Books from Finland - A literary journal of writing from and about Finland.

An extract from the novel Kuolema Ehtoolehdossa (‘Death in Twilight Grove’, Teos, 2013). Minna Lindgren interviewed by Anna-Leena Ekroos

At the Health Clinic, Siiri Kettunen once more found a new ‘personal physician’ waiting for her. The doctor was so young that Siiri had to ask whether a little girl like her could be a real doctor at all, but that was a mistake. By the time she remembered that there had been a series of articles in the paper about fake doctors, the girl doctor had already taken offence.

‘Shall we get down to business?’ the unknown personal physician said, after a brief lecture. She told Siiri to take off her blouse, then listened to her lungs with an ice-cold stethoscope that almost stopped her heart, and wrote a referral to Meilahti hospital for urgent tests. Apparently the stethoscope was the gizmo that gave the doctor the same kind of certainty that the blood pressure cuff had given the nurse.

‘I can order an ambulance,’ the doctor said, but that was a bit much, in Siiri’s opinion, so she thanked her politely for listening to her lungs and promised to catch the very next tram to the heart exam.

When she got to Meilahti she waited for two and a half hours. She read some Donald Duck comics, solved seven sudokus, and had learned two long articles from last year’s Health News by heart – one about sea buckthorn oil and another on dry mucous membranes – before she got in for her urgent tests. The handsome specialist figured out what Siiri already knew: she had a heart arrhythmia. He spoke in a strained voice and wanted Siiri to have more tests and have a pacemaker installed to normalise her rhythm.

‘What rhythm will I be set for? I hope it’s not a waltz, although there is a song about a waltzing heart. It would be hard to use two feet to walk in threes.’ She was trying to make a joke, but this doctor too was very serious.

‘Generator node and electrical impulse pathways, at which point the sinoatrial node and frequency limit, respectively, in which case an elective surgery or microprocess, perhaps also a telemetry device, all in all a nearly risk-free procedure.’

Siiri listened for a while and then said that she was 94 years old and they couldn’t install some gadget inside her to make her live longer.

‘This is a very small operation that is done under local anesthesia. The pacemaker is placed under the skin and the electrodes are threaded through a vein to the heart. It will remove the unpleasant symptoms and increase your quality of life,’ the doctor said.

‘Are you sure about that?’ Siiri asked. ‘What kinds of things do you think would give and old person’s life quality?’

‘Well… studies show that for the aged… after all, good health is the first step to a quality life. An untreated heart arrhythmia can be life threatening.’

‘You mean that in the worse case scenario, I could die?’ Siiri said, feeling very brisk and strong. ‘You’re still a young person, so maybe you don’t know that getting old is mostly unpleasant. Days pass slowly and nothing happens. Your friends and relatives are dead and gone, and your food has no flavour. There’s nothing worth watching on television and your eyes get tired when you read. You feel sleepy, but sleep doesn’t come, so you end up lying awake all night and dozing off all day. You feel all kinds of aches and pains, constantly – small pains, but still. Even the most ordinary tasks become slow and difficult. Like cutting your toenails. You can hardly imagine. It’s a huge, all day operation that you do almost anything to put off.’

The doctor glanced nervously at his watch and promised to write Siiri a referral for a pedicure, for which she could request state health compensation. He turned his back to her and became absorbed in his computer screen.

‘As far as the pacemaker is concerned, studies show that these small matters affecting health can be crucially important in increasing well-being, not to mention that a pacemaker would go a long way to increasing the length of your life. According to Current Care Guidelines…’

‘In that case the answer is clear,’ Siiri interrupted with relief. ‘Install the pacemaker in someone younger, some fat person who feels too well and makes the mistake of going for a run and dies. Even my sons died. And Reino the foreman’s son. And a lot of other people. We old people don’t die from anything, even if we would like to. Sometimes at the home we talk about how you doctors don’t seem to understand that death is a natural thing. Life ends in death, and there’s no sense in offering longer life to someone my age and denying me sugar for my coffee. It isn’t a failure of medicine when people eventually die of old age.’

The doctor turned around and looked at her in surprise.

‘But you’re a lively person in good health. Why in the world should you die? Current Care Guidelines…’

‘Because everybody has to die,’ Siiri said. She squeezed the doctor’s muscular hands, holding them in her own wrinkled ones, so he would understand that guidelines and studies and pacemakers can’t change this fact about the world.

‘One day you’ll die, too. And I hope that you’ll be old enough then to know what dying is, and not fight it. Maybe you’ll even be waiting for it, like me and my friends at Twilight Grove. Even if you put pacemakers in all of us you won’t change our everyday life one bit. So I thank you, from the bottom of my heart. I need your report and I’m grateful that you’re writing it. May I have two copies of that paper? That’s all I need from you, and I hope that you’ll take care of young people who are too tired to even work anymore. The nurses at Twilight Grove are so overworked that we’re practically left alone there.’

The doctor looked anguished. He tugged his hands forcefully out of Siiri’s well-intentioned grip, rushed to the sink, disinfected his hands, tightened his necktie, straightened his doctor’s coat, and sat back down in his chair to stare at the computer screen as if the machine actually knew something and would give him the solution to this dilemma. Then he straightened up, picked up his dictaphone, and started to murmur into it, glancing now and then at Siiri.

‘…otherwise healthy for her age comma memory functional and the patient is alert period refuses pacemaker however period in respect of the patient’s wishes taking into account her advanced age period.’ The doctor turned off the dictaphone and asked her if she wanted some depression medication in addition to the heart medicine.

‘What for?’ Siiri asked, sincerely surprised.

‘They can help your… condition. You might regain your desire to live.’

Siiri got up. She was about to put the dumb lug straight about the the hard facts of life and death, but she remembered her heart and its raggedy impulse pathways and took a deep breath before saying to him that she didn’t need any of his silly pills. She didn’t need them now and she hadn’t needed them back when her husband died. The doctor was persistent.

‘Some sleep medication might be helpful. You said that you weren’t sleeping at night, and there’s no point in that.’

Siiri started to have the desperate feeling that she would never get out of there without a stack of prescriptions. There had been something in the papers about responsibility for outcomes, how it was becoming a problem for public sector employees. Outcomes were measured in numbers, so child protective services was considered more effective when more children were reported to state custody officials, and doctors apparently were only earning their salaries if they sent patients for surgery and wrote them an adequate number of prescriptions.

‘That’s not what this is about,’ the doctor said wearily. ‘I’m just trying to help you and do my job as well as I possibly can.’

Siiri realised she’d behaved badly. The doctor surely had enough work to do without her making more work for him. He had studied hard to be able to prescribe sleeping pills to old people, and what would happen if all his patients refused his pills and pacemakers? He had no need, at his age, to know what a 90-year-old’s life was like. It wasn’t his fault that Siiri had lived to be too old. She thanked him for a job well done and left, headed for the tram stop. It was such a beautiful early winter day that she decided to walk one stop further toward town just so she could look at the majestic Aura Building, designed by Erkko Virkkunen, which was still handsome even though they had ruined the window frames a long time ago when they renovated it.

Translated by Lola Rogers