My life as a pig

You are welcome to my body. A dialysis by Clive Sinclair. Illustration by Richard Jenkins

It is the end of the afternoon. The new arrival, a little boy clutching Captain Scarlet, takes one look at me and turns to the nurse. "Mummy," he says, "is that man dead?" I perk up immediately. "Of course I'm bloody not!" I cry. Nor am I Captain Scarlet, though my blood is having an out-of-body experience. It is being pumped out by my heart and drawn into a machine via a soft plastic tube. This is where most people with no kidneys end up. There is a variety of ailments that can get you here. I have polycystic kidney disease, formerly a killer. In fact, if it weren't for my mechanical organ, that little boy would have been dead right. Welcome to my secret life.

Other men sneak off to the apartments of their paramours to enjoy old- fashioned infidelity. I am more futuristic; on Mondays and Fridays I get intimate with a machine. Don't be fooled by the sign which says renal dialysis unit, this is no medical facility. It is a bloody chamber whose whoozy inhabitants recline, like the denizens of an opium den, the better to indulge their most outrageous whims. It is a decadent brothel, an emporium of fin de siecle vices, a pit of sadomasochistic iniquity. No, my innocent friend, I am not dead, nor even sick. I am simply possessed by a depravity which, if it is not indulged at least twice a week, will surely kill me.

It is in the genes. Polycystic kidney disease was imported from Stashev, Poland, by my maternal grandfather. Three of his four children inherited the condition. Two, denied dialysis, died in the Seventies. The third, my mother, was luckier. She commenced dialysis in the mid-Eighties and continued with it until her death (of other causes) in 1993. And so, when a grim-faced specialist broke the news that I was following the family tradition, it wasn't exactly a shock. That was some years ago. The information made surprisingly little difference; at least it didn't until last summer, when my normal life came to an end.

In September, having been informed that my kidneys had finally collected their P45s, I was sent to see Mr T, a surgeon at the Lister Hospital in west London. The waiting room was full of fellow sufferers. There was an old couple I recognised from last week's clinic calmly browsing through the Reader's Digest while some younger counterparts seemed more distraught. The woman, an attractive blonde, clutched her husband's hand; her face was white and she was trembling. "Are you here for treatment?" asked a nurse. The women nodded. "My wife is very nervous," added her husband, whereupon the woman began to weep.

A doctor approached me. He wore thick glasses, and he had a very loud voice. "Ah, Mr Sinclair," he said, so that the whole neighbourhood could hear, "you are in end-stage kidney failure, and you have been thinking about what form of dialysis you prefer. Is that right?" As it happened, he was wrong. For the past week I'd been trying to evade the subject altogether, assisted, it must be said, by the hospital's inefficiency. "Hasn't anyone from the unit contacted you?" he enquired. I shook my head. He summoned a nurse. "Right," she said, "follow me."

There are two types of dialysis available; the familiar, vampiristic haemodialysis and the more mysterious CAPD (an acronym for continuous ambulatory peritoneal dialysis). The latter sounds much less fearful, less traumatic, and can be done at home; but it does require the dialysand to infuse a special fluid, which absorbs excess waste and water, into the peritoneal cavity four times every day. Alas, this isn't done via the bellybutton.

The nurse led me to a large room. In its centre, hanging like a grotesque fashion accessory, was something that resembled a flak jacket with a six-inch plastic umbilical cord. The nurse tweaked it. "This is the catheter through which the fluid is admitted and expelled," she explained. "It's Mr T's job to insert it in your abdomen." I tried on the jacket and peered in the mirror. It did not suit me. I definitely did not like the idea of sprouting a second omphalos in my mid-forties. Presumably I'd also sound like the kitchen sink, with two litres of that special fluid continually on the move in my belly. The nurse handed me a booklet entitled Peritoneal Dialysis. It had a rainbow on the cover. Inside were drawings of a man with various bags attached to the catheter. He was naked, but had no genitals. Were the anonymous authors sending me a subliminal message?

We were talking big issues here, so I decided not to be shy. "How about my sex life?" I asked. "There's usually some embarrassment at first," admitted the nurse, "but if your partner is willing there's no reason why you shouldn't continue to enjoy normal sexual relations." My late wife would have been game, I am sure, but what is a complete stranger going to think when I start to look shifty on our first night and whisper, "Before I take off my clothes there's something that you ought to know about me..." I remembered that the sight of David Bowie sans pupik in The Man Who Fell to Earth made me want to throw up. How could I expect a girl not to faint if she witnessed something even more grotesque?

Of course there were other considerations beside getting laid, but this isn't War and Peace, so we'll stick to the point. I was asking the nurse if there was any evidence that the alternative method - haemodialysis - caused impotence, when Mr T's secretary appeared and beckoned me to follow her to the surgeon's lair.

Mr T was invisible, being flanked by two opaque flunkies, one of whom I had already met. All I could hear was a plummy voice that sounded on the point of demanding a Pimms No 1. No one looked at me, let alone offered a word of greeting. The secretary and the nurse, who had tagged along, stood in front of the door, as if to prevent my escape. I sat down and tried to convert my apprehension into aggression. Eventually, after ten minutes or so, the bit-players parted like the Red Sea and the newly revealed Mr T said, as if to no one in particular: "All right, roll up your sleeves and lie on the couch." "Are you talking to me?" I said, trying to pitch the sound somewhere between naivety and fury. "Come to the couch, please," said Mr T.

At first things went swimmingly. "No problems here," said Mr T as he pumped up my left arm and examined the veins. If I plumped for haemodialysis he would have to effect a subcutaneous connection between an artery and one of those unproblematic veins. The resulting confluence being called a "fistula" or a "Cimino" (after the clinician who developed the procedure, rather than the blood-thirsty film director). Incidentally, Mr T's comment was not directed at me, but at his sidekicks (neither was introduced, so I'll call them "Glasses" and "Moustache").

The latter, Moustache, then ordered me to unbutton my shirt and loosen my trousers. I undid the belt. It didn't suffice. "We need to feel around your groin," said Moustache, as he exposed his cousin, Pubic Hair. "A big cough, please," said Mr T, as he began to palpate Tierra del Fuego. "Cough again," he continued. Before long it sounded like Franz Kafka was in the room. "What do you make of this?" he asked Glasses. "A bit facel-vega, don't you think?" Facel-vega? Had I heard right? Isn't that a make of car? "Definitely," agreed Glasses.

I was asked to stand up. "Lower your trousers a bit more," said Moustache. I dropped them a couple of inches. "No," said Moustache, "let go of them altogether." I was particularly reluctant to release them, although they were covering nothing. But I had no choice. My penultimate line of defence crumpled to the floor. I thanked God that I was wearing my Greenpeace boxers with their discreet dolphin motif, rather than my brazen Popeye shorts with the cartoon characters and the hearts. Not for long. With a single tug, Moustache removed them and Mr T grabbed my naked balls and ordered me to cough yet again. "Yes," he said, "definitely facel-vega."

I was thinking three things. 1) That I didn't like this Sloane Ranger fondling my balls as if they were kiwi fruit in a supermarket. 2) That he had discovered some further, dread disease in the body politic, such that my polycystic kidneys will be looked upon as old and trusted friends. 3) That the nurse, with whom I was discussing my sex life a few minutes before, would now be of the opinion that I actually had nothing to lose.

"No doubt about it," echoed Moustache, "it's facel-vega." I can take no more. "Would you mind translating?" I said. "In good time," replied Mr T, still holding my balls. Eventually he permitted me to pull up my trousers, informing me that I had the beginnings of an inguinal hernia, which would have to be repaired with extra surgery if I opted for CAPD. That settled it. "In that case I'll go for the haemodialysis," I said. "I'm beginning to feel like a waiter taking orders," complained Mr T, wittily, "with patients saying they'll take this, or don't feel like that." "Better a waiter than the main course," I replied.

And so the fistula was made. There were three of us in the ward who had all survived the operation. We shuffled around, our wounded arms forming right angles, outstretched and wrapped in white mufflers. We resembled a trio of trainee falconers awaiting the return of our absconding birds.

The doctor at the next renal clinic confirmed that Mr T had done an excellent job. The fistula was working well. When touched it buzzed like a live wire. In the trade this was known as a thrill. I had never seen this doctor before. He was wearing a black tie. Dr V (a name tag was attached to his stethoscope) was obviously not big on tact. None the less, I attempted to make contact. He had a pronounced Spanish accent. "Where are you from?" I inquired. "Colombia," he replied, "in South America." "I know where Colombia is," I said. "Oh," he said, "most people don't." I began to wonder if this man could be an ersatz doctor, an impostor, an out-of-work actor who had wandered in off the streets. Especially when he made the dread pronouncement: "You must commence dialysis as soon as possible."

The first time is like losing your virginity. "You will feel a little prick," said the nurse as she drove in the needle. "Don't worry," I replied, "I feel one already." Needless to say, the nurses don't regard themselves as sex objects. To them the dialysis unit is utterly devoid of erotica, merely a place of work. They obviously want me to stay well, but aren't particularly interested in the characteristics that usually attach themselves to that condition. In their eyes I am not a man, I am a patient. As such I am required to be good humoured, stoical, dependent, and sexless; Homus Dunkerqus.

And so it happens, on occasion, when I am having the needles removed at the end of my trial, I feel soft flesh nesting in my cupped hand and realise that I am holding the left breast of my saviour. I don't blame the nurses for regarding me as an it rather than a thou, I recognise that they require strategies to retain their equilibrium, just as I do. I understand why they prefer to keep their real lives under wraps, but must advise them that their uniforms are much more charitable with their underwear. Like Andre Agassi's shorts at Wimbledon these tend to transparency. You can find out a lot of things about a person by studying their knickers, which I often do as the hours drag by. Forgive me, my sisters of mercy, forgive my voyeuristic impulses, forgive my petty attempt to reassert my masculinity, to convince myself - if not the little boy with Captain Scarlet - that there's life in the old dog.

There is just one escape from my predicament (excluding death): a transplant. At present the only available donors are the brain-dead, a much smaller proportion of the population than you'd expect. So I'm investing my hopes in Astrid. Astrid is a pig. Hitherto any xenotransplantations would have been negated by a protein called "complement". This is the immigration official from hell, the body's own Dirty Harry, conditioned to track down every scrap of foreign tissue and blow it away with the equivalent of a Magnum 45. Astrid, however, has been genetically engineered to develop hearts and kidneys that will sweet-talk and switch off this rejection process. She is already the matriarch of three generations, hundreds of descendants, all running around with what are, in effect, human organs. I'd be proud to call her Mum.

I am well aware that some have ethical problems with this use of animals. Supposing I decide to re-marry (about as likely as a transplant). I can't quite picture my bride-to-be, but I can see my prospective mother-in-law with frightening clarity. "Well," she'll ask, "is he Jewish?" To which her daughter will reply, "Most of him." Whereupon she'll want to know which bit isn't. So I'll tell her. The vision of grandchildren with trotters and curly tails will surely prove too much for the poor woman, "Oy!" she'll wail, "Fetch the rabbi!" Actually she need not torture herself; the former chief rabbi has already given his blessing to such transgenic procedures, as has a senior Muslim cleric. So long as the unkosher flesh is not ingested, the animal isn't forbidden; anyway, both religions regard the preservation of life as the most pressing and sacred of duties.

You see I don't always think about sex, I have my serious side too. For instance, when the nurse runs tubes around my left arm, as she connects me to the machine, I recall the days before my barmitzvah, when I was compelled to wrap phylacteries around that same limb, thereby dedicating my heart to God. What I didn't know then was that God was equally keen on kidneys. Recently a well-educated friend pointed out that in biblical times the kidney was regarded as the seat of guilt and, as such, was often the subject of divine scrutiny. I consulted the Good Book, and saw that he was right. "Oh let the wickedness of the wicked come to an end; but establish the just," saith David the psalmist. "For the righteous God trieth the hearts and kidneys." Later he adds, for good measure, "The darkness and the light are both alike to thee. Thou has possessed my kidneys." Jeremiah is even blunter: "But, O Lord of hosts, that judgest righteously, that triest the kidneys and the heart, let me see thy vengeance."

Most would regard this as an abstract concept, certainly nothing to worry about in this life. Not me. My heart is tried periodically with an ECG, my kidneys tested week-in week-out. I may pretend that the hospital is a whorehouse devoted to the pleasure principle, but I know that it is really a place of severe judgements. I go there because of my guilt. After my first session I felt very light-headed. "Cold turkey," said a nurse. "Your body is not used to being free of toxins." She was right. I hardly knew myself; a Sinclair sans sin. If modern philosophers are correct and there is no distinction between mind and body, then this guilt is a material thing, nameable and quantifiable. There is my creatinine, five times higher than normal, and my urea, a mere three times over the top. What has led to this guilty state I really do not know. Perhaps I am being punished for an unpardonable iniquity committed by a distant ancestor. Anyway, there is irony in an atheist (albeit a Jewish one) who has always regarded God as immaterial suddenly finding himself subject to a machine with divine attributes. Surely our nonverbal communication is a form of prayer.

The machine is my shepherd. It leads me through the valley of the shadow of death. It judges my kidneys and finds them wanting. Even though I am full of guilt, it forgives me. It effortlessly draws the poisons from my body, it cleanses me of sin. At the end of my three hours I am ready to return to the world, shriven, my soul like a newly laundered sheet. "I'm done!" I cry. One of the vestal virgins approaches. She releases me, then unhooks a transparent bag, bulging with my filtered venom, and drops it in the bin.

Suddenly, as if in a vision, I recognise my crime. I am here because I am a writer. The entire process is but a metaphor for my craft. For creatinine read creativity. It builds up within, like poison, until I can do nothing but discharge it. Out it flows, lava from Mt Ego, streaming across the page. And where do these outpourings end up? Like my other toxins, in the bin. Poetic justice, you might say

Clive Sinclair will be giving a public lecture next spring on the kidney as metaphor as part of his duties as the British Library Penguin Writer's Fellow