Absence by Raymond Tallis

One September evening in the late 1970s, a type 50/50 diesel engine was hauling a small train through growing darkness. It seemed to have given up travelling and was simply approximating. The train had left Birmingham New Street station over two hours earlier and had still not reached what, for three of its passengers, was its destination. There had been innumerable stops, some labelled and apparently purposive, others unlabelled and without evident purpose. Unknown to themselves, the three passengers, each in a separate under-populated carriage, were soon to become mportant to one another as major characters in the story that is to follow. But to say this is to cheat, shamelessly xploiting the power of preterite narrative to turn time from a scalar to a vector quantity. Besides, I mention Sister Janet arker BA, SRN (who is checking, with a slight frown, the proofs of her article on Faecal Incontinence) and Dr William elldorm MB, BS, FRCHD (who is spotting trains) only in order to lay them aside in favour of Dr Nicholas Page. Dr Page, a medical practitioner in his thirtieth year, has at last fallen asleep, after an action-packed journey. Some of the action, it has to be admitted, had consisted of his packing the contents of a succession of cans of Brewmaster into his shapely frame. Although he has drunk enough to earn a good going coma, he is only lightly or fitfully asleep, obtunded rather than zonked, and is even now muttering to himself. He is recalling, perhaps, a weepy parting at Euston Station from Felicity his girlfriend (the saline had been hers, not his). Or maybe he is re-running the highlights of his long, rather one-sided, conversation with the guard who had at first wished to punch only his ticket. If we have elected to join Nick Page at this late stage in his journey it is in order to spare ourselves a good deal of embarrassment. His address to the guard - garnished with academic puns and erudite allusions - was but a short stretch of a monologue, directed at various persons, that had lasted almost without a break from Euston station to a few moments back. We may imagine ex-passengers all over the South and Midlands of England informing their loved ones that they have discovered a new allotrope of Hell:

"There was this chap on the train crapping on for hours - I mean he went on and bloody on and bloody on! Imagine getting stuck in a lift with him!"

Who is this youngish man? What is he doing on this train? And what is the matter with him? Well he is a man in trouble, and for the first time in his life, he is seriously troubled. Until recently, Nick, a St Jidgey's man, had looked like being a hospital consultant, a future specialist of international repute, a leader of his profession...

...And so Nick had taken time off from clinical medicine to conduct research which, he expected, would generate more publications and a doctoral thesis worthy the degree of MD, and which might, epiphenomenally, lead to discoveries that could benefit humanity. Only a week ago, he had been Research Fellow in the Department of Haematology in St Jidgey's. His research had been going well.

He had been investigating the phenomenon of senile purpura. "Purpura" is bruising and senile purpura occurs spontaneously in old age. On account of the folk tradition that the bruises are caused by the devil plucking at the aged, trying to draw them from life, they are sometimes called "the devil's pinches". Nick had not been able to substantiate the claim that they were death's love-bites, but he had made considerable progress in identifying the defect in the wall of the capillary blood vessels that accounted for the bruising. He had already presented his results to general approval at a couple of scientific meetings. The success of his research was a foregone conclusion as he had conducted it under the direction of Professor Fibrin whose work on platelets had made him an international name. Moreover, unlike most of his colleagues at St Jidgey's, whose presence was as welcome as dysentery in a jacuzzi, Fibrin was extremely genial and genuinely kind. Nick liked him and he liked Nick.

So why is Dr Page now an ex-Research Fellow, mining his way northwards through the darkness (for darkness has fallen while we have been introducing him) away from the capital to the provinces? Occasionally individuals living in London respond to the call of the wild and go North ? sometimes in search of the roots they have read about in a book purchased in W.H. Smith's. But all Nick's roots are in the South. And, besides he doesn't have roots beyond an extended family that gathers to argue at Christmas and a few photographs and certificates in a biscuit tin in the parental home. No, he is going north in order to work - at the North Brompton Royal Infirmary. This extraordinary fact warrants further examination so that its extraordinariness may be fully appreciated...

...Nick's career to date had been remote from places like the NBRI. Although he had read much in the medical press of the woes of overseas doctors stranded in the less popular reaches of the NHS, he had seen little of it first hand. Coming to work in the NBRI amounted virtually to dismounting from his career. What possible reason could there be for such an extraordinary act of self sabotage? Simply this: he had had to leave St Jidgey's because he could no longer bear to remain there. This near-tautology does not advance our understanding to a great degree. Further explanation is required.

Dr Page has until now travelled not only professionally but also socially in the fast lane. Which is not to say that he is a social climber, rather that one of his preferred ways of socialising is by climbing into people's beds. This preference is satisfied not because he is a good doctor, which in the field of sexual competition counts for nothing, but because he is extremely good-looking. It is probably worth mentioning his appearance at this stage because it is well known that those with good looks are forgiven much - bad behaviour, stupidity, even intelligence. He is just above medium height, is well built, has thick fair hair, fine regular features and blue eyes whose glances are such as to place a frost of sacred terror over the pericardia of many females.

"He lays them and then lays them aside." No, that is unfair. But it cannot be denied that most of his affairs have been short-lived and that it is he, not the relevant she, who has broken them off. He has an eye, but not an ear, for pretty women. His razor-sharp mind finds their minds as disappointing as the minds of the average male and most post-coital discourses dispiriting. And so, without wishing to do so, he has caused a good deal of suffering. This suffering has worried him but not excessively - certainly not sufficiently to cause him to discontinue the behaviour that brought it about.

And then, one day last Spring, his easy-going attitude to the vicissitudes of love changed. He fell for someone who did not fall for him. Or not at first. Or not completely. Or perhaps not at all. Her name was Susie and she came to work as a technician in Professor Fibrin's laboratory. Perhaps it was because she, too, had blue eyes, a shimmering amethyst blue, that she was unimpressed by his; perhaps because she, too, had fair hair, longer and more fine-hued than his, that she was unimpressed by his fair hair. Perhaps it was because she too had full lips, fuller than his so that they were creased in their attempt to fit into the available space, that she was apparently unexcited by his generous mouth as by the other features of his face that she could outshine item by item. Moreover, she didn't like his manner; the assumptions, for example, implicit in his greeting her one day by kissing her cheek - though to this she had responded, if not in kind, at least without overt hostility. Anyway, one lunchtime when they found themselves alone in the laboratory with some platelets, he had kissed her on the lips. She had closed her eyes and opened her mouth. Now while she may plausibly have closed her eyes to rest them after a morning of looking down a microscope, the open mouth did suggest a certain amount of acquiescence in the procedure. The conclusions Nick drew from this were, however, shown to be false. The following day, he had extracted her from the laminar flow cabinet, where she was drying her just painted fingernails, and had taken her out for a drink. She had refused to let him hold her hand and reacted to the mildest of kisses as a princess might respond to the lecherous advances of a methylated dosser.

I won't document their relationship ( or non-relationship) - what he did and how she did or did not respond - but state simply that for several months he seemed alternately to be making progress and going backwards. By early summer, he was past the point at which he could have shrugged off the whole affair, offsetting failure against his many successes under the rubric of "You can't win ‘em all." For reasons that he did not fully understand, her yeses and noes were more crucial to his happiness than anyone else's yeses or noes had ever been - and infinitely more important than the outcome of the study of capillary fragility that had brought them together. His anguish was heightened by her obtrusive weekends that underlined his exclusion from her life. She would arrive at work on Friday morning with a travelling bag and the kit appropriate to the weekend's diurnal activities - wet suit, surf board, etc. - and be picked up direct from work on Friday evening by the latest Porsche-driving boyfriend. And she would come in late on Monday morning exhibiting to his jealous eyes all the diagnostic signs of fatigue derived from strenuous intimacy.

So she became his continuous preoccupation. He was unable to forget her even when he was in bed with a new girlfriend. Susie's vacillation between welcome and rejection, however unconscious, seemed designed to maximise his suffering. In his sick old age, when there was a revolution on and he was tired and angry, Pavlov designed a particularly ingenious experiment. He took a group of dog volunteers and conditioned them to associate an elliptical light with the most delicious food and to associate a circular light with an appalling electric shock. He then investigated what happened when the dogs were presented with a light that varied continuously between an ellipse and a circle. They all went mad - every single one of them.

It would be an exaggeration to say that Nick went mad. Those who are unused to suffering are prone to overestimate the place of their own on the scale of human woe (though Nick's suffering was sharpened by the knowledge that he was himself being treated as he had in the past treated many others). And it would be unfair to hold Susie entirely to blame for his mental state. For at the same time that he was embroiled in his affair with her, other things were happening in his life.

For a start, he was coming near to achieving the goals he had set for himself since his early twenties. There is nothing like arriving for making you question the value of the journey. Do I really want to be a Consultant in a teaching hospital for the rest of my days? Have I lived enough before I settle down? Even - or perhaps especially - the mindless hedonism of Susie's life was a critique of his own more serious existence. And there was a third factor that may have explained why his madness or near-madness or simulated madness took the form that it did. Recently, Nick had again started reading books that lay outside his speciality of medicine. His research post had given him the leisure to do this for the first time in ten years. More specifically, he began to read philosophy. Now everyone is familiar with the dangers that lie in books, if not from first hand experience. As many addicts of the Beano are aware, Don Quixote was driven mad through reading too many romances. His mistake - which suggests that he was mad even before fell among novels - was that he thought what he read in books could be applied to his life. Now this is silly but it is a hazard run by impressionable readers.

Nick, anguished by a love affair, facing what Mr Conrad described in "The Shadow Line", was just such an impressionable reader. In his anger and despair, he looked to the consolations of philosophy to lift him out of the pit. Whoever directed him to the works of the recent French philosophers - in particular the writings of M. Derrida and M. Lacan - has much to answer for. In the ingenious writings of certain Parisian maîtres à penser he found not only a mirror in which to view the senselessness of his condition but also the hint of a cure that was worse than the disease to which it was directed - But this is to look too far ahead. Sufficient to say that he took seriously ideas that others merely got tenured posts for expounding; tried quixotically to live by, at least inwardly, the unthinkable notions that the professionals merely lived off...

...One day, after he had received a decisive no, delivered orally and backed up by a letter written in Susie's remedial class handwriting, he saw an advertisement in the British Medical Journal for a locum Registrar at the North Brompton Royal Infirmary. After a long, and difficult, interview with Professor Fibrin, he obtained permission to terminate his research contract three months early (on the understanding that he would finish his MD thesis) and so escape the endlessly tantalising presence, the standing refusal, of Susie.

Mmm...One of the first things a medical student learns is that ingenious explanations rarely lead one to the correct diagnosis. And one of the first things a contemporary student of English literature is taught is that the basic attributes of fictional characters - obsessive love or guilt, madness etc. - are just so many stylistic devices to enable the author to bring together material - jokes, apercus, observations - that would otherwise remain scattered and unpublishable. For these two reasons, we should be suspicious of the explanation I have offered of the condition in which we find our physician-hero...

...But already the train is slowing to a halt and Nick is waking up. He is feeling, as one does after a drunken doze on a train, as if meaning has drained from the face of the universe. This will not stop him talking of course. The end of meaning will merely provide the occasion for more words - dead messengers still running with the news from the Battle of Marathon.