Between Two Tides

The Tide Tables

High water, Saltgrave Hade. The crossing is safe two hours either side. After that the road belongs to the sea, and the sea does not take patients.

That notice hung in my surgery for fifty years, written first in Dr Quayle's copperplate and latterly in my own worse hand, and I am taking it down today because there is no one left who needs telling. Iris has the tide on her telephone now. She holds the little machine out to me as if it were a relic of some saint, and in a way it is. It does in a glance what cost me, more than once, a ruined axle and a long wet walk and a flask of tea gone cold in a hedge.

I am clearing the room. That is the polite word for it. A man does not clear a room he has sat in for half a century; he disturbs it. Every drawer is an ambush. Here is a packet of cigarettes a patient pressed on me in 1971 as payment, unsmoked, gone the colour of weak tea. Here is a child's tooth in a twist of paper with no name on it, so that I shall never know whose triumph I was keeping. Here is the rubber tubing of a stethoscope perished to crumbs, and under it the ear-pieces still bright, because the brass of a thing outlives the use of it. That is true of doctors as well.

The surgery is the front parlour of a stone house behind the sea wall, in a village the maps spell Saltgrave and the older people still call the Grave, which is a marsh joke and not a kind one. We are on the landward lip of the Hade, a brown estuary that goes out at low water to a country of mud and silver creeks and comes back twice a day as a sheet of moving steel. The high farms sit on the Holm, an island that is only an island for four hours in twelve. Between us and them runs the causeway, the low road, marked along its length by the perches — withy poles cut and driven each spring, leaning a little drunk, that tell you where the firm ground is when the water has rubbed out the rest. Learn the perches and you live. That was the first thing Quayle told me, before he told me anything about medicine.

I came in the autumn of 1961, twenty-six years old, with a new wife and a diploma and a black bag, and the bag is the only one of the three I still have. Nell gave it me. I want that on the record early, because so much of what follows is hers and she will not say it for herself now, the obstinate woman, having gone and died on me two winters back without leave or notice, the way she did most things. Heart. I heard it go wrong under my own hand on an ordinary Thursday and I, who have restarted the hearts of strangers on kitchen floors, could do nothing with hers but hold the wrist and count and watch the second hand of Quayle's old watch carry her off the edge of the table of the living. A doctor is permitted to know a great deal. He is not permitted, it turns out, to be of the slightest use to the one person it would matter to save.

But I am ahead of myself, which is the privilege of the old and the curse of the memoirist, and I had better go back to the snow.

There is a thing I should set down first, plainly, so that you read the rest knowing it, the way I now read everything. In April I noticed in the shaving mirror that I had turned the colour of a church candle. A man who has watched a thousand faces for that exact buttery wrongness does not need a second opinion, but I drove to Calderwick and got one, and then a scan in the city, and they showed me the grey shape on the screen with the particular gentleness they keep for one of their own. Carcinoma of the pancreas. The doctor's disease, we used to call it, because we are the ones who understand the joke. It is not operable. It is not, on the whole, negotiable. They give me the autumn, perhaps the edge of winter if I am dull about it.

So I am taking down the tide table, and I am writing this between the two tides that are left to me, and I find — this surprised me — that I am not much afraid. I will try to say why before I am done. It has something to do with the snow, and with Eli Tace, and with a great many doors opened to me in the dark.

The Crossing

The first baby I delivered at Saltgrave nearly died, and so, on the way to it, did I, and so very nearly did my wife, and we were not yet married a fortnight.

It was January of 1962, the hard winter, the one the old men measured all later winters against and found them soft. We had come at Michaelmas to a practice that was really one tired man, Quayle, with a bad chest and a wish to be by his fire, and he had handed me the parish the way you hand a stranger a heavy dog on a short lead: here, he is yours now, mind he doesn't have you over. By Christmas the snow had come and not gone. It lay in the lanes to the tops of the walls so that you walked along on the level of the field, and the Hade froze at its margins, plates of grey ice grinding on the tide, and the perches stood up out of a white nothing like the masts of drowned ships.

The telephone then was a shared line, four houses to a wire, and you lifted it to a chorus of breathing. On the third of January it rang at eleven at night, which is the hour the body chooses for its emergencies because it is the hour least convenient to everyone, and it was Walter Ravenhill from the Holm, shouting down the bad line as men shout at the sea, that his Edie's time had come and it was coming wrong.

"Wrong how, Walter?"

"Backside first," he said. "Missus says. There's a foot."

A footling breech, then, the worst of the lot, with the cord at risk of coming down and the head left for last and least, and the only doctor a fortnight in post on the wrong side of a tide that — I had the table by heart already — was three-quarters in and rising. The causeway was gone. It would not give itself back until past two.

I have thought since that a wiser man, an older man, would have telephoned for the boat and waited and let the night decide. I was twenty-six and had not yet learned that some nights decide against you no matter what you do, and that a doctor's first duty in the dark is to arrive, because the arriving is itself a kind of medicine even when the bag is empty. I put on everything I owned and I went out to the car, and Nell came out after me, buttoning her coat over her nightdress, and got in the other side.

"You'll not manage the bag and the gate and the lamp," she said. It was not an argument. Nell did not have arguments; she had conclusions, and presented them already wrapped. She had trained two years as a nurse before she married me and left it, which was the custom then and a waste then and I will say so. She had, that night, more nerve in her cold hands than I had in my whole shivering body.

We could not take the road. We took the boat — old Sankey the eel-man rowed us, swearing in a steady devotional way at the ice, the oars going in with a chop like an axe in a log — across the black moving water with the lamp at the bow throwing a yellow coin onto the floes, and the snow coming level off the sea so that it stung. Halfway over, a slab of ice took us broadside and the boat went up and sat down hard and shipped a bucket of water cold enough to stop your breath, and Nell took my arm, not in fear, but to put the bag higher out of the wet, and I understood for the first time what I had married. Not a wife who would keep my house. A colleague who would keep my nerve.

Ravenhill met us with a hurricane lamp at the slip and ran us up the lane through snow to his knees. The farm kitchen was the warmest room I had been in for weeks and smelled of paraffin and blood and the particular animal fear of a labour gone long. Edie Ravenhill was a small fair woman grey with the work of it, past speaking, and her mother by the bed with the look of a woman counting how many of these she had seen end badly, which on the marsh in those days was too many.

There was indeed a foot. There was, when I had scrubbed in water Nell had set to boil on the range, a second foot, and then the long bad business that I will not parade for you except to say that a footling breech delivered at home by lamplight is a thing done with the hands and the held breath and a kind of praying that has no words in it, and that the danger is at the end, when the body is born and the head is not, and the cord is pressed and the clock you cannot see is running. The baby came in a rush at last, blue-white, slack, the cord round the neck twice like a man's scarf, and it did not cry, and the kitchen went very quiet but for the range.

I have wondered since what the women in that room saw. A young man they did not know, a fortnight in the parish, holding their dead child by the ankles. What they did not see, because I kept my face for it, was that I was as frightened as they were. I cleared the small mouth with my finger. I laid the child along my forearm, face down, the heel of my hand at the little back, and I did the thing Quayle had shown me on a doll one wet afternoon with his pipe in his teeth: I breathed, my mouth over that cold mouth and nose, small breaths, a man's lungs are too big for it, you give them a sip not a draught — and Nell rubbed the spine with a warmed cloth, hard, the two of us bent over the child on the kitchen table like a pair of thieves over a lock.

Nothing. Again. Nothing. And then — I will hear it till I stop hearing anything — a cough, no bigger than a cat's, and a flush of pink coming up under the blue from the chest outward like dawn over the flats, and then the indignant red squall of a child who has decided, against the run of play, to live.

It was a girl. They called her Iris, for the flower and for nothing else they ever told me. I weighed her on the kitchen scales against a bag of flour because there was nothing else, and entered in my book liveborn, breech, resuscitated, 6 lb or thereabouts, mother and child well, and we waited in that kitchen with sweet tea and the dawn for the tide to give us back the road. Walter Ravenhill wept into his own hands at the range and then was ashamed and went out to see to beasts that did not need seeing to, which is what men of that place did with feeling, then and now.

I want you to keep Iris by you as you read. She runs through this like the perches through the marsh: you will lose sight of her for a chapter and then there she will be, marking the firm ground. She is the reason I can put my pen down at the end of it with a steady hand.