A dark-haired student nurse came into the ward. Smiling at my wife, she pulled back the bedclothes and dug the urine bottle from between my legs. Inspecting its level, she flipped back the sheets. Immediately my penis began to dribble; with an effort I controlled the sphincter, numbed by the long succession of anaesthetics. Lying there with a weak bladder, I wondered why, after this tragic accident involving the death of an unknown young man – his identity, despite the questions I asked Catherine, remained an enigma to me, like an anonymous opponent killed in a pointless duel – all these women around me seemed to attend only to my most infantile zones. The nurses who emptied my urinal and worked my bowels with their enema contraption, who steered my penis through the vent of my pyjama shorts and adjusted the drainage tubes in my knees, who cleansed the pus from the dressings on my scalp and wiped my mouth with their hard hands – these starched women in all their roles reminded me of those who attended my childhood, commissionaires guarding my orifices.

A student nurse moved around my bed, sly thighs under her gingham, eyes fixed on Catherine's glamorous figure. Was she calculating how many lovers Catherine had taken since the accident, excited by the strange posture of her husband in his bed, or – more banal – the cost of her expensive suit and jewellery? By contrast, Catherine gazed frankly at this young girl's body. Her assessment of the contours of thigh and buttock, breast and armpit, and their relationship with the chromium bars of my leg harness, an abstract sculpture designed to show off her slim figure, was open and interested. An interesting lesbian streak ran through Catherine's mind. Often as we made love she asked me to visualize her in intercourse with another woman – usually her secretary Karen, an unsmiling girl with silver lipstick who spent the entire office party before Christmas staring motion-lessly at my wife like a pointer in rut. Catherine often asked me how she could allow herself to be seduced by Karen. She soon came up with the suggestion that they visit a department store together, where she would ask Karen's help in choosing various kinds of underwear. I waited for them among the racks of nightdresses outside their cubicle. Now and then I glanced through the curtains and watched them together, their bodies and fingers involved in the soft technology of Catherine's breasts and the brassieres designed to show them off to this or that advantage. Karen was touching my wife with peculiar caresses, tapping her lightly with the tips of her fingers, first upon the shoulders along the pink grooves left by her underwear, then across her back, where the metal clasps of her brassiere had left a medallion of impressed skin, and finally to the elastic-patterned grooves beneath Catherine's breasts themselves. My wife stood through this in a trance-like state, gabbling to herself in a low voice, as the tip of Karen's right forefinger touched her nipple.

I thought of the bored glance which the assistant, a middle-aged woman with the small face of a corrupt doll, had given me as the two young women had left, flicking back the curtain as if some little sexual playlet had ended. In her expression was the clear assumption that not only did I know what had been going on, and that these booths were often used for these purposes, but that Catherine and I would later exploit the experience for our own complex pleasures. As I sat in the car beside my wife, my fingers moved across the control panel, switching on the ignition, the direction indicator, selecting the drive lever. I realized that I was almost exactly modelling my responses to the car on the way in which Karen had touched Catherine's body. Her sullen eroticism, the elegant distance she placed between her fingertips and my wife's nipples, were recapitulated in the distance between myself and the car.

Catherine's continuing erotic interest in her secretary seemed an interest as much in the idea of making love to her as in the physical pleasures of the sex act itself. Nonetheless, these pursuits had begun to make all our relationships, both between ourselves and with other people, more and more abstract. She soon became unable to reach an orgasm without an elaborate fantasy of a lesbian sex-act with Karen, of her clitoris being tongued, nipples erected, anus caressed. These descriptions seemed to be a language in search of objects, or even, perhaps, the beginnings of a new sexuality divorced from any possible physical expression.

I assumed that she had at least once made love to Karen, but we had now reached the point where it no longer mattered, or had any reference to anything but a few square inches of vaginal mucosa, fingernails and bruised lips and nipples. Lying in my hospital ward, I watched Catherine summing up the student nurse's slim legs and strong buttocks, the deep-blue belt that outlined her waist and broad hips. I half expected Catherine to reach out and put her hand on this young woman's breast, or slip it under her short, skirt, the edge of her palm sliding between the natal cleft into the sticky perineum. Far from giving a squeal of outrage, or even pleasure, the nurse would probably continue folding her hospital corner, unmoved by this sexual gesture, no more significant than the most commonplace spoken remark.

Catherine pulled a manila folder from her bag. I recognized the treatment of a television commercial I had prepared. For this high-budget film, a thirty-second commercial advertising Ford's entire new sports car range, we hoped to use one of a number of well-known actresses. On the afternoon of my accident I had attended a conference with Aida James, a freelance director we had brought in. By chance, one of the actresses, Elizabeth Taylor, was about to start work on a new feature film at Shepperton.

'Aida telephoned to say how sorry she was. Can you look at the treatment again? She's made a number of changes.'

I waved the folder away, gazing at the reflection of myself in Catherine's hand-mirror. The severed nerve in my scalp had fractionally lowered my right eyebrow, a built-in eye-patch that seemed to conceal my new character from myself. This marked tilt was evident in everything around me. I stared at my pale, mannequin-like face, trying to read its lines. The smooth skin almost belonged to someone in a science-fiction film, stepping out of his capsule after an immense inward journey on to the overlit soil of an unfamiliar planet. At any moment the skies might slide…

On an impulse I asked, 'Where's the car?'

'Outside – in the consultant's car-park.'

'What?' I sat up on one elbow, trying to see through the window behind my bed. 'My car, not yours.' I had visualized it mounted as some kind of cautionary exhibit outside the operating theatres.

'It's a complete wreck. The police dragged it to the pound behind the station.'

'Have you seen it?'

'The sergeant asked me to identify it. He didn't believe you'd got out alive.' She crushed her cigarette. 'I'm sorry for the other man – Dr Hamilton's husband.'

I stared pointedly at the clock over the door, hoping that she would soon leave. This bogus commiseration over the dead man irritated me, merely an excuse for an exercise in moral gymnastics. The brusqueness of the young nurses was part of the same pantomime of regret. I had thought for hours about the dead man, visualizing the effects of his death on his wife and family. I had thought of his last moments alive, frantic milliseconds of pain and violence in which he had been catapulted from a pleasant domestic interlude into a concertina of metallized death. These feelings existed within my relationship with the dead man, within the reality of the wounds on my chest and legs, and within the unforgettable collision between my own body and the interior of my car. By comparison, Catherine's mock-grief was a mere stylization of a gesture – I waited for her to break into song, tap her forehead, touch every second temperature chart around the ward, switch on every fourth set of radio headphones.

At the same time, I knew that my feelings towards the dead man and his doctor wife were already overlaid by certain undefined hostilities, half-formed dreams of revenge.

Catherine watched me trying to catch my breath. I took her left hand and pressed it to my sternum. In her sophisticated eyes I was already becoming a kind of emotional cassette, taking my place with all those scenes of pain and violence that illuminated the margins of our lives – television newsreels of wars and student riots, natural disasters and police brutality which we vaguely watched on the colour TV set in our bedroom as we masturbated each other. This violence experienced at so many removes had become intimately associated with our sex acts. The beatings and burnings married in our minds with the delicious tremors of our erectile tissues, the spilt blood of students with the genital fluids that irrigated our fingers and mouths. Even my own pain as I lay in the hospital bed, while Catherine steered the glass urinal between my legs, painted fingernails pricking my penis, even the vagal flushes that seized at my chest seemed extensions of that real world of violence calmed and tamed within our television programmes and the pages of news magazines.

Catherine left me to rest, taking with her half the flowers she had brought. As the elder of the Asian doctors watched her from the doorway she hesitated at the foot of my bed, smiling at me with sudden warmth as if unsure whether she would ever see me again.

A nurse came into the ward with a bowl in one hand. She was a new recruit to the casualty section, a refined-looking woman in her late thirties. After a pleasant greeting, she drew back the bedclothes and began a careful examination of my dressings, her serious eyes following the bruised contours. I caught her attention once, but she stared back at me evenly, and went on with her work, steering her sponge around the central bandage that ran from the waistband between my legs. What was she thinking about – her husband's evening meal, her children's latest minor infection? Was she aware of the automobile components shadowed like contact prints in my skin and musculature? Perhaps she was wondering which model of the car I drove, guessing at the weight of the saloon, estimating the rake of the steering column.

'Which side do you want it?'

I looked down. She was holding my limp penis between thumb and forefinger, waiting for me to decide whether I wanted it to lie to right or left of the central bandage.

As I thought about this strange decision, the brief glimmer of my first erection since the accident stirred through the cavernosa of my penis, reflected in a slight release of tension in her neat fingers.