Also by Tim Parks
















SEX IS FORBIDDEN (first published as THE SERVER)














About the Author

Born in Manchester, Tim Parks grew up in London and studied at Cambridge and Harvard. He lives in Milan.

He is the acclaimed author of novels, non-fiction and essays, including Europa, Cleaver, A Season with Verona, Teach Us to Sit Still and Italian Ways. He has been shortlisted for the Booker Prize, won the Somerset Maugham Award, the Betty Trask Prize, The John Llewellyn Rhys Prize, the John Florio Prize and the Italo Calvino Prize.

About the Book

In Extremis is one of the most implacable, but also one of the funniest, novels about death and family you will ever read.

Thomas knows there is something he needs to say to his mother before she dies. But will he reach her in time? And will he have the courage to say what he couldn’t say before? His phone is buzzing, his mind is racing, and he can’t concentrate on the significance of what is happening. Should he try to solve his friend’s family crisis? Should he reconsider his separation from his wife? Why does he feel so utterly confused and paralysed?

In his most exhilarating book to date, Tim Parks explores how profoundly our present identity is rooted in our family past. Can we ever really change?


Mother’s corpse. This is what I keep thinking about.

Should I view it?

Why can’t I decide?

I was at a conference for physiotherapists in Amersfoort. There was much discussion of the pelvic floor and anal massage. For the first time, I opted to try the treatment myself. At breakfast a Portuguese paediatrician had sworn by it. It had saved his life. The physio, from California, warned me that a single massage might do no more than bring back old pains. But I was curious. Afterwards in the shower I felt an unpleasant urgency, a burning in the bladder and, with it, a shift in my state of mind: fretfulness. It was all too familiar. Then, glancing at my laptop as I towelled myself dry, I saw an email had arrived from my sister, addressed to both my brother and myself. ‘Mum going downhill fast. Better come now.’

So the question was: whether to give the talk I had been invited to give, or to depart at once. It is the decisions you can’t take that make you wonder who you are – despair sometimes. But this one was easy. I was only going to lose a couple of hours; I felt a certain responsibility to my hosts, who had paid for the trip and been generous. The business with the corpse is different. Actually, if I say ‘corpse’, I feel there can be no problem ‘viewing’ it. Viewing is their word, not mine, as if one were looking over a property, or the scene of a crime. And if I say ‘Mother’, then I really do want to see her. Tears come. But you can hardly use the word ‘view’ to speak of seeing your mother. It is ‘viewing Mother’s corpse’ that is the problem.

What struck me about the massage was the man’s delicacy. He came to my hotel room, knocked softly on the door. Dropping my trousers, it was impossible not to think of a homosexual assignation. He was aware of my embarrassment and wanted only to keep the situation no more or less than what it was, a physio massaging a patient. ‘Stick a pillow under you, mate,’ he said. He was grinning. Perhaps he thought all Englishmen called each other ‘mate’. Aged forty-fiveish, chinless and pockmarked, he was not a good-looking man, yet extremely attractive to be around. A man entirely at ease with himself, I thought. He communicated ease. I was envious. What I want, I had told my shrink on our first tumultuous meeting, is to be at ease with life. She frowned as if to say, Don’t go running ahead of yourself now, Señor Sanders.

If I look back I can count perhaps half a dozen other medical intrusions in this territory. All painful, one excruciating. Invariably humiliating. On all fours, up on an examination bed. Taken from behind. You an animal; they in their white coats in complete and castrating control. Why am I talking about this now? Didn’t I say I couldn’t stop thinking about my mother’s corpse? But that’s not quite right. What I am actually thinking about, or trying to decide, is whether I should view the corpse – her corpse – knowing she wouldn’t want me to. She would be humiliated, though she can’t be, being dead now. Instead, this physio laid me tummy-down on the cushion, legs spread, and began to massage my buttocks, much as one does with a baby. I was surprised, tensed for violation. He chatted to me about how he had got into this line of business, years ago now. Certainly it wasn’t what he had meant to do when he studied physiotherapy. He chuckled. His voice was gravelly and pleasant. The gentle rotation he applied to the upper part of the buttocks was exactly the massage I had given our tiny children when they couldn’t sleep, years ago. Still I was tensed for violation. He chatted on about how Dr Sharp had talked him into it. He was using jelly of course, though he must have warmed it in his hands first, because I hadn’t noticed the usual warning coldness of jelly squirted onto the skin. Dr Sharp was an extraordinary person, he said. He had charisma. And, extraordinarily, I realised he was already in there. I hadn’t noticed. Presumably with a glove on. It was warm and full and undeniably pleasant.

‘My job,’ he laughed.

I checked what the flight situation was. I would have to forgo the flight to Madrid and book to Heathrow or Gatwick. I did some googling. My bladder was burning. The flights were expensive, but there was nothing for it at this stage. How much should one shop around, when one’s mother is dying? And how, I wondered, could an event that had been as reassuring as that massage, even pleasant, have stirred up so much pain, for it was building now, not to mention this agitated state of mind? I recognised it. Yet my mother had gone out of her way to shop around for the cheapest way to die, to save the money she wanted us to have when she was gone. That was important for her. To leave us with a little money. More important for her than for us, perhaps. Even if it would be paid for with pain. I moved from KLM to easyJet and saved fifty-nine euros, though I lost an hour into the bargain. I would just have time to grab something to eat at Schiphol. Now I had to give the talk.

Of course I should have given the talk before the massage rather than after. Then I would have been in good faith when I told the physiotherapists I was pain-free and had been for years. I was a success story. It is easier to convince people when you’re in good faith. On the other hand, the very fact that a mere massage had brought back the pain – only temporarily, the physio assured me – was proof that this was a condition that had to do, as they claimed, with muscles and muscular tension, not infection or cancer, and so in a way was reassuring.

But what if it wasn’t temporary? What if that one gentle massage set off the nightmare again, for years to come? Where would that leave me with Elsa?

First the Portuguese paediatrician spoke. His English was poor and he wasn’t used to talking about embarrassing subjects. All the physiotherapists were women. Big Dutch women. He stumbled and made mistakes. But he was handsome in a Latin way, and a good ten years younger than me. The ladies relished his timidity, his embarrassment, his poor English. He talked about pelvic pains, back pains, shooting twinges in his legs, urinary urgency, abdominal stiffness, anxiety. ‘I was beginning to think I must kill myself,’ he announced rather abruptly. ‘I am never previously imagining this. But life is horrible. For months and months. Also I am impotent. There is no pleasure. I am complaining every time with my dear wife and children. I am becoming a bad, unhappy person. Very unhappy. You know? And every day there is misery.’

The Dutch women were attentive. I wondered why there were no men. Are all physiotherapists in Holland women? The Americans leading the seminar were men. Or are Dutch men especially averse to carrying out anal massage? The Portuguese doctor spoke for longer than he was supposed to. In particular about the experience of self-massage with Dr Sharp’s famous wand. It had saved his life, he repeated. I had the impression he wasn’t unaware of the seductive potential of intimate confession. Some of the women looked promising. Meantime, I had a train to catch.

‘This is a muscle like any other.’

The physio who had massaged me now stepped in, to say a word between our two testimonies. This was unscheduled. On the other hand, I hadn’t told him my mother was dying. Nor that I was experiencing pain and urgency, following his massage.

‘Actually, it’s the same kind of tissue as the shoulder muscle. Nobody is embarrassed about having their shoulder massaged, are they?’

The physio went to the back of the room and wheeled forward a life-sized plastic skeleton, its torso packed with organs in an attractively coloured three-dimensional jigsaw puzzle. Hanging from a hook on a mobile frame, inanimate Mr Plastic swung and clacked with cheerful relaxation. Everything was loose and easy, as my body will never be. Unpacking the abdomen, the physio reached in and plucked out the pelvic floor. It was made of pink silicon and shaped rather like the cups of those plungers used for clearing blockages in kitchen sinks, or an oversized tennis ball sliced in half.

‘This should be elastic,’ he said, squeezing the cup and letting it pop open again. He placed it on his middle finger, which passed through a hole where the anus is. ‘Instead, in the men we’re talking about, but many women too, it feels as stiff as an old boot.’

Again I was struck by how at ease this man was. For all his chinlessness and pockmarkedness, he gave the impression of being truly present before us, in a way the handsome Portuguese paediatrician hadn’t quite. The paediatrician had been hidden somehow, even at the moments of most intimate confession. Perhaps because he was speaking a foreign language, or because of a general unease. He was brittle, withdrawn. Perhaps it’s part of this condition. You could view him, but you couldn’t quite see him. In contrast, the physio’s immediacy, swaying easily in cheap grey tracksuit and trainers, was heartening, even beautiful. He was a healthy man.

Now it was my turn. I shifted a desk away from the wall so that I could lean back against it and half stand, half sit in front of my female audience, commanding but casual. I had been made aware from the youngest age, of course, of the importance of posture in delivering a talk. Just watching my father in the pulpit had been enough. The difference between the Reverend Sanders elevated above his congregation, in the black-and-white authority of his robes, and nervy Ted Sanders sprawled in an armchair after lunch, his trousers loosened, was total. My mother too was no slouch when it came to combining body language and rhetoric. Only a month ago she had mentioned preaching to a congregation of two hundred. You could see she was pleased with herself. ‘Absolutely,’ Dr Sharp insisted when I had asked, just the previous week, if he really needed me to be there. Wouldn’t it be enough, I had suggested – I was feeling a little tired and overstretched – to write a testimonial for them, or do a video interview perhaps? In the end I would be saying the same things.

‘No, it’s absolutely crucial you be there,’ Dr Sharp repeated. ‘There’s nothing like putting flesh and blood in front of people.’ He chuckled on the phone from California. ‘Someone called Thomas should appreciate that.’

I was surprised he had picked up on my name.

‘I hope they won’t be eager to push their fingers in my wounds,’ I laughed, and he said, ‘I’ll pay you double if they try.’

He was serious. Actually, he was already paying far more than I was used to being paid for a twenty-minute talk. But this is hardly my regular field. He was paying through the nose to put my flesh and blood in front of fifty Dutch physiotherapists. This, in the end, was why I had decided to go to Holland and do the talk despite the fact, given Mother’s condition, that an urgent trip to London was always on the cards; despite a more familiar kind of conference only two days later; despite the fact that, incredible as it may seem, I was falling in love, or believed I was, and did not want to be away for a moment longer than was necessary, since it seemed to me that every day I spent away was a day lost in pleading my cause, a day in which Elsa could take the smart decision to steer well clear of an old shipwreck like Thomas Sanders.

Almost an hour behind schedule when I got up to speak, I nevertheless spent thirty silent seconds, perhaps a whole minute, wriggling myself into a comfortable position, half sitting, half standing on and against this desk, smiling at my audience, breathing easily, letting people see who I was; above all, making sure to appear relaxed and pain-free, even though, as I have said, ever since the after-lunch massage I was not pain-free at all. On the contrary, I was now in some considerable pain. All sadly reminiscent of the past. So much for curiosity.

Kicking off, I followed the outline Dr Sharp had suggested: a brief biography, what kind of person I was, my professional, mainly academic life, a sketched account of the chronic pains I had run into in my late forties, some discussion of how the medical profession had failed me, concluding with my discovery of the Sharp and Morrison approach, my email exchanges with the doctor, and finally light at the end of the tunnel, etc., though of course I had never made the trip to Sharp and Morrison’s San Diego clinic, or ever been treated by a physiotherapist following the famous San Diego protocol. Until today.

‘No, it’s better that way,’ Dr Sharp had enthused. ‘It’s really better.’

Dr Sharp, I was discovering, was always enthusiastic, or scandalised, a man who seduced or repelled you with his boundless evangelical energy. ‘That way it doesn’t seem so much like our sell,’ he said, ‘or like we’ve brainwashed you or something. You just took our model, from the book, a couple of conversations, and ran with it. On your own.’

‘If I look back,’ I wound up for the physiotherapists after twenty minutes of intimate and unpleasant details, ‘it seems impossible to account for this illness, this recovery, this whole experience, in easy terms of cause and effect. I was wired up in all kinds of ways over many years, then I was in all kinds of pain over some years. I sought rapid medical solutions, urological interventions, in vain and with growing frustration, until, dimly, I began to perceive that the problem was me. My body was me. My pain was me. I would have to work on myself – physically, mentally, without the help of conventional medicine.’

Dr Sharp, I noticed, who is not in reality a medical doctor, but a PhD in psychology, was beaming and assenting as I said all this but, rather than reassuring me, his enthusiasm, coupled perhaps with the angry smouldering in my belly, made me feel that everything I was saying was false. I was telling the truth of course – aside perhaps from not relating these new pains, consequent on a first massage of just the kind we were here to promote, but this seemed an unnecessary complication – I was telling the truth as of a couple hours before; the truth as it was when, following our email correspondence, Dr Sharp had invited me to put my flesh and blood before the physiotherapists, and yet it felt like it was not the truth; in fact it felt particularly misleading and false, in part perhaps because I had become so aware over recent years of the need to perform when giving a talk, or teaching a lesson for that matter, any kind of public discourse, and in part because, although it was the truth as of a few hours ago, it wasn’t quite the whole truth. My wife had made this objection on numerous occasions and suddenly I felt very conscious of it. ‘Everything you say to people about your so-called health problems,’ my wife told me, ‘is false. Because you never tell the whole truth.’ Ex-wife, that is. What she meant of course was my unfaithfulness, my doubleness, which lay at the heart of the matter as she saw it. It made her angry, she said, that I was applauded for my candour when in fact I wasn’t candid at all. ‘Nothing but the whole truth is the truth,’ my wife said. And she was right. But how can one tell the whole truth in just twenty minutes? And with your mother at death’s door.

‘I was wondering,’ asked a rather matronly woman in the second row, ‘how all this impacted on your marriage?’

It was question time. Dr Sharp had suggested twenty minutes talking, ten or fifteen fielding questions, then I was free to go. My train was at five-o-five. He didn’t know that. He thought I was leaving later. ‘If you don’t mind,’ he had said. This was earlier that morning, before the massage. The fact was: questions reinforced a speaker’s authenticity, showed there was someone there beyond the prepared talk, open to interaction. ‘Only interaction really constitutes reality,’ Dr Sharp had said, ‘for most people.’ This was why they learned so little from books in the end. ‘People read books, even the most fantastic books,’ he said, ‘brilliantly written and instructive and so on, but they learn very little, because they’re in a passive position, they can’t ask the writer questions and hear something back. They can’t touch him.’ There was a sense, Dr Sharp said, in which books remained for ever in the realm of the hypothetical, because the words that constituted them were silent. They never left the printed page and, as a result, people just couldn’t take them on board.

So now I was facing a question that did indeed put a finger in my wounds. The impact of my condition on my marriage. Without the gel and the gentle massage.

‘I don’t mean the physical condition in itself,’ the matronly physiotherapist elaborated, and in parenthesis one has to wonder at the level of English that people have now achieved in Holland, compared, say, to Portugal, or Spain for that matter, or Italy or France, ‘but your frustrations with the doctors, your new awareness of your body, then this whole attempt to change your lifestyle that you’ve been describing. Did it impact on your home life?’

I leaned back against the desk and looked at the audience. A few hundred miles away my mother was sinking fast. There were now three-and-a-half hours before the flight, of which a good hour must be spent on a train that was actually leaving rather soon. I had better not miss it. But still I hesitated. It was a good question that the buxom Dutch woman had asked; in a way, it was the question. Then I could see from her face that it was also a sympathetic question. She meant well. This wasn’t morbid curiosity. This Dutch physiotherapist, in her early fifties I would have guessed, genuinely wanted to know what was going on in the lives of the men she was treating – what they were going through, emotionally. So she could treat them better. One might object that it was also a very personal question. But wasn’t the whole thrust of this seminar that the problems Dr Sharp was treating were very personal? That life in general is a highly personal affair, hence treatment for sufferers with these problems – and I had certainly been one – needed to be not only personal, but intimate? What could be more intimate than a massage through the butt? In fact while I had been with the physio in my hotel room shortly after lunch, trouserless on the bed, the fifty or so physiotherapists at the seminar had been taking turns to practise on each other the same technique that he was applying to me. Grotesque as it may sound, fifty Dutch lady physiotherapists, aged between twenty-four and sixty, of every body shape and size, had reorganised the dining tables of this conference centre in Amersfoort in order to stretch themselves out on the table tops and massage each other through the anus. Think of that, if you will. While my mother was dying in London. They had done this so that they might know what feelings were at stake, both from the giving and the receiving end, as it were, when they treated sufferers like myself. What it felt like to have a finger penetrate their butt and explore the pelvic wall, front, back and sides; and again how to accomplish this penetration and carry out this exploration in a way that did not feel like a gross violation to the person whose butt was being thus penetrated and explored. And this willingness on their part, the Dutch physiotherapists’ part, I felt, to do this – to come to the aid of their patients in this unappealing way, to recognise that a person was also, and in some cases perhaps above all, his or her butt, his or her pelvic floor, which might need to be massaged, not impersonally, and certainly not automatically, as if all patients were the same patient, but intimately and with constant feedback – Is it sensitive here, and here? What about this pressure, and this? – all the time aware of the elasticity or rigidity of the muscle wall touched through the colon, the which, however scrupulously the patient has prepared himself or herself for treatment, doubtless bears its light patina of shit – such willingness on their part made any reticence on mine, handsomely paid as I was to talk about how I had escaped from the pains in question, ridiculous. It would be ridiculous not to agree to say a word about my marriage and its relation to my problems, once I had accepted the invitation to come here and talk, come in part of course because I was being well paid (I’m not stupid), but also because I genuinely believed that without Dr Sharp’s book, which despite his remarks on the limitations of books and reading I had very much taken on board, very much given credit to, allowing the words to leave the page and circulate in my mind and even alter my patterns of behaviour, without that book I would still be suffering serious abdominal and perineal pains – which in fact I was suffering, right at this moment, thanks to that massage, but that’s beside the point – and still be getting up to go to the bathroom six times a night, something that I sincerely hope does not kick in during the days and weeks ahead, otherwise I may very much regret that massage. For why would Elsa ever want to live with that?

‘You don’t have to answer,’ the woman said gently. Apparently I was taking longer than expected to reply. Actually I had begun to smile, though no doubt there were those present who could see I didn’t really feel like smiling. I was performing. My face was being made to smile when in fact I was not smiling. Or no, I was smiling, really smiling, but the way one does when brought up against the sheer impossibility of a task, the sheer enormity of some seemingly innocent question. You look at this task, consider this request, and shake your head, knowing you are quite unequal to it. You will never get to the bottom of this question. Never complete this task. And in your despair, or simply resignation at something quite beyond you, you smile. That was the smile I must have been smiling now, and having smiled it, I was also holding it, exaggerating it, so they would all know this was the smile one smiles in the face of impossibility, etc., though they couldn’t have known of course the business of my mother approaching death’s door, or the fact that despite my age I believed myself, grotesquely, in love.

‘Marriage. Illness,’ I smiled. ‘How can one ever – to risk a pun in present circumstances – get to the bottom of such matters?’

I hesitated while one or two tittered. In terms of their English, I suppose, it was rather sorting out the men from the boys, throwing puns at them like this. Though, as I said, those present were all women. ‘We have heard Salvatore talking about the impact of his condition on his family,’ I said. I sighed. ‘Inevitably, when a cheerful man sinks into joylessness, this impacts on his family. Inevitably, when a handsome guy like Salvatore experiences impotence, it impacts on his marriage.’

I stopped. What was I going to say? The truth is I still use the noun ‘impact’ as a verb with some reluctance, slipping on a rubbery metaphorical glove, as it were, as if there might be a patina of shit on the term. I can’t help remembering the time when this usage was the merest Americanism, though now it has become absolutely respectable, even fashionable – as, hopefully, anal massage may one day become, if not fashionable, at least respectable. Not to mention falling in love at fifty-seven. And when shifts like this occur, shifts I’ve initially resisted, raising the banner of proper language use and correcting those, time and again, who come to my seminars, only to see the shift prevail, inexorably, as is the case with ‘I impact this, you impact that, he impacts the other’, there comes the moment when I swing round one hundred and eighty degrees and force myself to adopt the new usage as frequently and emphatically as possible, precisely to punish myself, I suppose, for ever having presumed to know what standard English might be, for ever having imagined my own professorial opinion could count for something against the overwhelming reality of what everyone else is doing and saying. Yet even as I give in and go with the flow – suddenly teaching the exact opposite of what I have taught hitherto – I still can’t prevent myself from putting on that rubber glove, from feeling that actually the language was better when ‘impact’ was a noun and didn’t impact on other words. And even as I speak, no doubt there is something in my voice that alerts people, that tells them: Professor Sanders is using this verb reluctantly, yet emphatically, with a sort of bitter, self-destructive irony. It’s off-putting. He has decided to go with the flow, but he feels the flow is a sewer. ‘The reason,’ the physio had told me when I had pulled my trousers back on, after his massage, ‘why those other doctors you mention hurt you so much was because they didn’t really want to be doing what they were doing. You know? They knew they had to put a finger up there, it’s a diagnostic duty, but they didn’t really want to do it. And when you’re conflicted, you do things badly, awkwardly, angrily. You communicate awkwardness and anger.’ In general, the physio said, much of the pain that was experienced in the world was the result one way or another of people’s state of conflictedness. They didn’t want to be doing what they had decided, or had been told, they had to do.

‘Having said that,’ I continued, still addressing myself to the matronly Dutch physiotherapist whose pale, wide eyes had fastened on mine, ‘one might equally well reverse the question you put and ask, not how the condition impacted on the marriage, but how the marriage impacted on the condition.’ I hesitated. ‘You might even wonder whether domestic unhappiness wasn’t intimately linked with the genesis of the condition.’ Again I hesitated and smiled the smile of impossibility. ‘To cut a long story short,’ I said, ‘and not wishing to attribute blame to either party, we separated.’

The woman at once said she was sorry, she hadn’t meant to ask a difficult question, and I said she really mustn’t be sorry. There was nothing to be sorry about. It was an excellent question she had asked and I only hoped my answer had been useful. However, alas, I now had a rather better reason to be sorry – to apologise, that is – I said, because I really needed to leave rather urgently to catch a train to the airport. I had to fly to London where my mother was critically ill. I had imagined, I told the physiotherapists, from the schedule we were all given, that my contribution would be well over by this time, but since we were now running almost ninety minutes late, I was in serious danger of missing my train and then my plane and hence …

Hence what?

Dr Sharp jumped to his feet and shook my hand and asked the fifty physiotherapists to applaud, which they did, and for rather a long time, which obliged me to stay and accept the applause, though I kept motioning for them to stop, giving an impression that modesty wouldn’t allow me to be applauded so generously, but in fact because I was in a hurry to leave. ‘Wait just one moment,’ Dr Sharp was saying as the clapping died down, ‘and I’ll join you in the taxi. Just to check that you make your train on time.’ He turned to the audience. ‘Thomas will now describe days one and two of the three-week protocol,’ he said briskly, and I think this was the first moment I registered the fact that the physio who had massaged me was also called Thomas. Not a doubter at all, I thought. So much for names.

Two minutes later I was waiting in the conference-centre reception area with the bag I had already packed, while Dr Sharp took rather longer than expected to join me. I went outside to see if the taxi had arrived, which it hadn’t, and fretted in the cold till it did, then came back into reception and fretted again because Dr Sharp still hadn’t come down. This was cutting it fine, to say the least, I thought. I turned on my mobile and sent a message to Elsa, telling her the talk had gone well enough, but that now I had to fly to London where my mother’s condition had worsened. Not home to Madrid. ‘I miss you terribly,’ I texted. Was this actually true, I wondered, before pressing the Send key, or just a formula? Certainly I wanted her to be aware of the importance I gave to the relationship that was forming, but there was really too much to be thinking about right now to miss anyone, even my mother. ‘Grandmother is very ill,’ I texted all four children. ‘If you want to see her again, you should travel soonest.’ Should I text my wife? Ex-wife? Dr Sharp still hadn’t come. I decided not.

The conference-centre reception area was deserted and I began to wonder if there had been some misunderstanding. To the left of the reception desk was a bathroom, but that could wait till the train. Had Dr Sharp really said he would come to the station with me? Could the applause have distorted what he said, so that I was waiting for him in vain? He wasn’t coming. I should get straight into the cab. Having seen there was a bathroom, I was now more than ever aware of an urgency to use it. And did it really matter, if one did or didn’t arrive in time for the death of a loved one? What possible difference could it make? I could hear Thomas the physio’s voice through the open door to the seminar room, talking about the need to familiarise patients with the geography of their pelvic floor, which, for the sake of convenience, he said, they would be speaking about like a clock face seen from above, where noon was the prostate and six the coccyx. ‘Most of our work will be done between ten and two,’ he said, and I smiled, imagining that someone with poor English would be bound to misunderstand and assume he was saying they mostly did their massages around lunchtime. There were now only twenty minutes before my train was supposed to leave, when I decided after all to go to the bathroom.

The pee wouldn’t come. It was a perfectly ordinary bathroom with the usual recommendations, in Dutch, German and English, to wash one’s hands, and a condom-dispenser by the door, which seemed a little odd in a conference centre, unless it was just an acknowledgement that conferences have all kinds of other functions besides those officially declared. The Portuguese paediatrician, I thought, was well set up, despite his affectionate talk about his wife and family. One product was called Billy Boy. Or perhaps because of that talk. A guy who says he’s separated and suffering is hardly attractive. Who wants a fling with a sufferer? A loser. Though I hadn’t said I was suffering. I don’t feel like a loser. In fact this was a blissfully happy period for me. Wasn’t it? I mean the last couple of months. In any event, I had no interest at all in exploring the charms of the Dutch physiotherapists. The pee still wouldn’t come. It burned but wouldn’t come. Things will only get worse, I thought, with the stress of catching train and plane, and Mother dying. So much for bliss. The massage had been fatal. Not to mention the finger-in-the-wound question. Shouldn’t it have been Thomas, I objected to myself, who stuck his fingers in others’ wounds, not they theirs in his?

‘There you are!’ Dr Sharp had put his head round the door. ‘I was wondering where you’d got to.’

At which exact moment the pee began to flow. Since the doctor stayed standing in the doorway, I also lost a few seconds washing my hands, an expediency I might otherwise have skipped.

It really was terribly important one made it to the deathbed of one’s parents, the doctor told me as soon as we were settled in the back of the car, and he said the reason he had taken a minute or two to get ready was his decision to put together a bag for the night. I would never make it to the station now, he had realised; I should have warned him beforehand if I meant to get the five-o-five, so the only thing was for us to take the cab together directly to Schiphol, after which he would ask the driver to proceed to Amsterdam where he, Dr Sharp, was to have dinner with a wealthy Swiss industrialist who was offering to sponsor the San Diego protocol.

‘Surely it’s only five minutes to the station,’ I said. ‘We can still make it, can’t we?’

A taxi to Schiphol would cost a fortune.

‘Our industrialist will pick up the tab,’ Dr Sharp said. And he said he couldn’t tell me the name or even profession of this wealthy man, although he was quite famous in his field, because he didn’t want it to be widely known that he had suffered from such an embarrassing condition. He felt it might undermine his authority.

I laughed. Having a pain in the balls was harder to admit to than being gay these days, I said. And Dr Sharp agreed. In fact being gay, Dr Sharp thought, was ‘becoming rather more a boast than an admission’. ‘We’re so heavily invested in our self-images,’ he said. ‘I often tell people, you’ll never be completely cured until you’re comfortable with having other people know who you really are.’ Not that people, he conceded, actually wanted to know who you really were. Quite the contrary. They had enough on their plates without hearing about your travails. Nevertheless, it was important for you personally not to feel you had to be forever hiding something, since that would be stressful and humiliating and would aggravate your problems. Being candid was part of getting well, he said.

‘Do you think,’ I asked him in a moment’s random mischievousness, ‘that some people who are not gay pretend to be so, in order to enjoy the celebrity of “coming out”?’

Dr Sharp didn’t reply.

The taxi ran into traffic on the fast roads leading out of town. I had no sense how long the ride might take, having made the outward journey on the train. My wife texted me to say she felt close to me and to ask me to give her regards to my mother. This meant the twins had spoken to her. But the twins did not text. Nor did the older children. My wife didn’t reproach me for not texting her. She was reminding me she was a fine, loving person and that I had done the wrong thing when I left her. Fair enough. Perhaps I had. I tried to concentrate on what Dr Sharp was saying about a hormonal cream to treat anal sores. Why did I feel it was a matter of overwhelming importance to see my mother before she died? And if I felt like that, why had I not abandoned the talk to the physiotherapists and run at once? Was it vanity, the desire to stand up in front of the fifty female physiotherapists and tell my story? He had missed seeing his father by a whisker, Dr Sharp now said. It was sad. Whereas with his mother, it had been a long-drawn-out affair. It was not, he said, that one has anything to say to a dying parent, anything to tell, in a melodramatic Hollywood-movie sense, secrets or explanations or anything; it was more a confirmation of loyalty, solidarity. ‘When you die you want to have around you the people who make you who you are. Your people. Your folk. You want to feel they are giving this time, and making this effort to be with you, as you set out on your last journey.’

I wondered, I said, whether that was really true. ‘Maybe the truth is that we project that desire on to them. So that we can get a payoff from satisfying their imagined requests, when actually they’re entirely taken up with their own personal dying.’ Which alas was hardly a journey, I added, but an end to all journeying.

He laughed. ‘You’re sharp, Thomas. Doubting doubtless hones the mind!’

But he had no doubt, Dr Sharp went on, that his mother had indeed wanted him to be there, if only because he had heard her on the phone begging his sister to come ‘before it is too late’.

‘Your sister,’ I said. ‘Not you!’

‘I was already there,’ he laughed.

‘But did your mother specifically ask you not to leave?’ I asked.

‘She did not,’ he admitted. ‘But I never said I wanted to leave.’

I was surprised by how sarcastic and unpleasant I was being. I was also surprised by how cheerfully Dr Sharp was putting up with it. Perhaps I was angry that I risked missing the flight because of him. The taxi was in a long tailback on the sliproad to the motorway.

‘The truth is,’ I told him, ‘there is something I want to tell my mother that I have never told her. I don’t want to miss this last chance.’

And what was that, he asked?

I sighed. I wasn’t really sure, I said. ‘I just have that impression – that there is something that has to be said. I’ll know when I get there. It will come out.’

‘Interesting,’ Dr Sharp thought. Or maybe he thought I was bullshitting him.

The taxi driver turned the radio on. There was some merry discussion in Dutch. Perhaps it was a quiz show. Raising my voice, I said I really needed to be at the airport in an hour and five. Would we make it? The driver turned on the navigator, which gave our estimated arrival time in present traffic conditions as seventy minutes. ‘As you see,’ he said, ‘there’s not much I can do.’

‘Try to relax,’ Dr Sharp told me.

Then I told Dr Sharp that one of the reasons why I was so wired up was that the massage his physio Thomas had given me after lunch had on the one hand convinced me beyond all doubt that the pelvic floor really was the source of my sufferings – my erstwhile sufferings – but at the same time just touching it had reactivated those sufferings. They were no longer erstwhile. What was I to do? The idea of plunging back into months of chronic pain was so depressing.

Dr Sharp was thoughtful. He was a jovial, generous, fleshy man, very much taken up with his own projects, but more than willing to focus on you for the few moments it took to assess your needs.

‘Everything you have told me about yourself,’ he said, ‘convinces me that you have managed to control your problem by making a big investment in relaxation techniques, yoga, breathing exercises, whatever. Essentially, you have learned to chill a little, to turn down the stress temperature, and that has got you out of gaol. Stress comes from ourselves as much as anything else. But when things get out of hand, when you’re out of your normal environment or crisis strikes, you lose control and soon enough you find yourself in pain again.’

His conclusion was that I should come to San Diego, follow his protocol for a month and have the problem massaged out of me, once and for all. It would be painful at first, but beyond pain lay comfort and freedom. ‘Above all,’ he said, ‘you should learn to use the self-massage wand, which would empower you to take control of your own destiny.’

‘Empower’, like ‘impact’, is a word I have trouble with.

Then as we sat in heavy traffic on the autobahn between Amersfoort and Schiphol, and my mother lay dying in London, Dr Sharp lifted his bag from the floor, clicked it open and pulled out one of three or four plastic bags. Through the transparent plastic you could see a yellow-and-amber tube shaped rather like a short snorkel, except that the U was more open than with a snorkel, and instead of a mouthpiece there was a white ball the size of a large marble and at the other end a handle running perpendicular to the tube, as if at the top of a small spade, a children’s beach spade perhaps. Beneath the handle, the straight shaft of the instrument was enclosed for perhaps three inches in a rubbery yellow sheath, from within which a grey wire emerged that then connected to a small box, also yellow and featuring a liquid-crystal display. First the ball was inserted in the anus, Dr Sharp explained, and he leaned back and lifted his knees onto the seat of the taxi to show how the sufferer slipped the curved end of the wand – the mouthpiece of the snorkel, if you like – covered with a rubber glove of course, well-lubed needless to say, between his thighs, beneath his scrotum and into the anus. After which you operated the handle – ‘Joystick, we call it!’ he laughed – to steer the ball, now deep inside the colon, to the point on the pelvic wall that triggered your pain, and then pushed forward, sideways or backwards on the wand to apply pressure and massage that point. Gently! The display on the gauge responded to the tension generated in the flexing tube as you forced the U open, and hence indicated how much pressure you were applying to the muscle, internally, so that this could be monitored and gradually increased over a period of months.

‘We’ve had it patented,’ he said. ‘It has passed all the stringent US standards for medical equipment. This will do it.’

The doctor’s enthusiasm was contagious. He was convinced he had the solution to a problem that plagued millions of men. And many women. If only they had been willing to listen to him on the subject of anal massage. The taxi began to move as the jam on the motorway freed up. For my mother, who would never have dreamed of inserting items in her anus, no matter what kind of pain she was in, time was slipping away.

‘Could you give me one, please,’ I asked Dr Sharp. ‘I’d like to try.’


The corpse-viewing dilemma did not come whole. It crept up. The first whiff arrived with an email from my sister listing expenses incurred as a result of my mother’s death – money that she, my sister, had taken from my mother’s bank account in the hours immediately after the death, but before it was registered and the account consequently blocked. Mother had given my sister her bank card and PIN number, it seemed, for precisely this purpose. These items of expenditure I barely glanced at, knowing as I did that my sister would behave scrupulously when it came to money, and that anyway the very small amounts my mother was leaving were hardly of a kind to turn around the precarious financial circumstances my separation from my wife had left me in. But my eye did stop on the word ‘embalming’. Embalming: £98. ‘Mother would never have wanted to be embalmed,’ I immediately wrote in reply to my sister, ‘and if she had, she would definitely have included the service in the funeral package that she herself chose and paid for years ago.’

As soon as I had fired off this email to my sister, I felt rather foolish, for of course my sister would know all this far better than I did. At the same time, I felt a sort of concern for my mother, as if, now dead, she needed protecting from the things she would have considered a violation, not so much of her body, which she always insisted was a matter of no importance, but of her sense of propriety, and above all her strict belief in the absolute separation of flesh and soul, such that any money or effort spent on aesthetic appearance beyond the requirements of respectability or the merely practical needs of the body was a waste. Mother hated waste.

My sister, without taking offence, but rather as if I had simply queried, out of curiosity, some unexpected purchase, responded that since Mother had asked for cremation, the law required that two doctors certify the cause of death, and a third certify the certification, so to speak. Only then could the cremation date be booked. This took time. After which there was a waiting list for the cremation itself, such that at least two weeks would pass between decease and funeral. The nice lady at the undertaker’s, whom my sister hadn’t actually met but had spoken to on various occasions over the telephone, had suggested that since these days people liked to view the body (for ‘closure’, she had explained) in the week preceding the funeral, it might be an idea to have a relatively inexpensive temporary embalming performed in order to allow this to happen, in order to get the corpse, as it were, through to the funeral in a respectable state. Uncle Harry, my sister wrote, had already been along to see the results and pronounced them excellent; Mum looked, or at least so Uncle Harry had said, very much her old self, in the pale-blue tailleur she used for special occasions with matching bonnet. ‘Not that I have any intention of going to see her myself,’ my sister went on. ‘I prefer to remember Mum as she was. But that’s just me. You’re welcome to, if you want.’ And she explained that the undertaker’s in question was the one directly opposite Hounslow railway station.

Again I responded to my sister’s email immediately, which is a bad habit I have, since my immediate response almost never coincides with my more settled opinion of a day or two, or even just a few hours, later. In this case, a few minutes. ‘I am sure you are right,’ I answered. There was a ‘certain appropriateness’, I joked, rather flippantly, in Mother’s going to her funeral in her Sunday best, obsessed as she always had been that one should be ‘properly spruced up for church’. I was glad, I dashed off – not foreseeing as yet the area of dilemma I was entering, and I think one of the reasons one responds so immediately to emails is that if you don’t, there is a good chance you’ll never respond at all, with all the messages the world throws at you these days; plus of course, having been pompous and abrasive in my previous email, I was now eager to reassure my sister, who after all in the absence of her two brothers was taking on herself all the responsibilities surrounding my mother’s death – I was glad, I wrote, that Uncle Harry had been cheered by his viewing of the body, rather than the opposite, since with his age and his cancer, the thought most present in his mind must have been that all too soon he would be in the same position as Mum, on his back in a box.

This was the gist of my immediate response. Reassuring and flippant. But only moments after sending it, from Berlin it must have been, I was remembering how uncannily precise and sure of herself my mother had been, when she had first spoken to me of her funeral arrangements. It was a memory that took me back some four years to a summer spent in her tiny house off Hounslow High Street. I was there, needless to say, because my wife and I now seemed unable or unwilling to go on holiday together, or indeed to spend time together in any way. I had invited my then lover to come on holiday with me to the UK but she had refused. If I wasn’t going to leave my wife, she said, the last thing she needed was to start building up happy memories that could have no future. She wouldn’t come. On the other hand, she hadn’t left me outright. Presumably, then, she was putting pressure on me. Presumably my wife too was putting pressure on me, or I was putting pressure on her. Or on both. In any event, we had a stand-off which amounted to the worst of all worlds and there I was, a man theoretically with two women but actually with none, staying at my mother’s house for the summer, ostensibly because this elderly Christian lady needed, or at least would be grateful for, my presence, being ill and having recently been operated on – mutilated might be a better description – but in reality because I had no idea what to do with myself, no idea what to do with my marriage, no idea what to do with my lover, no idea even whether I wanted to stay in my job in Edinburgh or make some major move abroad: disappear, as it were, and as I eventually did, from the family radar.