Birthday party

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‘Birthday Party’ by Al James

A short story donated to support the work of Kidney Research UK

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BIRTHDAY PARTY

“Surprise! Surprise! Happy Birthday!”

Ruth scans the room in astonishment, taking in all the grinning and cheering faces.

“Is this your doing?” she says, turning to Jamie beside her and whacking him playfully in the

ribs.

“Well you’re not forty everyday.”

His arms are around her.

“So this is why it was all so mysterious!”

“Look.”

In the centre of the room is a large cake. . . and behind it the familiar face of . . .

“Sarah? But she’s in Melbourne!”

“Was. Till yesterday.”

Sarah, looking gloriously tanned is running up the room towards her.

“Sarah!”

“Ruth! Happy birthday sister!”

Arms out towards her; big hug as of old times. Tears begin to form,

“Don’t make me cry . . . you’ll smudge my make-up.”

“Well don’t cry, you great blubber! Not changed much have you.”

“I’m just happy!”

Laughter and more hugging.

“Mummy, mummy. Grandma’s here.”

Six year old Charlie, pulling at her dress, demands attention, pointing across the room.

Mother is waving her arms wildly while dad, sits sedately beside her as always, but smiling

happily.

“How did you get everyone here?”

“Planning. Took a bit of organising but . . . come on, there’s a table for us over here. Charlie

you coming with us?”

“Yeah!”

Jamie is guiding her across the room to the table where her mum and dad are, and Gemma

is sitting with them. Sarah’s husband is there too and both their boys. Charlie, holding

Sarah’s hand and pulling her along, has run around to the table before them.

There are flashlights; cameras pointed at her and cheering all around the room.

“You’ll be on Facebook for weeks, mum!” Gemma announces with full eleven year old

authority.

“How many are here, Jamie?”

“Sixty, seventy maybe. Don’t know exactly, but everyone wanted to come.”

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“Oh my God, Jamie!”

“Well you’re very popular. They all want to celebrate your special birthday.”

She grins, sits back. Waiters and waitresses are walking around the room now and up to

their table. Suddenly, for no particular reason, the pain round her back niggles. It’s been

there on and off, nothing serious. She rubs it. Sarah notices.

“You alright, sis?”

“Just something I’ve had a little while now. Nothing much.”

“Sure?

“Old age creeping on. Mustn’t let it affect all this. I had no idea . . .”

“Jamie’s been planning it for months. He called us ages ago with the idea.”

“Happy birthday, Ruth!”

Dad is stretching his glass out towards her, and everyone else around the table is following

his lead.

“Cheers!”

Clinks all around the table, smiles and grins as they all drink to her.

“Thankyou so much for all this. You’re making me cry.”

Covering laughter round the table.

A young waitress offers her a bread roll. She shakes her head as she looks through the

starter menu. Strangely, the sickness feeling, an odd kind of nausea, is with her again as she

does so. She lifts her hand to her throat as if holding it back and the peculiar taste is there

again.

“Not that feeling again. You sure you’re not . . .”

“No Jamie, I’ve told you. Definitely not.”

Grinning he calls across her to Sarah.

“She’s been getting this sicky feeling lately. Thought she was pregnant.”

“You did!”

“You sure about that?” Sarah says.

“You know what it’s like . . . you’ve had your two. It’s not the same at all. No morning

sickness for a start.”

“Happy birthday Ruth!”

“Jean! How nice of you to come. Everyone . . . this is Sister Jean. Ward sister; my boss at the

hospital.”

“Ruth is our very special health care assistant,” she announces around the table like a proud

parent, “as good as many nurses. I couldn’t help but adjust the rotas to be here.”

Underneath the embarrassment, it’s difficult not to feel pride.

She picks at the main meal when it arrives. Everyone around the table is eating happily,

even picky Gemma.

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“Mmm, chicken. Lovely,” she says.

“Pity you don’t eat up more often at home then,” Jamie says.

“Dad!”

“Well look at Charlie. Stuffs everything in sight into his mouth.”

“Boys! Pigs more like.”

Charlie, sitting next to her, pushes an elbow into her side. Jamie is quick to quell them

before any retaliation takes place.

Ruth watches, amused. Certainly a different dynamic having one of each instead of two the

same like she and Sarah are, and like Sarah’s boys across the table chattering and laughing

together

“Your boys even laugh with an Australian accent,” she says.

“Well that’s where they’ve spent their lives, sis, what do you expect?”

“Suppose so.”

She smiles and lifts a small fork load of chicken to her own mouth. Swallowing it feels like an

effort. The plate in front of her has ceased to be a pleasure. Pushing it away half-finished

feels unavoidable. No one notices immediately.

She looks round the table. Shane and Glen, fourteen and twelve, named after their cricket-

mad father’s favourite players, erupt with laughter at some private joke. They have already

finished their plates.

“You two seem to have consumed everything at great speed,” her mum says.

“Yeah granny. We bogged in.”

“It was beaut!”

It’s hard not to laugh at her mum’s bemused face.

“Aren’t you hungry Aunt Ruth?”

Shane is pointing across at her plate, drawing everyone’s attention.

“You don’t want more, I hope Shane?”

“Well . . .”

“I expect they’ll be coming round with seconds in a while.”

But Sarah’s attention has been drawn to her plate now.

“You finished?”

“Yes. I don’t seem to be hungry much these days.”

Sarah’s blue eyes seem suddenly fixed on her. She has the strange sensation of the sounds

in the room around her fading into a distant place.

“You’re not well are you?”

“That sounds very dramatic.”

The eyes are still on her. It feels unusually uncomfortable.

“Jamie said that the other day, but it’s nothing . . . really.”

“For someone in healthcare you seem very unaware of having any symptoms yourself.”

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“Symptoms?”

“Not much appetite. Sick feelings, and if I’m not mistaken you’ve lost weight . . .”

“I could do with that,” she says laughing, but it feels false.

“Get yourself checked, kid. Don’t risk it.”

“Risk? Risk what?”

“You shouldn’t need me to tell you people who ignore symptoms of any kind are taking

risks.”

The sensation is of a black hole opening out inside her. For a moment she wonders if she is

going to be physically sick. Her hands are on the table steadying herself.

“You know don’t you?”

“What?” she manages to say.

“That you might need medical attention.”

Crystallising within her, like disparate particles coming together. All the separate pieces

she’s known but not wanted to link up. She nods. It feels shaky.

“We’re here for ten days. I’ll come with you.”

Arms around her, comforting, sisterly. For now she can hold it together.

The other side of her, Jamie is on his feet. There is a rapping sound, quickly repeated when

the first has little effect. The room around her comes back into focus as it quietens. Two

children squabbling across the room are hushed by Sam, fellow HCA looking guilty for a

second. Then glancing up, she catches her eye and waves elaborately. A stifled laugh from

elsewhere, then a moment of quiet.

“I know this was a surprise for Ruth . . .”

Cheering, laughter.

“But we’re gathered here today . . .”

More laughter; someone mimics the phrase in a regal falsetto. Shushing from around him.

“Let’s drink to Ruth, my lovely wife, forty today!”

Commotion as chairs scrape. One of Sam’s children surreptitiously wallops the other.

Clinking of glasses; her own name repeated round the room. Then . . .

“Happy birthday to you, happy birthday to you. . . ”

The birthday song comes to an end with cheering. Someone shouts out ‘speech!’, but it’s

the last thing she feels like doing

“Thankyou,” she says, waving around the room and sitting back in her chair. It will have to

be enough. Tears feel as if they’re not far away. Around them the usual hubbub returns as

the orders for the sweet course are taken and the waiters begin cutting the cake. Sarah is

looking at her with determination lined into her smile.

*

The waves lap against the beach. There isn’t much wind to cause any great swell across the

North Sea, but it’s cold, barely above freezing. On the horizon a weak sun struggles to shine

through grey cloud.

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“I miss this coastline in the winter.”

“Winter? It’s summer for you over there in Melbourne isn’t it?”

“I know. Glad to escape the heat for a few days to be honest with you.”

“Really?”

“God yes! Near forty degrees at the moment. We grew up here with all this flat landscape,

wide horizons and the sea never far away. If Dennis got a job here in East Anglia I’d be over

the moon.”

“Will he?”

“No chance. Australian through and through. Like the boys.”

Without warning, Ruth catches her foot in the sand and nearly falls. The niggling pain is

there again.

“You alright?”

“Just stumbled. That’s all. . . don’t look at me like that, Sarah!”

“You what?”

“Like I’ve got some serious illness or something.”

“You’re not your usual self.”

“How do you know what’s usual? We’ve not seen each other for three years.”

Sarah is staring at her. Their pace slows. Neither speaks for a while.

“What’s wrong, Ruth?”

“I told you yesterday at the birthday party. I just don’t feel too good.”

“And I said I’d come with you . . . to get you checked out.”

“Mmm.”

“You’ll make a doctor’s appointment . . . tomorrow morning?”

Some way out, a huge ship is travelling across the horizon.

“It just makes me feel irritable. I don’t like feeling tired all the time.”

“So that’s a yes?”

Sarah has moved closer. There is a temptation to resist, refuse to engage in what feels like

big sister coercion, but she doesn’t. As if sensing what’s happening inside her, Sarah’s arm is

in hers.

“I’ll ring them for you if you like.”

“I can do that for myself!”

She turns to see a smile on Sarah’s face. The urge to hit out like a five year old is strong, but

recognising it inside herself it’s impossible not to laugh. Soon they’re both laughing, but she

senses hysteria is not far below the surface.

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She is conscious of pain, but not enough to keep her awake. She moves around towards the

already sleeping Jamie. His gentle breathing is comforting and she slips into a sleep of

swirling mists. Somewhere Sarah is calling, but the shadowy shape in the mists doesn’t seem

to be her. The pain in her back is there again and she knows something is not right.

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Someone speaks; a woman’s voice. It sounds like ‘Don’t fret yourself’ but inside her she

knows that isn’t the message. Her hand is in front of her mouth. For some reason she thinks

her breath might smell. The voice comes again; ‘Ruth, Ruth, look!’ it doesn’t sound like

Sarah’s voice, but in her head she is sure it is. Ahead of her the mist is clearing as if to reveal

whatever it is she must see, but at first there is only an empty space. Unexpectedly the

sound of water is in her ears; loud as of a waterfall. Then she can see it; water cascading

from a rock face high above her. She steps forward, propelled by some force to be right

inside. The coldness strikes her body; a strange sensation of the water going not only onto

her but through her, right inside her as if washing every part of her. She tries to cry out but

the words won’t come.

Hands are on her.

“Ruth!”

“What?”

“You alright?”

“Why are you waking me up?”

“You were shouting. In your sleep.”

“Shouting?”

“Must have been dreaming. What was I shouting?”

“Sounded like ‘no’. What were you dreaming?”

She is awake now, and sitting up in bed. The dream has already faded. There is a taste in her

mouth; metal. It’s been there before.

“I can’t remember.”

Her back is wet with perspiration. Jamie has already noticed it.

“I’ll get you a towel,” he says, stepping out of the bed. Tears are not far away, but giving in

doesn’t feel like an option.

There is a noise at the door and light footsteps across the room.

“Mum.”

“Charlie, why are you up?”

“Heard you and dad talking.”

He is already climbing into the bed beside her.

“Can I come in with you?”

“Looks like you already have.”

Jamie is back with the towel. He lifts the damp nightdress and wipes her back.

“You in here again?” he says

In the glow of the bedside lamp she can see his face smiling.

“Well just this once.”

He snuggles into her.

“What’s that smell?”

“Smell, Charlie?”

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But she knows, really. Her own breath. A fragment of the dream returns, and with it the

words. In an instant she knows: ‘Don’t fool yourself’; that was the message.

*

Charlie is very happy. Four days now, Shane and Glen have been around to play all manner

of games with him. More than anything, he loves the play fighting and all the Australian

humour. Even when they refer to him as ‘our little ankle biter’ he doesn’t seem to mind.

Three way boxing is another delight as they prance round the living room, fists held out.

“Ooh that’s a king hit!” Shane shouts out when Charlie’s fist breaches his defences.

“King hit, king hit!” Charlie yells in pride. A little later; “Just going to the dunny,” he shouts

out, announcing his intentions to everyone.

“What’s that?” Ruth asks Sarah.

“Slang for the bathroom.”

“He’ll probably go on saying that long after they’ve gone. It’s just up his street.”

Ruth loves them being around, and especially having Sarah there too. In her head is the

feeling that would be good to have enough energy inside her to really enjoy it, but that’s

how it was at the moment.

Dennis and Simon have no problem disappearing to the local pub and returning in fits of

laughter. It’s Gemma she feels sorry for with no obvious benefit from the visit. At least she’s

got her friend Lucy coming round during the half term holiday. ‘They’re just wowsers!” Glen

says, and Charlie of course mimics what they say. Both of them disappear to her room

looking highly self-righteous.

She tries not to think about yesterday’s trip to the doctor with Sarah, but bits of it keep

coming back into her head. No diagnosis; she didn’t think there would be. It was painful

when the sore spot on her back was poked and pressed in the examination.

“Could be kidneys causing problems,” the doctor says, “but we’ll get some tests done.”

Her manner is reassuring.

“You’re not diabetic, although the reading is just a little above normal.”

Most worrying though was the blood pressure monitor.

“Hundred and seventy three over ninety five, now that is high. But could be what we call

white coat syndrome. Are you stressed?”

“I do this every day with others.”

“What do you do?”

“HCA: at the general.”

“Different when it’s yourself.”

The grin is professional but not unsympathetic.

The ‘sharp scratch’ from the nurse down the corridor is no different.

“Do you do this too?” Sarah says.

“Not usually; but I’ve seen it often enough.”

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Shane has Glen in an armlock, doubling him over. Charlie is shouting ‘give in?’ in a loud voice

and Shane makes as if to pull the arm up higher. Glen falls to the ground, then sits up,

rubbing at his wrist. Charlie dances around him like an Indian Chief in an old Hollywood

cowboy movie.

“Less noise you two!” Sarah shouts from the kitchen.

“Boys!” Ruth says.

“Tell me about it.”

Gemma and Lucy are in the kitchen.

“Can we have something to eat?”

“What like?”

The landline telephone cuts through all the noise. She picks it up.

“May I speak to Ruth Barlow please?”

“Speaking,” she says. The authoritative woman’s voice is unexpected.

“Oh, hello Mrs Barlow, Dr Woodward, from the surgery here.”

“Hello doctor.” Alarm bells ring inside.

“We have the results of your recent tests. I need to discuss them with you.”

“Is something wrong?”

The taste of metal is suddenly in her mouth again.

“It’s better if we talk in the surgery. I can see you at 4.15 this afternoon if you are available.”

In the kitchen, Sarah is looking at her.

“Doctor wants to see me,” she says.

“When?”

“You did say 4.15 today, doctor?”

“Yes, is that all right?”

Sarah is miming ‘I’ll come.’

“Is it all right if I bring my sister?”

“Of course. I’ll book you in now.”

The call ends.

“She wants to see me today.”

“What for?”

“Didn’t say. You sure it’s alright if you come?”

“Of course it is.”

“Makes me feel guilty. Your holiday and that; and dragging you to the doctors. Twice now.”

Charlie comes running into the kitchen, squealing.

“Monsters chasing me,” he shouts out, grabbing hold of her leg.

He doesn’t look distressed. A moment later, Glen’s and Shane’s heads peer round the door

with mock scary faces. Charlie squeals again, but he’s laughing too. She rubs his hair as the

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monsters prance into the kitchen. He runs round her and Sarah, knocking over the broom in

his path and rushes back into the living room with the boys in pursuit.

“Does it look like we’re having a bad time?” Sarah says.

She laughs, but her stomach is churning inside her.

*

“Hello Mrs Barlow.”

Dr Woodward’s professional smile moves from her to Sarah and back again.

“I’ve asked you to see me to discuss your test results. They do I’m afraid indicate a

problem.”

“A problem?”

“With your kidney function. You have a GFR of 17. . .”

“What’s that?”

“I’ll explain. We start with kidneys working at full effectiveness. That’s 100%. During life,

everyone’s effectiveness drops a little, but anything above two thirds, say 70%, is still within

normal range. With your general filtration rate – that’s the GFR; at 17% it means your

kidneys are less than one fifth effective.”

She stops, looks at her, across to Sarah and back again, letting the news sink in.

“That’s serious,” she says.

“Well yes, I’m afraid it is.”

“Can you do anything about it?”

“Oh yes, lots. Many people have low kidney function. They’re out there getting on with life,

not knowing they have a problem.”

“Don’t they know?”

“They’ll probably have symptoms; which they’ll ignore. Especially the men.”

Doctor Woodward’s face moves briefly into a smile, but when she doesn’t smile herself, the

face in front of her face returns quickly to the serious expression.

“We call them the missing million . . .”

“Million?”

“Oh yes, there a very many people with renal problems as we call it. Quite a time bomb for

the NHS, I’m afraid.”

“I see.”

“What can you do?” Sarah says.

She hasn’t spoken for some while, so her words break into Ruth’s thoughts.

“First we need to know what the cause is. I’ll refer you to a specialist straightway. You’ll get

an appointment quite quickly. They’ll take it on from there.”

“And after that?”

It feels good that Sarah is asking the questions for her.

“Well if we can increase your kidney function we’ll do that.”

“If not?”

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“In time, you’ll need to be dialysed, which clears the body of toxins on a regular basis.”

“For how long?”

“Until you can get a transplant.”

“Transplant?”

“Another kidney from someone else, which can be transplanted into you. The medical

science is excellent now. Unfortunately, there are very few donors as yet, so there’s a wait.

But the specialist will explain all that to you.”

She has the feeling Dr Woodward wants to bring the session to a close.

“Someone will phone you from the hospital soon,” she says.

They make their way out.

A child is crying in the waiting area as they pass through. Bundled in warm clothing, the little

distressed head peers out with visible tears in his eyes. The young mother with smudged

mascara attempts unsuccessfully to pacify him. She looks up briefly as they pass. Tears are

not far from her eyes too.

“I hate it when babies cry,” she says when they are outside.

“Mmm. Goes right through you, doesn’t it.”

“We don’t cry like that at our age.”

“No.”

“But sometimes I feel a great surge building up inside me. I have to control it.”

“Why?”

“Well it’s what we do.”

“That’s because we’re English. You could cry out if you wanted to.”

“I had a dream last night.”

“You can remember it?”

“Not at first, but bits have come back to me. You were in it.”

Sarah laughs.

“Why doesn’t that surprise me?”

“No, listen. There was this message. ‘Don’t fool yourself’ it said.”

“What’s that about?”

“All this I think.”

She is conscious of waving her arms about to no particular purpose. There is a sharp wind

blowing from the direction of the sea. It feels harsh, uncompromising in its force.

“My symptoms. I’ve looked it up on the net. Tiredness, metal taste in my mouth, nausea,

pain; they’re all symptoms of kidney problems. You’ve persuaded me to come here.”

“It’s what sisters are for isn’t it?”

“Suppose that’s why you were in the dream. Thanks.”

Sarah’s arms are outstretched and she accepts the offer of an embrace. The child’s tears

don’t surface, but they are in there somewhere.

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“Let’s get back to the chaos back home now. I can’t do anything else till my appointment

comes through.”

They walk across the medical centre car park against the force of the wind.

Watch out for the next instalment – coming soon on the Kidney Research UK website!

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