Sunday, January 14, 2018

Got Them Old West of Scotland Deep-Fried Heart Failure Blues Again: An essay

9 January 2018

Bedtime is both scary and a relief. You pop the statin (80mg, four times the amount you used to worry you were allergic to) and the gut-settling Lansoprazole, and they’re like magic pills that will get you through until morning, when you can hit the aspirin and the big-boy clot-busting Clopidogrel, then the blood pressure medication and the compulsory porridge. But they’re talismans, holy artefacts, symbols, and going to sleep is an act of faith. Buttressed by the GNY bottle on your bedside table.

Not that you’d know much about it, probably, if the pump gave out, an artery split, a stent blocked, apart from a second or two of unbearable wakefulness.

And you’re kind of reconciled to it. But not to the effect it would have on your loved ones, on the woman who sleeps beside you and who has fought so hard to keep you alive. So you worry. And then you comfort-read some PG Wodehouse or Patrick O’Brian and miraculously, go to sleep.

Daytime brings an assortment of minor aches and pains, some of them worse than others. Shoulder, fingers, that chest? Are these the twinges of an angioplasty settling down, or signs of imminent disaster? You tire easily. Can’t concentrate. And it’s not meant to be like this, is it? You’re meant to be energised, delivered from heart failure, oxygenated and fresh, pain-free, ready for anything. 

Plenty of exercise, the doctors said. Walking is best. Half an hour plodding around the garden and you’re knackered. You look at your beloved bicycle and wonder if you’ll ever ride it again. You’re allowed to drive now, but what happens if you have a heart attack behind the wheel? More damage to other people. Possibly. 

This sore shoulder. That’s how it all began, this time. Should you call the doctor? Can you face yet another ambulance trip, the shaving, the ECGs, the sucking of blood from your arm, the hospital, the air ambulance? What would the kids feel if you neglected to take every healing opportunity? But then you go online and find that post-stent condition is not pain free, necessarily, that the kind of things you’re  experiencing are commonplace, universal. And so is depression.

Then you think, finally, to hell with it. This is no way to live, thinking about death all the time. We’re all dying.  You’ve been given a a chance to live. Take it. Embrace it. And you wheel the bike outside, climb on, push off.

And switch on. Because handily, it’s electric.

***   ***   ***

29 December 2017, Aberdeen Royal Infirmary

It’s like the Everglades, seen from space. A mass of tributaries, main waterways, squiggly streams and dead-end  rivulets.  Unmappable, unnavigable, you’d think. But in fact Dr Ryan knows this system of moving liquids like the back of her hand. Better, as she’s a consultant cardiologist and this is a heart, connected and plumbed arterially and venously. 

It’s my heart, in fact. and it’s failing.

One of those wiggles used to narrow dangerously, but three years ago it was successfully widened by inflating a tiny balloon in it, and then inserting a little wire mesh tube to keep it open. A stent.

That wasn’t Dr Ryan, in fact, who’s a young Irishwoman, but Dr Broadhurst, who isn’t. They are both experts in catherisation, the use of thin wires inserted through an artery in the wrist or groin to repair damaged or dying hearts. It’s called angioplasty, a follow up to an an angiogram, which sees something called “iodinated contrast medium” — it’s got iodine in it — injected into your bloodstream and then detected, using X-rays, on screen, and which provides that astonishing picture of the Everglades I’ve just described.

But this is now. The 29th of December 2017, and there are more, worse problems. One of those arteries, a big one, has narrowed viciously. There’s a heap of plaque which has built up, fortunately not blocking the stent that went in three years ago. Dr Ryan has just stented another narrowed blood vessel, but the big one needs a second opinion, and we could be looking at something that can’t be treated by angioplasty. Instead, I could need a Coronary Artery Bypass, which would involved not wires, but knives and saws. This artery is called the Left Anterior Descending, or LAD. It’s important. So important, a blockage in it has a nickname: the Widowmaker.

***   ***   ***

27 December, 2017, Hillswick, Shetland isles

Sore shoulder. Probably just a muscle thing. I can hear a clicking if I raise my arm. Probably the Ehlers-Danlos Syndrome that runs in the family. And it’s just after Christmas. I’m way too heavy, over 17 stone for the first time, unfit and overeaten to the max. But all that red wine and my daily drugs make any repeat of the heart problems I suffered three years ago impossible, surely? Aspirin, megastatins, blood pressure stuff. That ox cheek, cooked for 14 hours, was amazing. The mutton. The turkey.  The beef rib. The roast potatoes and braised carrots.

And Ive been chopping wood, digging out peat. Still, Boxing Day, I go to bed with a  couple of paracetemol and then wake up at midnight, shoulder very painful, and for the first time in a couple of years, break out the GNT spray, just in case, It opens up the arteries in exactly the same way disco poppers used to, back in the, ah, day. Probably because it is exactly the same stuff. Couple of squirts, pounding headache, Pain eases. Off to sleep. Hey, it’s probably nothing.

Next day, I’m tired, but hey, it’s the inbetween days. That nagging soreness comes back. We go out to a friend’s for dinner, and on the cold walk back, the pain in my shoulder seems to be spreading. But it’s not agonising. It’s like a dull toothache. I’m sweating though. Feeling  rough. Doom-laden.

I know. By this time I know. But I can’t bear the thought of hospital, drips, canulas, ECGs. Been there, done that. Those hellish backless gowns. The moans and night terrors of fellow patients, the impossibility of showering with tubes coming out of you...a couple more paracetemol will sort this.

But I live with a doctor, and she can tell something’s wrong. the pain is veering to my chest now, but it’s still not sledgehammer stuff. She knows the history though: The stent  (angioplasty)three years ago, the family background, the genetic run of heart disease and sudden death. We both know people (most of them men) who stoically braved chest and arm pain and then paid the final and unnecessary price. Calls are made, A doctor arrives. Which makes three, if you count my final year medical student daughter, Martha. It’s brutally cold and dangerously icy, but an ambulance makes it.  an hour later, I’m in hospital, the canula is in my arm and I’m sure, absolutely sure there’s nothing wrong with me. I’m fine, I say to anyone who’ll listen. I’m absolutely fine.

As it turns out, I’m not. I’m absolutely not.

***   ***   ***

1963, Troon, Ayrshire

I knew that giant machine was out there, somewhere. Its slow mechanical boom measured out my childhood insomnia, night after night. My parents had no explanation, putting it down to the imaginings of a boy whose flights of fantasy were already a puzzle to them. And every morning in our douce Ayrshire town, I’d dismiss the golf course or a ship at sea as the source. It seemed so unlikely. The railway repair plant known as Barassie Works? Something echoing down the coast from the  huge Ardeer explosives complex? A malfunctioning Scalextric set?

Thump. Thump. Thump.

Each night I’d try to sleep, hoping, believing that the steady thud in the darkness wouldn’t be there. But it was, faint mostly, sometimes louder, occasionally appearing to shake my entire existence. What was happening? What were the people operating this enormous piece of technology making? 

One day I forgot to listen for it, and fell asleep without effort or raging thought. And years later, I realised I’d been listening to my own heartbeat.

***   ***   ***

I grew up surrounded by heart attacks, heart failure, heart disease, the expectation of sudden death. My parents were from Bellshill in Lanarkshire, and I recall two grannies’ houses shadowed by steelworks and pit bings, smoke, smog and the reek of rotten eggs. One grandfather killed in his thirties in a crane accident at a mine, another dead at 50 ‘running for a bus’. His heart gave out. 

Snatches of adult conversation about friends and relatives who had dropped dead, collapsed, in their 30s and 40s. Victims of the same heavy industrial diet we consumed: pies, pastries, cakes, white bread and fat, always fat. “Eat it up”, we’d be told, gazing at the slimy white collars to lamb chops, “it’s good for you.” Chips, battered fish, deep fried mutton pies and I still remember my first pizza, straight from the bottomless reservoir of boiling oil, a succulent sponge of melted lard.

Nobody really understood or treated cardiac arrests, though how was I supposed to know what happened in hospitals? Men and women went in, having fallen over. They were diagnosed with a ‘heart condition’, and told to rest. And then, sooner or later, they died. But then, everyone died, and it was still not too long after the Second World War. Life was cheap. Expectations were low.

I left home, married young. My mum died, aged 50, the same age as her father. Heart.

***   ***   ***

1980s, Glasgow

Until I was in my late 20s, and began drinking, I could and did eat colossally, and at a settled six foot two, never weighed more than 12 stone. Four meals a day (late night curries after amateur and then professional religious gigs, a substantial tea having been consumed pre-soundcheck). Even when, post-religion, lunchtime pints of journalistic heavy and nightclub tins of Red Stripe and Grolsch, were chased with dawn wallowings in Absolut vodka, steak, Henri Afrikas burgers and softpack Marlboro, I was thin. Rock’n’roll. I loved that quote about Dylan: “Not so much burning the candle at both ends as holding a blowtorch on the middle.” Someone gave me some Tom Wolfe books, which led to Hunter S Thompson, who provided the excuses for some hard living I didn’t have the talent to justify. Still, I worked at it. All of it.

***   ***   ***

1990s, Shetland, Scotland and beyond

The trouble with marrying a doctor is they do practise on you. And the early diagnoses weren’t good. Heart, inevitably. Odd rhythms, something called extrasistoles. Pitter patters and hesitations, half-beats, trips and stutters. Jazz heart. Breathing problems, checked out, revealing old scarring on the lungs. I’d never really liked smoking, more the  posing about with Zippos, perfecting that Alain Delon style of holding the fag, so giving up wasn’t a major trial. Cholesterol tests: my levels were sky high. That diet, still cheerfully soused in meat, gravy and saturated fats. And the genes. It had been a dark joke, a cheery shout against the fates while knocking back whisky, eating crisps and wishing Silk Cut was Benson and Hedges: Mother dead at 50, grandfather dead at 50, me next. A large Laphroaig please.

Heart. But I was on statins and a daily aspirin. Two bouts of angina - one after a triple espresso and two hand-rolled Samsons, one after a roller coaster ride at Alton Towers - were followed by some attempts at modifying my diet and bigger statins. But there were side effects. Twinges in my legs, bad dreams. And I was busy, really busy, working harder than hard, writing, performing, broadcasting, travelling, helping bring up kids. Blood pressure began to be a problem. But hey, there were pills for that too. Beta blockers, which had the added benefit of meaning you never got nervous. Not ever. My heart settled down. Steady as a rock. Thump. Thump. Thump.

***   ***   ***

April 2015, Shetland

I was 59 and in trouble, but I didn’t realise quite how bad it was. Loving daily broadcasting too much, trying to second-guess an employer, the BBC, which could and did extinguish freelance careers on a focus group’s or  managerial whim. Hating the graveyard shifts I ended up doing, panic attacks on and off air. “This is killing me,” I told Susan. Trying to engineer an exit via more local copywriting work. Exercise: cycling, treadmill running. Sixteen and a half stone. Sleeping badly.

I was in Unst, doing tourism development work. Ate some extreme pies, woke up after not enough sleep and hit the bike. Took a couple of beta blockers and an aspirin. Got home, collapsed. Heartbeat down to 30, and not because of Lance Armstrong superfitness. Some chest pain. Ambulance, blue light, hospital. Feeling better, but Dr Wilson was indefatigable in her disbelief. Air Ambulance to Aberdeen, accompanied by Martha, who happened to be at home. Dr Broadhurst at the Catherisation (Cath) Lab where they light up your blood vessels for an angiogram. While you’re awake. “Oh yes,” he says, “We’ll just put in a stent to sort out that narrowed artery while we’re in.” Ninety per cent stenosis. Blocked. “There are some arteries we can’t get to, but we’ll treat them with drugs.” Fine. It all seemed to be happening to somebody else.

Truth is, I was lucky, The drop in heart rate back in Shetland was probably due to an overdose of beta blocker, but the consequent angiogram revealed the terrible truth: I had been a whisker away from the arterial blockage that had killed my mother and grandfather. Despite my aspirin and statins, my blood vessel were caked in plaque. I was put on more drugs, to prevent clotting, and my statin intake was quadrupled. All, I was informed, would be well.

Except, two and a half years later, just after  Christmas, it wasn’t.

***   ***   ***


After a year, they take you off the Clopidogrel, and you trust in aspirin to keep the clots from forming. I’d hated that Clopidogrel. I bled easily - teeth, a spouting thumb caught in  a Volvo door, and a knee that swelled to twice it’s normal size after an encounter with a rock. I still remember the pop when it burst like balloon and the blood drained away. My blood pressure remained high, despite all the various pharmaceutical attacks on it. But I was active, busy and seemed relatively OK. Still ultra-wary of aches and pains (is that a stroke? A toothache or a coronary?), but getting on with things. Children married, I began public speaking, a few radio shows. The pump thumped on.

I functioned. Motorbikes were out, electric bicycles in. And of course, the creeping affection for fat conquered good sense. Ghee-heavy curries, the Northern Isles’ propensity for heavy-duty meat straight from the croft, particularly mutton. Cheese, oh cheese, great corpse of milk! And increasingly, chocolate.  Not to mention the availability of the Best Fish Suppers in the UK (officially certified) just down the road apiece. And I perfected pakora using my trusty, grease-caked Breville deep-fat fryer.
Recip├ęs for disaster. Then came Christmas.

27 December, Shetland

It was cold, so cold, the coldest night of the year. The ambulance skittered cautiously north towards us, 40 miles from the Gilbert Bain Hospital in Lerwick. I had been told to sit still. I munched aspirin and some blood thinner, wished this wasn’t happening, unconvinced, disgusted, resigned.

An hour in the ambulance, half-naked, wired to an ECG, the pain getting worse,  cold, frightened. At the hospital, the usual painful battle for blood vessels by junior doctors. The questions: “On a scale of one to ten, how painful?” Three. Five. Seven. I don’t know. They need to know how sore it is, so no morphine, not this time. Thank God, they forgot the anti-emetic last time and I was sick as a dog. 

A side room. The hospital isn’t too busy. Susan is here. I am so fed up with frightening her. This is not fair. Dr Fryer, consultant, arrives. Is there pain? Yes, there is. My history arrives. A thick file, six decades of increasing trouble. And given what’s happened in the past, in my family, there really isn’t any alternative. Aberdeen is contacted, but hopes for a speedy trip south are low; it’s Christmas, the NHS is under pressure. There are front page headlines about ARI being closed due to flu.  Overwhelmed. 

Just thirty  hours later, I’m in an ambulance so cold none of the medical instruments inside work. It’s a hard and sparkling day, and we - Martha, bless her, home for Christmas is with me again - are on our way to Sumburgh. I know the way, know this special route directly onto the tarmac by the fire station. The yellow Air Ambulance swoops down as we arrive. an hour to Aberdeen, another freezing ambulance to hospital, and within two hours I’m in the Cath Lab, shaking and shivering  in a theatre kept even colder than those bloody ambulances so the incredibly complex machinery can work properly. I feel terrible, trembling uncontrollably, and I swear I can feel that wire, probing like a Dyna-Rod in my chest, scraping, inflating, bending my heart and its vessels to its will.

***   ***  ***

13 January 2018

More than two weeks now since The Stenting, a Saturday morning. Susan’s at work, the dog’s barking at a TV show about Peru, where pet dogs are allowed to roam the capital in generally well-behaved packs. Dexter wants no part of this Peruvian canine democracy. I’ve managed my regular morning’s half-hour tramp around the garden, and I’m feeling not too bad. Last night was crap - neck pain, nausea, the inner certainty that I’d be heading back to hospital, visions of a blocked stent (did I dislodge it by chopping wood too forcefully? No, I was reassured by Susan and the entire internet, which is full of  angioplastered people seeking reassurance, many of them as disturbed and upset as I clearly am). A couple of squeezes of GTN, but that nitro-glycerine-poppers-head-swell just made me feel worse

 Susan cooked me fried (olive oil) eggs on toast and made me have sugar in my tea, and I began to feel gradually better. I’ve been following a strict low-fat, low-sugar diet since The Latest Event and my body  was demanding more fuel. Also, a confession - I had a beer, and it’s becoming clear that alcohol no longer works for me. Which, for a semi-professional whisky writer, is a bit of a blow. White wine doesn’t count, obviously, and neither does Chilean red, which is full of antioxidants. Apparently.

I lay down on my side to sleep, and there it was: the big machine from childhood days in Troon, beating in my ears. Not so much a thump now, there seemed to be a hydraulic element there.

Whoosh-thud. Whoosh-thud. Whoosh-thud.

Seven hours later, I woke up.

So here we are again. This morning, I’ve decided to eat properly. Toast. Cereal. More toast. Pills first, of course. Aspirin, Candi Staton (Candesartan), Atenolol, Amlodipine, and of course Cloppy Doggerel itself. I’ve thrown out the grease-impregnated deep-fat fryer, and a Von Shef  Low-Fat Air Fryer has arrived via Amazon which can provide chips, apparently, without the same risk of death and sclerosis. We’ll see. Aurore the French postwoman also brings my new industrial stapler, for which I have plans. A construction project. For the first time, I’m thinking ahead. 

The possibilities are endless. 

Work has been piling up. Jobs to be done, things to write, videos to make, photographs to take, local radio shows to record. A cookery column has been commissioned, believe it or not, the first one to be about lumpsuckers. I have a book coming out, co-written with my son James. Be good to stay alive to see that published. It’s about Shetland and food, feasting and frying, the community politics of fat. It may need some editing, in light of recent events. 
I need to see the bairns, the grandweans, my dad, my sisters. I yearn for the return of daylight. Spring. And I’ve started playing the guitar again, one of the five I own, just about matching the number of chords I know.

And guess what? I think I need another one. A guitar, not a chord. There’s  an old, soulful Harmony on eBay, made in Chicago. It could be here in a week. If I keep working, I can afford it, just about.

Something to look forward to.

Right. Must get on.

16 January

Excruciating back pain, just under my shoulder blade. But I’ve been on the treadmill, in the garden lifting things. Hurts if I breathe deeply. Worry. GTN doesn’t touch it, which is kind of good news. Clopidogrel makes you bleed easily, and it’s possible I’ve torn or strained a muscle.

Better safe than sorry. And so it’s off to Lerwick through the snow, with Susan. The resus room again. Those fantastic nurses. ECG, canula, bloods, blood pressure, full examination over three hours by our much-valued cardiologist. It’s muscle damage. My heart is working fine. The relief is overwhelming.

Now we can start again.

I am definitely buying that guitar

Copyright Tom Morton, 2018.

Heartfelt thanks and eternal gratitude to Drs Ryan and Broadfoot at the Aberdeen Royal Infirmary Cath Lab, to all the other team members there and on the cardiology wards. In Shetland, Drs Pauline Wilson and David Fryer robustly refused to accept my bleating about being “fine, honestly, it’s nothing”. Thanks to the road and airborne staff of the Scottish Ambulance Service in Shetland and Aberdeen, all the nurses at the Gilbert Bain Hospital in Lerwick and everyone at the Hillswick Health Centre, especially  Dr Andy Muir. 

The NHS is under constant threat of erosion from many sides: defend it.

To Susan and Martha, love and gratitude, over and over again. And all my other offspring - Magnus, James, Sandy and Dave, as well as the many folk who sent messages of support. 

Please, if you have a sore shoulder...get it checked out. Have a look at the British Heart Foundation site, here: