The Plimsoll Line (7 page)

The cat mewed in the kitchen toward the angle of the stairs. It had just returned from its nocturnal outing and on entering the house noticed a vague smell of freshsqueezed lemons that spread through the living room and was climbing to the next floor. It followed the trail and caught sight of boots stepping on the stairs without making the floorboards creak, and also the waterproof fabric of a red parka. It mewed even more loudly at the foot of the stairs, until the man awoke in the bedroom and it sensed him feeling around on the still warm sheets with his hand and stepping barefoot into the hall. In a nightdress, outside Laura’s bedroom, the woman was observing the shadows of furniture with a sleepwalker’s glassy gaze. The man came up to her sleepily, his hair stuck to his forehead and his eyelids swollen.

“What is it?”

“It’s Laura,” she pointed to the far side of the bedroom.

“What?”

“Laura, it’s Laura,” she repeated.

“What do you mean?”

The man looked in the direction his wife’s finger was pointing. He poked his head inside the bedroom.

“There,” she insisted.

He sighed very gently. Put his arm around her.

“Let’s go to bed.”

“Can’t you smell it? Polanski noticed it, too,” she said, pointing toward the cat.

“Please, Ana, let’s go to bed. There’s nothing there.”

He took her by the elbow, and the two of them moved off down the hallway. But after they’d gone back to bed, there remained on the second floor the soft scent of wet hair, and the parka fabric, cold, almost frozen, and a trace of defenselessness, which is why it mewed even louder than before. After a while, the man stuck his head out the door, and his face was full of knots, and it was still like this when he raised a slipper in the air and hurled it at the cat. The projectile missed its head by a mere inch and crashed into the wall. As it fled toward the living room, it heard the voice of the man cursing from upstairs. “Fucking Polanski.”

“In-put, out-put; in-put, out-put . . . ,” recites the man in time to the rhythm marked by the machine, apparently indifferent to the loop formed by the two plastic tubes through which his blood is circulating. Dozing in the imitation-leather armchair, “in-put, out-put; in-put, out-put . . . ,” he keeps his right hand on his forehead without noticing that, outside, a new day has begun under a weak sun, soft and frosted like the skin of a winter orange. A dirty light pours over the city through the clouds, but the man is unable to see this, since the dialysis room still gives off an impression of night, as if it hadn’t dawned yet, and this appearance is due to the light coming from the fluorescent tubes, which radiate the ancient luminosity of a classroom.

It’s already after nine. The patients have been connected to the machines for an hour. The voices of the nurses gathered around their coffee in an adjoining room form a distant counterpoint to the soft, monotonous noise of the machines and the sighs and coughs of the patients who are asleep, or listening to the radio with earphones, or doing like the man, who keeps his left arm still on the armrest while mumbling “in-put, out-put; in-put, out-put.” Man and machine seem to be connected by a bond far more complex than periodic renal depuration therapy, and though the ties of the transparent plastic tubes that join them might suggest a fragile connection, the truth is that an attitude of iron discipline seems to have sprung up between them, which a routine repeated over the last six months—five hours a day, three days a week—has transformed into a dependence that is familiar, even desirable, but ultimately unhealthy. The man rocks in a relaxed position, like a tourist on the beach, one knee bent, his hip sunk in the reclining chair. He is filled with a sense of complacent lassitude, since he almost can’t feel the points of pain in his arm; this morning the jabs were rapid and accurate, with none of the annoying mishaps that rather regularly slow down the venipuncture process in a painful operation of trial and error he generally endures with a stoicism that does not exclude the odd curse muttered under his breath. “Sonofabitch, goddammit,” he whispers with a strained expression, pale from the pain, when Sara, the nurse, fiddles with the needles in search of his bloodstream. There is still, however, the inevitable apprehension of a bite, and he imagines the stings of a metallic insect under his skin. This is why he continues saying “in-put, out-put; in-put, out-put” and keeps his arm very still, so that the insect will persist in the attitude of a subcutaneous parasite for the next five hours. For as long as this pact of stillness holds, the blood will keep flowing, gently pumped through the cannula.

The prelude to this is enacted early each morning with monotonous exactitude, without variation, and this repetition of actions appears to have been conceived as a way of molding the patient’s will, in terms of both security and fear. The arrival by taxi, stopping at the entrance to the clinic, the wait in a little room next to the elevators, which are decorated with pious, soothing iconography—Millet’s
The Angelus
, Fra Angelico’s
The Annunciation
—and the shrill notes of an oboe playing “Raindrops Keep Falling On My Head” on a loop over the loudspeakers, a melody he hums to himself as he advances down a hallway whose walls retain a vague aroma of anesthesia, of patients, and everything passes in front of his eyes, still swollen from the fluid retention of the last forty-eight hours, as though it were a dream, and the impression continues in the elevator, because the song keeps playing inside the cabin, above his head, until he stops at the eighth floor. He replies to the greeting muttered by the patients who have been waiting for a while, seated on cretonne sofas in the anteroom, but says good morning so quietly that only his shirt collar hears him, and he walks straight past and pushes open the door, resting his hand on the sign with blue letters that reads,“Dialysis Room. No Entry To Unauthorized Persons.”

He got undressed in front of the mirror, and he had the impression the glass did not reflect him but rather a sleepy shadow that appeared to be duplicated behind him. He came out of the cubicle in a pair of beige-colored pajamas and weighed himself on the scales. The ward manager confirmed his excess weight. “Three point seventy-five pounds,” she said, while at the same time jotting down the figure in her accountant’s notebook. He ignored the nurse’s reproachful tone and sat down at the venipuncture table. He rolled up his left sleeve and tied the rubber band around his biceps, using his mouth to help him, like a junkie. Other patients close their eyes, look away, chatter with false joviality, or slip in some meteorological comment, something that in the man’s eyes serves only to aggravate the procedure, since nothing will stop Sara sticking two needles as thick as Bic ink cartridges into their arms. Unlike the others, he doesn’t look away, he needs to keep an eye on the process, to see how the other nurse’s gloved fingers feel for the fistula and choose the exact spot, so that in this rather childish way, he can foresee the intensity of the pain that is coming as soon as Sara sticks in the needles. He then holds his breath, clenches his jaw, and counts to ten. But this morning he got to seven without feeling any pain, the needles having slipped through his skin with silky precision, without a tear. The nurse clamped the tubes and released the rubber band. “All set,” she said, and he looked at her without seeing her, surprised by the painless exactitude of the operation. Sara cracked some joke about bullfighting he couldn’t quite make out—it may have had something to do with
banderillas
and a scrawny bull—and only then, on his way to his armchair, holding his tubed arm aloft, did he noiselessly expel the air retained in his lungs, all without so much as a “sonofabitch, goddammit.”

He only has to wait for the time to pass quickly while his blood enters the machine through the plastic tubes, passing through filters and circumvolutions where it is mixed with saline solutions and cleansing serums whose taste he begins to note on his soft palate—“in-put, out-put; in-put, out-put.” Now he knows what to expect, he is familiar with every one of the machine’s sounds and their meanings, he can recognize the first symptoms of a blackout, he is aware he might have cramps in his calves at the end of the session, that the needles sometimes come out and have to be reinserted, that the machine might detect an air bubble and halt with a beep of alarm; it’s better to sleep, to relax, to become one with the prosthesis that is the machine, not to think too much, or perhaps to think too much, one never knows, until sleep comes or he is overwhelmed by tiredness. He is no longer alarmed at seeing his blood depart from him, not like in the beginning. The first time, six months ago, he couldn’t help feeling faint when he saw his dark, poorly oxygenated blood heading in short bursts toward the machine’s insides. He stared at this technical feat while sitting paralyzed in the imitation-leather armchair after a nurse with short, muscular legs had shown him in, as if inviting him to take part in a social gathering. There were men and women asleep, connected to their dialyzers by cables. One or two raised their hands in greeting. He felt dizzy. The nurse was not unaware of his weakened spirit, flustered as she was at having given the new patient a smooth, round bruise after several failed attempts to stick the needles in his fragile veins, slippery as snakes, as the ward manager had remarked while watching this young woman’s first venipuncture with an examiner’s scrutinizing gaze, something the tremulous university professor, despite his dizziness and pain, couldn’t help noticing. He reached the armchair, and his forearm felt swollen like a leather ball, but he thought this must be normal, and he clung to this thought as he watched his blood leaving his body for the first time. It was simple and strange—five liters of blood with extremely high levels of urea, phosphorus, and potassium exited his body, passed through filters, saline solutions, and valves, only then to return to the inside of his bloodstream, cleansed now of waste, as pure as water from a mountain spring. It was a simple exchange of fluids, and the process gave him the idea that his insides formed a network of nickel-plated, translucent arteries, the circulatory system of a highly primitive organism. It occurred to him that he had descended on the zoological scale and attained primitive perfection. He had seen this in nature documentaries, primitive organisms are the simplest, the ones that do without any biological ostentation in order to adapt to their environment with a minimum expenditure of energy, and now he was two things—an entry tube and an exit tube. He felt his heart pumping blood and the force of each beat being transmitted to the tubes, which trembled on his arm with the slight, regular quivering of antennae. Apart from his sense of alarm and anxiety, the process could be reduced to something as simple as falling in time with the machine, its gentle, monotonous rattling—“in-put, out-put; in-put, out-put.” After half an hour, a woman in a pink-colored uniform brought in a tray with breakfast—coffee, bread, butter, and jam. The woman broke the roll in two and spread butter and jam on both portions. She pointed to the plastic cup, poured in coffee and milk. “Sugar?” she asked. “Two,” the man replied, making a
V
for victory with his fingers.

The procedure has been enacted without variation, the nurse has continued spreading jam on the bread, and he has eaten it with one hand in order to then fall asleep next to the machine with his left arm motionless and bread crumbs in the folds of his pajamas. This repetition of actions—five hours, three times a week—has put him in his place, among the other patients occupying other dialyzers—Ángel, dozing next to him with a radio pressed against his ear, dreaming of cakes and swimming pools; Andrés, a Jehovah’s witness who, in Ángel’s words, approaches his treatment as if he were buying shares in the real estate agency of Heaven; Marcela, a palmist and tarot card reader who has an astrological phone-in show on a local radio station, which envelops her in an aura of mystery, something that, in Andrés’s words, the hospital workers compensate for by giving her extra attention; Ambrosio, an ex-miner who drinks and eats with suicidal abandon; and Tere, a small, deaf girl with the face of a tawny owl, whom he has never heard say a word or seen reading anything or listening to the radio, who only ever stares out of the window at the pigeons delousing themselves on the sill, as if she didn’t know why she was there, and who on occasion, whenever Sara misses the fistula and a small jet of black blood emerges from the hole, shudders slightly and emits a squeak very similar to the sound of a badly oiled door.

At the start of his treatment, he would become quickly overwhelmed by tiredness and close his eyes, and his brain would activate a superficial sleep that merged with the fermented smell of iodine, disinfectant, and sweat, a fleeting, fragile sleep, like on a bus journey. He dozed, attentive to the slightest movement of his arm. It usually happened that his mind would wander, leaving the room, and at that pleasant distance he would become unaware of his body, to the point that his arm, relaxing, would slip off the armchair. This slight movement was preceded by a sudden feeling of vertigo. He would then wake up, and the fluorescent light from the tubes on the ceiling would flood his abruptly open eyes. The first time, he blinked on feeling a slight tear in his skin. He thought he saw the succubus of his bad dreams climbing toward the lights. He blinked again to push away the steadily growing pain, but his arm kept swelling under the tape like a bladder. The process ground to a halt, and the machine emitted a shrill alarm that shot through the room and the dreams of the other patients, bouncing off the ceiling, against the windows, zigzagging over the tiles, like light from a laser pen, until it reached the nurses’ station at the far end of the corridor. He stared in amazement at his swollen arm and the loose needles.

“Oh my . . . ,” exclaimed a nurse, heading for the machine. He saw her pressing buttons and clamping tubes. She proceeded to rummage around under the skin of his arm with the needles. It seemed to him she did this with an electrician’s fluency. He clenched his jaw when he felt the tiny steel tips digging under his skin and swore under his breath.

“Oh my . . . ,” exclaimed the nurse again, continually moving the needles in search of the bloodstream until, finally, the blood went back to circulating through the tubes. She put surgical tape over the wound and wagged her finger, as if telling off a child. “Don’t forget to practice with your rubber ball, fifteen minutes a day,” she insisted, “you have to strengthen those veins. And as soon as you get home, put some anti-inflammatory cream on that forearm, you’re going to get a good bruise.”

He watched her head recede toward the nurses’ station, her updrawn hair bouncing on the back of her neck, suntanned, gymnastic, and was suddenly overwhelmed by an extravagant mix of gratitude and guilt.

He repeats “in-put, out-put; in-put, out-put” in the knowledge that it’s not the needles or the machine but he who is living under a parasitic, dependent regime, since the real burden is his body and not the machine, which will always remain focused on the perfect logic of its surroundings, deaf and dumb, oblivious to the fact that he is a man rather than anything else with a circulatory system—a horse, a monkey, a cow. This idea envelops him in a deceptive sense of self-complacency he isn’t always capable of avoiding, since it confirms his suspicion that he is living in constant deferment, between parentheses. Once connected to the machine, he only has to worry about the feeling of guilt concerning his blood and the fear of it being wasted as it passes through the tubes. Like all patients, he knows he is under obligation to inspect his own excrescences, not without a certain fearful satisfaction. The machine is running, and he notices every change, every arrhythmia, oblivious to anything not ascribed to that state of siege. In this way, man and machine each continue in their own space.

The doctors have their names embroidered in blue thread and their pockets full of ballpoint pens, felt tip markers, and pencils. The head of the nephrology department is in the habit of squeezing the feet of patients while reading the results of their latest analyses. The others merely nod in silence, knowledgeably, huddled around the ward manager’s notebook, and after their rounds, once the director of the nephrology department has squeezed, one by one, the feet of all the patients, they move off down the hallway, forming a hermetic group of healthy, freshly showered men who leave the pleasant aroma of cologne in their wake. He thinks they already constituted a separate group before they entered the room, like all the other men and women not in the hospital—people walking down the street on their way to work, the bus driver charging passengers for their journey, the lottery ticket vendor stationed at the door to the healthcare center—because at heart and in practice they
are
in another place. Or perhaps he’s the one who’s in another place. This impression of foreignness begins in his body and spreads outward, as if the fact of having a sick body transported him to another sphere of reality and conferred on him the suspicion of a crime. At times, this impression crystallizes and turns into resentment; he catches himself staring at another driver through the window of the taxi, somebody who is smiling or talking to himself while listening to music or going over the day’s tasks, stopped at the light, in his car, without realizing that next to him, reclining in the seat of the taxi taking him home or back to the clinic, someone is envious of his healthy complexion, his glistening eyes, his absorption in the music or some banal concern, and for a moment would like to be that carefree driver returning home after a day’s work, to take his place, and for that man to suddenly feel the exclusion and the affront of illness and spend five, six years, or possibly the rest of his life, connected to the machine, “in-put, out-put; in-put, out-put.”