Four White Walls

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Four White Walls (Memoir, Young Writer Award 2023)
Manuscript Type
Logline or Premise
I am familiar with death.

It surrounds me every day - my family owns a funeral service. Death didn't scare me until I almost died at 20 years-old following an appendectomy and a sepsis diagnosis. In the midst of this life-changing experience, I examine my own existence as malady possesses me.
First 10 Pages


I am familiar with death.

I became conditioned to it from a young age, I didn’t learn the hard way by losing a loved one; my family owns a 108 year-old funeral service. It never occurred to me that I should be frightened of it, nor did I ever imagine I would almost die at 20 years-old.

I was a healthy and vivacious woman before undergoing an appendectomy in April 2019 and an emergency laparotomy to treat sepsis the following September. After my operations I suffered with severe anxiety, depression and PTSD; I mourned the loss of my healthy mind and body for over three years. Even after the storm of my malady calmed, I still believed either I was going to die, or someone I loved would pass.

I spent three years paralysed by fear. It was a wasted three years of holding myself back because of an event I had zero control over. Unfortunately the tendency to seek control is a universal human flaw, most of us believe that if we are in the driver's seat we will be prepared for unpredictable situations. However, when we make a plan, God laughs.

I am familiar with death, therefore I am familiar with the importance of life and what makes it worth enduring. I’m glad I learnt this at such a young age, so I have the rest of my life to apply it. If you are suffering, I hope you learn to let go and enjoy the unexpected just as I have, as my mum has always said, "It’s not the be all and end all."

Chapter One

September 2019

Since I was about four or five, I’ve had this awful habit of biting the skin around my fingers. To begin with, it wasn’t induced by stress and anxiety, but the older I got the more I would nibble at my fingers in stressful situations. And right now, my fingers are red and raw.

The doctors are muttering and lingering outside my curtains.

‘Deborah. It’s great to see you.’ Dr Salaman approaches my bed, followed by several trainees. ‘We have some news regarding your CT scan. You will have to go for a major operation, and it’s not something we can rush or perform overnight. We’ll most likely take you to theatre on Monday morning. We do have to prepare for the worst. Do you understand?’

I nod. My throat tightens.

‘We won’t know how bad the infection is inside until we operate. But I have to inform you of another procedure called a stoma.’

I look at the other doctors standing around my bed. There are too many people here. One, two, three, four, five—

‘A stoma is when we have to—’ Dr Salaman spoke of things I didn’t know or understand.

I took deep breaths, inhaling through my nose and exhaling through my mouth.

‘Do you have any questions?’

Inhale. Exhale.

‘How big will my scar be?’

‘Well—’ Dr Salaman uses her small finger to draw an invisible line from my belly button down to my lower abdomen. ‘Usually this is the incision we make. But—’ She drew her finger back up to my belly button, and extended it farther above to my lower chest. ‘If necessary, the incision will expand the whole length of your stomach.’

I stare at the line she marked with her finger. What if it’s worse? Dr Salaman adjusts her tone when she sees my expression change.

‘We have to prepare you for the worst.’

‘No, I understand.’

She has a sympathetic half smile on her face. I’ve often seen that smile from doctors, family and friends when they haven’t got anything else to say.

‘Hopefully, we’ll see you on Monday morning.’

I nod and the herd of doctors leave through the curtains.

I cling onto my bed sheets, using them as a tissue as I wipe my damp cheeks. I want my mum. I want both my parents to come back off holiday, sit next to me and stroke my hair. I want my mum to tell me it’s going to be alright. I want to be told I’ll survive this operation like the last one. I want to believe I’ll survive. But I fear death; I’m scared I won’t wake up.

I text my mum.

The doctors have been in. They said my fertility may be affected. It could take me two to three months to get back to normal.

I pick at the skin around my fingers. Three minutes later she replies.

"I can’t even imagine how you’re feeling at this moment love."

I’m heartbroken. After my appendicitis, the fear of returning to hospital has consumed my mind ever since. It’s been a waiting game, and now, here I am for the third time in five months. I don’t trust my body anymore.

* * *

My curtains slice open and my sister steps through them.

‘Have the doctors been in yet?’

I sit myself up, my arms quiver. I tell her the same thing I told our mum. ‘It’s going to be fine, they finally know what’s wrong.’

She takes a deep breath. ‘Mum and Dad are flying home tomorrow.’

‘No! They should enjoy their holiday.’ I shake my head. ‘I shouldn’t be getting in the way of it.’

‘You know they’ve not been able to enjoy their holiday since they found out you were in hospital.’

She’s right. But guilt still floods my stomach.

After Aimee leaves, the stoma nurse walks into my cubicle.

‘Hi. Deborah Alty?’


She’s about my height, maybe a bit older than me, and a blush pink scarf is wrapped around her head.

‘I’m here to talk to you about having a stoma bag.’


She pulls a small clear bag from her pocket. ‘This is a stoma bag. Sometimes a laparotomy can result in the patient needing one. Your surgeon will make an incision, which will bring your bowels out of your body and into this bag.’ She pauses. ‘So you won’t be emptying your bowels in the conventional way, but it’ll all go in here.’ Surprisingly, my eyes are dry. ‘You could just be relaxing on the sofa and you won’t even need to get up.’ Oh great, a dream of mine has always been to take a shit while watching TV. ‘We can get you different coloured bags, like a black one. A black one can be a bit more discreet.’

I nod, thinking about my social life.

* * *

6 AM. The nurse wakes me, lightly tapping on my arm.

‘Miss Alty. I’ve got to take your obs. What’s your name and date of birth?’

I sit up in a slow, silent motion. ‘Deborah Alty, 1st December 1998.’ This happens every time any staff admits me medication or obs, which is often. ‘How did you sleep?’ She wraps the band round my arm to take my blood pressure.

‘Not well. I’m worried.’ I spit the words out desperately. I don’t know why I said that, typically regretting it immediately. What type of reassurance could I be offered this close to my surgery?

The nurse stops for a moment, looks at me and carries on. ‘Why would you be worried?’ She scribbles notes onto my papers, glancing up every so often.

Where do I start? The scar. A stoma bag. The infection. How many more nights in here?

‘Oh, I don’t know. They told me it’s a major operation. An emergency laparotomy. I’m worried about—’ I pause. ‘If it’s worse than they thought.’

‘I’m afraid that you’ll just have to wait to find out. Dr Salaman is highly praised. I wouldn’t worry too much if I were you.’ She smiles at me and finishes. As she leaves, she pokes her head back through my curtains. ‘Good luck.’

* * *

10:30 AM. Aimee sits to my right, talking about her new house. Occasionally she’ll take her phone out and show me this chair, or that pillow, or this lamp. Her dark hair bounces on her shoulders as she talks. I listen silently and enjoy her excitement. She stops mid-sentence and looks over my shoulder. I turn to look and see an empty bed being wheeled towards my own. As I exhale, my chest becomes hollow.

‘Miss Alty? We’re ready to take you to theatre.’

Two men in green uniforms stand at the foot of my bed, waiting for me. I want to grab hold of Aimee and beg her to not let them take me. Reluctantly, I swing my legs over the bed. As I walk over to the empty bed, I feel everyone’s eyes on me. When I hug and kiss my sister goodbye, I hold on for a moment longer. The men wheel me out the room. As I pass the other women they say, ‘Good luck.’ I watch beds and wards flicker by as they take me downstairs. My body stiffens and remains motionless.

They park my bed in the middle of the room and walk over to the front desk.

‘Hi, we’re here with Deborah Alty.’ Looking around, I realise this must be the last stop before surgery. There’s a lot of empty beds in here, at least seven. The bright lights combined with my curiosity to inspect the room causes me to feel nauseous. I rest my head against the pillow and stare at the ceiling. There’s a brownish water stain. That’s the fourth one. I’ve become an expert at inspecting the ceilings; they’re suddenly much more interesting when I have nothing else to do. Someone should probably tell them they have a few leaks. ‘We’re off now. They’ll come to get you soon. Good luck.’

My stomach feels grossly unwell. A concoction of stabbing pains, hunger and worry sloshes inside.

I’m not waiting long before I hear my name. A small blonde, middle-aged woman stands to my left.

‘Hi. Deborah Alty, is it? Can you give your date of birth and name?’

I nod, forcing a smile. ‘Deborah Alty, 1st December 1998.’

‘My name is Debby. I’m one of the anaesthetists. We’ll be taking you through to theatre now.’ I’ve never met another Debbie the same age as me. A strand of blonde hair falls from her blue hair net. ‘Deborah? Are you ready?’



We reach theatre three; the room is very narrow and overcrowded by scrubs.

‘Hello, Deborah, my name is Darren. Do you prefer Deborah or Debbie?’

‘Debbie.’ Although I say that, I enjoy the staff calling me Deborah, only my parents call me it, so it’s nice to hear it when they’re not around. When I was born, my mum allowed my dad to name me. He suggested Deborah-Anne. My mum liked it and agreed to it, on the one condition that no one ever shortened it to Debbie. But what they didn’t anticipate was as a four-year-old starting school, I wouldn’t be able to pronounce my own name. I always thought it was weird how parents could look at their baby and name it something old-fashioned like ‘Mary’ or ‘Deborah’ or ‘Helen.’ My older sister is called Helen-Jayne.

‘We’re about to start admitting the anaesthesia. We’ll be giving you a couple, one of which will be an epidural.’

Then the tears start.

‘What’s wrong?’

It’s the question of all questions that is bound to set me off. All the nurses stop what they’re doing and gather around me. ‘Hey, you can talk to us. We don’t want you upset.’

‘I’m scared.’

Debby holds my hand. ‘Scared of what?’

I feel close to death. I am close to it. Partly in the sense I’m terrified of losing my life, but what I rather mean is that it follows me—sits on my shoulder, hangs over my head like a grey cloud. How do you escape death when it is inevitable? How do you stop thinking about death when it won’t let you rest? These are genuine questions, because I still don’t know. I don’t have the answers. I only pose the questions of irrationality and anxiety.

‘It’s okay. I’m okay.’ I take a moment to control my breathing.

‘Are you ready for us to start admitting the anaesthesia?’

I nod.

‘Can you sit up and hunch over? Like a foetus.’ Debby stands in front of me and holds both my hands in hers. At this moment, a thousand emotions overwhelm me. It’s a horrible, crumbling feeling. A worthless, embarrassing moment as I sob in a room full of strangers.

‘You’ll feel a sharp scratch. This is the epidural.’

A burning pain enrages my back.

They lie me back down and hand me an oxygen mask. ‘Can you inhale and exhale, slowly? It won’t be long now.’ Inhale. Exhale. Inhale. Exhale. Inhale.

* * *

I hear my name, but I don’t see anything.


I’m confused.


I was dreaming. I’ve already forgotten what about. But for a moment, I forgot where I was. I slur words.

‘Deborah, you’re out of surgery and in Critical Care.’ The blurry figure stands by my side.

‘Stoma.’ I drunkenly stumble over my words.

‘What did you say?’

‘Do I have a stoma?’

‘No, you don’t have a stoma.’

My sight slowly comes through, fuzzy and distorted.

‘But Deborah, I have to show you these.’ She lifts up a large bag with yellow liquid in it. ‘This is your catheter, and these are your draining bags.’ The nurse proudly holds up two smaller bags with tubes that lead underneath my gown. ‘These bags are to drain excess fluid out and prevent infection. They’re connected by tubes that are embedded in your lower stomach.’

It’s Debby.

‘Deborah, do you see this?’ She holds up a small, neon green button. Debby takes my hand and slips the button inside my palm. ‘Here, you keep hold of this and press it every time the green button lights up.’

‘What is it?’

‘Your morphine button.’

I sigh, relieved.

* * *

I spend most of my time asleep. Nurses leave me a glass of water, but not to drink. I’m not allowed to drink. Instead, I dip a tiny sponge on a stick into a glass and suck the water out. My mouth tastes of burnt chemicals. The room that surrounds me is so clinical. Four white walls. Behind me, I hear the beeping from different monitors. I’m connected to these machines by multiple wires; I lay in a tangled chaos with a dry mouth and an awful headache.


Aimee, her boyfriend Jake, and Hannah walk through the door. As soon as I found out I was going back into surgery, I texted Hannah. Despite living four hours away in Oxford, she was adamant she would drive to see me. Many people wouldn’t do that. Her brother almost died this year; he was in an induced coma for weeks. I doubt hospitals are easy for her.

‘I brought you flowers, but I forgot you aren’t allowed them in hospital.’

‘Han, you didn’t have to get me any.’ Speaking is a bigger task than I thought it would be.

‘Anyways, they’ll be waiting for you when you’re home.’

I’m overwhelmed by her consideration.

‘Your hair looks ginger.’

I give Hannah a thumbs-up. I’m not even naturally ginger, but that’s what I get for box dying my hair since 13 years-old. ‘How are you feeling?’ Aimee starts to stroke my hair.

‘In pain. Tired and thirsty.’

Jake picks up a sponge on a stick, dips it in water and passes it to me it. Embarrassingly, my arms are too weak to take it. Instead, Jake holds it up for me, and I slurp out the tiniest amount of water.

‘I want to sleep.’

All three of them take a seat and stare at me with furrowed brows.

* * *

I don’t remember much of my time in Critical Care, except for when my mum and dad walk through the door. As soon as I see them, I break down. The past two times I was in hospital, my mum and dad were there every day, being without them this time has been especially difficult. The guilt I felt about ruining their holiday leaves me as soon as I see them.

‘You’re so tanned,’ I say to my mum. I inherited all of my mum’s genes except for her dark complexion. My dad, however, hasn’t tanned much at all. I struggle to comprehend the reality that my parents stand before me; I’ve felt so vulnerable without them. They both kiss me on my head.

‘I’ve missed you so much.’

‘We’ve missed you too. We’re just glad you’re okay now.’

I stare at my parents in awe, I love them. Ever since my appendectomy in April, I’ve had a much better relationship with them. I’m not saying I had a poor relationship with them, but when things like this happen, it puts life into perspective. I think after spending the past five months in and out of hospital we all realised how precious life is.

I look at my dad. A concerned expression shadows his face. My dad is more dramatic than my mum. He always assumes the worst. I can’t blame him though, he’s a funeral director. He sees death every day and knows a hundred different ways a person can die. I know this because, a common dinner table conversation is usually about who died recently. My dad has met a lot of people through his work, sometimes when I tell someone my last name in Blackburn they’ll ask, ‘Are you Russell Alty’s daughter?’ Which can be both a conversation starter and a killer, because they clearly know my dad for only one reason. But I’ve got to give my dad credit, it’s not an easy job dealing with death on a daily basis. This wasn’t his first career choice. He used to teach in London, after studying a postgraduate degree at Oxford. My dad prides himself on his intellect.


Tracy Stewart Tue, 08/08/2023 - 17:45

This submission covers two subjects not often written about - the impact on a young person from ill health and how it feels to be raised in a family business which is all about death.

The writing is promising and I would be very interested in learning more about the author's real purpose for the book, and why the author wants to tell this story, what she hopes the reader will gain from reading it, who it's aimed at.