Tuesday, 17 April 2018
The Calabash Tree
It felt like The Last Supper. My wife and I had lunch at Apuglia, an Italian restaurant behind London's St Bartholomew's Hospital. I had tagliatelle with porcini mushrooms and a glass of prosecco. There was a bicycle on the wall, for art not transport. I wasn't going to travel anywhere for some days and my body was about to be worked on with skills the equal of da Vinci.
We walked into the hospital past the chapel and Anne told me that she would light a candle there when I was having my operation.
It was now early evening and when my wife left for home I calmed my nerves by playing a Tibetan bowls recording through my earphones. I tried to meditate, but it was impossible. The last time I had had an operation, for subdural haematoma, I had been blasé about it all and remembered chatting to the others on my ward. But on that occasion most of my brain was on another planet. This time, at this hospital, I was definitely earthed. Super-conscious of all that was going on and about to happen.
There were some distractions; stethoscope on chest and back, blood tests and blood pressure and a visit from the anaesthetist, I was given two razors and asked to shave my chest, arms, legs and groin. It reminded me of plucking feathers from slaughtered chickens. Not a pleasant task but painless. The pain was to come later.
The next morning my chest was sawn open, my heart was stopped and blood flow was directed with a heart-lung machine. My body was cooled down and Anne tells me she was present in intensive care when they brought me back to consciousness by warming me up. She said that the nurse threw a switch and I started to twitch like Frankestein's monster. My eyes, she said, looked like the 'living dead' and she was afraid that I was about to sit up and pull out the many tubes and wires inserted into my body.
During the three-hour operation my aortic valve was replaced with cow tissue, leaving me ever grateful to my reluctant and gentle-grazing posthumous donor.
Of course I have no memories of my time under anaesthetic except to confirm these words from Diogenes: 'Where there is life there is no death. Where there is death there is no life.'
All I can remember from my time in intensive care is the button I was told to press when I needed a morphine shot to ease the pain.
Two days later and in the High Dependency Unit I was now conscious and taking note of my surroundings. Not very pleasant as I seemed to be connected to multiple monitors as well as tubes inserted into my stomach, neck and groin and with wires connected to my heart.
I spent two nights in HDU and it was exhausting. Any attempts to sleep were stopped by the constant checks; temperature, blood pressure, blood sampling and medication administered, as I remember, though the tube in my neck At one point the patient beside me went into a cardiac crisis and with great speed the 'crash' team arrived. I wasn't in a fit state to count precisely, but was told later that there would have been fifteen in attendance. Strangely comforting to witness such positive pandemonium in the service of continued life.
I can remember telling a nurse I hadn't had a pee for ages. She laughed and invited me to look below my pyjama trousers. My God, there was a tube inserted into my penis. I remembered a friend of mine who had once suffered terrible pain when this was removed after an operation who told me, 'my cock never gave me so much pleasure as it gave me pain when the catheter was removed.' I decided I wouldn't rush this procedure.
On the evening before surgery I was interviewed by a Filipino nurse who, when told about my earlier brain surgery, said she had once worked in neurology, but had decided to switch to cardiology. When I asked her why, she answered, 'The heart, I love the heart.'
Then there was the nurse pushing my bed down a corridor when moving me to a new ward. On hearing I was a writer, he brought my bed to a stop and quoted verbatim from Gabriel Garcia Marquez's 'Love in the Time of Cholera': “Age has no reality except in the physical world. The essence of a human being is resistant to the passage of time. Our inner lives are eternal, which is to say that our spirits remain as youthful and vigorous as when we were in full bloom. Think of love as a state of grace, not the means to anything, but the alpha and omega. An end in itself.”
Also a Filipino, (The NHS seems to be dependent on this nation), Brian Piniera, has now become a friend
'Breath in deeply', instructed a nurse when replacing my chest bandage. 'Puff out your chest,' she said, 'like a Robin Redbreast.'
Back on the post-op ward I got to know my fellow patients. Barry had already had three heart operations when he arrived at Barts for his fourth. His operation lasted 28 hours and they 'lost' him three times. He told me of his out of body experiences which had traumatised him and made him scared of going to sleep.
He and Erroll, a Trinidadian bus driver from West London, would chat about youthful memories of their island homes and their love of the calabash tree, its soft brown bark home to multi-coloured orchids. They told me that these trees, pollinated by bats, grow on hillside pastures, along roadsides and wherever there are human beings.
After five days I was ready to go home, but the final task was to remove two 'pacing' wires wrapped around my ventricles and connected to a monitor I had to carry round with me. I had thought that the two plasters on my stomach were stitches, but a nurse told me they were the entry points for these wires and that I must remain in hospital for twelve hours after their removal. If pulled out incorrectly I could die.
Brian works in stem cell research at the hospital but, from time to time, turns up on his old ward to help out as a volunteer. He is well known and well liked throughout the hospital. He was visiting me when I was given this information and offered to undertake the procedure. I was happy to have him do this tricky task.
It wasn't painful but it was frightening as I watched him start to draw them out. They were each 20 cm in length and have to be removed slowly and with a steady hand. Brian is an incessant talker, but I urged him into silence and shut my eyes.
Here I am writing this. Still alive and conscious that every breath I take is a gift of life and time. My cow and the skills of my surgical team have given me ten to fifteen years, but I have been told one of my two carotid arteries is 50% furred up. So who knows what I have left to me.
It's quality I must go for now. A friend of mine helps run an organisation called 'The 'Long Now'. They have constructed a clock which ticks once every 100 years. I used to be a bit cynical about the project, but now I understand that perspective much better.
Whatever life is left to me I owe it to myself, to my loved ones and family, to not let it go to waste. I will try to put back together my dysfunctional family. I will write more and have written four articles for social media sites since returning home from hospital. As a political activist they are, of course, aimed at achieving a better world, if not for myself, for the future.
Part of that better world is here today in the form of the NHS, a health system based in Aneurin Bevan's words on the principle that, “No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”
I am lucky to be a citizen of a country that can still offer me free medical procedures that have kept me alive. (A note to zenophobes. The NHS is run by people like my Filipino nurses, my cardiac surgeon, an Egyptian, while my earlier neurological surgeon was Nigerian).
I was very aware of this after both my operations and what needs to be done to save our medical services from the privatising predators who are creeping in through the cracks in our defences.
As recently as five months before I was admitted, Barts were responsible for their own catering. Brian told me what pride he took in serving food to his patients and how this was a central part of nursing care. Today this has been handed to Serco, who run our prisons and whose annual revenue from healthcare is over £1.4 billion. Breakfast was tepid tea or coffee, cereal or porridge and toast. As I bit into the cold, spongy “toast” I could imagine Serco executives meeting to discuss how to cut back their costs to increase their profits. “Let's start with breakfast”.
Back to the Calabash tree. Barry told me that the pulp of the fruit has medicinal properties and acts as a remedy for asthma, dysentry and blood pressure and can be used to treat haematomas and tumours.
The NHS is our Calabash tree.
I wrote this poem soon after the operation.
My blood pump was stopped
while a machine took over
the job my heart had done
for almost 73 years.
A cow's pericardium replaced
my narrowed, furred valve
that no longer moved like
a sea anemone's fronds.
This valve was given without
agreement or consent
so I made a vow to my dead donor
to never eat beef again.
Last time it was a subdural haematoma.
I escaped with my brain intact.
That involved an earlier pact,
made with myself, to act wisely
with attention to my herd.
My plan of action now
begins with breaking through the fence
to arrive, together, in greener pastures.