In late August 2017, I was admitted to hospital in Bristol as an emergency patient. Although I could walk from my home to the ambulance in the street outside, and the attending paramedics drove at what they called ‘road speed’ without using their siren, I was closer to death than I have ever been. I had developed sepsis behind an infection caused by a kidney stone. Two days earlier I had woken with a hot ache at the right side of the base of my back. When the ambulance delivered me to the A & E department, a consultant came to my bed. By then, he said, as he drew black arrows on my abdomen with a marker pen, I was ‘falling off a cliff’.
Stone rhymes with bone. And the months of sickness that followed – between a first operation to by-pass my dangerous rock, and, then, a second to remove it – gave me time (feverish at first, enfeebled later, convalescent on a sofa later still) to discover something of my own inner geology, a living landscape, and, having somehow taken a stone inside, to think about what it might mean to have internalised geology.
Fifteen years ago, I often listened to Steve Wright’s Sunday Love Songs on BBC Radio 2. The network describes it as ‘a blend of classic love songs, dedications and real-life romance stories.’ I am not especially soppy, but at that time something of the show’s mix hit home. My heart wasn’t so happy or made up then – my house seemed built on sand – and every week I totted up the number of times a dedicated song came with a description of the dedicatee as the ‘rock’ of the dedicator. Some weeks we made double figures.
I’d like to dedicate this song to my rock, and to two experts in demolition, Mr Koupparis and Mr Timoney, of North Bristol NHS Trust.
My first operation stopped the stone in its tracks. In my right kidney – its birthplace and residence – it had grown too bulky to go anywhere else, but was knocking at the exit. Stones over 5 millimetres in diameter are thought mostly too big to pass. Mine was measured at 6. Mr Koupparis inserted a stent – a 250-millimetre-long plastic tube passed up the pipe of my penis – that effectively sidelined the stone and let my kidney drain urine down my ureter as it ought into my bladder. The stent remained in situ for twelve weeks and my ‘chaotic blood’ calmed, at least for a time.
I was occupied for months: immobilised by my stone and almost continually aware of it; rescued by the stent, but then injured by it as it outstayed its welcome and turned against me with disabling pain. I came to both fear and to love that word ‘pass’, with its suggestion of traffic and of camouflage. Inside myself, I had grown a new feature. Here was a novelty item in my own grotto. But, unlike most of its solid surroundings, my stone was mobile; and furthermore, my body knew it as an erratic and wanted it out.
Won’t you roll away the stone?
To pass a stone for a man (men are rocked more often than women) can mean to roll it from kidney to bladder, or from bladder to urethra, or from within your penis until, at journey’s end, it falls out. The colic or pain of such a passage is famous for being bad. It has been measured; often only childbirth is said to beat it. Similarly, a rock might be moved through a glacier and jettisoned. Only poets have guessed at the Weltschmerz that might prompt. As the doctors discussed my passing chances, I thought of the lead-shot from a wildfowler’s gun that I spat once from a mouthful of goose meat onto an enamel plate. There, it zinged like a ball finding its place on a roulette wheel.
In hospital, I was often asked to rank my pain on a scale of one – not so bad – to ten – deadly. I answered, thinking of the Avon Gorge near my home, its savage gash of limestone perpetually wounded by a muddy river. The rock routes undertaken by cliff climbers there, as elsewhere, have been adjectivally graded – easy, moderate, difficult, hard difficult, very difficult, hard very difficult, severe, hard severe, hard very severe, and extremely severe. There was a guide – though I was never a climber, I have a copy somewhere in my bat cave of books – whose title I’ve carried with me for decades. It was called ‘Extremely Severe in the Avon Gorge’.
An un-passable stone, buried within a cage of flesh and bone, will linger. It might shift within, but may not appear until either the carcass disappears from around it, like a melted glacier, or it is otherwise removed from the stricken body, like a quarried item. Our species has suffered rocks for ages. We’ve been stone-formers throughout our own geological epoch. A bladder stone, found in 1901, in an Egyptian mummy was dated to 4800 bc. Thus laden, we have long sought remedies. Surgery to treat kidney stones was first described in the eighth century bc in India.
And, behold, there was a great earthquake: for the angel of the Lord descended from heaven, and came and rolled back the stone from the door, and sat upon it.
My stone festered as it waited. Or rather it caused my waste and grot, whose egress it blocked, to fester behind it. On its own, I think, a stone might be innocent, but it had so grown that, as well as allowing filth to bloom, it could only hurt what it touched or moved against, its home. In hospital, I had various CT (computed tomography) scans: screen grabs of meat bingo played in my septic tank. Among the slices of old mortadella was a moony white shape, pin-ball round and gun-pellet hard, apparently alive, wounding my lights and melts and offal, hurting my softness with its dense intelligence. The image I saw was as close as I have seen to my British Geological Survey map of Bristol (sheet 264, solid and drift edition): a spread of browns and greys, tongues and folds and mattresses, pressings and contusions and bleeds, a bruised body, the injured ground beneath our feet.
The stone felt bad enough unpassed. At school, aged eleven, hiding at the out-field boundary, I stopped a six in my pubescent groin, winded by a well-struck cricket ball. Aged fifty-six, at home after hospital, I felt the same pain for three months. I knew, by then, that I was unlikely to pass the stone, but the thought alone made me curve tighter, more foetally – from a time before bone – into myself.
I got stones in my passway and all my roads seem dark as night.
Awaiting granulation by laser, I lived around a rocky shadow, peeing various bloody and earthy vintages with wincing trepidation, walking with difficulty, and, latterly, stooping in anguish as I stood. On good days, I felt like the Little Prince, drawn leaning nervously over his own planet; on bad ones, like Sisyphus wedded to his rock. The medical talk I longed for was of a divorce: the smashing of the globe to something gritty that might exit my body as gravel, or sand, or, better still, dust.
The Living Landscape of Britain gives the international standard measurements determining rock sizes – for 1952 at least: stones are 2 mm or more in diameter, coarse sand is 0.2–2 mm, fine sand is 0.02–0.2 mm, silt is 0.002–0.02 mm, and clay is less than 0.002 mm.
When I came round after my first operation, out of the nothing-bliss of anaesthesia, I had had a catheter fitted. The stent allowed out the stuff that the stone had blocked. As well as making my own rock, I had been sickly busy with finer and dirtier calculus. My catheter bag, taped to my thigh like a gunslinger’s holster, filled with a bloody custard or what the nurses, who siphoned it off, called ‘sludge’.
Laid low, on my bed, I read.
In Clarence Ellis’s The Pebbles on the Beach (1954) there is a chapter titled ‘The Birth, Life and Death of a Pebble’:
Pebble-hunting is a pleasant and health-giving hobby, whether pursued on the beach, the lake-side or the river bank, and all but those who are nearing the last stages of decrepitude can enjoy it.
Francis Ponge, among the great French phenomenological poets of the twentieth century, has a long prose poem called ‘Le Galet’ or ‘The Pebble’: ‘a pebble is a stone at the precise moment when its life as a person, an individual, begins, I mean at the stage of speech.’ The poem is, in part, about making art, but it is also an imagining of the death-in-life of the hard matter of our planet:
Since the explosion of their colossal ancestor, and their trajectory across the heavens, beaten back without recourse, the rocks have fallen silent.
Over-run and cracked by germination, like a man who has stopped shaving, hollowed out and filled with loose earth, no longer capable of reacting, not one of them utters a word.
Their faces, their bodies split. Naïveté comes to the wrinkles of experience and settles in. Roses perch on their grey laps and mumble their simple-minded diatribes against them. They let them. They, whose disastrous hail once cleared forests, whose time is for ever, reduced to stupor and resignation.
Gaston Bachelard, French phenomenologist-in-chief, writing about shells in The Poetics of Space, discusses the pre-Darwin evolutionary ideas of the eighteenth-century French naturalist, Jean-Baptiste Robinet. He believed that stones, especially fossils, were ‘roughcasts’ of body parts, with each organ having its ‘own causality that has already been tried out during the long centuries when nature was teaching herself to make man.’ Robinet’s books are illustrated with fabulous engravings of penis-shaped and vulval stones, and others that imitate the ear, the eye, the hand, and the kidney. Robinet thinks of form ‘from the inside out’ Bachelard says.
In the summer of 1801, Coleridge often went walking in the Lake District. On June 18 he found a rest stop and a bedrock:
A Hollow place in the Rock like a Coffin – a Sycamore Bush at the head, enough to give a shadow for my Face, & just at the Foot one tall Foxglove – exactly my own Length – there I lay & slept – It was quite soft.
Guy Davenport, essayist and novelist, was born in South Carolina in 1927. There, he ate mud. He writes about it in an essay in his book called The Geography of the Imagination:
One of my great culinary moments was being taken as a tot to my black nurse’s house to eat clay. ‘What this child needs,’ she had muttered one day while we were out, ‘is a bait of clay.’ Everybody in South Carolina knew that blacks, for reasons unknown, fancied clay. Not until I came to read Toynbee’s A Study of History years later did I learn that eating clay, or geophagy, is a prehistoric habit (it fills the stomach until you can bring down another aurochs) surviving only in West Africa and South Carolina.
The eating took place in a bedroom, for the galvanised bucket of clay was kept under the bed, for the cool. It was blue clay from a creek, the consistency of slightly gritty ice cream. It lay smooth and delicious-looking in its pail of clear water. You scooped it out and ate it from your hand. The taste was wholesome, mineral and emphatic.
‘I took advantage of being at the seaside to lay in a store of sucking-stones’ – Molloy, in Samuel Beckett’s novel of the same name, prefers pebbles over mud.
I took a pebble from my pocket and sucked it. It was smooth, from having been sucked so long, by me, and beaten by the storm. A little pebble in your mouth, round and smooth, appeases, soothes, makes you forget your hunger, forget your thirst.
I lost weight. My ribs rose gaunt through my chest like a furrowed hillside. There seemed less of me than before; just skin and bone and the still-buried stone. Man’s spirit in his bone-house dwells, wrote Gerard Manley Hopkins. Mine sank with my stone. I learned what rocky animals we are, we and the rest of the chordata, built around our cartilaginous skeletal rods. And, coming after that, just fossil selves or stony relics or dust and no more. After my first crisis, I didn’t think that death would put in a claim right away, but the stone moved on me, and came to determine and define everything that I was. It dragged like an anchor. My thoughts weighed as it did. All my stories became one – a life beneath a lodestone, a stone in the heart of me, like the toad’s crystalline jewel crowning its leathery head and piloting everything.
A kidney stone is made, most often, of calcium oxalate. The same salt is used in manufacturing ceramic glazes. Calcium and oxalate – some produced in the body, some found in foodstuffs – are very insoluble when mixed together in urine, and when concentrated in it, they crystallise. A seed-crystal forms and adheres to an internal surface of a kidney. There, in a renal cave, it grows and aggregates, drip by drip, rather like a stalagmite.
Our courtship had lasted for ages. I have been a stone-former for at least a decade and had long known of my masonic disposition. Small stones had been picked up before on one scan of my kidneys after a bloody urinary tract infection, but they did little otherwise to advertise themselves. I recognised the pain, knew its source when it woke me, but I hadn’t known I’d been feeding a boulder for years.
Before a sea tide ebbs on a beach, a grazing limpet heads home…to its home scar. The shape of the bivalve’s shell can grow to precisely match the contours of the rock where it fixes; the limpet marks the rock, the rock marks the limpet. Richard Pearce has been counting the same in North Cornwall ever since the oiling disaster that followed the sinking of the Torrey Canyon in 1967. Before I got ill, he had shown me Porthmear beach where there are, he has counted, one million home scars.
My wife, Claire, was born in Cape Town. She grew up in the shadow of Table Mountain and climbed its cliffs and gorges with her father and her friends. Exposed rock pressed on her life, early and deeply, a home-scar imprint such that her current sometime-stays in the apparently rockless flats of the fens around Cambridge feel like a de-boning exile.
She and I live sometimes there on the silt and the peat, as well as in Bristol, but sometimes also on the rocky peninsula that extends southwards from Table Mountain to become the Cape of Good Hope. Our village on the Atlantic shore, crouching beneath cliffs and various bergs, has attracted new-age rock workers. As I lay in wait for deliverance in Bristol, I followed the local news in Scarborough. A spotted eagle owl was picked up, apparently ill. Its finder dispensed two medicines. The bird was fed porridge and a healing crystal was hung around its neck. It was put overnight in a comfy box, but the next morning was found dead, flat on its face.
In my recuperation, I slowly walked a little of the Suffolk coast at Covehithe and Benacre. There were gulls feeding inland on the muddy pig fields, and there was the sea hungry at the shore all along the beach. The cliffs of sand are new, the water is at work, shouldering off hods of stuff on its tides, carrying flints and bones, gravels and house bricks down the North Sea. The beach is broken at Benacre and the reedy broad that was once there is now a brackish lagoon. The wood, at its fringe, is collapsing where the sea bites, and undermined trees, their ground taken from beneath them, have fallen towards the saltwater like woody skeletons.
The second leg of my walking-cure included a trip to the Great Rift, the opening of the earth that runs south from the Red Sea deep into southern Africa, like an epic ditch or a kind of anti-backbone. Lammergeiers are birds of the Rift walls and Ethiopian highlands and, on a previous visit near the rock churches of Lalibela, I’d watched the huge rusty vultures or ossifrage pick up livestock bones – vertebrae and femurs – from stony mountainsides, and drop them back onto the hard ground, shattering the osseous tissue for the softer marrow within. Their diet is more exclusively bone than any other bird. In the sierras of Spain, where the lammergeier is also known, it is called the quebrantahuesos, or bone-breaker.
I never saw my own stone, nor was anything other than unconscious when it was, first, approached and cordoned off, and then, later, detonated and collected. I imagine it white and round, its own planet; in fact it may well have been jagged and brown, a conglomerate of grits, more like the case of a caddisfly larva than Jupiter.
Wikipedia has a page on famous people who have had kidney stones. Samuel Pepys is the best-known sufferer – best-known, because he kept his stone in his mind as well as on his desk.
His started out in his bladder. He had lived under a succession of ‘fits of stone’ since he was a student at Cambridge. For years he was in pain and peeing blood. I know a little of this. For six weeks, my toilet splashed red every time I visited. I never got used to the colour or to the thought of all that wasted blood draining from me.
Surgery was a last resort in Pepys’s time, but, aged twenty-five on March 26, 1658, he braved it. He was held down and tied to a chair or a table in the house of a friend. Tied – to keep him still, and to prevent him from running away. There was no anaesthesia.
Thomas Hollier, expert lithotomist, removed Pepys’s stone. He worked fast. The extraction took less than a minute. Claire Tomalin’s account of the surgery is terrifyingly gripping:
First he inserted a thin silver instrument, the itinerarium, through the penis into the bladder to help position the stone. Then he made the incision, about three inches long and a finger’s breadth from the line running between scrotum and anus, and into the neck of the bladder, or just below it. The patient’s face was sponged as the incision was made. The stone was sought, found and grasped with pincers; the more speedily it could be got out the better. Once out, the wound was not stitched – it was thought best to let it drain and cicatrize itself – but simply washed and covered with a dressing, or even kept open at first with a small roll of soft cloth known as a tent, dipped in egg white. A plaster of egg yolk, rose vinegar and anointing oils was then applied.
The stone rolled out intact, the size of a tennis ball. Real-tennis, as it was then, used smaller balls than Wimbledon, but Pepys’ s stone was still about 50 millimetres across. If both his and mine were spherical, and if size is taken as volume, then his was 578.7 times as big as mine. He was up and walking two weeks after he was cut.
Pepys marked his operation day for many years. He was proud of his stone, had special dinners in commemoration, and had his prize set in a wooden case that cost him twenty-four shillings. On the fourth anniversary in 1662 (‘the Lord’s name be praised for it’), he had a lunch for three guests: ‘a brace of stewed carps, six roasted chickens, a jowl of salmon, hot, for the first course; a tanzy [pudding] and two neats’ tongues [ox or cow], and cheese, the second’. In his diary for June 1669, John Evelyn records getting Pepys to show his stone (‘as big as a tenis-ball’) to Evelyn’s similarly afflicted brother, ‘to encourage his resolution to go through with the operation’.
In 1669, the last twelve months of his diary, Pepys recalled the day of his surgery but forgot the year. When he died, aged seventy, in 1703, he had survived forty-five years since he was cut. Some have speculated that he was also given an accidental vasectomy at the same time. He never fathered a child. An autopsy revealed that the old malady was still at work: the original wound had broken open and Pepys had a gangrenous bladder. There were also seven stones in his left kidney.
Almost three months to the day after my first admission to Southmead hospital, I went back. Mr Timoney marked me up with his black pen. I was talking about The Archers, and then I was waking in a nappy and being offered a drink of water. In between, the surgeon had taken a laser and a camera and what he called a ‘basket’ on a brief trip, via my penis, inside me. He had been able to collect most of what he blasted. Blood spotted my nappy but, even climbing out of the fog of anaesthesia, I felt better than I had in months. I could stand without aching and my eyes met further horizons than I had seen for weeks. The pain, in fact, got worse, but only for two days as the last of the shattered stone left me, dragging a train of coarse sand, and I yelped and had to be held at the shoulders by Claire as I stood at the toilet. After that, I ate ice cream and fattened myself, and stretched flabbily outwards, never so soft and rockless, never so happy not to know my insides.
Mr Timoney wrote to me. The stone ‘reserved at the time of your ureteroscopy’ was an ordinary calcium oxalate one. This type, he continued, ‘is likely to recur within eight years unless you increase your fluid intake by two litres per twenty-four hours, avoid added salt and avoid weight gain…’
I fill my glass from the tap. And then again.
This essay is taken Cornerstones (Little Toller, July 2018), a new anthology of subterranean writing, from contributors including John Burnside, Linda Cracknell, Sara Maitland, Alan Garner, Sarah Wheeler and Esther Woolfson, edited by Mark Smalley.
TIM DEE is the author of Landfill, a book about gulls and people (Little Toller, September 2018). He has also written The Running Sky and Four Fields and has edited The Poetry of Birds (with Simon Armitage) and the recent anthology Ground Work. He was a BBC radio producer for twenty-eight years. His next book is about the spring.