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  Lika with me all day. She came at seven in the morning and sat with me until eight in the evening. She is an angel. Lyuba peeped in. An unimaginable comfort in these circumstances. Most importantly, analysis found no carcinoma in the lymph nodes. My armpit is left alone. In a week’s time a histological check before deciding how to proceed.

  My neighbour in the ward is a kindergarten teacher from the north, on a pension. She was supposed to have her operation in Haifa but wanted Dr Zamir. Theoretically she should have to pay 18,000 shekels, but insurance covers 15,000, leaving her just three thousand to pay – less than one thousand dollars. In effect, everything is free. This is socialised medicine. My neighbour too had that very latest injection and is not in pain.

  I am here privately, but special. Dr Lesha Kandel is a friend, and Vladimir Brodsky, the chief anaesthesiologist, is a friend of his. All the Russian doctors are coming to me for book signing. VIP! Aside from the interest in my books, everybody else gets exactly the same treatment, only without paying.

  Poor Russia! 145 million people going under the knife without anaesthetic, rolled in the dirt and infected in hospitals with God knows what. Poor Alla Belyakova. They found she had bowel cancer. The Blokhin Centre said, ‘Go away, it’s too late!’ She was admitted in Troitsk, south of the Urals, and is delighted. It is a horrible cancer, and poor Andrey, her son, is autistic. What will become of him?

  My breast is completely absent: there is even a dent. It has been interred in a special burial ground at the Givat Shaul Cemetery. Lesha Kandel buries all the amputated Jewish appendages from his orthopaedic department there. ‘For some reason, Muslims and Christians seem totally unconcerned where their removed organs or body parts lie,’ is what he said.

  My left breast is at rest in the land of Israel. Perhaps only a first instalment!

  I am staying with Lika. A strong draught blows through the apartment. Something slithers, and then falls, in the kitchen. I go in and close the window. On the floor is a picture that had been on the fridge. It is by an Israeli artist, Miriam Gamburd, exhibited in Paris in 2001. Fleshy, busty women are taunting an Amazon who is central to the composition. She has her hand on one breast. The other, the left breast, has been amputated. We are stunned. The picture had been there for ages but we only noticed it today.

  So many mysterious, significant happenings. My world is protecting me: my friends, friends of friends, their relatives, the doctors. Everyone is looking after me, and pride of place goes to Lika.

  In spite of everything, it has come together wonderfully. There is so much joy here. I should have a small ex-voto silver breast made and hang it in church on an icon of St Panteleimon or someone, even if the breast was not actually saved. Good Lord, it has been done already – Andrey’s ‘half’ was my ex-voto!

  Poor breast! It took me such a long time to get round to saying goodbye. Of course, it had behaved very badly, but I have a lot more to apologise for. Seventeen years of hormone replacement therapy!

  Why am I writing all this? Because I need to develop a new relationship with my body, and primarily with my breasts. As I approach three score years and ten, I have all sorts of things to feel guilty about, but right now I feel worst about what I have done to my poor body. How odd, that after a lifetime of being offhand, even cruel, with my blameless body, I have only realised it now!

  This whole story is beyond belief. It looks as if I am going to get away with it, but even if I do not, so much here has been wonderful.

  I heard yesterday that Galya Chalikova has stage 4 ovarian cancer with metastases, and ten litres of fluid in her abdomen. I phoned and asked her to consider the Hadassah. The third catastrophe in the last few months: Alla Belyakova, Vera Millionshchikova and now Galya. My own gnat bite hardly merits mention. It is all just heartbreaking.

  I am reading Conversations with Alfred Schnittke. Brilliant, in places astounding: ‘After my stroke there is a lot I do not understand, but I know more now.’ Intuitive knowledge. I can allow myself to cry over that. Jerusalem is a city with plenty of places where you can go to weep, but it is not obligatory.

  Ten days later. I hear I will need a second operation because a cancer cell has been found in one of the five glands, where the analysis had shown nothing. It is scheduled for 3 June. It will take slightly less time, but the basics are the same: general anaesthetic, drainage, healing. It may hurt more. Afterwards the likelihoods are: five years of hormone treatment, for sure; local irradiation, possibly; and, the worst option, eight courses of chemotherapy at intervals of two weeks, over four months. I am obsessive about making contingency plans, but it seems even the worst option means everything will be done by October. There are, however, more dire possibilities. I am at stage 3 by the Russian definition, but with metastases in the axilla.

  It is Trinity Sunday and tomorrow is Monday of the Holy Spirit. It is four in the morning and the megaphone-voice of the muezzin broadcasts the call to prayer. I willingly join him.

  I am waiting for it to be morning, and hoping to see Zamir today so I can fit in a lightning trip to Moscow before chemotherapy.

  I am writing away at the novel but it shows no sign of coming to a conclusion. I am on edge and tired, I feel unwell, but very happy. In fact, full to overflowing. I discover Gidon Kremer and two other musicians on YouTube clowning about with themes from classical music. Like Nabokov writing about Chernyshevsky, the priest’s son playing quite unselfconsciously with his father’s censer. Young people amuse themselves by playing with things that are sacred. They are in their element.

  A week in Moscow. Hard going. Lots of people, things to do, none of it really necessary. I visit Vera Millionshchikova. She is in remission. Her skin is peeling, her nails growing back, new hair appearing. She is settled in a hospice, on the understanding that she will die.

  Jerusalem. I fly back with one day to spare. What do I feel? Nothing. Tomorrow, 3 June, I have the second operation.

  The operation was yesterday. I feel all right. My arm is not painful if I do not move it, but is if I make sudden or sideways movements. I will be discharged tomorrow. It is hot, the light is strong and I have an extraordinary sense of clarity, although quite what is clear I cannot express.

  Ein Karem

  I have been living for over three months in Ein Karem now, and it is one of the most magical places on earth. Until 1948 this was an Arab village, and it became Jewish overnight, as it had been two thousand years ago, when the Arabs left for Jordan on the day Israel declared independence. John the Baptist was born here, and this is where the two most famous Jewish women met, Mariam the mother of Jesus and Elisheba the mother of Johanaan. Mary and Elizabeth. There is a spring where they are said to have met, and a nearby well, where they are also said to have met. You are shown a cave which supposedly housed the dwelling where John the Baptist was born.

  Everything here proliferates. Several places claim to be where the mothers met, and there is more than one monastery: St John in the Mountains, the Sisters of Zion, the Sisters of the Rosary and the Russian Orthodox Gorny Convent. From my favourite, the Sisters of Zion Convent, you have the best view towards Jerusalem. I was there yesterday, on the Feast of the Transfiguration of Our Lord. There was no service, because the Orthodox and Catholic calendars are different, and it was too difficult to go up the hill to Gorny. Yesterday the temperature was a record forty-three degrees.

  I went into the empty chapel, and then out into the orchard. The fruit is not consecrated, but the trees looked beautiful and seemed none the worse for it. Nearly all the lemons were green. A pear tree had fruit scattered over it like light bulbs. There were a lot of pomegranate trees, the loveliest of all. Most of the pomegranates had a crimson-lilac hue, although some were still green. Others were no longer green but had yet to turn purple. They gleamed like gold in the sun.

  Alphonse Ratisbonne, a baptised Jew from France, founded the convent 150 years ago.

  The village is in a valley, with the vast Hadassah Hospital above it. Apart fro
m my left breast buried in Givat Shaul, the rest of me is alive, feeling very well, and looking forward to continuing for some time yet to explore the world, to rejoice and reflect on the magical and interesting way that life is arranged.

  I have time now to think about what has happened to me. I am undergoing chemotherapy, with radiotherapy to follow. The doctors are optimistic and have decided I have a good chance of coming out of this alive, but of course I know that, ultimately, nobody gets out alive. A strikingly clear and simple thought has occurred to me: illness is a matter of life, not of death. What matters is how we comport ourselves as we walk away from the last home we live in.

  There is also the major topic of suffering, which I am thinking about all the time but so far without reaching a conclusion. My ideas would not go down well with any Orthodox priest. It seems to me that suffering simply should not exist. The fact that it can evoke heroic endurance and courage is beside the point.

  I am renting a small, single-room Arab house built on the roof of another house, large and incredibly beautiful, one of the most beautiful houses I have ever seen. How the Arabs who had to leave all this behind, almost without warning, must grieve for it still.

  Israel inclines you to reflect. The story of this land is all about insoluble problems. It is a minefield of peoples and ideas, a minefield of history. Dozens of tribes have been exterminated, hundreds of languages and ancient communities have been lost. It is a cradle of love, and a place where people choose death. It is the land of revelation (as I do not doubt), but revelations occur in other places too, anywhere. History begins at any point in time.

  The Big Green Tent is still not done. I cannot remember a time when I was just writing it – I seem always to have been trying to finish it.

  After my third bout of chemotherapy I could work no longer. I could neither read nor sleep. It was extremely hot in Israel, but in Moscow and the rest of Russia the heat was even more unbearable. My son Petya and his family stayed in Moscow, unable to leave because there were no tickets, or because they had no strength, or because they had nowhere else to go. With two small children at home, they barely went outside the apartment. They installed an air conditioner. The smog was so dense they could not see the next apartment block. It was very distressing. I would have liked them to come to Israel, but they had no passports for foreign travel.

  There were three-week intervals between the injections. I was all for flying back to Moscow to see to the children, but everybody advised against it, so I spent another month and a half in Ein Karem. During the worst weeks I hardly came down from my roof. Friends visited me, bringing food I could not bear to look at. Everything lost its taste – eating was like chewing cotton wool.

  A miracle occurred. For the past few months I had been listening a lot to music, partly as a professional obligation. The protagonist of my novel is a musician, and I needed to live through this aspect of his inner life. I read a lot of books on music, but by now the drugs had so flattened me that I could only lie there like a dead fish, incapable of doing anything other than listen to it. I began doing so, almost twenty-four hours a day.

  I always knew my limits, having given up music school at the age of ten. For many years that joyful sense of liberation defined my relationship with the piano. It was an instrument for torturing children and I avoided it. My happiest memory from those years is the wonderful musical discord I heard walking down the school corridor. Music emanated from every door, merging into a marvellous noise of everything playing at once, new every time.

  Ten years passed before I listened to music again. Not Beethoven and Schubert, but Scriabin and Stravinsky, Prokofiev and Shostakovich. I went to concerts at the Scriabin Museum and listened to Mahler. It was great, and very much the in thing, but music was only one cultural component of my life and there was much else besides. Nevertheless, I always knew I was skirting the edge of a dense forest, not venturing into the depths.

  Here, in Ein Karem, something happened. New possibilities of perception opened up. Perhaps one side effect of the poisonous chemicals permeating me was to break down a membrane preventing music getting through to me. It was a dramatic change. In the night, up there on my baking hot roof, I listened and listened. Sasha Okun kept me supplied with excellent CDs and I could not have wished for a better guide through the forest. Lika brought a player, which sounded wonderful in Israel but when I moved back to Moscow, it seemed fairly indifferent. Were my ears sealed again?

  Seemingly not. I do not know how many times I listened to the Art of Fugue played by Samuel Feinberg, better than Richter in my estimation. Just as many times I listened to the sonatas of Beethoven, Schubert and Haydn, and to so much else. Music was flushing the poison out of my system.

  I had more radiotherapy, and in those weeks, bald, weak but in good heart, I again set about finishing my novel.

  Hadassah

  I moved to another apartment, still in Ein Karem. Now I have a separate house next to the Greek church. On the other side of my fence is the cottage of the caretaker and the priest, apparently the same person. The windows of the church are wide open and I can follow the service from my balcony. My landlord is a devout Jew born in İzmir in Turkey. His wife is from Australia and works at the Hadassah Hospital as a nanny for very small children, of which she has plenty of her own. They are loving parents, not strict, but the children are respectful and cheerful and do as they are told. They invited me one time to Shabbat, a busy table with teenaged sons, daughters and their young friends, a single lady who was a neighbour and me, the tenant. Our host is Sephardic so there was none of that nostalgia for the herring, potatoes and pickled cucumbers of East European Jews. It was Middle Eastern fare, bread and wine – an unfamiliar style, quite different, but with the same prayers and blessings.

  Five times a week I went to the hospital, as if I worked there, to be irradiated by the electron gun. An uphill path took me from the village to the hospital and the oncology department. A helicopter pad on the roof can be seen from afar. In wartime the wounded are brought here, delivered within two hours from any part of the country. Israel is small and wars and terrorist attacks are frequent. The hospital is enormous, with as many storeys underground as above. The bottom floor is a locked surgical department, fully operational in case of war. This country respects and takes good care of its soldiers. That is another topic, and any comparison of the lot of Russian and Israeli service personnel can only bring tears and recrimination. We have a lot to learn from the Israelis about how to organise our health services, as well as about the relationship between the army, the government and society.

  But I digress. I now have a detailed knowledge of Hadassah Hospital. I know its doctors and nurses, its long passages and corridors covered in plaques with the names of benefactors. ‘This chair, piece of equipment, office, department was donated by so-and-so’ in memory of a deceased grandmother, grandfather, mother, sister. On the ground floor is a synagogue with stained glass by Marc Chagall, donated by the artist.

  This is a state hospital, the largest in the land, and it attracts huge donations from Jews in Israel and all over the world. The traditional tenth of your income paid as a tithe is now most often donated not to a temple but to charity. Scientific research benefits particularly.

  The hospital is full of volunteers. Jewish women in wigs push trolleys with drinks and pretzels, or take wheelchair-bound patients for a walk. All citizens of Israel are treated here, Jews and Arabs alike, and the doctors too are both Jewish (half of them from Russia) and Arab. After my surgery I witnessed a comical scene: two patriarchs were wheeled down the corridor towards each other. One was Jewish, wearing a black velvet kippah and Hasidic robe, followed by his wife in a wig and a posse of children, from teenage to very small; the other was a handsome sheikh, resplendent in white cap and robes, with his wife behind him in a richly embroidered dress, and also with a whole brood of children. Both had had surgery for cancer. They drew level, nodded to each other without making eye contact and
moved on. Hadassah is a zone if not of peace then of truce. It is like a watering hole: when it is a matter of life and death, passions subside, ideology takes a break and territorial disputes become meaningless. A person needs very little space in a cemetery.

  At the hospital, doctors fight for people’s lives, and the value of every life is the same. The patient should not suffer pain: that is a principle of all civilised medicine. Ten times a day, during every procedure, you are asked, ‘Does that hurt?’ One time I replied without thinking, ‘It’s fine. I can put up with it.’ ‘What? You are in pain? But that is bad for you! We must stop the pain immediately.’

  This is what they are taught at medical school: pain must be prevented. Mine has been the Soviet experience: dentists only recently began anaesthetising their patients. Throughout my childhood and youth they drilled teeth, tore them out by the roots, changed dressings and removed stitches regardless of pain. Unfortunately, I know only too well how difficult it is to get painkillers in Moscow, even for patients in the terminal stages of cancer. Imagine the situation in the provinces. And then there are the maternity hospitals where staphylococcus is endemic. They cannot be sterilised with ultraviolet light from quartz lamps because nothing is capable of sterilising ruins.

  These thoughts usually come to me on the way back from radiotherapy. Of course, you do sometimes suffer radiation burns here too, but they protect you as much as possible. A lead shield is moulded specifically for each patient in accordance with their anatomy, to prevent the radiation from damaging the heart and lungs.

  Cancer is a cruel disease and, despite the doctors’ best efforts, patients are by no means always cured. People die even in the best clinics of America, Germany and Israel. But the situation is far worse in Russia.