Bleeding Out

From time to time I receive an invitation. I could refuse, and sometimes I do, because there are conditions to accepting that I cannot always satisfy. The invitation specifies a place, a date and a time, any or all of which are suggestions that I could change. It is made as easy as possible for me to accept on my terms, desirable as it is to those who invite me, that I turn up, whenever and wherever I can.

The invitation is to give blood.

Blood is a perfect paradox: while science can now understand its function, separate and identify its contents, naming and classifying them to uncover their meaning, the word still carries the resonance of mystery and the symbolic. It has long held a place in rituals, literally spilt as in sacrifice or symbolic in celebration. It signifies violence as well as connection: the blood feud and bloodlines. Myths may no longer hold, for example that the nobility have blue blood, but family still can claim allegiance, despite the most tenuous of blood links.

To science blood is no longer mysterious. In the seventeenth century William Harvey published De Motu Cordis (1628) in which he presented his argument for the circulation of the blood. Today, almost four hundred years later, so many more of its secrets have been discovered, as the products it transports can be identified and analysed. Analyses can reveal the state of health of the organs, or the levels of sugar and cholesterol. The markers of diseases too, can be determined. And in the field of genetic testing, blood can give answers to more particular questions of identity, from who your ancestors were to who you might come to be, as the discovery of predispositions to various disorders and diseases is refined.

From the examination of blood much of a life can be understood, measured

and quantified. Blood has an equivalence with life as it does with death; there is a limit to how much you can lose and remain alive. From the recent epidemic of stabbings on London streets we have learnt a horrific new expression, as victims are said to be ‘bleeding out’.

And yet, small amounts can be lost without harm, and then restored. The body will manufacture and replace the loss within a few weeks. This is what makes blood donation possible. It is in theory a free gift that puts little burden on the donor and can be repeated many times.

There is no payment, at least not in the UK. The NHS Blood and Transplant service (NHSBT) depends on altruism. Much of scientific research does too. The testing of new drugs or treatments requires the recruitment of both healthy volunteers and patients. In the scrupulous and heavily regulated process one essential step is the necessity of informed consent. Anyone invited to take part in research must be provided with a written information document. Among the many required sections is one that must inform the potential participant whether there is any benefit to them of taking part. And frequently it is explained that while they may not benefit, others in the future may do.

A key identifying feature of blood is its division into different groups. In 1900 Karl Landsteiner distinguished the ABO groups: A, B, O and AB. ( Since then others have been identified. ) I belong to O rhesus negative, found in 13 per cent of the donor population. There are rarer groups but O negative has a distinction. It is known as the universal blood type because it can be given to anyone. Yet we can only receive our own kind. Our generosity is, in that sense, not reciprocated. As a registered universal donor, from time to time I am reminded of my particular importance. I am needed, or rather 470ml of my blood is requested. The email entreats, ‘Please donate soon, our stocks are low.’ My altruistic desire to do something useful is to be rewarded with gratitude, the slight hint of coercion softened.

The transfer itself is efficient. There is a sort of ritual, but it is medical and practical, excluding any hint of the mysterious. I take a seat in the waiting

area and fill in a health questionnaire, with searching questions that include my possible sexual partners and travel abroad. I am required to drink at least half a litre of water. I have a private consultation, brief, with one of the staff, who from a finger prick test determines whether my iron levels are satisfactory. I am asked if I have had breakfast. My future recipients and I are cared for through this investigation into my health and well-being. To give blood I lie on a reclining bed in a room with half a dozen others. Beside me, the blood collects in a bag cradled on a rocking device that accompanies the process with a regular, electronic beep. This is perhaps the closest the experience comes to delivering an incantation, though it is wordless and is intended to alert the staff to any alteration or interruption to the flow. It is also a reassurance that I am succeeding. The position of the device is such that it is out of my direct sight. This may be accidental, or to prevent any squeamish reluctance as it distances reality.

Afterwards I return to the waiting room, where I am offered tea or squash and biscuits or crisps. There is daytime TV. I can have a sticker for my coat, to advertise my good deed. After I short time to recover in these mundane surroundings, I return to the more selfish concerns of daily life.

My donation will be anonymised by the time it reaches its destination, after testing and possibly separation into its components: red cells, platelets, and plasma. One gift can thus benefit more than one patient; unlike organ donation this is not a one to one relationship. There is no discoverable link between us, we people with roles not names, the donor and the recipients. Rigorous testing is now standard, but this was not always so. There is at present an inquiry into the Contaminated Blood Scandal, when in the 1970s and 80s the NHS imported plasma that infected thousands, many of whom subsequently died.

Recently the donation service has begun to send a text, a few weeks later. ‘Thank you for donating. Your blood has been sent to St X’s Hospital’. The invitation and the thanks provide enough of the personal, they must hope, to make donors feel recognised and valued enough to return. Altruism must be encouraged. I know that my body will make up the loss of the white cells

and platelets in a few hours; the red cells take longer to return to normal levels. I may feel a little tired, but I will not suffer from the temporary lack. Yet I have given something that is not without deeper meaning. The purpose of the gift is transfusion, the taking of blood from one person to infuse it into another, an act whose intimacy and symbolism is blurred if not annulled by the process of collection and use. Medical science and the importance of maintaining blood supplies separate the gifted blood from any emotional response other than the pleasure and satisfaction of giving.

One of the questions at the screening stage is of ethnicity, though the answer may be optional. I am not asked what kind of blood I believe I have, or who I think it makes me, or how to measure that. These questions have no relevance to the usefulness of my blood, an anonymised quantity of O negative making its way through the system to this or that hospital and possibly to eventually playing a part in saving a life.

If I think of my identity as it is determined by blood, I consider what my parents and grandparents have passed on to me in fractions, in halves and then quarters. This is not uncommon. Are you half this or that? Or wholly the other? What I am and in what proportions, is not obvious to anyone else. No one can sniff you out, as the giant in the story of Jack and Beanstalk could.

One half is me is American, and of that, one half is Jewish. That quarter is from my grandfather, whose family left Bucharest for America sometime in the nineteenth century. My genes might provide evidence. Reports of findings by the various private DNA services now offered widely online suggest that I am also likely to be given details of how much of my genetic material is Neanderthal. These trace findings may be based in science, but their separate meanings can have a different resonance based in the emotions, not in facts. I may carry genetic material inherited from the Yorkshire whalers who sailed across to Cape Cod in the eighteenth century, as I do from the Romanian silk traders who fled the pogroms, not to mention the assorted Germans and Welsh ancestors my father occasionally claimed, and countless unknowable others going back through time. Blood

of different nations and peoples, yet to which do I feel I belong? Where is owed the most allegiance? My Jewish blood bears an obligation, perhaps I inherit that too. It is not a question of religious observance, or respect for the most orthodox interpretation of Jewish identity, for that would exclude me. A grandfather does not equal a grandmother in the matrilineal scheme, though that distinction would not have troubled the Nazis. I have met other people with one Jewish grandfather who do not feel Jewish at all. This is often not a simple question of denial, more that is a mere curiosity to them, though in the world after the Holocaust I find that a little chilling.

I don’t always feel a necessary connection, any more than I might with those who were born under the same star sign, or who belong to my blood group. It is an emotional response that co-exists with the evidence of science, a response that may have as much to do with upbringing as inheritance, with history as well as haematology. It is both symbolic and real, thus drawing together blood’s contradictions.