The intensive care unit of a hospital in south-west London, 9.30pm. A vast spaceship dashboard of drug delivery systems is silent, monitors displaying the word ‘Privacy’. I gradually become aware that my father has died.
The relatives and friends gathered dissolve into grief. I look at my father’s body. He looks very dead, but then he has looked dead to me this last week.
I am aware as this is happening that it probably represents the single biggest headfuck and heartfuck of my life, and also that if it were happening in the US, the place of my father’s birth, it would probably be considerably worse.
In the UK, we treat anyone for free. This is why that is important.
The place of Bill’s death is a foundation hospital, a beautiful and calm building with a vast central atrium filled with natural light.
Foreign nationals get free NHS treatment when they’ve been here for a year or otherwise have legal residency. A San Francisco native, Bill landed in London in 1976 (I was born here, a UK citizen, two years later). He had three hip operations and was treated for throat cancer four years ago. “Oh man,” he said last year, “if you were to add up what the NHS has spent on me, it’s phenomenal.”
As a professional gambler, he paid very little tax. He smoked, he drank. He had no will, no funeral plan. He hated forms. Had he stayed in the US, I’m pretty sure he would have no health insurance.
Thursday afternoon, I sit by Bill’s bed. Talk to him, say the nurses, he can probably hear you. I find I’ve got nothing.
An hour by a bed in the ICU is long. I bring some Vonnegut to read to him, but don’t even open it. I just sit.
Late in the evening the doctor comes to talk to me. Bill’s heart is hammering away at 150, 160. The rest is a multi-organ pile-up. “This could go on for days or weeks, but my feeling is that he will pass away tonight.”
So this is how it ends. I am sad, but ready. I go to bed in the snug visitors’ room – the existence of which amazes me – in assurance they will wake me when it’s time. He will cling on for five more days. The notices say ‘a short illness’, but they don’t give any sense of how long and hard that can be.
Now it starts. There are many phone calls, wartime intimacy with people I have met perhaps twice or haven’t seen in 20 years. A sudden, completely different way of being.
Occasionally I sit by Bill’s bed. I don’t do small talk, and wittering away to an unconscious form seems too much like praying. Nor is there any big talk to be had. I hardly know this man. Some fondness and respect, a sense of duty and humanity, are what will keep me here.
There’s nothing to say, so I say nothing. I put my hand over his hand for a bit. The skin is cool. It feels like a small lamb joint. I feel ridiculous. I feel ridiculous.
This is life in hospital. Within 24 hours, it seems like all there is. Exhaustion makes a moron of you. It is a place where intelligent adults sit around trying to figure out the simplest things – dinner plans, how to use a mobile phone – and fail.
You max out, fast. You feel useless to yourself and everyone else. You can’t tie your shoes. You can’t fill in forms. You don’t know what money is. You can’t.
The doctors are amazing – frank, kind, judicious. They negotiate the treatment of an almost-lost cause deftly and delicately, tweaking dosages, consulting, tweaking, considering. They operate within uneven medical and ethical restrictions, balancing responsibilities, managing expectations. They respect life and death equally, and they allow death to take over the second they see that inducing life to continue would be abominable.
They are going to step down the drugs and see if he responds, rises to the challenge of continuing to exist. If not, “we’re not going to jump up and down on his chest”.
This hard slog is eased hugely by the mundane magnificence of the staff, and by the knowledge that all this is free and taken care of and I do not have to bust one precious braincell filling in forms or worrying about finding money to pay for the care of my dying deadbeat dad.
I return to this miraculous fact many times a day, in exactly the same way that I return often to the little visitors’ bedroom, lock the door and curl up on the bed.
Imagine if I had to worry about that stuff. With what, exactly, would I worry about it?
Day whatever in the ICU. Things change minutely. The position of tubes. The dance of side-effects and counter-effects. 167, 168.
You look tired, says a nurse. Have some toast. I decline politely. She badgers me – just one slice. Tea appears. Two slices of toast follow. Little airline pods of butter, and jam. Jam!
The registrar asks how I am. I am drunk on jam. I beam at him over the artificially inflating ribcage of the man who gave me life and then mostly left me to it, and then I swig tea.
This is how you healthcare. It’s care of those clinging to life and care of those spinning in their orbit. There’s no division. At one end, there is a malfunctioning heart, so you give it the right dose of the right drugs. At the other end is an exhausted relative, so you give her toast.
By now I am convinced that the NHS – and I hyperbolise, but only slightly – is the greatest achievement of humankind, the nearest we get to a benevolent deity, a goddamn superhero. It is an imperfect manifestation of a beautiful ideal – free care based on need, free care for all, without judgement, without reservation.
However long this goes on for, they’ll continue throwing resources at this individual and never show a single sheet of figures to any of his relatives. Not because they’ll get anything back, but because this is what the NHS does.
It’s free care for cancer sufferers who smoked, for alcoholics. Free care for American immigrants, for jerks and gents. Free care for absent parents, for guys who tried to try. Free care for the only father I will ever have.
I’ve probably spent no more than a month in the conscious presence of my dad in my life (I don’t think my first year or this last week count), and now there is no more time. They are withdrawing the drugs at last, allowing death to do what it has to do.
Bill dies of heart failure, his skin the colour of sand, his mouth open. One of his tear ducts leaks, because none of this is dramatic or unbelievable enough.
His 22-year-old nephew weeps on my shoulder. The nurses start gently removing tubes. The monitors display ‘Standby’. Standby. I feel nothing. I feel something.
Whatever Bill meant to me as a person (I’m still working that one out), I was overwhelmed with awe and gratitude at the infinite care and gentleness shown him as a human being by the health care system of this country. It is nothing less than life-affirming.
I cannot imagine how any civilised country could do better. I cannot see how any country can be truly civilised without it. If my family and I had had to deal with the vagaries of insurance, forms, debt, I suspect we would have proceeded directly to becoming burdens on the system ourselves. Goddamn it, Joe, you’ve got to be kind.
A longer version of this article originally appeared in Not Safe For Work Corporation (www.nsfwcorp.com)