On Writing the Hospital

A nurse named Sylvia brought me into the operating room, where she introduced me to two more specialist nurses – I was too stressed to catch their names. They were going to thread a plastic line through a vein in my arm all the way to my heart. Eyes smiling from behind their PPE, they laid me down on the table, and told me they were going to administer the anesthetic. As they wiped my bicep with antiseptic, they asked questions about my life outside the hospital. They asked whether I worked or studied. I was twenty-one. I told them I studied—Russian and Spanish. They lit up.

Sylvia was from Italy, the short woman with dark hair was from Greece, and the tall one with dyed-red hair was from Romania—each of them spoke at least three languages. The Greek nurse had studied German, and asked me whether I found it difficult to learn a language with a case system. Did I think differently when I spoke Russian? The nurse with red hair had studied Tolstoy and Dostoevsky at school in the Socialist Republic of Romania, the same novels I would be reading for my finals the following year. “They’re wonderful,” she said. I nodded, nervously declining “игла,” the Russian word for needle, in my head. They were preparing the syringe. “Take a deep breath.”

The pain was dull, but interesting. I had never had a local anesthetic, and paid close attention to the knife as it nagged at the inside of my arm. I had already started writing about what was happening to me: poems, essays, a couple of which had been published. I wanted to remember how the incision felt. The skin was soft and thin, worn out from the chemicals that were killing my cells indiscriminately, just barely containing my steroid-induced puffiness. I was a month into chemotherapy for stage iv Hodgkin’s Lymphoma, and it was damaging my veins, making them harder and harder to find. My nurses prodded and pricked me with the precision of master tailors, tracing my blood vessels with an infrared vein finder.

Finally, frustrated, they decided to install a PICC line in my upper arm: a port they could attach to the infusion bags, delivering their chemicals straight to my heart, which I could see now, on a screen next to the operating table. They were using an ultrasound to follow the tube there, where it had ended up, they said, in perfect position. I didn’t feel the plastic, only the first blunt pressure of the scalpel opening me up.

That was in April 2020. My treatment coincided almost exactly with the beginning of Covid lockdown in the UK. I had a reassuring prognosis, but without the treatment that almost killed me, I would have died, quickly. For a week, there were visitors: friends and family who came to hold my hand as the pain pricked, as the nausea rose and fell. Then the hospital all but shut down, and I sat through my infusions alone on an overstuffed, mechanized armchair, in a mask. Most of the time, I was deeply, irrevocably lonely.

But that afternoon in the operating room, I felt the rare buzz I found myself chasing. There were times the hospital felt magic, when it felt tangible that medicine could do the impossible, that loves—past, present, and future—were being saved there. Sometimes I even felt, as I did that day, that language was curing us all—that communication itself wound its way in and out of our sick bodies, explaining them back to health.

Toward the end of Garth Greenwell’s latest novel, Small Rain (FSG, 2024), the unnamed narrator has a PICC line fitted. “It goes all the way to the other side of the heart, to the—; and she used several words I didn’t understand, I glazed over again, though I did catch the final two, vena cava, because they were short and also beautiful, and even with my almost nonexistent Latin I could translate them: empty or hollow vein.” Greenwell’s narrator experiences the body first and foremost through language.

Though unnamed, he is a narrator many will already know from Greenwell’s first two novels What Belongs to You (FSG, 2016), and Cleanness (FSG, 2020): a poet from Kentucky who lived in Bulgaria for many years, where he taught English and became entrenched in the local gay scene. In Small Rain, he has returned to the US, and is living in Iowa with his partner, L, a Spanish poet who teaches at the university.

One afternoon in 2021, he experiences a moment of excruciating, life-altering stomach pain. He grits his teeth through five days, reluctant to go to the hospital in the middle of the pandemic. When he finally arrives at the emergency room, they tell him his aorta has torn—a medical event only fifty percent of people survive. In the two weeks of hospitalization that follow, we follow him as his body is held captive, and his mind wanders—to his past, and what he had imagined of his future. Mostly, he thinks of love and poetry, which are personified in his beloved, L, who texts him constantly, checking in on him each day during his highly restricted visiting hours. The resulting novel is a kind of epic in miniature—one which recognizes the hospitalized body as a site of poetry, contemplation, and love.

So much of Greenwell’s novel felt eerily familiar. I was particularly taken by his description of saline, the liquid used to flush out intravenous lines: “then my mouth flooded with the taste of saline, that ghost taste, and the shorter woman applied a large dressing to my arm.” That ghost taste was one I knew well, one which it felt impossible to describe to someone who hadn’t tasted it themselves. Again, in a new way, it felt as though language was curing me. Not retroactively, exactly—maybe it was more of a balm, healing the scars and helping them fade.

Leafing back through old journals the other day, I found an entry which unsettled me profoundly. I had written that I felt my situation was doubly alienating: that it was rare to get cancer so young, but even rarer to get it during a global pandemic. I couldn’t place my finger on what it was that made it unique, but had a feeling it was everything_that the world had shifted irreparably, and taken me along with it. I wrote of wanting a precedent, a novel or poem by someone in my position, but there were none. Small Rain was the first book I have read which deals with the pandemic as more than an oddity—as something which changed the texture of life and the sensation of being a body, an ill body in particular.

I am still trying to write about what happened to me, only now I’m writing a book, one in which the oncology ward appears in flashback. Almost four years to the day after my chemotherapy began, I married a man I had watched care for his father in the final stages of dementia. As I witnessed his acts of care, and was reminded of those carried out for only a few years before: medicines administered, mess cleaned up, frailties accounted for. Our circumstances, equally anomalous in our mid-twenties, have united us in a pursuit to put it all into words—to bear witness not only to the unlikeliness of our experience, but its beauty, too. Our stories, as well as our lives, have become inextricably linked. My cancer and the care I received are more than interludes in our new narrative—they are an extension of the love and care I have seen him give, and which we give one another.

Extreme illness and the hospitalization it almost always entails has always been a challenge to literary expression—a subject so intensely bodily that it strains at the limits of language. And yet Greenwell’s Small Rain reminds us that this challenge is not one to be overcome, but rather to be reckoned with—that doing so is literature in and of itself. Small Rain is also evidence of something I have long intuited, that the extremes of care—both given and received—are paths to romantic love, rather than away from it. As it becomes more and more imperative that we document the experience of hospitalization, both during and after the pandemic, Small Rain guides me in the right direction, hopefully, through language toward love.