Gartnavel Ghosts

Gillian Shirreffs

What follows is a working out.

A back and forth.

A negotiation of place and time.

But first, a potted history. It’s the summer of 1991. A 21-year-old girl is invited to attend an interview at Gartnavel Royal. She gets the job. It’s the summer of 2021. A 51-year-old woman is invited to attend an appointment at Gartnavel General. She gets cancer.

Clearly, the cancer was already there. Growing. Like the fear in her belly. But it wasn’t there until the examination followed by the mammogram followed by the ultrasound followed by the biopsy followed by the appointment with the breast surgeon who has in his possession the pathology report containing the results of the biopsy, confirming she has breast cancer.

More accurately, the results of three biopsies: tissue was taken from two sites in her breast and one site, a lymph node, under her arm. Two of the biopsies show cancerous cells (one site in her breast and the lymph node in her armpit). The third biopsy shows pre-cancerous cells (in the other site in her breast).

More accurately, in my breast.

In my armpit.

June 1991

I sit down on a chair in an empty corridor and wait for my name to be called.

I’ve just turned 21 and I’m nervous.

I suspect family connections have secured the interview (I’m the daughter of two nurses, one of whom is a friend of someone higher up). I turn this over in my mind and hope it won’t count against me with the not so high up person who is about to stumble over the pronunciation of my ridiculous surname; that instead my unbridled enthusiasm coupled with the fact I’m hardworking and studying for a degree in English Language, will go in my favour.

My previous jobs have been seasonal and mainly involved dishes – the washing of them – and I’ve typically been referred to as ‘the student’.

Why bother learning someone’s name if they’ll be gone in a matter of weeks?

I feel in my bones that this job, if I get it, will be different.

It will mark a transition.

August 2021

I indicate and make a left turn off Great Western Road.

I’m reminded of the butterflies I felt in my stomach when a vehicle in which I was a passenger made this same turn thirty years earlier.

The car park is busy.

A space finally opens. It’s tight but I manoeuvre into it.

Forward and back; forward and back.

I take a breath.

Check my appearance in the rear-view mirror.

And step into August sunshine.

As I approach the entrance of Gartnavel General, I see it not just through the eyes of the 51-year-old woman I’ve become, but also through those of my younger self.

The front door slides open, and we walk in, together.

I locate the waiting area and check in.

The man through the glass smiles and indicates I should take a seat.

It’s early.

My appointment has been made for just before the breast clinic begins, so I have my choice of chairs. Despite this, I choose the one nearest to him.

When my name is called, a name I opted to keep despite the married alternative being so much easier to say, I’m aware of my younger self, standing, too.

After the doctor examines me, she draws a circle on my right breast in black pen.

I assume this is not good.

I’m told to go to radiology where, she explains, I’ll have a mammogram.

I follow her directions, aware of little other than the anxiety that has taken root in my chest, a tightness underneath my ribs. Significance surrounds me: in the walls that form an honour guard as I walk to my next destination; in the new waiting area with its Covid information and carefully spaced seats; in the sound of my name being mispronounced once more.

I know, without being told, that a change has taken place.

The idea that it will be fine, that I will leave unscathed, has vanished.

June 1991

The project team onto which I’ve been hired is new.

Brand new.

Our mission is to equip both inpatients and outpatients with useful life skills.

My role in all of this is to teach adult literacy. Thanks to a budget overspill, funding has been made available for a three-month post (a perfect way to spend my last long university summer holiday: earning whilst learning to teach). Thankfully, I won’t be alone in this endeavour: my role will sit alongside a permanent post, which has been filled by someone much older and wiser. A colleague who will become a coffee-buddy, a lunchtime friend.

On my first day of work, the former ward in which we’re to be housed is in a state of flux. Beds and privacy curtains are being replaced by desks and chairs; side rooms are being transformed into teaching spaces.

The first order of business is a crash course in Adult Basic Education. I approach it in the manner of a teacher’s pet. I complete the course and receive a certificate which, a year later, will share box space with my degree scroll.

Once certified I meet my first student, Alec – not his real name.

Alec looks older than my dad. I realise that this could make our teacher/student relationship difficult. His openness, though, is humbling. It becomes clear that he wants me to teach him how to read and write, and this desire is greater than any discomfort he might feel about my lack of age and life experience.

In our first lesson, I start at what I think is the beginning.

I awkwardly reintroduce Alec to the letters of the alphabet.

What develops is a conversation. About life. Its complexities.

I’m taught just how fortunate I am.

August 2021

I meet my oncologist for the first time on Wednesday the 25^th of August. I’ll later learn that pre-chemo appointments always happen on a Wednesday, at least the twenty-two that are in my future do.

Dr Kerr – not his real name – is based at the Beatson West of Scotland Cancer Centre. This is a building that didn’t exist in 1991. It’s in what was lawned gardens, from memory, and sits in front of the Maggie’s Centre, another new kid on the block.

Thanks to the Writing the Asylum project, I’ve seen old photographs of the Gartnavel campus, showing a farm on this site. A farm which was attached to what was then The Glasgow Royal Lunatic Asylum. I presume its purpose was to provide sustenance for both the body and the soul.

As a structure, the Beatson looks good: it has modern lines and is unobtrusive in the landscape. It gives, at least to me, a sense that excellent medicine takes place inside. And there’s something calming about it: light colours and a nice amount of glass. If a building can instil confidence, this one does.

In terms of location, it’s close to the train station – a train station I often used as a girl, commuting to and from my job at Gartnavel Royal – so I likely walked over the ground on which it was built many times never imagining that someday a hospital would spring from the soil under my feet. A hospital that would send me a letter inviting me to attend an appointment with an oncologist.

An oncologist I never wanted to meet, but who is everything you could want in one: an expert in his field; a clinician who listens; a consultant who thinks out loud and changes his mind, right there in front of you, as he tries to ensure he balances each and every variable to make certain he provides the right treatment for you (in this case, me).

June 1991

I quickly learn to tailor my lessons to suit the interests and motivations of my students.

For instance, Alec – still not his real name – wants to be able to read the newspaper.

Despite spells as an inpatient, he’s managed to hold down the same job for years and takes a newspaper to work every day. He tells me he pretends to read it at lunchtime, whilst eating his sandwiches.

Once we’ve worked on what are deemed to be the fundamentals, our time together is spent poring over words and sentences cut from the pages of the Daily Record, his paper of choice.

I find out a fair deal about football during the hours we spend together. In particular, the machinations of two local clubs. None of which I commit to memory.

I tend to go for a walk during my lunch break. The pleasant weather draws me out into the garden grounds.

One of my colleagues is a horticultural tutor. I like to skirt the periphery of the small groups he teaches. There’s a clink to their rakes and trowels I enjoy and I’m sure I can smell the warmth of the soil as they turn it over.

In the shadow of the old asylum, I sometimes let my mind wander, imagining the stories of this place: the footsteps that went before.

I never think about those that will come after.

September 2021

My first infusion of chemotherapy is arranged for the 9^th of September, our 21^st wedding anniversary.

Keen as I am to get started, I’m relieved when the date is changed to the 16^th.

In truth, I’m not keen, but it’s what I tell people.

I still haven’t figured out my relationship to the cancer in my body. I’m scared of it and what it will do to me, but the means of its destruction are frightening, too.

Poison. Cut. Burn.

It’s not the more common of the breast cancers: my hormones are not involved; some other action is at play.

The word aggressive has been used.

My lay person understanding is that it grows and multiplies more quickly.

Is skilled at spreading.

It’s probably best, I realise, that we get straight on with its annihilation.

But keen is not what I feel.

Due to its aggressive nature chemotherapy comes before surgery.

Or maybe it’s because the cancer has already exited the breast.

I don’t exactly understand why and I’m not sure it’s been explained.

But there is a reason.

One that doesn’t bode as well as if it were otherwise.

That’s the sense I have been given.

September 1991

A nip enters the air.

Autumn arrives with the turning of the leaves: the year ages in shades of orange and yellow; green gives way to gold.

My final year at university is looming and my three-month contract is about to end.

Or so I think.

I’m called in to see my boss.

She has a proposition.

There’s some money available for a part-time position.

Just one day a week.

Would I be interested?

Of course.

Of course, I would.

September 2021

The first infusion introduces me to ‘the chemo corridor’ and ‘the big chemo chair’.

I believe these are just my terms, but they could be part of a shared consciousness.

It also introduces me to canulation.

My hands are soaked in hot soapy water to make the veins easier to see.

To work with.

On this occasion my right hand is chosen.

It has good veins, I’m told.

Thankfully, the nurse manages to canulate in one.

This will not always be the case, but I don’t know that yet.

I also don’t know that in 60 hours, or so, I’ll spike a temperature.

That when I phone the Beatson helpline I’ll be told to go to the Queen Elizabeth.

[In this time of Covid, the Beatson will have no truck with anyone spiking a temp.]

I don’t know about the seven hours I’ll sit in an overflowing waiting room.

Waiting to be seen.

Or the sepsis that is waiting for me.

The masks and gowns; the isolation room; the IV drip of antibiotics.

The days and nights I’ll spend perilously unwell.

Or that when I return to the Beatson for my second infusion, I’ll be rail thin and bald.

Apt to cry easily.

A ghost of my former self.

October 1991

It’s a challenge, but I’m just about able to juggle my work at Gartnavel with senior honours English Language and my role as Vice President in charge of Welfare on the Student Representative Council. It mainly involves prioritising Gartnavel and the SRC over lectures, tutorials, and library time.

I tell myself it will be fine.

My Gartnavel students have been reduced to a handful, one of whom is Alec.

Both he and I are pleased that we’re still working together. With some urgency, we focus on writing now, along with the paragraphs he’s reading from the Daily Record. I suggest we use lists and letters as a way to practice words and sentences.

We start simply with the sorts of lists he can take to the supermarket and build up to letters to an invented pen pal, who is interested in football.

Alec’s progress suggests to me that he was more able than either of us realised.

Perhaps it was partly an issue of confidence.

Or maybe, during his short, disrupted education, he had assimilated more than he was aware and just needed someone to spend time with him, helping him unlock things he already knew. Someone who would focus solely on him.

December 2021

My final cycle of pre-surgical chemo takes place on the 9^th of December.

At least, we’re hopeful this will be the last cycle. I’ve had three more emergency hospital admissions due to treatment-related infections – all of which have been quite grim – and my understanding is that it would be helpful to move me onto the surgical stage, even if it means more chemo afterwards.

There’s to be an MRI first, which is scheduled for December the 22^nd.

Before it happens, I’ll have had another emergency hospital admission.

A gift from that last chemo session, which has a wallop in the tail.

Terrible as chemo has been – and it has been the most awful thing I’ve ever experienced – I’m more frightened of surgery.

My one previous experience of it didn’t go well.

In the May of 2001, a minor day surgery morphed into something much worse. Something that put certain of my organs under strain, in particular my kidneys and pancreas. And involved a week in hospital on a drip.

No one ever discovered what had caused my body to react in that way.

There was talk that it might have been a reaction to the anaesthetic.

December 1991

Gartnavel’s landscape has changed again.

November’s gusts have stripped away the leaves.

The predominant palette is mud brown.

We’ve moved out of our home in the West House having been relocated to a wooden and glass building that sits in the grounds below.

I’m reminded of being a little girl at St Machan’s Primary School.

My Primary Two and Primary Three were spent in ‘the huts’.

Our new arrangement feels remarkably similar, down to the displays of work we’ve affixed to the walls. To make the place more cheerful, more inviting.

But it has the same temporary feel.

No one says this.

We all agree it’s good that our skills centre has a dedicated place.

A ‘non-hospital’ space.

Encircled by nature.

Amidst grounds that shelter birds and rabbits and foxes in wintry thickets.

January 2022

The night of my first surgery for breast cancer is spent in Ward 4A of Gartnavel General.

I don’t sleep.

Presumably, this is as a result of the aftereffects of the various drugs I’ve been given and the excitement I feel that the operation is over. And I’ve survived, my terror of the anaesthetic having come to naught.

The sun rises late and lazily; the slow January dawn reveals the view from the window opposite: Gartnavel Royal.

As I study its dark form, I’m struck by the thought that this building, this ruin of a place I once knew – in which I walked and talked and taught and grew – had been there throughout this thing that other people call a journey.

Watching.

It was, after all, the original inhabitant of this site; within its grounds these other hospital buildings were brought to life.

Its empty windows have kept silent vigil.

It was there, just steps away, during that initial examination and the biopsy that followed. Its towers and buttresses offered strength and solace during chemotherapy and now, here it stands, my morning companion.

In my reverie I am transported back.

Not to the mid-1800s of its birth, but to my own youth.

To the girl I was when I first walked up its sweeping driveway and stepped inside.

March 1992

It’s cold and wet, but swathes of crocuses have begun to replace the snowdrops of winter.

Colour is returning to Gartnavel.

Finals are almost upon me.

The last day we all knew was coming, has arrived.

There’s coffee and cake.

And laughter.

Alec has written me a thank you card.

It feels like a greater achievement than anything I’ll ever do academically.

March 2023

I could never have imagined that this is how I would return to Gartnavel.

Regardless, its grounds and its buildings hold a special place for me.

It ushered in my adulthood; gave me my first ‘proper job’; instilled my love of teaching; was a place of growth, of blossoming.

And yet, the hardest moments of my life have happened in this place.

It’s where I was told there was “something” in my breast “that shouldn’t be there”.

And that the surgeon hadn’t got clean margins.

That there hadn’t been a complete response to the pre-surgical chemo.

It’s where I had two surgeries.

15 sessions of radiotherapy.

22 infusions of chemotherapy.

It was in the shadow of the asylum, that we experienced it together.

The girl I was. The woman she’s become.

I’ve comforted her; held her hand.

She’s reminded me that this is a season, and seasons pass.

Commentary

This commentary reflects on the difficulties I encountered when trying to write Gartnavel Ghosts and explores the ways in which Gartnavel itself helped me to overcome them.

I was excited to be part of Writing the Asylum. A brilliant project. An important one. I approached the patient record I was sent as a researcher, a reader, a writer. But I was also in the midst of cancer treatment, and I just couldn’t connect.

I therefore went in search of something that would inspire. I dug through records. Looked at myriad photographs. Immersed myself in an archive that is fascinating.

Yet I was left cold.

The problem, clearly, was with me.

This realisation led me to start from first principles: my own experience of Gartnavel and its ghosts. I started the piece many times. Over and over. It was a formless thing just outside of my reach. Nothing would come. And what did was turgid, so I classed it as nothing. It wasn’t the writing I expect of myself.

After over a year, I wrote the reflection that follows.

It became the key to unlocking Gartnavel Ghosts.

I offer it to you now as a representation of what it has been like, for me, as a writer who was diagnosed with breast cancer 20 months ago, to try to write again.

A Reflection

I’ve found it difficult to write about Gartnavel. I’ve found it difficult to write. I hadn’t expected to. Because writing is what I do. It comes as naturally as brushing my teeth. As easy-breezy as drinking that first coffee in the morning. Or it did. Before cancer.

Cancer is the thing that gave me the second half of my Gartnavel story. Cancer is also the thing that has made me ‘not a writer’. Who’d have thought? I get a creative writing doctorate, and, in short order, I lose the ability to write. To think in the way a writer thinks. To think. About something other than cancer.

It feels like there isn’t a place for me. Not anymore. And yet this is a project about place. A special place. Gartnavel. And I’ve fitted there twice. 1991. Gartnavel Royal. I get my first proper job. 2021. Gartnavel General. I’m told there’s something in my breast that shouldn’t be there. The euphemism isn’t mine. It’s borrowed from my breast nurse (not her actual title). I feel like I no longer fit. In places. With people. I don’t fit into me. The shape has changed. The shape inside. The shape inside the bit that other people see. The shape inside my skin. Inside my bones. Let’s say, for talking’s sake, my inside shape used to be a large parallelogram. Maybe now it’s a small kite. No room for writing. Or for thinking the thoughts that precipitate writing. But fear still fits. And it’s taking up more room. As is the awareness of mortality. My own mortality. Anticipatory grief. The fear of missing out. The fear of being missing. From lives. From places.

The frame has also changed. There’s less of it. Less fat. Less muscle. Not so much hair. And what there is of the hair is strange. A stranger to me. It’s curly. In an old lady perm from some point in the 1980s way. An old lady perm from some point in the 1980s that the old lady forgot to tend. I was bald. For a bit. That was worse. But not as bad as the moments before surgery. Or than chemotherapy. Or sepsis. Or waiting for the effects of radiotherapy to bloom.

Which brings me back to Gartnavel. The way it blooms. Less tended than it once was. Yet its beauty undiminished. Grass and flowers and trees. Wilful in their survival. Their roots deep and intertwined. They gird themselves in fallow times. Flourish when the season allows. Ever beneath the steadfast watch of the asylum. Under its protection.

And I realise that I, too, have been planted in this place.

So many of us have.

I am surrounded by those who came before.

Those who have walked with me.

And those who don’t yet know their path will bring them here.

To find healing amongst Gartnavel ghosts.