Histories begins with a consultant, Dev Bhatia, walking into the hospital. It ends, six days later, with the same man walking out of the hospital, this time pushing an ailing colleague’s wheelchair. These six days are told through short chapters, each sharing the reflections of one of a host of characters – physicians, nurses, patients, families, porters, and medical students – all living, breathing, and dying within a hospital. This tableau of hospital life is tender, concise and beautiful. It tugs at the strings of the white coat, the patient gown, the cocktail dress and the dinner suit, to reveal human flesh, both frail and magical.
The hospital we enter with Dev contains within it love, hatred, betrayal, fear, life, disgust, sorrow, fatigue and, ultimately, death. Into the seams of each story, each monologue and dialogue, and each life, is weaved breath, in its liminality, invisibility and precariousness. Histories is a book about breathing and stopping breathing, as well as stopping (in order) to breathe, as Dev reflects ‘how it felt to him that life visibly contained the fact of death, just millimetres inside its translucent skin’ (8). Lucy, a nurse, watching a tracheostomy, is ‘shocked at the proximity of a body’s breath to the outside world’ (90). It is this liminality, this proximity of life and breath to death and disintegration, that animate the tender unfolding of Histories.
Breath, for Guglani, is the individual barometer of each life, each emotion, each disease. Hospital breaths are measured and felt, they are supported by oxygen or a ventilator; they are laboured, unsettled; they are medicalised breaths, counted and noted on patient charts. This medical breath-world contrasts with the outside world of the healthy, in which ‘we all casually breathe air’ (25). Indeed, Tom, the hospital chaplain, comments on one ward’s windows that ‘allowed just a narrow strip of world to breathe from, like an air pocket in a flooded cave’ (139). The outside air isn’t the same as the hospital air; the ailing and problematic hospital lungs are not the same as the healthy, outside world lungs, careless in their ease.
The contrast is deep, but also easily erased, and indeed, as Histories unfolds, we discover that ‘we’re more penumbra than wall’ (150). How the all-too-human openness and vulnerability Guglani reveals in the book penetrate even the most protective (and masculine) magical white cost. Almost every one of the medical staff breathing in the book is touched by illness. Peter Nicholls, a consultant, has a sick wife. Beth Harding, a hospital domestic, has a sick daughter. James Chester, a senior consultant, collapses in the hospital car park. Lucy Conway, a staff nurse, discovers a lump on her neck. And when Lucy is washing a cancer patient her supervisor ‘peels open’ the curtains and looks at them ‘like here, behind the curtains, were two patients. And this has suddenly seemed fine’ (97).
Breath is also tested in the requirement to treat whilst maintaining a professional distance from patients, that is so difficult for Dev. He becomes ‘breathless and tearful on reading a patient’s scan report’ (5). He betrays that distance in an enigmatic scene, in which he examines Sarah, the wife of a colleague. ‘He examines her neck, feels for nodes […] Her soft, pale skin, and there, the mark by her ear. He leans in, kisses it. Soundless, real’ (10). This ‘punch of intimacy’ (158) is the backlash to the distant, cynical, macho doctoring Dev despises. The distance is intended as an antidote to the hospital’s ‘inhaled sadness,’ that the doctors and nurses and porters and physios need to come to terms with (40). But the proximity to suffering and the realisation that ‘we’re all dispensable’, ‘the waters close behind us without leaving so much as a ripple’ (88-89), as James Chester says, unravels the meticulously traced and carefully maintained line separating the treating from the treated. In the end, ‘the troubled breath of so many’ is not just the breath of patients, but the shared breath of all human beings walking the corridors and filling the beds of this hospital.
Breaths punctuate patients’ stories, their ability to speak their pain. A patient wheezes, his oxygen mask pulling to one side, the elastic pressing into his skin (18). People’s complaints, and sighs and silences are all breathed in this hospital, taking the long route from cry to scream to silence again. Some are heard, many are not. The difference between the hearing staff and the ones deaf to these breaths and utterances, is expressed in a tense dialogue between the hospital chaplain and an arrogant consultant, Nathan Monroe. What starts as a theological dispute between a chaplain and an atheist, is in fact an expression of the gulf between those attuned to troubled breaths and those who are not.
We hear the breath of a silent homeless man, brought into the doctors’ mess by Beth, a rebelling hospital domestic, who serves him tea and bread whilst locking out of the room the enraged medics, its rightful owners. ‘He didn’t speak’, she says, ‘but I could hear his breath, the wet in it’ (32). A silent, homeless man pitted against a growing group of medics, displaced so he can eat and breathe in peace, for once.
Breath is also the source of imaginings and nightmares. Nancy Wilson, a nurse specialist, imagines a Richard, a cancer patient, and his partner, Martha, together: ‘her body attaching itself to his mouth like he was breathing her’ (121). Can life be sucked in through another’s breath? Can Richard be rescued by love, saved from his illness dragging him ‘down into the cushions like his corner of the room held a different gravity’ (122)? The short reply: no. As Richard gets sicker, Martha breaks down: ‘this morning, she said, in our bed, Nancy, the sheets were soiled and he had his hands out, covered in shit, calling me in, asking me to kiss him. I can’t now, she said, I don’t love him now, please, Nancy’ (122-123).
A junior doctor, Sebastian Bowen, dreams repeatedly of inserting a chest drain ‘but instead of pleural fluid or air, arterial blood pumped from his incision […] A crowed gathered, tutting at the harm he’d done, the mess he’d made, the growing mess of blood and waste’ (21-22). This is the unravelling we all despise and fear. Health professionals in their fear of error, of chaos, of failure; patients in their fear of pain, and loss of control, and death. The unravelling we rebel against with every breath.
‘I wonder who’s really on display,’ reflects Josh, a porter (14). This question underpins the book with its quizzical, penetrating, and largely critical view of a certain type of male physician, male desire and male fear of loss of virility, command and presence. It is the inevitability of this loss that is portrayed in Histories; a lesson often not learned by men who are otherwise accomplished. But the dinner suit worn so proudly by the eminent consultant Nathan Monroe as he leaves the hospital to give a lecture, is now seen for what it is: nothing more than a momentary shelter from the great unravelling that is life.
Havi leads Life of Breath at the University of Bristol. She is Professor of Philosophy and her research examines the experience of illness and of receiving healthcare from a phenomenological perspective to enhance communication between healthcare practitioners and patients and identify focused interventions.