Beyond the High Blue Air Read online

  I don’t like flying at the best of times and I especially don’t like flying in small aeroplanes. This is the most physically frightened I have ever been. I fear the laid-back pilot, the tinny fragility of the plane, the grinding noise of the engines, the low altitude and proximity to the snow-covered mountains below us; above all I fear the effect of the rarefied cabin air pressure on what little oxygen is still being supplied to Miles’s brain. Half an hour into the flight I begin to detect an unmistakeable smell of burning; yes, there is undoubtedly something burning in this aeroplane. I lean over to the nurse and he leans towards me. I shout in his ear, Can you smell burning? Mmm, he says, and turns to tap the co-pilot on the shoulder. They talk closely and then the nurse undoes his seat belt and crawls, bent double, down to the back of the aircraft. I can’t see what he is doing as he crouches down but he returns calmly and now shouts in my ear, Heating, the heating, better it’s off, okay?

  I nod but I’m not okay. Miles has begun to judder, his body jerking, his head shaking terribly from side to side. The woman doctor leans forward to take his pulse and check his oxygen saturation level, then sits back in her seat. He continues to judder and I think he must be sensing something through his comatose state, that his unconscious registering of the change in his environment is triggering these severe spasms. I can do nothing to soothe him, except let my hand linger on the top of his head and try to will my love through to him, to enfold him and cocoon him with all the force of my love.

  Ridiculously the plane lands at Biggin Hill, with its connotations of Biggles and schoolboy comics; how Miles and Will would have loved that as small boys. It’s a beautiful day and as Miles is lifted out of the plane and on to the runway I realise it is the first time the sun has shone on him for six weeks. His skin has a ghostly sheen, his immobile eyebrows and closed, thick eyelashes unsettlingly dark in comparison. I can see that the two young men wheeling his stretcher try not to look at him too obviously, but it is unusual to see someone in a coma at close hand and they are both fascinated and repelled. Miles is still a handsome, powerful, athletic-looking young man in spite of his pallor; his rigid unconsciousness shocks. An ambulance is waiting outside the small airport and the cheerful driver helps me in. You sit next to me, love, in the comfortable seat, he says. You must be a bit out of sorts after that flight. The medics can go in the back with him. He’ll be all right, don’t you worry, love.

  He talks all the way to London, turning on the siren whenever the traffic looks bad ahead. That’s the joy of these things, he says, gets you where you want to in no time.

  II

  The ambulance drop-off point is in a small street at the back of University College Hospital, one of London’s great flagship modern hospitals. Two porters wheel Miles on his stretcher up to the third floor Intensive Care Unit. I follow with the Austrian doctor and nurse, and entering the unit we are met by a young man with a harassed expression and a junior doctor’s badge pinned to his white coat. Take the patient into this room, he says, pointing it out to the Austrians, and then to me, Please wait in the reception area while I examine your son. I have time to see Miles handed over to two nurses waiting in his empty room, to see him being slung, rigid, from the slightly higher Austrian stretcher on to his new bed so that he lands awkwardly with a jarring thump. I register the first inkling that something is different here. For the past six weeks the Austrian doctors and nurses have done what they had to do with a kind efficiency that I assumed to be the norm.

  Waiting as instructed in the empty reception area, I close my eyes and feel myself falling exhaustedly through deepening layers of incomprehension. But I’m back in England, I tell myself, and things will be easier now, things should become clearer. Eventually the young doctor reappears and as I instinctively search his expression for any glimmer of hope, there is nothing. I’m afraid the Austrians seem to have got it wrong, he says, without preamble. I don’t understand why they appear to have increased your son’s score to 4 on the Glasgow Coma Scale whereas in fact he’s only 3. It’s not a very clear report, he says (the Innsbruck doctors had taken the trouble to translate it into English). And I’m afraid too, he adds, that since he’s arrived on a Sunday the on-duty neurologist will have to be called, which may take some time.

  As I wait for the neurologist in Miles’s room, I stand at the window and stare out over the teeming Euston Road below, cars streaming in both directions, hundreds of people going about their Sunday oblivious to the crises of lives they are passing by. Each time I close my eyes the sensation of falling returns. The neurologist finally arrives, flustered; I realise it must be irritating to have been called away from her Sunday especially to see Miles. There is barrier nursing on Intensive Care Units; everybody, staff included, must wear plastic aprons and rubber gloves when handling the patients but this doctor does not. Are you the mother? she says to me. Yes, I reply. I am going to examine your son, she tells me and then asks the nurse with a hint of exasperation to pass her the small torch that is quite easily within her reach. Pushing back Miles’s eyelids in turn she shines the torch close up to see whether his pupils contract with the light and then hands it back to the nurse with a grimace: hopeless, it implies.

  I watch her as she continues her examination. Miles is still in a coma after six weeks, he is evidently severely brain-damaged, what is the point of her or him being here – she makes this all very clear. Then, looking at me directly for the first time, she says, I’m afraid I don’t think it’s worth sending him to the Acute Brain Injury Unit at Queen Square. I think he should just go straight to Putney. Perhaps she meant to use the word appropriate instead of worth, but worth just slipped out. Nothing else is said; she leaves the room.

  Putney: I know the hospital. Formerly The Royal Hospital for Incurables – a large billboard at the side of the road proclaimed its ominous presence on the A3, the route I took every time I drove Miles and Will to school in Winchester; it was a shock each time to read it. How terrible, we would say every time we passed. How chilling the name was: Hospital for Incurables. Then one day when we drove past the sign had been replaced with the grander and more politically correct Royal Hospital for Neuro-Disability. I remember we talked about the change, about how words can influence attitudes, that moron and spastic and mongol are no longer usable. I can only think now of the unknown future that was crouching so mockingly, viciously, ahead of us as we drove blithely by. What else might still be waiting there?

  Before leaving I meet with the young clinical director of the ICU whom I had spoken with from Innsbruck. He had been helpful and reassuring throughout and all the arrangements for Miles’s admittance to UCH had been made by him with the expressed intention that after examination and assessment Miles would be transferred to the Acute Brain Injury Unit at Queen Square. I wonder if he has already spoken to the neurologist or to the junior doctor who saw Miles on arrival, but his assurance no longer seems as certain. I am alerted to something going on that concerns Miles and that I am not party to. But with relief I find the sensation of falling has disappeared and instead I have landed with an invigorating shock. If I’m to be at war here, I think to myself, I will fight them to the last.

  I have come home for the first time in six weeks. Inside, the house looks strangely distant, as though I am seeing it through the wrong end of a telescope. Everything is the same and not the same, it has been recalibrated by this thing that, last time I stood right here, was in the future, and now it has happened and nothing can be the same again. The house is old; it knows more of life than I do. Built in 1780, solid and Georgian, it is a house confident of its place. How many people have come home to it, opened the familiar front door under its delicate tracery of glass fanlight and stepped into the wide hall with this same mixture of feelings? Relief to be safely home, mixed with new and terrible knowledge? Soldiers have returned here from the horror of trenches and gas; what has happened to Miles simply adds another layer to its accumulated history. Life will go on,
it says. Here, for the time being, you are safe.

  There is an antique painted Vietnamese cabinet in the hall, which had been due to be delivered the day after Miles’s accident. It seems to hold a special significance, straddling the break in my life; how innocent Ron and I were when we saw it and decided to buy it, and when I arranged for it to be delivered that particular Monday morning. Miles has never seen it; he will be pleased that it has replaced the carved wooden African drum he disliked so much. In fact it wasn’t a large drum but the suitcase of a former Queen of the Cameroons, packed and carried by her slaves, intricately carved out of some exotic black wood that gleamed even in the dark. Miles thought it had bad karma, that it filled the air with sinister intent. Please get rid of it, Mum, he said, it’s malign, it’s not right here, it isn’t meant for this house. It’s as though it holds a curse, he said. Too painful to think about that now. I walk through to the kitchen and open the fridge and find a glass bowl full of sliced oranges in caramel syrup – they would have been served with my home-made cardamom ice-cream at the lunch party that was interrupted six weeks ago, but Ron saw the guests out after I’d taken the call. How strange that the oranges have lasted; I suppose the caramel syrup preserves them. The ice-cream is in the freezer untouched, a family favourite and certainly still edible, but I scoop both oranges and ice-cream into the bin. I don’t want them in the house.

  Outside, the garden has changed from the last bleak bare bones of mid-March to freshest early summer. Everything has come into leaf, a wild palette of greens touched here and there by late flowering tulips and the earliest roses just beginning to bloom. Will, Claudia and Marina are here, Ron has put champagne on ice for us all, and as we sit outside in the cool scented evening we drink a toast for Miles. His absence is ringing through the house and we each have the same urgent need to include him, keep him here with us, not let him go. There is so much to talk about, not least the events of the day, but I am wondering why Ron isn’t having a whisky – I know he prefers it to champagne but he has poured himself a glass of wine instead. Miles enjoys whisky as much as Ron does and a ritual has evolved whereby he gives Ron a special bottle to try out every Christmas and whenever he is home they sit down to a glass or two together and put the world to rights. I ask Ron if he wouldn’t prefer a whisky and he says, No, I don’t feel like one. He looks away down the garden, lost for a moment, then turns back to me and says, I don’t think I’m going to have another whisky until I can drink it with Miles. I reach across and hold his hand; for such a powerful and complex man Ron can be as transparent as a child. We fall to silence. The garden walls are high, the world shut out beyond them; this place will be a retreat for us all.

  Despite the horror of those weeks in Innsbruck, the dread-filled walks to the hospital twice a day and the inert, profoundly damaged Miles we encountered every time, I had guessed they might be halcyon days. While different members of the family came and went and I remained in the quiet town with its clean cobbled streets and Tyrolean propriety, we were a family together in a bubble of privacy, isolated by our shared grief and protected by our anonymity. We had no need to present ourselves or explain our situation.

  Back in London we are a family that has been visited by disaster, marked out, different. I could be a foul black crow. Limping with my scabbed feet, dragging a broken wing behind me, eyes glittering, my wound an open gash; I leave a trail. I go out to parties, meet my friends, and that is what I am. They see me coming and part silently, afraid. What can they say?

  Grief, I discover, changes you. I have become different, outside and inside: outside, because I am now an object of pity and horror, no longer safe; inside, because my terrible new sensitivity has destroyed tolerance – there is no room left for it. Friendship is put to the most severe of tests. I cannot bear to think how often I may have failed my friends in the way some fail me now, so often unwittingly, I know.

  I don’t like my new self.

  At the time of his accident Miles was in St Anton with work colleagues on an office-sponsored break, but it has not occurred to me to connect his employers in any way with the tragedy that has befallen him. So I am surprised to receive a call from a senior partner at the firm with an offer to cover the cost of the air ambulance home, and asking whether there is any other help they can provide. I am touched by his evident concern for Miles and we arrange to meet. We sit in a coffee bar in the City and talk about Miles, and this obviously successful and impressive older man tells me that it was difficult having Miles working for him. The difficulty, he says, was that I knew in many ways he was already better able than I am to do my job. But he was nevertheless junior to me and so that could be a problem. I wish Miles could have heard these words; I know, from what he has told me, that their working relationship was not easy, but I wish he could be here. I know he would share my admiration and respect for this man’s honesty and graciousness.

  After the meeting I receive a letter from the company’s HR department, informing me that Miles will continue to receive two thirds of his salary until a clear prognosis is made. Later on he will receive a lump sum in an insurance pay-out. I could not be more grateful for this extraordinary generosity and support from what, from the outside, might appear to be another large faceless corporation. I am just beginning to realise, too, how much this financial support will be needed in the months to come.

  During the next two weeks Miles is seen by a procession of doctors, to assess his condition before transferral to Queen Square. I listen with bewilderment as one after the other is dismissive of his chances of recovery and is against sending him to the Acute Brain Injury Unit. We had understood that he’d returned to London on the assurance of a place there, and after the professional and ambitious approach to Miles’s treatment by the Innsbruck medical team I am shocked. I am given a range of reasons why Miles cannot go to the ABIU: there are no beds available, the ABIU does not admit tracheostomies (this is patent nonsense, as a friend who is a speech therapist at Queen Square confirms), Miles lives in the wrong postal district for admittance, there are only limited resources for neuro-rehab, unlike Putney. There seems to be a strange game being played where the rules have been intentionally withheld from the family, and it begins to take on the dimensions of a blood sport with Miles as the quarry. We feel as though we are being treated with contempt for not knowing the rules and for blindly playing on, ridiculously keeping up a fight for Miles to have a chance. It is as if the medical establishment is amassing its ranks against an irritant intruder. A mistake was made in accepting him into this hospital and he is not wanted here. He is transgressing the norms of admission and hospital spend, particularly, it seems, since his injury did not take place within the right postcode for admission. It could be a farce, but I discern the unmentionable truth: he is too damaged to warrant time and money being spent on him.

  It is a matter of medical politics and budgets and my confusion begins to turn to disillusionment. I had not thought doctors operated, as a banker or a businessman must do, in monetary terms. But suddenly here it appears to be the case; the concern is above all for keeping to the rules of the budget. Naïvely, I see now, I had believed in the humanity of doctors, but even more disillusioning is their comprehensive dismissal of Miles as a person; the human story is irrelevant and he is just another Traumatic Brain Injury, a TBI, a bed blocker. I long for Dr Stizer and Professor Benir and bitterly regret our decision to come back to England.

  As a family, we understand Miles may never recover, but how can we be asked to abandon him at this early stage without trying everything in our power to give him a chance? We know the first twelve months are the most vital and at this point it is only six weeks since his accident. Miles is still in a coma; to give up now would be unimaginable. We exist on a taut wire of hope and despair, and hope is not synonymous with optimism. Optimism is to believe that things will always turn out for the best; true hope is clear-eyed, knowing the negative but desiring the positive. For Miles’
s sake we must retain hope; if we let despair tip the balance we are all lost.

  Ten days have passed when I am told Dr Stephenson is coming to see Miles. This is extraordinary, and our last chance, since as a consultant on the Acute Brain Injury Unit he may have the power to overturn the other doctors’ decisions. I wait for him in Miles’s room, sitting by the bed and explaining to Miles that an internationally acclaimed expert in brain injury is coming to see him. I want him to find this reassuring but I want him to perform too, to impress the doctor, to rise to the occasion. He has always risen to a challenge, but how can he now? I’m sickened by my desperation.

  The door opens and Dr Stephenson greets me briefly before continuing straight over to Miles’s bed. He is an imposing-looking man, tall, dark, the impression austere. He acknowledges the nurse but appears to have no need to assert his position with either of us. He introduces himself by name to Miles and then he watches him silently for some time before he begins to examine him. He might be a paediatrician examining a newborn baby, so gentle is his handling of Miles, his quiet, serious manner conveying a sense of profound respect for this mute, damaged young man under his care.