the key proviso, as my GP sagely advised, that one should still keep away from neo-natal units and the like (because the first thing anyone recovering from a potentially dangerous illness wants to do is spend time around newborn babies).

Suffice to say, my first outing was not to a baby unit. Instead, I took myself to Tesco. Stepping outside for the first time in over a week was jarring – I won’t belabour the point by making otiose analogies to a prisoner in a cave finally taking a step into daylight… but I had easily become accustomed to my absence from human society, and it was no joy to be back amongst the chattering, plodding hordes.

V. Reflection

What are the benefits of illness? That it forces us to rest, to abstain from physical activity, and thereby to take stock from what consolation the mental faculties can offer? To what extent is sweaty, nauseous self-absorption a benefit, when so much of existence is contrived to obviate the barren confines of the self? The melancholy penchant for navel-gazing loses its appeal when every last wisp of navel fluff has been teased. So no, in this instance I did not find the abundant ‘time to think’ therapeutic.

What else? Cynic that I am, it is obligatory to celebrate the fortuitous weight loss that illness so often brings. During the quarantine period itself I cannot have lost any weight – true, my appetite was diminished, but how many calories does it take to flop on the sofa all day? It was only with the return to everyday activities that the after-effects of flu could be noted. I was tired; my energies were low, and I still had lingering aches. Post-viral myalgia (muscle pain) was not an uncommon occurrence (so my GP advised me) – surprisingly, despite my leanings towards hypochondria, I did not dwell on whether this myalgia would blossom into fibromyalgia or some gloomy post-viral auto-immune disease (after all, it’s never lupus).

The upshot of this protracted sense of malaise was that half a stone dropped from my poor, myalgic frame as I soldiered on through the thankless rigours of existence. On the down side (to some it would be a positive) I had been so long without alcohol (those familiar with my gin-craving will marvel at this turn of events) that I lost all desire for it, and on my first night out with friends in my post-quarantine freedom, I wound up drinking tea (admittedly this was after several vodkas and a pitcher of Margaritas).

Dashed

“Science and art, or by the same token poetry and prose, differ from one another like a journey and an excursion. The purpose of the journey is its goal, the purpose of an excursion is the process.”

Franz Grillparzer

‘O for that warning voice’ writes Milton at the opening of Paradise Lost book IV. Of course the warning voice he requests could and should have been provided by the spuriously omniscient god whose atrocious misdeeds Milton expressly sought to condone; mine on the other hand could easily have been provided by an appeal to common sense and experience – and yet we would surely all have punctured an artery if we paid serious heed to either.

So it was that I agreed to stride from retirement, to resume once more the splintering fatigue of physical exertion. I previously completed the Dolphin Dash (all six miles) in May 2007. At the time I was convinced that four miles walking a day (weather permitting) to work and back was more than adequate preparation, although a few practice runs soon put paid to that risible fancy. It would be dilatory to spiral into too much detail, but it suffices to note that calf pain, shin splints, crunching knee joints and simmering blood blisters were the legacy of that brief athletic career.

Since then I tried and failed to revive a desire to run on several fitful occasions – without the specific goal of training for a race, I could find little impetus to trot for half a kilometre before accepting easier ways to waste my life.

What then changed my mind? Was it simply the erosion of sense, the forgetting of former hardships in hope of future glory (hope which, as Turandot so acutely avers, always deludes)? Such speculations are for other times, for the fact is that my mind was altered (plus ça change).

Training, such as it was, was no more fun than before, although it did provide me with the specious reasoning to eat more chocolate (as if two minutes of running could expiate a chunky Kit Kat). My shin splints were more painful than my memory (usually so incisive when it comes to pain) allowed, and I was obliged to resort to such trickery as walking on one’s heels (the experts swear by it) to render my lower legs more elastic. To my credit, not once did I force myself to go for a run before work. Some so-called experts will claim that early morning is the best time to exercise, and that half an hour’s running on an empty stomach is the key to staying thin (how silly – anorexia does the same, with much less effort). Forcing myself to move at all is almost intolerable before that first cup of tea has worked its magic, and even then the will to stand up is barely worth the trouble. Sometimes almost a week would elapse without the flimsiest run, but it was disarmingly easy to inveigle myself into the pretence that mental preparation was just as crucial.

On the Friday before the Dash I was able to harness the anticipation, and propel myself for several kilometres without pause. Stomp, stomp, stomp. I told myself to think simply of the next step: the rhythm, steady and dull, must prevail. What a metaphor indeed for human life, that only the imposition of monotonous, laboured routine can give purpose to an otherwise bare and thankless yawning of time.

The morning of the Dash arose. As I composed myself, I did feel what I took to be an adrenalin rush (hindsight whispers to me that it was possibly an aneurism); while the buzz was undeniably vivifying, I was however mindful of the cautionary words of Bev Baker, viz. that one should never kill when angry, as the lapse of control and composure always yields mistakes. Was the heightened sensibility of anger different to any other head-rush? Both might prompt one to do something one would afterwards, in the cool crispness of reason, regret.

I had declined Susan’s kind offer of a lift to the starting point. The walk to the Dolphin is no strenuous trek (I used to dawdle as far on my regular treks to Mill House, an ordeal as lacerating to the spirit as the Dash would prove to the soles of my feet). I was there in 20 minutes, and I assured myself that such a warm up would stand me in good stead, even though the last thing I felt like doing after a brisk walk was to launch into a steady run for six miles. That said, there was little steady about my running once I’d kicked past mile two.

My previous Dash had seen grey skies and drizzle, which actually proved quite conducive – one is less likely to linger in the rain. This time however the sky was blue, and the sunshine warm. Mindful of exposure, I had already applied factor 30 to my pallid hide, and my sleepy eyes could droop and languish at will behind my sunglasses. I had my bottle of water, a pocket of glucose sweets, two anti-inflammatories concealed in a piece of tissue, and perhaps the greatest sustenance, a fresh playlist of motivational ditties on my ipod. I wondered how easy it would be to switch off one’s mind and run blindly, relentlessly, till the course was complete; but not having the requisite handgun to blow out my brains, I ground my teeth and prepared for the start.

And so it began. The lesson learnt from my former Dash was to pace myself – in 2007 I started briskly, and took great pleasure in overtaking seemingly healthier specimens, but peaked too soon and could quite happily have keeled over by mile 3. This time I started slower, unburdened by any need to overtake. Yet the realisation that I wasn’t actually running very fast began to vex me, and I derived little assurance from the fact that, measured though my pace was, hardly anyone was overtaking me (and no, this was not because I was in fact last). As I plodded on, it hit home that the whole thing was less exciting than 2007: the novelty was gone, and I was just another runner, with nothing to prove. Indeed, having proven that I could run (or at least hobble) six miles, the onus was now to improve on my previous performance. Thankless indeed is the task of appeasing one’s own expectations, should they ever break loose and surface for air.

I ran. Britney impelled me to Break the Ice, but I was more inclined to take said ice and drop it in a long glass of gin rather than shatter it with my velocity. Still I ran. My shins did not trouble me, my lungs did not wither from exhaustion. My feet however, rudely rejecting the support supposedly proffered by my special socks (cushioned in all the right places so as, theoretically, to obviate blisters), were stinging by mile two. Hmm. Maybe special socks were of little use, when the trainers I wore were over two years old, with barely any tread remaining. Hey ho. I stopped in my tracks, registered the full pain of burning blisters on each foot, looked slyly behind me to assure myself that no one was yet gaining speed, and fumbled in my pocket for a painkiller. Yes I know, athletes should avoid masking pain with drugs, lest they unwittingly exert themselves into aggravating the injury, but I wasn’t even half way, and besides, it wasn’t as though I was knocking back codeine (how I miss you, poor dispossessed cousin of smack) and running with a shin bone poking through my sock.

From then on it was painful to run. I had made the mistake of cutting my nails a few days before, so I could not even practice the old trick of digging claws into palms to distract from pain elsewhere. I was sorely unimpressed when I crossed the three mile mark and realised I had an equal distance ahead. Tempting though it was (and ever will be) to lapse into Macbeth-style brooding desolation, I was prompted to ask what would Kimberley do? For indeed my playlist had soared to the elysian heights of Girls Aloud, and who could not be inspired and enthralled by the example of our saintly girls teetering up Kilimanjaro (though presumably not in stilettos)? Would Cheryl allow a weeping blister (besides the one she married) to hamper her? No indeed.

On I stumbled, shrugging off my frustration that even running on tiptoe was not proving a success. I no longer noticed any mile-markers, and so grew oblivious to the distance between me and my journey’s end. I was by now running in fits and starts, rather than a seamless dash, but when I caught a glimpse of Helen gaining on me I derived the incentive I needed to run more and walk less. Even in pain, the competitive edge is not entirely obscured (back in 2007 I was miffed indeed when Susan and Helen overtook me after my initially promising start; indeed it was very unsportsmanlike of them not to let a gentle novice lead the way).

The final stretch, back along the Grand Union canal, did not see me gather and compress my remaining strength into a heroic sprint. Rather I began to feel that it mattered little, that it would soon be over and gladly forgotten, all efforts wasted like so many vain intentions. Usually such pervasive depression of sprits does not descend until a task is complete, but I am nothing if not pre-emptive when it comes to dejection (happiness, as Euripides so fluently opined, does not exist). Yet then, as if to chide my fractious mood, my ipod sallied into ABBA’s Voulez Vous. There were indeed people everywhere, a sense of expectation hanging in the air… Knowing now that the end was in sight, I pursed my angry lips and stamped to the bitter end, quickening my pace at last. Admittedly it was more to gratify and earn the applause of the idle spectators than to prove a point to myself that I broke into a sprint once the aforesaid idle mob were in view, but I did still enjoy a warm feeling when the lady at the finishing line congratulated me and placed a medal round my neck (and yet – would that it were a noose).

But where the endorphin rush? The elation? The relief? The deed, as Goethe tells us, is all, the glory nothing. True, I was relieved that I could stand still, but with the sudden stillness came the churlish disappointment that my time was 63 whole minutes. Pah, over an hour – no wonder I could not justify any sense of achievement (to hell with Goethe, I now wanted glory). Admittedly, I had knocked two minutes off my previous time, but back then I was a breathless amateur. In truth, such sentiments of spiteful self-recrimination were largely unconscious, as my attention was eagerly diverted by the table of bananas and chocolate bars – I was not going to deny that I had earned a chunky Kit Kat, at least.

The fevered blood of sin

“Misery made me wise.”
[Shelley, Prometheus Unbound]

Given that I only write to record some invidious medical procedure, or to catalogue some damage to body and mind, it is auspicious that I have composed no such tales of late. No less a seer than Nelly Furtado tells us that all good things come to an end, and so it is that a new chapter of raving affliction begins.

It was a Thursday afternoon when the ache in my jaw became obtrusive. Despite the marauding rage and hatred that are my life force, I am not one to gnash or grind my teeth; hence the source of pain was likely medical. By evening it was toothache proper, and by Friday it had graduated to the stage where eating anything was an ordeal. Any joy at the consequent weight loss I might experience was punched clean away by the mocking constancy of pain.

I looked up a few emergency dentists, but then speculated at the likely price and decided to book an appointment with a regular dentist. The earliest they could see me was in two weeks. Hmm. I wondered if it would get better on its own. By the evening it was getting close to the worst pain I had ever known (and I have had some pretty obscene migraines in my time – a broken toe was heaven by compare). I phoned the emergency dentist and made an appointment for 9pm. Typically the dentist in question was situated across the road from where I work – I had thought of popping across there during the day, but was put off by the fact that it was a dental practice combined with a beauty salon. By 9pm I wouldn’t have cared if it were twinned with an abattoir, indeed I would have welcomed the distraction of being strung up and exsanguinated.

I hadn’t been for a dental check up for over two years – yes, yes, my bad. I never liked my former dentist, and his practice is in Hayes Town, which is a right slum these days (a far cry from the jovial suburb in which I was born). I knew I had a chipped filling that needed looking at, but when the emergency dentist started prodding it to see if that was the tooth in question, I was obliged to point out that it was actually the other side of my face. The problem lay in (or under) a crown that my old dentist had fitted many years ago. An x-ray revealed that he had not filled the root all the way, so over the years it had become a little pocket for bacteria, which had finally decided to emerge and say hello to the rest of my jaw. It would need a specialist to put it right, and he made an immediate referral [so immediate that two weeks on I’ve still heard nothing – not that I was looking forward to spending £550+ for something the shabby NHS could do on the cheap].

In the interim he gave me an injection in the gum to anaesthetise the pain, plus a handful of antibiotics to take now, and a prescription for some more to begin the next day.

No longer in pain, I went home feeling suddenly starving, and forced down a bowl of cereal before going to bed. Such was my relief that I abjured entertaining violent thoughts towards my former dentist. The last time I saw him I did remark that I had occasional pain in the area of my crowned tooth. He took an x-ray (for which he provocatively charged me as a private patient, despite being a nominal NHS dentist). He advised that the x-ray showed nothing amiss – curious then that a similar x-ray two years later effortlessly exposed his substandard workmanship. I recall that surgeons in ancient Egypt faced death if their patients died on them: what torment should a negligent dentist endure?

I can tell you that the anaesthetic wore off at 2am Saturday morning, when I awoke in some new pit of agony. Dante perhaps was right, that there is no greater sorrow than the remembrance of former joys in present (and everlasting) misery; I would add that there are few torments more atrocious than the recurrence of a torment formerly overcome (I know, I have watched the Matrix trilogy). Dante put those words in the mouth of Francesca da Rimini, damned to the black whirlwinds of the second circle of Hell for adultery with her brother-in-law (damned alongside her, but too busy weeping to add anything to his beloved’s tale). For the sake of justice I am happy to report that their murderer was earmarked for the ninth circle of Hell, where Dante condemned traitors (by ‘virtue’ of killing his brother and his wife, he was guilty of treason to his kin). I make this learned digression simply to mention that those damned to this first zone of the last circle of Hell were encased to the neck in ice (Dante found that nine circles, albeit subdivided in some cases, were sufficient to house the sum total of the damned; Dante was of course writing some 600 years before Val Lehman). The lovely poet goes on to tells us that some of the ice-encased damned were so cold that their ears had fallen off (lack of circulation, I expect), and that the chattering of frozen teeth made music like the song of the stork. I am guessing from the lack of odes to its beauty that stork-song is not noted for its plangent grace, and that the sound was therefore displeasing to Dante’s ears (in which case those with no remaining ears should have counted their blessings). But I am now talking utter bollocks. What I was trying to say was that even those frozen from the neck down in Dante’s Hell, whose ears had been seared off by frostbite, remained conspicuous by their chattering teeth. Thus, with all physical sensation chilled from my body, would I still be able to feel this fucking pain in my jaw.

I still tried, however, with an impromptu ice pack clamped to my mouth, but when the melting ice began to trickle down my neck I thought, ‘Bollocks to this,’ and sought an alternative. Happily I could remember where I last saw my pliers (for some reason that my subconscious has yet to define, they sit more or less permanently on my cherished box set of Beethoven’s 32 piano sonatas). Grabbing them, I stormed to the bathroom like one possessed, glared scathingly in the mirror, opened wide, and without even rinsing the pliers I proceeded to apply them to the offending crown. I had calculated neither the strength nor time required to wrench out a tooth (least of all an artificial one); all I knew was that the pain would be a blessing to what now I suffered. Sadly the clatter of metal against enamel grated on me somewhat, and after a few angry tugs I gave up and stormed to the kitchen. In the (lovely new) fridge were the dregs of a cocktail I’d made the other day: equal measures (i.e. lots) of tequila and white rum, steeped for days with one whole lemon (quartered). Ordinarily a most uplifting tincture – but would it rise to the demand of clarifying consciousness into oblivion?

I have never been one to seek oblivion through alcohol – far too clichéd, and also lazily redundant given the other options so easily at hand. I poured the cocktail into a glass, reached for my bedside bottle of temazepam, and shook two pills into my hand. Under normal circumstances half a tablet is quite capable of easing me to sleep. Under these extraordinary circumstances four times that quantity was the least I’d need. I necked the pills; I necked the tequila and rum. I went to bed. The absence of further memories of tortured struggle indicates that I fell asleep quite soon, although I awoke before 9am in much the same pain.

I wonder that, despite the opulent vocabulary that ever enriches my melancholia, I am stumped when it comes to an adequate description of dental pain. An ache is by definition a dull pain; an ache can be tolerated. The term toothache is therefore either a self-deprecating understatement, or (like headache) an ignorant slight. A person does not carve glass into his arm to distract himself from a simple ache.

I rose, showered, dressed, and stamped to the nearest pharmacy to collect my prescription. 1.5 grams of amoxicillin for 7 days… wondering if I could match it with equal measures of temazepam, I spent the day largely immobile on the sofa. I needed to conserve my strength, as that evening I was going out to dinner with Susan, Michael, Julie and Jason. It was a double celebration, for Susan’s Marathon efforts and Jason’s forthcoming birthday, so I did not want to miss it. I figured I’d be pissed off if someone cancelled on me because of toothache, so I soldiered over to Susan’s, only just getting there in time for the cab. I had told Susan the day before that I was feeling crook, and clearly I now looked it, as she asked if I wanted to go home. I feebly insisted that I’d be okay, and that something to eat would do me good; I did however add that I probably wouldn’t want to go on anywhere else after the meal (save perhaps a morgue).

We arrived at Brown’s of Windsor, which not surprisingly for a Saturday evening was heaving. As we waded through the throng to the bar, I began to feel suffocated. What was worse: the unceasing chatter of traitors’ teeth, or the deafening clamour of small talk in a jam-packed bar?

By the time I had a long glass of G&T in my hand I was positively feverish. I dashed to the toilet, convinced I was going to throw up, but after a splash of cold water to the face I returned to my gin. As a measure of how ill I was, I sipped my drink slowly – normally my first gin is down my neck in two minutes. Julie commented on how pale I looked, and felt my brow (motherhood had made her good at such things), and both she and Susan asked if I wanted to go home. I don’t think they’d have minded at all if I did, but I again insisted that I wanted to eat something. However for my next drink I chose coke (with no vodka – can you imagine?), and when we got to our table I was happy with water.

It would actually have been a great evening if I hadn’t been racked with agony. I say ‘great evening’, inasmuch as it being memorable for its mishaps: Michael and Jason’s starters were cold, so they sent them back, only to find the kitchen had run out (I think they had mussels), so would they like to choose another? By the time they got their second choice the rest of us had more or less finished ours. Then our main meals came – except Jason’s. The waitress apologetically advised that they had also run out of whatever it was he’d ordered. He was understandably fractious, pointing out that they’d been happy to take his order, and had only advised that it was unavailable once they’d already brought everyone else’s meals. Smooth-tongued Michael convinced the waitress that we’d be more inclined to acquiesce if they got us another bottle of his favourite red (@ £37) on the house. Jason then received his second choice – steak – so quickly that it must have been already cooked and waiting. Julie also had steak, and hers looked so pink and tender that I’d have killed to be able to sink my teeth into it. However my teeth were in no position to sink into anything – I had the fish and chips, which was very good (and came complete with a pot of puréed peas (mushy peas to anyone else)). Eating did me good, and I managed ice cream too, but eventually the mechanism of jaw action took its toll, and by the end of the evening my tooth was killing me. We then had the fun of the bill - they had indeed given us the second bottle of red for free, plus Michael and Jason's starters, but we also insisted that they take off the price of Jason’s main meal too, which they did. So in effect we had two starters, a main meal and an expensive wine for nothing. Even this victory could barely raise my spirits, and I’m usually the sort of person who gloats to distraction if given five pence more change than was owed.

Susan and Michael did not want to go home yet; I on the other hand could be as unsociable as I liked. We had already booked (and more importantly paid for) a return cab to Uxbridge, so I said my goodbyes and made use of it. I went straight to bed when I got home. It wasn’t cold, but I was shivering (even at the time my spasmodic trembles struck me as comical). I then slept, only to wake feeling roasting hot. So passed the next eighteen hours, alternately cold and hot and feverish. Deeply unpleasant though it was, the fever did signal a turning point, as the pain was definitely lessening – had the antibiotics deigned to do something at last? Or maybe, I told myself, the infection had rotted through the nerve in my jaw, and I could no longer register the true calibre of my sufferings. As if to bear out my speculation, not only did my bottom lip feel cold and numb, but I noticed on Sunday evening (when I had attained a sufficient level of consciousness to gaze in a mirror) that my jaw had swollen up, hamster-style. Shrugging, I conceded that permanent facial disfigurement was no big deal if the pain had abated.

I managed to watch telly for a bit before returning to bed. I think that day I can’t have been awake more than 4 hours. By Monday morning I was still a tad feverish, but relatively pain-free. I found that if I stayed immobile I was perfectly equable; any protracted movement did induce dizziness and nausea, so I confined myself to my sick chamber for three days. A diet of Kate Bush and Chopin possibly threatened to elevate my fever into an elysian delirium, so I also watched old episodes of House in order to ground myself a little. With great fortitude I managed not to self-diagnose lupus or cerebral malaria; I didn’t even crave some of the esteemed doctor’s Vicodin.

Contrary to the words of the poet, fever is not in fact “a lovely way to burn”. When applied metaphorically, fever is taken as a state of intense, restless passion. Am I to believe that such imagery is entirely fallacious? When applied literally, fever is a state of feeling like shit 24/7, of having to go back to bed after the mammoth excursion of a walk to the shops, of sterile, mocking debility. So yes, the notion of fever as a state of nervous excitement is more than a little out of touch.

One upside to fever (besides the opportunity it gives me to elaborate on new depths of lassitude) is its rapacious infection of dream sleep. True, high doses of temazepam can also cause ‘vivid dreams’, but with a ten-year habit under my belt I am long since impervious to any such side effects. Suffice to say that my febrile nights have given rise to some of the bizarrest dreams of my life. Only last night I saw Patsy Palmer in a nightclub (I can report that she is a lot taller, and much better looking, in ‘real’ life). In another dream I was minding my own business doing the dishes when a host of people suddenly stepped out from a theatre somehow adjoining the kitchen (how very Jamie and the Magic Torch). I was hastily taken to one side, instructed to behave, and introduced to some vile WI-style hoity-toity harridans. Several of them seized upon the monstrous truth that I had longer nails than theirs. “I don’t like men with fingernails,” one protested, as though my very presence threatened to implode her universe. I was about to comment on her patently false and over-varnished nails, when another lady declared that the name Simon was very plain, and demanded to know what was my preferred boy’s name. I raised my eyebrows and answered, “Ba’al.” This led to something of a clamour, and a freakishly tall, half-baked woman tottered forwards. She was wearing a sandwich-board emblazoned with a slogan to the effect that Ba’al was responsible for Attila’s “ninja hordes” marauding Europe. I was about to point out that her conflation of all pagan peoples into one spurious enemy was insufferably stupid, when consciousness struck, and dispelled the sorry scene.

In yet another outpouring of my heat-oppressed brain, I found myself re-reading Crime and Punishment, only to get half way through and realise that he still hadn’t killed anyone. Instead, the book was about my own concern at finding a suitable bookcase. Hmm. Crime and Punishment is central to my psychological development, so its appearance in a dream gives me free rein to engage in reprehensibly overwrought speculation. Not only was the book my introduction to Dostoyevsky; I also began reading it at 3am one morning while under the then novel thrall of Prozac-fuelled insomnia. By the early hours I had reached page 100, and grew alarmingly suspicious that Raskolnikov’s restless, obsessive neurosis was a mirror of my own. I put down the book, and it took two years to rouse the courage to read any more. During that period I did not murder once, let alone twice, so I am able to conclude that any similarity between me and Dostoyevsky’s protagonist was purely incidental.

When Caligula finally awoke from a near-fatal fever in the first year of his reign as third Emperor of Rome, it is said by some commentators that he awoke minus his sanity, and so began the more colourful period of his empery. When the worst of my fever was over, it could be commented that I became equally injudicious, insofar as I returned to work on the Thursday (i.e. one week on from the infection flaring up). I finished the antibiotics the following day, and still felt a tad crappy (although the pain and swelling were a lot better). Over the weekend I began feeling even more tired and listless than usual, sleeping for ten hours at a time and feeling once more headachy and feverish upon waking. On Sunday I began to find it painful to urinate (surely the amoxicillin would have cleared up any lingering syphilis?). On Monday it was worse, but it wasn't till the afternoon (by which time I needed to go about every ten minutes) that I noticed that the burning pain on urination was colourfully illustrated by the presence of blood and pus: one would have been sufficient; both made me feel greedy. Once upon a time the sight of my own sweet blood was a balm to my anxiety; now it proved remarkably less encouraging.

I phoned NHS Direct, who were surprisingly helpful and said I had all the signs of a urinary tract infection (what a relief – I thought I might have been menstruating). The nurse recommended that I see my GP asap; of course I had already tried my GP, only to be told the earliest ‘urgent’ appointment was on Friday (i.e. 4 days hence). I refrained from insisting that pissing blood might not necessarily wait till then – not so much from gentlemanly decorum as the likelihood of such a statement cutting no ice with the care professional to whom I was speaking.

The NHS Direct nurse had asked if I had pains in the side/lower back, which would indicate that the infection had contaminated my kidneys. I reported that I had no such pain (the malaise of tedium vitae is a less localised ache). No prizes for guessing that within half an hour I had aches down my back, below my ribs, and round the pelvis. I was also getting shaky and feverish, and so rather than waiting four days for an urgent appointment I took myself to A&E.

Aside from the obligatory Vicky Pollard mother and daughter, it was actually a painless experience – they have tarted up the A&E unit at Hillingdon Hospital, complete with fake palm trees (all that was missing was a water feature, which in my condition would have been quite unfortunate). Ever the consummate administrator, I furnished the hospital receptionist with a sheet of paper listing the obligatory next of kin, address of GP, recent drug use etc. She was taken aback and asked whence I had got such a document – from my GP perhaps? I would have laughed derisively, but a frown had to suffice. Clearly patients with a modicum of common sense were intruders here.

I was seen within the hour. I had been troubled that my urine was no longer blushing with blood and pus (maybe the bacteria had burnt it all up?); my fears were swiftly allayed when the effervescent sample I provided revealed "a very strong bladder infection". I was packed off with 5 days of strong antibiotics (or rather antibacterials, not that I care for such pedantry), and the advice that if I had indeed waited till Friday it would most likely have enveloped my kidneys. Happy days.

As euphemisms go, ‘water infection’ is audaciously namby-pamby: the very word water effectively dilutes the real issue. Discussion of genitourinary disease is of course fraught with peril in our repressed and prudish milieu, which probably goes someway towards explaining why I drew such happiness from telling anyone who would listen that I was pissing blood and pus. It did occur to me that some might unkindly ascribe my ailment to amorous misadventures – but who am I to tear down another’s fantasies?

This does lead me to ponder what then is the true source of my malady. The A&E medic was concerned solely with diagnosing and treating the cause of my bloody piss. How I contracted such a sudden infection was neither here nor there. I would think it unlikely that a dental infection would scamper down to my bladder; at any rate, would it not lay waste (no pun intended) to anything en route?

So here I am again confined to sickbay. I now have the alternately rapturous and funereal (but always deafening) splendours of Wagner to medicate my mind. Parsifal was an inspired choice, given that the character of Amfortas sings a most splendid (eight-minute) lament on the chronic agonies of his (spear-inflicted) wound. Indeed he tells us that there can be no cessation to his pain, for the fevered blood of sin is ever renewed from the fount of longing. It was precisely such pseudo-theological mumbo jumbo that led the inestimable Nietzsche to break rank with his former hero Wagner.

Inflexible

Without wishing to spoil the ending, I must state at the outset that my recent endoscopy was quite possibly the single most hideous physical experience of my life. The actual procedure only took a few minutes, but as always there was plenty of waiting around before and after (as is standard with the NHS). I was aware that prior to the procedure (which they were at pains to stress is one of the simplest medical procedures around) there was the option of being sedated. I need hardly add that I would ordinarily leap at the chance for a free shot of tranquilliser, but they only give it if you have a 'responsible adult' to collect you, as it doesn't fully wear off for 24 hours (pah, even when temazied-up I am more responsible than most adults I know). Sadly I had only booked the morning off work, and as it was the first working day of 2008 I didn't want to roll in high on jellies. With hindsight it is always wise to dampen the nerves with a tranquilliser when facing all the jovial small talk and insincere expressions of interest in our festive experiences that inevitably assail us on a first day back.

Noting to myself that it was not and never would be my new year's resolution to cut down on drugs (this was a one and only exception), I bravely opted for the anaesthetic spray in the throat. After all, I thought, they keep telling me how quick and simple it all is, and the tube is but a "thin and flexible" little thing.

Hmm. If I say the anaesthetic spray tasted like sour whisky crossed with mouldy banana, you'll understand how lovely it was. I then had to lie on my side - however by this time I had already seen the 'tube'... It may well be a tiny camera, but the tube it is attached to is like a bloody garden hose - seriously. So I wasn't feeling particularly relaxed when they gave me a mouth-guard to bite on, and fed the tube down my neck. "Keep swallowing, and breathe through your nose," they advised. Well d'uh – I could hardly breathe through anything else. After almost vomiting about four times I was fine, other than the constant sensation of being choked (maybe a turn-on for some gentlemen, but sadly not for me). As an added bonus, they have to pass air into the stomach to inflate it so they can get a better look around – with the result that I was belching like a navvy (which is quite difficult when your throat is being wedged open). They took a biopsy of my stomach lining, as it was looking inflamed (nothing to do with the vat of alcohol consumed over the holidays). The tube was then removed. I was rewarded for being a brave little soldier with a cup of tea and three biscuits (having been expressly forbidden food and drink since midnight), and had to wait to be discharged. Astonishingly for hospital tea, it was actually a nice cuppa (I did specifically request a strong one – you should see the insipid gnat's piss they gave my nan (now finally free from hospital after 3 months…)). Speaking of nans, practically every other patient was about 80, so it was lovely to swap medical stories while waiting to drop dead. Finally I was summoned to discuss my results - everything looked fine, indeed so unexceptional that they didn't even take a photo of my stomach lining to show me (I was hoping to get it all on DVD).

The next day I had to phone to check the initial results: I was advised that the test for bacterial infection was negative (this was the most likely cause of my nausea). There are apparently no signs of anything sinister, so (like everything, it seems) it's all in my mind… Or maybe not. For a week later I had a follow-on appointment with my GP, who cheerily advised that the hospital had written to him to say that my results were positive for a gastric infection. Hmm. I explained that they had said the exact opposite to me; he didn’t seem too surprised at the cock-up. I therefore had to phone the hospital to ask them to re-check. The person I spoke to was particularly unimpressed when I pointed out that they had clearly made a mistake; she merely confirmed that the result was negative, and expected me to leave it at that. They are supposedly going to write to my GP with the correct results, but who knows? You would hope a hospital would take particular care in differentiating between positive and negative results, but maybe I’m just too picky.

Bilious

Fans of my work will recall the intolerable dolour I endured last summer vis-à-vis a simple blood test and x-ray that seemed to span the best part of a day. While the blood test indicated that I was in rude good health (liver and kidneys doing fine, despite years of lacing gin with sleeping pills), my nausea persisted. Was it all in the mind? Certainly the loss of appetite and resultant weight loss could suggest an incipient anorexia (provoked, perhaps, by vicious slurs that I was getting a pot belly?). Let those who say I am a bitter man take heed, for I happily descry the silver lining to this cloud: whether it be through nausea or anorexia, I lost a stone and a half, and for that I am thankful.

As the symptoms persisted with no known physical cause, I was ultimately rewarded with a referral to the hospital. I say ‘ultimately’ because if the cause of my irritated stomach had in fact been a cancer of the upper digestive tract it would have killed me by then (stomach cancer is a commendably ruthless and efficient killer). Much to my perturbation I was invited to an appointment not at Hillingdon Hospital (10 minutes walk away) but to the wilds of Mount Vernon. The place is not so much a unified hospital as a scattering of half-derelict buildings on a maze of a site. I therefore set off in good time, with a book of Russian short stories to maintain the necessary morbid mood. I arrived early, and had the foresight to enter the grounds by the one entrance that was actually in proximity to the building I was to attend.

Once I had climbed the solitary stairs to the clinic I was relieved of the bottle of piss I had been obliged to stow in my bag. I didn’t have to wait too long before the specialist was ready to see me. He was an Hispanic gentleman, and could therefore not pronounce nausea. There was a bit of the same old same old: yes, sudden weight loss is a worry, blah blah; I was a little unimpressed when he then asked if I could explain the loss of weight and appetite (um, isn’t that his job?). Was I, he pursued, under any great stress? As a lifetime of profound existential malaise had not made me perpetually queasy, it was fair to deduce that any other ennui could not on its own sicken me so wholly.

In order to rule out a few things, a blood test would be necessary, he advised. I blithely noted that I had had a blood test a few months back, and that the results were embarrassingly ordinary. He looked on his computer for corroboration of these results, and you’ll never guess what?

So, with my last results lost, deleted, or never even added to my records, I was obliged to have more blood drawn. The doctor said he would also refer me for an endoscopy, just to see what’s occurring; to further the pretence of actually taking me seriously, he also wrote a prescription for omeprazole. An anti-ulcer drug eh? Despite me having no symptoms of an ulcer.

I took myself to the blood-letting clinic at Mount Vernon (located in another of the disparate outhouses). In stark contrast to my ordeal at Hillingdon, here there was not a single soul in the waiting room. Even so I obligingly took a ticket and waited (the phlebotomist was in the blood-room talking loudly on the phone – a personal call too, from what I could gather, although in the absence of patients he probably had little else to do). I was summoned after a short delay. As a left-hander I am always heartened when blood-letters invariably go for the right arm (do they think blood is better on that side?). However I too had been going for my right arm of late, and had little inclination to share my scars with a stranger. I therefore proffered my mighty left arm, and won great praise for the robustness of my artery: “I wouldn’t be very good at my job if I missed that!” I wondered if it was a desolate chat-up line; however I wondered more what I could achieve if I were ambidextrous.

That done, I wandered the darkling grounds (has anyone since Keats used the word darkling?) in search of the hospital pharmacy. With hindsight I should have dropped off the prescription, then had my blood let, and then returned to pick up the drugs. As it was, the pharmacy lumbered me with the longest wait of the day (half an hour at least): I could have offered to pick the pills myself, but proximity to so much codeine is not always a good thing.

So concluded my first appointment at the Endoscopy Clinic. Dare you read of the second?

I will have blood

I am in blood
Stepped in so far that, should I wade no more,
Returning were as tedious as go o'er.

Macbeth

Next time I need a blood test, remind me to stab myself over a Tupperware bowl and convey said container of my vital fluid direct to the lab. Little did I realise how much life could be expended in the simple taking of a test. More fool me for reporting to my GP not only with protracted nausea but also a crook knee. Nausea is of course a notoriously vague condition, a symptom of practically any illness, a side effect of any number of medications, a by-product of a heat-oppressed brain as well as a reaction to a disagreeable food. So first things first: get a blood test to rule out a few potential suspects. And why not, while at the hospital, get an x-ray too, of the aforesaid crook knee? What could be simpler? Hah.

I arrived at the hospital promptly at 9am to find the waiting room already almost full. Pouting, I took my ticket, and was not best pleased to find some 40 people ahead of me. However I consulted the ineffectual guide that is experience, and told myself that in former times the wait was never too intolerable, and with a team of three bloodletters (as was usually the case) it should not take too long to whittle down the queue. Hah. Someone sitting near me grumbled that they’d been in yesterday, and it was even worse, so they gave up and came back today. It was mystifying that the few people called in to the bleeding room stayed there for an age. How long does it take to prick an arm? Were patients being bled to death? Were bodysnatchers at work?

Equipped with at least a modicum of foresight, I had brought with me Dickens’ Dombey and Son, and so was able to immerse myself in the domestic travails of Florence and Edith. With most unfortunate timing, however, Mr Dickens opted to conduct the reader into a digressive indictment of the manifold ills of human society. I had little stomach to swallow the metaphor of the “poisoned fountains that flow into our hospitals and lazar-houses,” and so I put down my book and sank deeper into my chair.

Time ticked along with its usual brazen indifference, and still the flow of patients was more a turgid sewer than the required steady stream. The interminable wait reminded me of an airport departure lounge – but at least when one knows one has nothing to do but sit and fester for six hours before boarding a plane, one can hibernate a little. Here, with no indication as to the cause of the prodigious delay, one was left to entertain all manner of unhelpful meditations on the arbitrary waste of endeavour. Had I not been heartsick when I stepped into that place, I assuredly was when I left.

Some two and a half hours elapsed before my number came up. How I pitied the elderly couple sitting next to me, who had some fifty or so people ahead of them. In the bleeding room I observed three staff, but two were occupied with other things, and I soon surmised that the creature working the needles was being trained (poorly). Given that the blood was thundering through my angry veins, I was taken aback at the slowness with which he managed to extract a single sample. Even so, the procedure could not have lasted more than two minutes, which left me all the more befuddled at how it was taking an average of four minutes per patient. Far be it from me to tell halfwits how to do their jobs, but surely it wouldn’t have stretched the other two staff too sorely to help out with the odd bleeder, just to reduce the abominable delay by a fraction?

After such a wait I knew I would be satisfied with nothing less than a diagnosis of haemorrhagic fever. Detesting all humanity, I prowled the corridors to radiology. The waiting room was neither as large nor as full as that for blood. I took a seat and observed the receptionist examining her split ends. The exactness and attention with which she did so augured well, I hoped, for the competence of the medical staff. Hah.

Forgive my unkindness, but the first radiologist to show its face (and a very greasy face at that) resembled a retarded Dawn French. I was relieved when she did not call my name, and attempted to settle back into Dickens. However the mental stagnation so capably harnessed in all such waiting rooms soon reduced me to nodding my head in weak dismay. There was at least a greater sense of camaraderie among the hostages than in the blood room: one after one people began voicing their dissatisfaction at the protracted delay. Staff would wander through, and chat to each other, oblivious to the seething unease before them. A few people got up to avail themselves of a ‘patient feedback form’ and so alleviated their malaise with a dose of regulated hatred. The folly of an Irishman using his mobile phone in the x-ray department (well d’uh) provided scant relief.

Ninety minutes elapsed before a different receptionist (the other having sloped off to examine her hair in greater detail) apologetically advised us that they were very short-staffed, but that someone from another department would be along shortly to assist. And indeed this welcome auxiliary called my name and escorted me to the big machine. Two x-rays later I was asked to wait once more, while she ascertained whether there were any major complications to my hobbled kneecap. Apparently there were not, as after a mercifully brief pause I was told to see my GP in a week and begone. Never have I left a building with such haste.

As an incentive to steer clear of hospitals at every cost (dying slowly in a pool of one’s own pus now seems preferable) the experience proved a tremendous success.