Every Third Thought

  For my daughters

  Alice and Isobel

  ‘Every third thought shall be my grave.’

  William Shakespeare, The Tempest

  Contents

  Introduction

  1. A Matter of Life and Death

  2. Injury Time

  3. Forever Young?

  4. I – Me – Mine

  5. The Skull of Man

  6. Silly of Me

  7. Losing the Plot

  8. Do No Harm

  9. Astride of a Grave

  10. The Will to Live

  11. The Person Who Was Ill

  12. Where Are We Going?

  13. The Good Death

  14. The Necessity of Dying

  15. Last Words

  16. One Foot in the Grave

  17. Staring at the Sun

  18. The Dying of the Light

  19. The Nowness of Everything

  20. A Month in the Country

  Bibliography

  Chapter Notes

  Acknowledgements

  Introduction

  ‘Every day, you get older. Now that’s a law.’

  William Goldman,

  Butch Cassidy & the Sundance Kid

  No one will ever know exactly what happened inside my head on the night of 28 July 1995, but probably it went something like this. First, for reasons that remain mysterious, a surreptitious clot began to form in one of my cerebral arteries, cutting off the blood supply to part of the one organ in the body that, after the heart, is most greedy for blood. Eventually, perhaps some hours later, like a breaking dam, the clot burst into the right side of my brain, causing an uncontrolled ‘bleed’ that would achieve irreversible destruction of cerebral tissue deep inside my head, in the part of the cortex known as the basal ganglia.

  My first reaction, when I came round in University College Hospital, drifting in and out of consciousness, was a kind of weird exhilaration. I had no idea about what had happened to me, but whatever it was, I seemed to have survived. Lying naked under a pink blanket in the intensive-care unit, wired up to the monitors, I was aware of being in the antechamber to the grave. Even now, years later, I can still recall the eerie fascination of this experience and of having, by great good fortune, returned to tell the tale.

  Physically speaking, I’d been poleaxed. My left leg was paralysed, and my left arm hung from its socket like a dead rabbit; the left side of my face, which drooped badly for about ten days, felt frozen, as if my dentist had just given it a massive novocaine injection. I could not stand upright, or even think of getting out of bed; besides, my penis was attached to a Convene, a condom-like device that drained my urine into a plastic bag. My speech was slurred; every few hours, a team of three nurses would turn me over in bed, as if I was a slow-cooking roast. In place of pain – I was never in any pain – there was a hallucinatory sense of detachment, as if I was outside myself, looking in.

  I felt then, and still feel some twenty-one years later, a powerful need to explore the consequences, and perhaps the meaning, of this very close call. In the words of the philosopher Wittgenstein, ‘How small a thought it takes to make a life.’ The event that I was learning to call ‘my stroke’ was an emergency that would not only transform my life, but also change my thoughts about death and dying for ever.

  As the great American transcendentalist Henry Thoreau puts it: ‘Things do not change. We change.’

  1

  A MATTER OF LIFE AND DEATH

  ‘No man is an island, entire of itself; every man is a piece of the Continent, a part of the main; if a clod be washed away by the Sea, Europe is the less, as well as if a Promontory were, as well as if a Manor of thy friend’s, or of thine own were; any man’s death diminishes me, because I am involved in Mankind.’

  John Donne, Meditation 17, Devotions Upon Emergent Occasions

  Ever since I fell dramatically ill one night in July 1995, I have found myself in the shadow of death. From the moment I woke on that distant summer morning, I have been an involuntary citizen of a world I have had to learn to live in, and be at peace with.

  Thankfully, within a year,∗ I was on the road to some kind of physical recovery. In my head I could never go back to my old self. In darker moments, I would mourn a former life. Now, each day is a reminder of human frailty. Getting out of bed each morning will always seem like an in-house memo about my fate. How and when will it happen again? That’s another mystery for which no one has a satisfactory answer.

  As a lucky survivor, for more than twenty years, I’ve been living with the apprehension of mortality. To put this another way, at least half my adult life has been spent in the psychological equivalent of A&E. What follows is a book I don’t have much choice about: it comes from the heart.

  Matters of life and death are my special subject. As you will discover in the pages that follow, I have developed an affinity for conversations with brain specialists and their patients. My survival after 1995 has had this profound and long-lasting consequence with which I’ve had to come to terms: for better or worse, I am a lightning rod for the unwell. Strangers tell me about their sufferings and demons. But few things are ever quite as bad as we fear. This experience has introduced me to many sad cohorts of distress. It has also come with some rare blessings too.

  On the dark side, however, you would have to be made of stone not to be moved by many stories from the front line of ill-health. Here is an extract from a letter I received soon after I came out of hospital in 1996: ‘We, too, have become inhabitants of the world of pain. Our lovely daughter was diagnosed with leukemia. A year ago, she suffered a stroke, contracted a serious infection and died of pneumonia.’ The letter goes on, ‘Now we are living in hell . . . I feel that I’ll never be happy again. There is nothing to look forward to.’

  As a long-term convalescent, I habitually encounter people talking about their illnesses, their breakdowns, crises, and bereavements. Sometimes, a hurt shared becomes a wound soothed. Perhaps this runs in the family. My mother, Christine, a resilient eighty-something, is a seasoned Cambridge grief-counsellor. She specializes in collecting poetry and prose suitable for funerals.

  Recently, I went to two burial services on successive mornings, and was reminded that, in my early sixties, I am no longer a spring chicken. Where strangers used to share their experiences of death and dying, now it’s friends who confide their anxieties about the ageing process. Suddenly, everyone is having that ‘third thought’. As one of my fellow mourners said, as she turned in greeting from the pew in front, ‘It’s funerals now, not weddings.’

  To some baby-boomers, this is unwelcome news. Since the Second World War, biochemical research has excelled in defying the odds against us with discoveries like the structure of the ‘double helix’, DNA – the molecule of life. In so doing, medical science has sometimes seemed to persuade itself, and many of its patients, that our traditional encounter with decrepitude, infirmity and death can be almost indefinitely postponed.

  At the same time, those post-war generations, in quest of self-fulfilment, have become complicit with a fantasy of immortality whose cruel outcome can sometimes be a yet more terrible endgame. The novelist Martin Amis once observed that, after the age of about sixty, whenever we think about the lives we have always taken for granted, we are obliged to concede that, in his words, ‘This is not going to end well.’

  Every Third Thought takes inspiration from my particular experience, but it’s also a response to an immutable predicament. A self-assured generation, which has lived so well for so long, is having to come to terms with a complex but universal truth: make peace with death and dying, or find the inhibitions of everyday life in your final years becoming a special kind of torment.

  The baby
-boomers’ response to this predicament (as one of them, I can recognize this) has been to put our heads on one side, look puzzled, drag on a cigarette, and say something like, ‘We seem to have a bit of a problem.’

  To which any rational person might respond: ‘What sort of a problem?’

  Baby-boomer: ‘That’s what we’re working on.’

  Rational Person: ‘What, precisely, are you working on?’

  BB: ‘The problem.’

  RP: ‘The problem you can’t begin to let yourself define or acknowledge?’

  BB: ‘I wouldn’t put it like that.’

  RP: ‘Well – how would you put it?’

  BB: ‘Well – like I just said – that we do have a problem.’

  RP: ‘And so . . . ?’

  BB: ‘You have to admit, that’s a start.’

  Etc.

  This book reminds anyone who has lived as if they were immortal that there are no privileges or exemptions – no backstage passes. The remorseless passage of time, and the unwelcome intrusion of physical frailty, must finally confront everyone with the same inevitable reckoning. The endgame is also about finding late-life criteria for day-to-day conduct, and becoming reconciled to the loss of early-life ambitions. You might feel thirty-five, but it makes sense to behave as if you are actually closer to seventy.

  This ‘Endgame’ is rather like that award-winning feature film we’ve heard about by word of mouth. Our experience of it, before a final showing, occurs in the mundane sequence of trailers – episodes of sickness, infirmity and physical breakdown – released in advance of the main feature. However, after this Coming Shortly, we find our appetite for the movie falling off. In fact, we’d prefer to postpone it. Fat chance. Inexorably, when ‘The Endgame’ gets screened, we shall be in the audience.

  So, welcome to my world. A word of warning: I am going to take you, the reader, on a journey down a one-way street towards an inevitable destination that remains as mysterious and terrifying as it is well known. To me, this juxtaposition of fear and familiarity, where life and death are braided together, is in the nature of being. My personal history means that I see the skull beneath the skin and the encroachments of oblivion. This is not macabre. I am at peace with any expression of this fundamental truth: the human animal, uniquely, knows that it is born to age and die.

  To elucidate this sometimes baffling mystery, I have turned to some favourite texts. In doing so, I acknowledge two things: first, that words, which can be so comforting, are rarely the equal of reality; but secondly, that language can build a bridge towards a better understanding of a fateful prospect. Or, to put this in grander terms, that culture can be the medium through which we become reconciled to the incipient darkness that crowds the margins of everyday life. Empathy might be one key to a necessary rapprochement with the terrors of imminent oblivion, just as personal candour will help to make peace with threats of extinction.

  The human condition has proved strangely resistant to modification. Despite the extraordinary progress of medicine, especially in neurology, and despite the many safeguards we have built into the way we conduct our everyday lives, we are still in the timeless world of our ancestors. To the Anglo-Saxons who settled Britain during the fifth century ad, after the Roman legions had departed, life was characterized by their poets as a sparrow fluttering out of the storm into the brightly lit mead hall, circling through the laughter and smoke for a moment, before disappearing once more into the dark.

  Sometimes, when I reflect on the vicissitudes of my adult life, I sense that darkness just beyond the window. Then I feel grateful to be still alive, in the warmth and light of summer, out of the storm, with just the first chill of autumn in the air to provoke a sense of excitement at the times to come. For many, these can be good years. The experience of crossing the frontier into those final decades can be liberating and uplifting, with the added thrill of a deadline. Sixty, they will say, is the new forty. Actually, sixty is still the old sixty.

  In her essay ‘Considering the Alternative’, Nora Ephron acknowledges, with bracing realism, that ‘it’s sad to be over sixty. The long shadows are everywhere – friends dying and battling illness. A miasma of melancholy hangs there, forcing you to deal with the fact that your life, however happy and successful, has been full of disappointments and mistakes. There are dreams that are never quite going to come true, ambitions that will never quite be realized.’

  It may not yet be the beginning of the end, but it’s unquestionably the end of the beginning. ‘Never send to know for whom the bell tolls,’ wrote John Donne in his neglected masterpiece, Devotions Upon Emergent Occasions, ‘it tolls for thee.’

  An ‘emergent occasion’ can also be a memento mori, as I discovered on 27 June 2014.

  2

  INJURY TIME

  ‘The boundaries which divide Life from Death are at best shadowy and vague. Who shall say where the one ends, and where the other begins?’

  Edgar Allan Poe, The Premature Burial

  It was a fine summer’s day in London when I tripped and fell while crossing the uneven pavement outside a row of shops – an antiques store, a hairdresser, and a twenty-four-hour grocery – in Notting Hill. At one-thirty on a Friday afternoon, I was leaving my weekly session of Pilates/physiotherapy with Dreas Reyneke, a retired dancer from the Ballet Rambert, a man of infinite sympathy, grace, and wisdom, renowned for his healing ways. When I came out of his anonymous black door, I was thinking about going home to shower and change for a long drive to Devon, where I was due to attend a wedding. Three steps later, I was pitched head-long towards the opposite of joy.

  The fall itself – my fall – occurred in an instant, but also in a kind of slo-mo. That old weakness on my left side, the residual deficit from my stroke’s paralysis, had long been a source of vulnerability, and now my worst fears from two decades were coming to pass. My first thought as I hit the kerb with my face was Tintin not Kierkegaard: ‘Oh, *@?%$*!’ Then the menace kicked in: this was what people meant by ‘a fall’, an Anglo-Saxon word that’s as old as the hills, rooted deep in our past, and edged with fear.

  It’s just a tumble to a child, or a pratfall to a clown, but falling is the curse of our later years, and a troubling one, too. The failure of the human frame, even in a fall, is a deep humiliation to our sense of ourselves. In the UK, per annum, about one in three people over the age of sixty-five will thereby break a leg, or a wrist, or, worst of all, a hip. (In America, the figure totals 350,000 per annum; in Britain, every minute, there will be six people over sixty-five suffering a fall.) That fall can be a gateway to incapacity and decrepitude: about 40 per cent of these fallers will end up in a nursing home; 20 per cent may never walk again. Among older people, according to Atul Gawande, in Being Mortal, the risk factors for falling already define our approaching infirmity: poor balance, dependence on prescription medication, and muscle weakness. ‘Elderly people without these risk factors’, says Gawande, ‘have a 12 per cent chance of falling a year. Those with all three risk factors have almost a 100 per cent chance.’

  In khaki shorts and scuffed trainers, it was not until I saw the blood splashed on the pavement as well as on my white T-shirt, and found its sinister metallic taste in my mouth, that I realized how badly I was bleeding from my head. Just a few days before my sixty-first birthday, here was I passing into a new world in which (as I lay full-length on the pavement) concerned passersby were bending over me with ‘Are you all right?’, and a smiley young West Indian woman on a quad bike was phoning for an ambulance.

  ‘We’re at the junction of Kensington Park Road and Pembridge Road . . .’

  While she gave directions, I was groggily getting to my feet, and staunching the flow of blood, gingerly feeling the cuts on my forehead. Mixed with gratitude, my main reaction to this ‘emergent occasion’ was to be massively pissed off. I was bloody, bruised, and disoriented, but otherwise okay. Perhaps I was concussed, but I didn’t think so.

  My next thought was: I do not want to go t
o hospital. (I’ve seen enough of those, thank you.) I want to go home. But then the ambulance arrived, a pantechnicon of rescue, also in slow motion, lumbering into view like one of those cranky Red Cross vehicles from my Fifties childhood. While two paramedics began their first inspection, Time swept me forward on a tide of questions: Date of birth? Profession? Home address? Medical history? And of course they wanted to take my blood pressure. Every medic in the world wants to take your blood pressure. For the record, after years of readings, I’m always Mr Normal: approximately 125/80.

  Now we were inside the ambulance, which was crazily tilted across the kerb, blue lights blinking, and they were radioing back to base about someone I really did not want to know about, ‘a sixty-year-old man with head injuries . . .’ Was that me? I could hardly believe it. But it was. ‘Who,’ I asked myself, ‘who would have thought the old man had so much blood in him?’

  My third thought, as the ambulance with its siren wailing began the short, almost stately, drive to St Mary’s Paddington, was, ‘This is injury time,’ an inevitable prelude to the last exit. By accident, by chance, without warning, and when we least expect it, in a blink between opening a simple black door, and taking three steps into a summer afternoon: This is how we go. Here I was in this NHS ambulance, with old memories roaring into consciousness after a sleep of many years – involuntary panic; helpless weeping; primitive fears on the warpath; and the sense of life itself hanging by a thread.

  Almost twenty years, in fact. Suddenly, I was back in that Islington street on 29 July 1995, taking the emergency route to University College Hospital on the edge of old Bloomsbury. That was on the summer evening of another fine day, and I was just forty-two, speechless and immobilized in the dramatic aftermath of a ‘right hemisphere haemorrhagic infarct’ (a stroke). I can recall looking through the window of another ambulance to watch the weekend world outside: shoppers crowding; cars inching through traffic; people with pints standing outside pubs.