The art of losing isn’t hard to master…
though it may look like (Write it!) like disaster

Elizabeth Bishop

“Learning from Disaster” is a trip down memory lane, recalling some sad events of my childhood and early adult years that led me on my path to forty years in medicine. The piece comes from my new medical memoir, “Healing by Intent” which is to be published later this year.

     “Do they always die at night?” I query my uncle as we climb the back stairs of the grimy terraced house. It’s three in the morning. I’m fourteen years old and on yet another house call with Uncle Ken, who is the sole doctor for three thousand Yorkshire miners and their families. A flu epidemic has swept the West Riding of Yorkshire this Christmas season of 1957, and the colliers, their lungs already caked with a working lifetime of coal dust, are dying like flies.
      “Pretty much. They seem to wait till everyone else is asleep. Independent types, these miners.”
The brisk walk in the December chill from Uncle’s car to number 23 in the row of coal-black dwellings has awakened me from semi-slumber. I try not to breathe in the pungent fumes of the outhouses that form a jagged line beyond each narrow strip of back yard.
      After our single mother’s death from cancer two years ago, my older sister Jane and I had made the journey from the south to the north of England to live with Auntie Joan and Uncle Ken, my mother’s younger brother. But this was only during our vacations, because we had both stayed on at our boarding schools down south. The alien accents that beset us on our first train journey to Hemsworth, the town that is the hub of Britain’s coalmining industry, has left us with an abiding sense of living on both sides of the ancient north-south divide. We belong neither here nor there.
     My night watches with my uncle over these wasted men have become a ritual whenever I am home from Epsom College, my boys-only school in Surrey’s stockbroker belt. I am all too aware of my uncle’s tacit purpose: to cure me of my resolve to go to medical school—a determination born in me at my mother’s death. My uncle has done his utmost to deter me. He takes special pleasure in harping on my total lack of aptitude for the sciences. An argument to which I have no counter: Greek and Latin are my loves at school; Organic Chemistry and Newton’s Law of Motion remain closed books I have no inkling to open.
     But our nightly vigils utterly fail to weaken my resolve. Not only do I find these families glad of the chance to tell their stoical tales of woe, but something often springs free in my uncle too. He has always been a gifted storyteller and, having little else to offer but his presence at these bedsides, he seems to take comfort in memories of other visits, and the intimacies that have grown up over the years between him and these dour Northerners.
     “Most of them I delivered too,” he tells me. “Cradle to grave I’ve known this one. Breech delivery, he was. Got a scar under there from my forceps.”
     “Was that at night, too?”
     “Yes. Midwifery’s mostly night work. Funny thing that, about births and deaths. Afternoon naps have saved my life. And they’re almost always born at home. I hardly send a one to the Infirmary. Tough as nails, these womenfolk. They’ll labor fifteen, twenty hours before they even call me. They keep the pubs open for the men. The grandmas—they’re almost all widows— deliver more than a few. They’ll often have the placenta waiting in the kitchen sink when I get there. They know I have to check it’s intact.”
      He recalls his first week of practice, the pithead bell peeling the end of the day shift. The tramp of coal-black men: an army marching down the steep cobbles, wheeling off one-by-one at each narrow front door.
     “They strip naked on the stoop, all weathers, scrub off the coal dust with a bar of caustic lye soap and a basin of ice-cold water the wives leave out for them. Their womenfolk don’t let them in till they’re spotless.”
     We are back at another bedside later that week. Though the man is barely the wrong side of forty, he looks more like seventy. At first sight I think he’s already dead, his breathing so shallow in the gloom I can barely detect his chest moving. I tune into the short sharp talk between his soon-to-be-widow and my uncle, struggle to decipher it.
     “Reet sorry to bother ’ee, Doctor.”
     “How long’s he been like this?”
     “Bin flaggin’ a week, like. Liggin’ int’ bed sin’ t’ weekend.’
     “Why didn’t you call me sooner?”
      She looks embarrassed. “’E tol’ me not to, Doctor.”
      Uncle sighs, stifles a yawn, pulls his ancient stethoscope out from its place in his worn black bag. The shadowy figure lies motionless on the bed. He has no breath for speech. His efforts to cough have become a death rattle. As Uncle draws back his coverings to listen to his chest, I take in the black-bloody spit stains spattering the sheet, sense the wife’s unwarranted shame as she rubs at them with a damp facecloth. By dawn these same sheets will drape he husband’s stone-gray scalp.
     “Maybe earlier we could have done something, Elsie.”
      She flinches. “Aye, right gormless I were, ’arkin’ to ’im.”
     Uncle looks chastened. “It’s no bother, you know.”
     These stark intimacies—between miner and wife, wife and uncle, uncle and me—stoke my flame and seal my fate. Robbed as a twelve-year-old of witnessing my mother’s death, her cremation, even her memorial service, I’m being granted a place of privilege at these thresholds. At these life-to-death transitions of these menfolk distant from me in class and Yorkshire know-how as any on our island.
Instinct guides me to forge brief links with their wives, even the children who often hold their own nocturnal vigil beside me. I start to grasp something of the vernacular.
      “Canna get ’ee summat to sup, lad?” an elder daughter quizzes me. A girl-woman of maybe seventeen, her beauty masked by fatigue.
     “No, no, I’m fine. Please don’t trouble.”
     “Nay bother, lad. Bah gum, thee looks jiggered. An’ famished.”
     “Well, perhaps a cup of tea, then.”
     “I’ll go mash the pot. Cut thee and ooncle some slabs of Parkin wi’ it.”
     I blink back unmanly tears at her kindness. No blutherin’ at this bedside.
     Uncle’s stories continue. Lessons in awareness, witness, toughest love. Lessons to last.

     But traveling for holidays throughout my teenage years between the upper middle-class Home Counties of England and the deeply industrial working-class West Riding of Yorkshire, I never get over the ancient north-south schism that dates back to the Norman conquest. As a diffident teenager, I am all too aware of my BBC accent, which the Oxford English Dictionary still defines as “the standard accent of English spoken in the south of England.” In the past it was termed The King’s English, or even Public School Pronunciation (the term public school being long associated in England with independent fee-paying boarding schools, as opposed to free state schools).
     I know only too well, without being explicitly told, that an accent like mine is associated with undeserved power and privilege, and that it has strong links to the ruling class and British nobility. Nancy Mitford and others have taken things a step further by dividing the English language into ‘U’ and ‘non-U’, to distinguish upper-class from lower-class speech. The words napkin, sofa, lavatory, and pudding are all fine, but never serviette, couch, toilet, or sweet.
      It doesn’t help to be saddled with a double-barreled surname, which seems to have been in my family since a Dr. John Pole married a Miss Jane Graham several generations back. This practice of linking names originated with the British aristocracy when wealth and prestige were major factors in negotiating marriages. While I have made a few friends during my Yorkshire vacations, I have never met anyone with my accent (or lack of one), or who went to a fee-paying boarding school, or who laid claim to a double-barreled surname. Among my new teenage acquaintances—sons and daughters of miners, all—the h at the beginning of a word is always dropped, and the g at the end of a word is never pronounced. The and to are simply t, and anything and nothing are always owt and nowt.
      But after a few pathetic efforts, I soon realize my attempts to merge in by adopting the Yorkshire idiom are doomed to embarrassing failure. Thanks to Uncle Ken, I finally catch onto a few words of dialect: liggin for lying in bed, blutherin for crying, Parkin for ginger bread—a Yorkshire specialty—reet for right, jiggered for exhausted, and tarra for goodbye.
      The whole time I live with them, Uncle Ken and Auntie Joan never consider leaving Yorkshire to journey south. The first two weeks of August always mean a car journey to the small seaside resort of Sandsend on the North Yorkshire coast. My uncle is a desperately nervous driver, and I am always assigned to sit upfront as navigator. Meanwhile Auntie Joan and their three daughters crowd, oftentimes cowering, in the back of his ancient Ford Popular. No one, including me, is aware of my worsening short-sightedness. I can barely make out the names on the timeworn street signs in the multitude of byways as Uncle Ken tries to negotiate his way through the dense township of York. He is the only one permitted to open his mouth, which he does often to yell at me for once more getting us lost under the battlement walls of the ancient city.

     I’m sixteen and back at Epsom for the summer term when I receive a letter out of the blue from Aunt Ella, my mother’s cousin. I remember her clearly from visits as a young child to her home in South Wales. Her curly auburn hair and boisterous laugh always made me think she should have been Mummy’s younger sister.
     “John, Uncle Roger and I want to come up to Epsom for Founders’ Day,” she writes, her flowing cursive reminiscent, too, of the weekly letters my mother would send me during term time. Founders’ Day is the college’s annual celebration when parents are entertained to tea in a massive marquee erected in front of the college, and the First XI cricket team take on their closest rivals—usually Haslemere or Charterhouse.      They duly arrive, and Uncle Roger and I sit in deckchairs in front of the pavilion watching the game in silence but with mutual enjoyment. My only discomfort comes from hearing Aunt Ella’s frequent shrieks of laughter from the tea tent, where she is busy making the rounds of my masters and other parents.
      Aunt Ella and Uncle Roger become faithful visitors after this, and I gradually stifle my embarrassment at Auntie’s gregarious behavior as she introduces herself to all and sundry. This is in striking contrast to Uncle Roger who holds back, as taciturn as she is voluble. I take to visiting them twice every semester for weekend exeats, catching the train on Friday afternoon from Epsom Downs station up to Paddington and onto the tube to Oxford Circus. From there I make my way to her TB clinic just north of Oxford Street, never failing to marvel at the sights and sounds of the hectic concourse.
     Aunt Ella is the head nurse, and by this time—the late 1950s—there are several effective drugs to treat tuberculosis. But there are still occasional outbreaks, especially in southeast London where poor housing and overcrowding are rampant. Auntie is often kept busy well into Friday evening, so after suffering the exuberance of her welcoming hug-and-kiss on both cheeks, I make myself comfy in one of the empty offices. Flo the tea lady supplies me with an endless supply of buttered scones and slices of Bakewell tart, along with “a nice cup of char.” There are several bound tomes of medical and nursing journals on the shelves, along with more recent loose issues of the BMJ. Though I can make little of most of the articles, I uncover an unlooked-for gift from my Classics education. Every journal page offers up an abundance of those Latin and Greek words that have beguiled me since I first wrapped my seven-year-old tongue around them: integument, polysaccharide, epileptic, glycolysis, cutaneous, appendicular…
     At last Aunt Ella is ready to take off around the corner to Sheriffs wine bar, where I am introduced to the delights of Harvey’s Amontillado. My penance for downing several glasses of this addictive Andalusian sherry is to run the gauntlet of her friends and, for all I know, perfect strangers with whom she has struck up acquaintance. We finally totter off to Liverpool Street station, toting countless bags of groceries from nearby Berwick Street market, where fruit merchants and fishmongers have been plying their trade since the eighteenth century. Uncle Roger has parked his brand new Wolseley 15/60 in its faithful spot to meet us off the train at Billericay, the commuter town twenty-five miles east of London where they live. I can always tell how long he’s been waiting from the number of stubbed-out Rothmans King Size in the ashtray.
Soon after my eighteenth birthday Mr. Parker, my house master at Epsom, quizzes me about my career plans. He expresses surprise at my resolve to study medicine.
      “I thought you were a classicist, Graham-Pole. Medicine’s a science, isn’t it?”
     He doesn’t press me for more explanation, but he’s aware of my mother’s premature death and perhaps senses a connection. A week later he hands me an announcement of a scholarship in Arts and Classics available to St Bartholomew’s (Barts) Medical School. The big drawback of this too-good-to-be-true gift is that I must cram two years of high-school biology, chemistry and physics into my unwilling skull in my first year of college. By guess and by God I stumble through the end-of-year exams.
     During my visits to Aunt Ella and Uncle Roger I get to know several upper middle-class men—all sons of city gents and fledgling city gents themselves. We make a memorable bachelor trip to the Costa Brava. Eight of us travel in two E-type Jags and two Mini Coopers via the ferry from Dover to Calais, then race each other southwest across France and over the Pyrenees. We stay in the small coastal village of Calella de Palafrugell east of Barcelona above a small bar, where a bottle of Spanish champagne costs the equivalent of an American dollar.
     We sleep off our hangovers until lunchtime, when our Spanish hostess rouses us with a magnificent lunch. After toasting ourselves all afternoon on the beach under the unrelenting Spanish sun, we play cards until it’s time to head once more to the Barcelona night spots. I teach my friends the uproarious card game of Donkey. We establish one house rule: whoever loses and becomes Donkey at the end of each game has to run downstairs to replenish the champagne supply. For reasons I never unravel—though I strongly suspect a conspiracy—I become Donkey more than ninety percent of the time. Maybe I just can’t hold my booze as well as my buddies.
     Early in my medical internship at Barts, Aunt Ella and Uncle Roger retire back to their homeland of South Wales. But their retirements prove to be short lived. Uncle Roger suffers a massive stroke which leaves him unable to speak, though he makes more effort to do so after this event than he ever did when he was still sound in wind and limb. Then Aunt Ella develops an inoperable stomach cancer—again reminiscent of my mother’s fatal illness. She lingers on for several weeks in semi-coma, attributable to both the spread of the cancer to her brain and the blessed balm of round-the-clock opioids she is receiving.
     I talk to her briefly on the phone, her voice weak and totally lacking its familiar bonhomie. I explain that I can’t get away from my job for several weeks, but I’ll see her just as soon as I can. I already know that asking my boss for compassionate leave is a non-starter: he wouldn’t give me a whole weekend off to get married three months earlier. I finally drive the 150 miles from our north London flat to Cardiff General Hospital, where the staff nurse greets me with a cheery Croeso I Gymru (“Welcome to Wales”).
     “Your auntie’s been a love to look after,” she tells me. “I heard all about you and how proud she was of you being a doctor in London.” She pauses, then adds, “And how proud your maam would have been.”
I hide my tears at these words spoken in a lilting Welsh accent I hadn’t heard since I was a ten-year-old. She directs me to a private room across from the nurses’ station.
     “I’ll leave you two to catch up, like. Don’t expect your auntie to answer you, now. I think she’ll know your voice, though.”
     I wipe my eyes as I draw near to my auntie’s bedside. Her features are calm, almost unlined. She doesn’t stir as I pull up a chair and tune into her periodic breathing. A slow inhalation is succeeded by no breath at all for a long drawn-out space. Then another deep intake. The Cheyne-Stokes pattern tells me at once she isn’t long for this world.
     I clasp her hand and speak softly. “Hallo, Auntie. It’s John. I’m so sorry I couldn’t get here before.”
     As I watch, she lets out one more breath. It proves to be her last one on this earth. It’s as though she has been waiting for me.