This book took me by surprise. Indeed, I was ambushed by it. I read it at a single sitting on a plane journey and the memory of it has been upsetting and inspiring me ever since. There has recently been an epidemic of pathographies — accounts of serious illnesses written by patients or by someone close to them. Most are of limited interest. A few, however, are masterpieces, striking a perfect balance between the metaphysical, physical, emotional and institutional aspects of serious illness. Three-three, two-two, five-six is one such masterpiece.
It is “an attempt to make sense of what happened to two people during the first four months of 1998”. The two people in question are the poet Ann Drysdale herself and Philip her partner (Hospital Number 332256) and the attempt is entirely successful. It is a harrowing journal, part prose, part poetry — beautifully melded together — recounting Philip’s hospital stay following his diagnosis of bowel cancer. He has radiotherapy and a major surgical operation. There is one complication after another, bowel obstruction; hallucinations from infections; a leaking bladder; a fistula; stinking abscesses; cardiac failure; bursting of the wound with a subsequent incisional hernia; and, finally, MRSA. The unremitting ghastliness of the physical events is made more unbearable by the attitude and behaviour of some of the staff who care for him.
This begins with his being called by the wrong Christian name — one he had discarded in the distant past. It is sustained by patronising, loud-voiced nurses, treating him as if he were both hard of hearing and hard of understanding, and addressing him in “a dumbed down patois, kindergarten pidgin” and talking to one another over his body during their ministrations. The sense of helplessness — underlined by all the waits that being ill and being treated for illness inevitably involve — is exacerbated by the feeling that complete, honest and consistent information is hard to come by.
The coldness of some of the nurses — in a hospital strong on rhetoric, mission statements and promises “none of which the system has the staffing levels or resources to fulfil” — and its impact on two vulnerable people is conveyed with terrifying authenticity. When MRSA strikes, Philip is moved into a side room and they lose their “parts in the popular hospital dramas” and move into what feels like “a vintage Becket two-hander”. Ann, meanwhile, has ceased trusting the nurses and has set up camp by Philip’s bedside, sleeping on the floor and clutching personal space around herself like inadequate underwear. Here is her “bailiwick” where she has learned the art of “repairing dressings, trouble-shooting drips and tubes, emptying the catheter bag, caring for the colostomy”. One day this is all removed as the room is tidied up — or blitzed, “cleared it of all the little daftnesses with which we had personalised it”. To this reader, it seemed the last layer of skin has been scraped off.
As he becomes mortally ill, Philip is moved to Intensive Care. Contrary to the expectations of those who imagine that the higher the tech, the more inhuman the treatment, it is here that Ann finds the nursing she had hoped for. Philip is called “Philip” and the first impression of ITU is “of a beautiful strangeness that took my breath away”. Staffing levels are now sufficient not only for bureaucracy, the routine tasks of care, and the corporeal works of mercy, but also for sensitive human kindness. Many pitfalls await him, however.
What makes Three-three, two-two, five-six such an extraordinary document is not only the brilliance of the writing but also the profundity of Ann Drysdale’s love for this man who, as she says, did not see her as his soul-mate. She was “too earthy”. And yet her earthiness stood her in good stead, as she kept her three month long vigil by his bedside, sustaining him as he suffered the twin assaults of his disintegrating body and the chilly institution in which he was cared for. Love does not conquer all, but hers makes a pretty good job of conquering most things — even “the smell of rotten matter trickling from his perineum”, which makes her reflect how “In his former life, he had been fastidiously conscious of the small offnesses that attend human existence”. This prompts a deeply moving poem. Here is its heartbreaking first stanza:
The stink of Scutari hangs in the still air
And rises as you shift your thighs in sleep.
You have been dealt too many wounds, my love,
And they are weeping in the dark.
I was reminded of Natasha’s care for Prince Andrei and the comparison, artistically, with those famous pages in War and Peace, is not absurd. The balance between love and fear, distance and closeness, observation and empathy, humour and despair, is extraordinary.
Her honesty is evident throughout the book. She admits that she made well-meaning nurses cry and worries that she may herself have become a harridan. She acknowledges that there are no villains in her story. And I would largely agree with that. The system promotes defensiveness and weaves a liana of bureaucracy around all those who work in it and values only things that can be measured and which correspond to targets. What price kindness in a world that does not allocate time for it? And there are problems that go beyond the NHS. In a hedonistic society, besotted by glamour, hands-on caring is not valued and over-worked nurses can feel resentful and unappreciated. To be a good nurse in a shallow world that prizes hairdressers and television personalities and advertising executives more than those who administer to the sick and vulnerable, one has to be a saint.
During those months of illness, Ann became “a watcher, a listener” and her heightened awareness is captured in her wonderful poetry and prose. As Philip is wheeled away for his operation he blows her “a scared, hollow kiss that fell short and clattered like an empty tin on the pitted vinyl flooring at my feet”. The bell for calling the nurses “tinkles/Like babies’ laughter”. And (true to her earthiness), the shocking dehiscence of Philip’s burst-open wound is compared to the “all-consuming cunt of sheelagh-na-gig” the fertility goddess.
Three-three, two-two, five-six represents something very rare in literature: great art that is also persuasive advocacy on a matter of the most urgent practical concern. It goes deeper than that of course, inviting us to think about the strange conflict between the personal and the pre-personal in the bodies in which we find ourselves and our loves. Most important of all, it tells a story of great love and true devotion.
I hope it is widely read and discussed. I would like it to be placed in the hands of every doctor, medical student and nurse. I wish I had read it when I entered medicine 36 years ago. I might have been a better doctor in the years that followed.
Professor Raymond Tallis, November 2006
The above text is reproduced here by kind permission of Prof. Tallis himself and the publishers, Cinnamon Press.