My Heart And I

When I was a boy, a teenager that is, I had a premonition. It was that I would die young. At worst in my early thirties and at best in my fifties. But here I am, still going, at sixty-four. So much then for the premonition’s of youth.

And though I have written fondly of my grandmother, I never ever stopped to think seriously about what it might be like to be “old” and in an era when sixty-four was old. Well I am not going to beat my breast about it, because the most natural thing in the world when you are young, is to be getting on with living. But now that I am “old” - what a surprise.

Until recently, when I looked in the mirror, I couldn’t help complimenting myself on how young and well preserved I looked, which tied in nicely with how I was feeling. And when I turned away from the mirror to look at people my age, and in some cases, at people younger than me by years, I was never one of them, definitely not, because they all looked so much older than me.

Perhaps what I was experiencing, as I approached what religious people would call, “eternal life”, was eternal optimism. But deep down I knew that the clock was ticking. And if I am to be truthful, I didn’t always like what I saw in photographs, and I had long since come to the conclusion that the video camera doesn’t lie.

Well now that the truth is out and that I have hinted at change, I am going to tell you that when the time comes, I hope to die with dignity and courage. With dignity by not resisting the idea of death, but instead, accepting it as part of the process of living. But dignity is a product of courage, a quality that is altogether more subtle and problematic. Because the courage that allows you to as we say: “let go” with dignity, has to be proportionate to your love of life. I know because I have had fleeting moments of panic at the thought of giving it up.

Now someone who was acutely conscious of his mortality was the poet John Keats, who, in his short life, produced some of the most memorable poetry in the English language. And a part of what drove him to succeed was the expectation that he would die young. Apprenticed in the first instance to a surgeon in Edmonton, Keats later abandoned his work as a dresser, (or junior surgeon) at Guy’s and St Thomas’ hospitals in London, to pursue his interest in poetry. But it wasn’t long before he was called on to nurse his younger brother Tom through his final illness, only himself to die in 1821 from the same disease, tuberculosis. He was twenty-five.

Such was Keats ability in crystallizing though and feeling, that many of his lines of poetry have become instantly quotable. Among them is this, the first line taken form his poem, “Endymion”: “A thing of beauty is a joy for ever.” And another, that reflects his feelings of vulnerability, is: “When I have fears that I may cease to be.” Well, here it is in full. And if you are not familiar with the language or poetic style of Keats, I hope that you will persevere. And for the same reason I have used italics, to highlight the structure of the poem:

When I have fears that I may cease to be

Before my pen has gleamed my teeming brain;

Before high-piled books, in charactery,

Hold like rich garners the full-ripened grain;

When I behold, upon the night’s starred face,

Huge cloudy symbols of a high romance,

And think that I may never live to trace

Their shadows, with the magic hand of chance;

And when I feel, fair creature of an hour!

That I shall never look upon thee more,

Never have relish in the fairy power

Of unreflecting love! – then on the hore

Of the wide world I stand alone, and think

‘Till love and fame to nothingness do sink.

Now what caused me to want to read this poem again, in the early morning hours, was my own feeling of vulnerability, knowing as I did, that this was the day when I would return to the Norfolk & Norwich University Hospital for an angiogram.

For those of you who might not know, an angiogram is a well-established procedure, a process of investigation that allows doctors to know at what point the flow of blood to the heart is obstructed and how severe that obstruction is. They do this by passing a tube through the groin and along the arteries to the heart, and even if necessary in to it, after which, by means of a special dye and the use of x-rays, they can determine the exact nature of the problem and decide on how best to treat it.

In my own case, in March, I was diagnosed as having mild angina, a chest pain that is usually the first sign that you are at risk of a heart attack. And the medicines prescribed, I was told were necessary, because I was: “just on the wrong side of safe.” In the circumstances, these were reassuring words, but they were tempered somewhat when the consultant raised the possibility of an angiogram at some future date. As she put it, (against the backdrop of an otherwise uncomplicated medical history,) “something has changed.”

In the weeks that followed this consultation I did well. My blood pressure, which for the first time ever, was high, returned to normal and the (bad) cholesterol was found to be at “4” - where doctors like to see it. And my heartbeat, with the aid of beta-blockers, had been reduced, I think, to 56 beats a minute. What was not so good however, was the fact that I was still occasionally getting angina, a discomfort that was easily remedied by the moderate use of a spray.

Now from the time that the idea of an angiogram was first mooted, to the day that the letter arrived asking me to attend the hospital for a pre angiogram assessment, I was consistent in my view that if offered the opportunity, I would agree to have it. But forty-eight hours before it was due to happen I began to have doubts. And twenty-four hours beforehand, I alerted my wife to the possibility that I might decline the offer. Why, I kept asking myself, should you agree to a procedure that though not technically an “operation” is invasive? And why, when you are “just on the wrong side of safe,” and the medication is working?

That evening, while still mulling it over, I turned again to the Internet and came across two articles. The first, on TIMESONLINE, was a comprehensive article entitled: “Looking after your heart”. And by the time I had finished reading it, I knew that I had been wrong to doubt and that my original decision to agree to the angiogram was right. The second article was a blog written by someone describing his experience of the procedure. And having read it, I resigned myself to a necessary but unpleasant experience.

Now before I tell you about the angiogram and its aftermath, let me tell you a little about my previous experience of hospitals.

I have long held the view that right-minded people should think of hospitals as strange places and that they should have no desire to go there unless they absolutely have to. And after a stay there with appendicitis a few years ago, I came away wondering how anyone could work there day in and day out and not fall into the trap of thinking of their patients, not as people, but as so many pieces of meat. Well, let me reassure you about the Norfolk & Norwich at least.

I dislike the media description of nurses as “angels” and with that said, I can tell you that the nurse in charge of that days angiogram admissions, was personable, attentive to every routine detail, patient and reassuring, knowledgeable, and when it was needed, diplomatic. It was a quality that I observed her exercising in full, as a patient describe how, (in the past,) she had “thrown away” tablets given to her by her doctor “to put under her tongue” and then go on to describe symptoms from that time akin to those of a heart attack: pain in her shoulder neck and jaw, which she believed to be indigestion. And upstairs in the post treatment room, there was ample evidence of normality. From behind a screen and in a lull between patients, I could hear voices comparing notes about holidays. And I think that a holiday photograph was in circulation. And when a trolley, (of some unknown description,) whacked a doorpost, or some such object, and there was a surprised response, someone with obvious good humour, wanted to know: “who was driving.” And as I stood in the treatment room momentarily contemplating a setting that looked like the lower deck of a warship, and in particular at the long narrow table on which I would be laid out, I became aware of someone’s presence, turning to look, it was the consultant coming towards me - smiling.

And I have never met the man who wrote the blog; though I concluded from reading it that he was a good and sensitive man. Not only did he admit to embarrassment at the idea of people working in the area of his groin, but also to having prayed, because of the loneliness that he felt during the procedure. By temperament I think I am lucky. And if I can put it somewhat mischievously, I couldn’t care less who sees or fiddles with what, as long as it is in the line of duty. And I was sufficiently interested in the mechanics of the process, as not to be too preoccupied with myself: The light in the ceiling that went on and off and the grey robotic disk that was creeping ever closer to my face and, as instructed, turning its head from side to side to get a better look. And the occasional click of a pedal, at which point I couldn’t be sure whether it was the table or the camera hovering above me that was moving. And of course there were the people, not least the consultants, who, overseeing the process, was guiding her “assistant” where necessary and interpreting; and whose pleasure at the sight of a healthy artery was akin to what I might feel at the sight of a pint.

Yes, I did let them know in no uncertain terms how I was feeling, as jell was rubbed into my groin. It was bloody cold, though I think I was more polite at the time. And I felt the pain as the needle went in search of the artery through which the catheter would pass to my heart. But having decided to agree to the procedure, I had also decided not to fight it. And something that I never expected, music. They were keeping themselves and me happy with some jaunty easy listening. And when someone asked what I though of it, I replied that if it had been left to me, I would have chosen something different. And when asked what I would have chosen, I said, “something more serene.” The truth was that the music was fine, but in the psychological warfare that was going on and where they already had control of my body, I wasn’t about to surrender my mind.

Now having an angiogram is a serious business and here I have a serious point to make. For all my fascination with high-tech medicine, and my interest in the people around me, and my lack of understanding of the language of medicine, by the time they had finished I knew that they had made a discovery. So while I waited on the ward for the consultant to come and discuss her findings, I was prepared to hear something new. And what it was, was this.

The reading from the treadmill test that I had in March, suggested that I had a narrowing of the right artery, but the angiogram disclosed that this was not so, that the narrowing was in fact, in the left artery; a finding which she described as “more serious.” At the time I was sleepy and tired and as I had been expecting to hear something new I didn’t press her to say more. Instead I listened as she explained that I would have to have an angioplasty, but that it was still to be decided as to whether it would be carried out here in Norwich, or at Papworth in Cambridge. But there was some good news also. The heart muscle apparently is in good condition and the long-term prognosis, (in answer to my question,) is good.

The following day I was in good spirits, feeling pleased that they and I now knew the exact nature of the problem, rather than having to rely on the vague notion of a narrowing in the artery. And when the doctor who will be doing the angioplasty phoned to introduce himself and explain how necessary it was for me to undergo the procedure, I took the opportunity to ask him what it was about the left artery that made my condition “more serious.” Put simply, this artery supplies blood and thereby oxygen to the largest portion of the heart. So the implications are obvious and not helped by the fact that the narrowing is at the point where the artery meets the heart and not further along.

Now just in case you are feeling depressed, here is another story about people who work in hospitals.

As I was being taken back from the treatment room to the word, though a maize of ceilings, (I was flat on my back with strict instructions not to raise my head,) I talked to the porter who was pushing me along, about Ireland. And then to the nurse who was accompanying us, who told me in answer to my questions, that she was from the Philippines. She was the same nurse who, when I first arrived in the pre treatment room, thought I looked “grumpy.” When I was back in the ward and my bed had been put neatly in place, I drew her attention to the woman sitting beside my bed saying: “this is Jenny, my better half.” Quick as a flash and smiling at my wife she said: “I’m sorry I couldn’t have brought you something better.”

Now good health matters for all kinds of reasons and especially when you are getting older and it matters to me for a particular reason. For years I have been thinking about retirement and preparing myself for a new life as a writer, especially of poetry. I have things that I want to say, some easy and some difficult. And I particularly want to say the difficult things in a language that is compelling to the point where the reader will want to stay involved. And while I accept that life is not in my gift and that it will go on nicely without me, I know that I have a better chance of succeeding in my ambition if my health is good. That way I will have the best chance of all of remaining mentally strong.

So, as we say when we raise our glass: “Here’s to" - the angiogram that I thought about not having, and to angioplasty.

__________

© Cormac McCloskey

"When I have fears that I may cease to be"
by John Keats (1795-1821)

Note: This blog, "My Heart And I" was first published on Windows Live Spaces, by me, on 2nd July 2006