IT HAD STARTED as a shadow on Irene Rivers’ lung. She was eighteen, the new cashier at The Confectioner’s Hall (she was quick with figures). Autumn was in the air. Russet and gold. A playful breeze leapt out cheekily at the street corners; the silver-backed waves cavorted as if in the last hour of play before dark. The Queen Bea was making its way into the harbour, the blue stripe on its funnel like a festive ribbon as if the liner were a huge, floating gift. It glided, a colossus, between the huddled houses. Crowds of passengers lined the decks, shielding their eyes against the defiant sun and waved – poignantly – as Irene turned away from the sea.

The interior of the hospital was umber, dolorous as a church, the equipment mounted on a platform, a tabernacle housing an all-seeing eye. Irene felt the cold photographic plates press against her chest, heard the radiographer bark – chin up, deep breath, hold – and feared the worst. She didn’t have to see the clouded blue picture of her lungs, the flowery clumps of infection. From the moment she surrendered to the embrace of a device that rendered her transparent, there was a shadow not only on Irene’s lung, but on her life too.

Granitefield. Superstitiously, no one called it the sanatorium though in the end the mere mention of the name Granitefield was enough to signal death and the illness that dared not be spoken of. Irene was acclaimed there, the one the nurses pointed to as proof of cure. Our Irene, they called her, when no one else did. Her mother, horrified by the notion that she might have contaminated the family (though, in fact, the opposite was the case; years of living in a damp, quayside house had aggravated Irene’s condition), would have nothing more to do with her. She had, by her illness, disgraced the household, her mother believed. It spoke of poverty, a lack of hygiene. Her brothers dared not visit her. They would have had to explain their absence to a mother obsessed with contagion. Instead they helped to scour her room and burn her bedding. What they remembered of her shamed them. The skirmishing in the kitchen on the last day of their father’s shore leave almost two decades before. A lighthouse keeper, he lived on a cathedral of rock, a prisoner of the elements. Stroked only by an incessant beam and the beating of the waves against his citadel, his horizon determined by the mood of the furious sea. He was a stranger to his own, a brooding, silent man. Porter made him morose but it was people who demented him. After months of solitude, the rowdy pubs, the thronged seafront, their cramped and dingy house seemed to torment him. In the midst of this human surfeit the waves would suddenly roar in his head, the vicious dazzle of the giant lantern he tended would blind him momentarily and a boiling spume would swell within him; he lashed out at whoever was at hand. Jack had tried to intervene that day but what he came upon so shocked him – his mother straddled on the kitchen table, a great marbled breast exposed, her skirts rumpled around a shady crotch, his father rooting at her – that he turned and fled. Sonny cowered in the back yard peering through the scullery window in greedy awe at the two dim figures flailing among the shard and egg yolks. So that was what they did. It was the last time either son would abandon his mother.

For Irene, her father would always be the hermit in the tower on the craggy rock they called the Spaniard where he spent over half his life. She thought of him out at the edge of the land, proud and fierce, atop his beacon of light, the one fixed point in a turbulent sea. As storms lashed the coast, Irene could hear from the upstairs room on Mariner’s Quay the vast bellow of foghorns in the night. Their echoes stayed with Irene and grew into a lifelong dread of lonely places. Lying between icy sheets, the winds thundering at the gable, she imagined her father out there, a wounded beast howling at the water’s edge, and a fearful pity for him would seize her. It reached out across the sheltered harbour, weaving gingerly around the jagged inlets of the treacherous coastline, over the oyster-coloured mountains and finally took wing across the bilious sea. But it was a delicate connection, Irene knew, full of a feline wistfulness that could not survive in his invincible presence. The imminence of his arrival in their house – the very bricks seemed to shrink from him – was like the threat of a thunderous Force Ten. To his infant sons William Rivers loomed, much like the tower he had come from, so no matter how far they stretched back their necks they could see no end to him. And as they grew, this monumental awe he inspired turned into a treacherous respect. They circled around him, making glancing landfalls and dodging his flinty gaze.

Ellen Rivers, calcified by her husband’s tidal rages and the harshness of her solitary life, served him with surly resignation. She said little, surrendering instead to the venomous interior life that fuelled her. She had hailed from a village further up the estuary now totally abandoned. Famine and emigration had robbed it of its people; Ellen’s family had been the last to leave. Like Lot’s wife she had looked back on that day and had seen a crumbling jetty and a ramshackle collection of empty houses, some no more than crooked gables already sinking into the bog, and cursed the folly of loyalty and the uselessness of love. Only Irene was spared her father’s ire. He was no kinder to her than the others but he had never lifted his hand to her; in the Rivers’ household this was a significant indulgence.

Her condition deteriorated during one of the stormiest winters the country had ever endured. She was sent to Granitefield in late November; her father, trapped on his rock, did not come ashore until early in the new year. He was told simply that circumstances had forced her departure. She had had to ‘go away’. It implied an unwanted child.

‘How else could she be?’ Irene’s mother told him with some relish. ‘Your daughter.’

The bus was a beast driven. It bucked and swayed. Wipers clung gamely to its snout. Inside, nervous suitcases rattled overhead. Moisture rolled down Irene’s shoulder. Granitefield stood in a stretch of grizzled countryside, seeping grey stone (hence its name) giving way to barred, teeth-like windows. A few trees rose supplicant from the duncoloured fields. The hills were like bruises.

‘Hold your breaths, lads, it’s catching!’ a passenger muttered as they shuddered to a halt at the gates. That was as close as they dared go. As Irene alighted she was aware of faces, grim and curious, pressed up against the muddied windows. She had come to accept the sleeplessness, the fevers, the bone-weary torpor, but she could not bear the leprous gaze of those who had already given her up for dead. The bus slewed around, listing as it did into a large, mud-coloured puddle, drenching her from head to foot. She felt she had been spat at. A cough rattled in her chest. It pained her. She tried to draw a breath but the louring sky would not yield up to her the portion of air that was rightfully hers. She could feel her mouth filling up. She raised a handkerchief to her lips. It came away scarlet. I will die here, she thought, drowned in my own blood.

They put her in a bathing hut. A white pavilion, intricate of eave. It is high summer already; time has flown. She is the child kept in from play. Outside a blue tumult. She can hear the thud of footsteps on the boardwalk. Somewhere a tiny band is playing, or is it the blurred wheeze of an organ-grinder? There is the whip and flap of bunting, the high shrieks of bathers. A skinny boy, showing off, leaps from the jetty, arms outstretched, head thrown back, his legs cycling wildly in the air. Irene strains to hear the jubilant splash but it never comes. Instead the door of the white room opens and it is she who is in the water, adrift on a sea of pain, great, glinting waves of it that shatter into thousands of tiny shards before her eyes. The liner is going down, rent in two. She is huddled in the bow of a lifeboat, a shivering survivor. Icebergs, white and enormous as the pain, groan and creak, jostling to crush the damp timbers of her life raft. There is a ferocious snap as the mountains of ice, now open-jawed sharks, gnaw their way through the sea-rotten ribs that hold her little boat together. The timbers gape. She is swallowed by the deep …

The operation, they told her, had saved her. But she had lost four of her ribs, cracked open by a giant pair of shears. The pleural fluid which had clogged in her chest had been dispersed but Irene felt a dizzying vacuum where the congestion had been. The knowing gaze of the X-ray, trawling through the blue seabed of her innards, had been followed by the hands of a surgeon who had made a forced entry, kneading the soft, red, pulpy heart of her. Without her ribs Irene felt as if part of her protection against the world had been removed. It was not only the mutilation but the fact that her bodily home had been tampered with, a gable wall torn away and like a half-demolished house, the colour of the chimney breast, the trimmings of the parlour exposed to all.

As a patient, Irene learned to kill time. She acquired the prisoner’s knack of being able to drop off to sleep at any time. Whole days could be drowsed away that way, the long, grey afternoons in particular, which yawned and stalled, tickingly silent after the clamour of the mornings. They were woken in the eggshell dawn with a swish of curtain, a pumping of pillows, the rattle of breakfast trolleys. A mess of yolk, a slice of thinly toasted bread already curling at the edges, were slapped down on their trays.

‘Tea!’ Bridget from the kitchens would yell like the last call of the stationmaster.

‘Medication!’

These were the destinations of their day.

The cleaners came in at eight to buff the floors, the clattery din of their buckets and mops like the tattoo of an advancing army. They moved swiftly through the wards working stealthily under the beds and into unused comers. It seemed to Irene like a punishment, this daily scouring, as if they were suspected of having smuggled in germs overnight. Invisible to the invaders, the patients lay trapped in their beds – stranded on high ground – while beneath them the very floor they walked on was purged. If she had set her leg down, Irene was convinced that it too would have got the blind blessing of a cloth.

And then, the doctors …

Later, out of isolation, wrapped up and pushed out on the verandah to take the air, Irene learned to play cards. Beggar My Neighbour, Fish in the Pond, Old Maid, as if they were rain-bound children at the seaside. Her neighbour in the next bed was a nun, Sister Baptist. She dealt decorously, holding her cards close to her chest.

‘Now, poker, I’d be game for that,’ Charlie Piper would say, ‘a bit of honest-to-God gambling.’

Charlie Piper. These names would haunt Irene. Charlie Piper sold fire extinguishers. Selling and quelling, he used to say, that’s my game. Charlie Piper tried to escape by rowing across the lake. He thought he could cheat death by a simple act of daring. It was a frosty night. He pushed off from the rotting jetty and rowed out, plashing softly across the still surface. But there were currents out there and he hadn’t the strength to row back. They found him slumped in the boat which had got tangled in reeds near the far shore. He had almost made it to the other side.

‘That’s not the spirit, Mr Piper,’ Sister Baptist would reply tartly. ‘We play for the fun of it.’

Despite the lack of gain, Sister Baptist played with an exacting energy.

‘Snap!’ she would cry, gleefully gathering up a winning bundle. The games brought out the savage in her. Victory made her wilful and greedy.

Mr Powers peered over his spectacles, his jowls quivering. He had been a schoolmaster, though in Granitefield, Irene realised, it did not much matter what you had once been. She could imagine Mr Powers, a once portly man whose flesh was caving in now, stalking between the schoolboy rows rapping on the desks with his cane or bawling out the roll call. He would know his pupils only by their surnames. When he wasn’t pacing in the aisles he would stand at the back of the class so they would not know where he was at any given moment. And he would wait for the first boy to peer back over his shoulder …

But they had exacted their revenge. While he had been hearing tables, his charges had infected him.

At cards he was never quite quick enough. He pouted when he missed but played on manfully, confident now only of defeat.

‘Pick one from the top,’ Sister Baptist would bark at him.

He was bullied into death, slinking off before the game was finished.

Netta Cavendish grew petulant and quarrelsome at the card table. Netta blamed her dancing days for her present condition. Dance hall sawdust had irritated her breathing tubes, she said. That and a drenching after cycling home in the small hours of the morning. Like every patient at Granitefield, Netta had to justify her illness; none of them, Irene noticed, could accept the random hand of fate. It was all due to something they had done, or something they had failed to do.

‘You only dealt me six,’ Netta would wail.

She dithered endlessly before abandoning a card, fingering one and then another, afraid to make the final choice. She died in much the same way, refusing to relinquish because she felt she had been wronged.

The Mother of all the Boys kept the score. She was an amazon of a woman; broad in girth, her shoulders larded from farm work, her hands like hams. She wore working men’s boots with the laces undone. It was almost impossible to imagine such a bulky frame surrendering to any kind of illness, and yet watching one of her coughing fits was like seeing an oak tree, huge and terrible, creaking perilously in a storm. Irene never knew her name.

‘I am the Mother of all the Boys,’ she would declare, ‘Pascal, Mikey, Florence, Bill and little Tom.’

But they never appeared, the five strong lads she boasted of, not even when she died, crashing heavily into darkness.

Meanwhile, Sister Baptist played on. Only Irene, tenacious for its own sake, could match her.

Granitefield had been a poorhouse in famine times; the high walls remained; the blue lime-washed corridors; in one of the outhouses was the huge, cast-iron cauldron in which the communal gruel had been stewed. Everything there was named twice, like signposts in a lost native language. The isolation units – their official name – were known by the inmates as The Camp. Home to the infectious, who remained nameless, shut away, until they were pushed, blinking, into the sunlight. Thence to The Manor as it was grandly called by the staff – the stone building visible from the road. For the ill these were The Wards. The sloping grounds which led down to the lake were referred to as The Yard. So called because every morning, the grass still wizened with hoarfrost, a duty nurse, or sometimes Matron herself, would lead snakes of patients out there for their daily constitutional. The exercise was good for them, the bracing air would revitalise their ailing lungs and punctured chests. Home to bacilli and tubercles, even their bodily parts were not their own. They were a motley bunch, their day clothes – layers of vests and woollens, greatcoats and hats – worn over regulation pyjamas. Like windswept scarecrows they tramped, two by two, down the gravel path that led to the lake shore and then, once, briskly around its perimeter. Crows cackled in the trees as they laboured, a chain-gang in search of occupation. Sometimes Irene worried that they might be led away to some strange, neglected place and abandoned. Or worse.

The route the walkers took was dotted with secret stashes – half-smoked Woodbines were hidden in the urns on the front balustrade, naggins of whiskey strapped to the underarm of the jetty – and this alone gave the daily dose of exercise the air of an excursion. There, skulking in the seeping woods among the dead leaves, a mouthful of spirits or a hurried draw of tobacco was like a draught of freedom. A taste of life.

Unfit for life they learned other skills. Afternoons in the Day Room, a crackling wireless on the go. The reception was always bad.

‘Due to our position in the world,’ Mr Powers said.

Which to judge from the radio was down a seething mineshaft. The sound came in waves, hissing and fading. Ernie Troubridge had taken charge of it. Ernie had been a docker; the coal dust had got him. He tinkered continuously with the radio, heaving the set about the room and perching it high up and low down, tilting it this way and that to minimise the static. He had fashioned a make-shift aerial out of a clothes hanger which stuck out like a twisted wand; it made everything much clearer, Ernie insisted. This became his occupation – carrying an angry box of sound around. Whenever he set it down he would stand over it impatiently twisting the knobs when, it seemed, the broadcasters had moved deliberately out of range. Occasionally he would thump its polished top and, scarified, it would leap to attention only to slouch again as soon as Ernie’s back was turned. What pleasure he got out of listening to it Irene could never fathom. The news either irritated him or confirmed his worst suspicions, though he responded to certain items with a triumphant ‘Aha!’ like a poker player with a winning trick. He liked to listen to the gale warnings. ‘Badweather up ahead, Cap’n,’ Charlie Piper would taunt, winding his head around the door of the Day Room.

He was about his business, a thriving black market in cigarettes and oranges, a complicated moneylending scheme. Everyone owed him. Ernie Troubridge, bent in the dusk like a man in conciliatory prayer to a spitting, vengeful god, ignored the jibes.

‘Tyne, Dogger, German Byte … falling slowly.’

And Irene Rivers would remember her lost father, keeping his lonely vigil at the edge of land, holding out against the storms.

Miniature industry flourished in the Day Room. There was Betty Long who knitted with a tight-lipped ferocity as if she were on piece-rates. She worked from two battered patterns – one a lemon-yellow matinée jacket, the other a baby-blue pair of bootees.

‘Oh, Irene, look,’ she would cry, fretting over lost stitches.

Irene would gently rip back to the flaw and Betty would start again. For whom the baby things were intended Irene never learned. She could have clothed an orphanage with the volume she produced but Irene suspected that she stored them away, a trousseau of candyfloss smalls for the children she would never have.

At the green baize card table Isla Forsyth did shell pictures; Babe Wrafter appliquéd; Mary Cantalow made cathedrals out of matchsticks; Sister Baptist crocheted. Small intricate things. Chalice covers, Irene guessed. Once, while showing Irene a complicated stitch, she asked sweetly, ‘You are one of us, dear, aren’t you?’

Irene looked at her stonily. That doughy expression, the unctuous eyes hungry for confession. She did not reply. What she believed would have shocked Sister Baptist. That there was no God; there was only sickness and health. And no one to save you but well-meaning strangers who cut you open and left a wound.