On Carrying Things

I very nearly didn’t write this, which is a thing writers say and rarely mean, but I closed the laptop on it twice, so make of that what you will.

A few weeks ago I showed an early version of Tagore to a room of writers here in England. Real ones, with books on shelves. I asked them to be honest and one of them was. She said the machine was strange, that most people wouldn’t understand what it was for, and that this was exactly why I had to tell them where it came from. Otherwise it’s just another gadget, she said. She was right. So this is me telling you.

I should explain something first, for those of you reading abroad, which is most of you. I trained and worked in the National Health Service. The NHS is free. You’re treated according to what’s wrong with you, not according to what you can pay, and it’s funded out of everyone’s taxes, so in a quiet way it belongs to everyone. When I had the choice of where to work, I went to one of the poorest parts of the country. I thought that was where a doctor was most needed. I still think that.

I’m an eye surgeon. The particular thing I do is called oculoplastic surgery, but the wider speciality is ophthalmology, which is the surgery of the eye, and as part of that I did on-calls. One week in every five I carried the emergency pager for the whole region, day and night. You learn to sleep in a state that isn’t quite sleep. You get used to the ceiling of your on-call room. You stop expecting the week to be yours.

There’s a part of the job people don’t know about. When a child is brought in and someone suspects they’ve been hurt on purpose, an eye surgeon is called. We look at the back of the eye with an instrument called an indirect ophthalmoscope, which is a light you wear on your head and a lens you hold in your hand, and it lets you see the retina. We’re looking for small bleeds there. Retinal haemorrhages. They can be a sign that a child’s head has been shaken or struck hard enough to do damage you can’t see from the outside. Sometimes the child is alive when we do this. Sometimes the child isn’t.

Where I worked there was a lot of poverty, and where there’s that much poverty for that long, other things settle in behind it, and so we saw these children more often than I want to write down here. You develop a way of doing the examination that lets you keep doing it. You don’t decide to develop it. It just arrives.

The one I still think about was ten weeks old.

I did the examination. I could hear the mother somewhere else in the department. She was making a sound I hadn’t heard before and haven’t heard since, and I don’t have a good word for it, so I won’t try to find one. I finished. I wrote my notes the way you’re taught to, plainly, no adjectives. Then I went out to the car park and sat in my car for a while before I drove home.

Not long after that I took some time out of medicine.

I didn’t understand, then, that you can carry a thing without ever agreeing to carry it. I understand it now. I’ve worked in remote places and in places where there was fighting, and it’s only lately, being older, that I can see what unhealed things do to a person. The irritability that lands on the wrong target. The anger that has no address on it. The way you stop being able to reach other people, and they stop being able to reach you, and neither of you can say why.

I couldn’t go to therapy. I told myself I didn’t have the time, which wasn’t the real reason. The real reason was that I didn’t want to say any of it out loud, to a person, in a room. I still don’t feel that I can. But I found I could write it down. Not well, at the start. That turned out not to matter. What mattered was that the writing held it, the way a cup holds water, and I could put a thing down on the page and then close the notebook and the thing would stay there instead of following me around.

That’s the whole of it, really. That’s my why.

Tagore is the machine I wanted and didn’t have.

I don’t know if that’s a good reason to build a product. It’s the true one. Thank you for reading this far, and for being here while the thing gets made.

Imran