Month: October 2015

Why troubles never come singly

~ Jennifer Barraclough ~ 4 Comments

Just as our lives were beginning to settle down, with Brian recovering from his heart surgery and its subsequent complications, our household was hit by another health crisis. A few days ago Clare, my 91-year old mother who lives next door, developed acute abdominal symptoms. For the third time in recent weeks I called the emergency ambulance, and for the third time spent most of the night helplessly keeping watch by the hospital bedside of a desperately ill relative. The surgeons were doubtful whether Clare could withstand the operation which would be necessary to save her life. I pressed them to try, for the alternative would be an agonising and undignified death, but they were reluctant to attempt such a major procedure in the middle of the night. Meanwhile repeated large doses of morphine and other drugs were failing to control Clare’s pain, nausea and distress, though eventually the anaesthetists performed an epidural which brought her some relief.

There was better news next morning. The surgeons did decide to operate, and Clare survived the removal of large sections of necrotic bowel. So far – though it is very early days – she is making good progress in hospital.

It seems incredible that our lives, so contented and well-ordered for the last few years, have been suddenly disturbed by this sequence of traumas. Sayings such as “troubles never come singly” “it never rains but it pours” and “bad things come in threes” suggest that negative events do have a tendency to cluster in time. I noticed this when I carried out my own research study to investigate “Life events and breast cancer prognosis” which involved repeated interviews with over 200 women over a three year followup. While some of these women reported very few happenings during the study period, there were others who experienced a whole series of disasters. Sometimes it was possible to identify a chain of events leading on from one another. Sometimes all the events seemed to stem from one single cause, which in some cases appeared to involve the personality and behaviour of the person concerned. Few of the events could be considered totally independent from those who experienced them.

Were the recent misfortunes of our own family linked, part of a cascade of events beginning with Brian’s heart attack? I have always tended to be sceptical of the theory that most illness is due to “stress” (the results of my own study, cited above, gave no support to the popular notion that stressful life events promote the growth of breast cancer). But there is no doubt that psychological stress can lead directly to imbalances of the body’s neurological, endocrine and immune systems, as well as to impaired self care due to missed meals and lack of sleep. I have no doubt that anxiety, overwork and exhaustion since Brian became ill have contributed to my own recent health problems of high blood pressure, sinus tachycardia, a posterior vitreous detachment of the eye, and delayed healing of biopsy wounds.

“Stress” is not the only possible explanation for the clustering of events, and maybe there are also metaphysical causes. According to the Law of Attraction, negative thoughts and feelings in response to adversity are likely to result in more of the same. And an astrologer friend, who like me was born under the sign of Aquarius, has cited “the ghastly Saturn square Pluto events which have befallen Aquarians of late”. I am trying to “take one day at a time” and appreciate good things like the spring roses blooming in our garden.

big pink rose

My husband’s heart Part 3: Cardiac rehabilitation

~ Jennifer Barraclough ~ 1 Comment

Over two weeks have gone by since Brian had his open heart surgery, and it is one week since he was discharged from inpatient care.

We are both very happy that he is back home, though there continue to be ups and downs in his condition. During good periods he is able to walk short distances both inside and outside the house, and to eat reasonably well. However he has relapsed into atrial fibrillation on several occasions, and a recent blood test showed him to be anaemic. At times he feels weak and breathless and is unable to get warm. Formerly an avid reader, he has no interest in books at present, though he does follow the news on his computer.

We were advised that recovery from such a huge operation takes about three months, so perhaps cannot expect too much too soon. His medication – currently including amiodarone, warfarin, aspirin, an occasional beta blocker – will be reviewed by the cardiologist next week.

After the previous month of acute anxiety combined with frantic activity – travelling to and from the hospitals to visit Brian every day while managing practical, legal and financial affairs at home and dealing with medical appointments for myself – my own life has entered a quieter domestic phase. My role as nurse-housekeeper is not unduly arduous, so I am catching up on lost rest and sleep. Brian and I have time to spend together in a relaxed way talking, listening to music, or watching the four cats in the garden.

Daisy with flowersLeo on gatepostMagic on plum tree best photohomer at feijoa tree

All the regular engagements which once provided structure to my weeks – singing with St Patrick’s choir, volunteering at Auckland SPCA, attending Auckland Film Society, dog walking on Takapuna beach, coffee dates with friends in the city, yoga class – have been cancelled for the time being. The activity which means the most to me, creative writing, is also on hold. Apart from this blog and emails to friends I have written nothing for six weeks, but look forward to getting back to editing my new novel soon.

My husband’s heart Part 2: Auckland City Hospital

~ Jennifer Barraclough ~ 3 Comments

Following on from my previous post: Brian spent 18 days in the cardiology unit of North Shore Hospital. On 23 September came the long-awaited news that a place for him was available at Auckland City Hospital. Accompanied by a nurse carrying a defibrillator, he was transferred by ambulance across the Harbour Bridge, and admitted to the cardiothoracic surgery ward in preparation for a five hour procedure to bypass his left coronary artery, replace his aortic valve, and repair the aneurysm of his ascending aorta.

We kissed farewell as he was wheeled through the doors of the operating theatre next day, and then for the first time since it all began I broke down in tears. Fortunately a close friend was available to take me out for coffee and listen to the story of our recent woes.

When the surgeon phoned me that afternoon to say that the procedure had gone well my relief was enormous. But when I arrived to visit Brian in the intensive care unit later on, I was told that he had had a stormy few hours. A group of doctors and nurses were gathered round his bedside. He was deeply unconscious and blood was flowing out through the drains in his chest.

Despite repeated transfusions of blood and blood products, his condition did not improve and shortly before midnight the decision was made to recall the surgical team and take him back to theatre. I was trembling with fear and distress, and very thankful that family members had come in to sit with me and then drive me home.

After the second operation, which involved the removal of blood clots and fluids, Brian began to get better. By next morning his vital signs were stable, and I was present to watch him being awakened from his drug-induced coma.

Two days later he was moved out of the intensive care unit into a four-bedded ward, where he stayed for over a week. On some days he made rapid progress, and on some days his condition caused concern. On two occasions he went back into rapid atrial fibrillation and required intravenous amiodarone to restore sinus rhythm. At other times his heart rate became too slow, and a week after the first surgery he had a pacemaker fitted. He had some brief spells of anger and despair, but overall remained remarkably positive.

Brian in Wd 42 after heart op.jpg

 

For myself, the physical and emotional demands have felt almost overwhelming, and I developed several apparently unrelated medical problems during the month that Brian was in hospital. These included an episode of hypertension and tachycardia beginning on the same night that, unknown to me, Brian’s recurrent arrhythmia was causing great concern. Anxiety and exhaustion were the obvious triggers for my own symptoms and, despite having done so much clinical and research work in the field of mind-body medicine, this was my first significant personal experience of stress-related illness. If I had had such an experience before my retirement I think I would have been a better doctor.

Brian has now been discharged from hospital, and although life may not be easy during the projected recovery period of three months, we are both happy and relieved that he is home again. Through this whole saga I have been tremendously grateful for the skill and kindness of the hospital staff; the marvels of modern medicine and surgery; the practical support, good wishes and prayers of family and friends; and the comforting presence of our three cats.

My husband’s heart Part 1: North Shore Hospital

~ Jennifer Barraclough ~ 1 Comment

It is over thirty years since my husband Brian started feeling breathless after walking up long flights of stairs. He was found to have aortic stenosis and an aneurysm of the ascending aorta. As time went by, occasional repeat investigations showed this pathology gradually getting worse, and several specialists advised cardiac surgery to prevent the risks – including sudden death – associated with his condition. He declined, on the grounds that his symptoms were not too severe and that the operation itself could be fatal or cause some intellectual impairment. His diagnosis was one factor in our joint decision to leave our medical careers in the UK and go to live in Auckland, New Zealand, where Brian had been born and brought up. That was fifteen years ago and over most of this time Brian has continued in good shape – even walking the Milford Track.

on milford track

He continued adamant that he did not want surgery. He asked me and our family doctor not to send him to hospital if the aneurysm burst, but to give him morphine and let him die at home.

In July this year, soon after his 82nd birthday, Brian had a bad attack of flu and we attributed his continued lethargy and reduced exercise tolerance to the aftermath of that. He did seem to be getting better. Then on 4th September, on the way back from an enjoyable evening at the ballet, he said he did not feel well. He refused to let me call for help. Somehow I managed to support him on the walk home, but as soon as I opened our front door he collapsed in the hall. At that point I went against his wishes and rang 111. Time will tell whether I did the right thing.

A skilled ambulance crew arrived promptly, and did an ECG which showed atrial fibrillation with a pulse rate of 160-170 per minute. They started intravenous amiodarone and advised that Brian was likely to die unless he went to hospital. With a little persuasion he agreed to go. After many hours of investigation and treatment in the resuscitation unit of North Shore Hospital he was admitted to a ward and at 4 a.m. I took a taxi home.

The immediate cause of the collapse was not a ruptured aortic aneurysm, but a 70% blockage of the main stem of the left coronary artery. With excellent medical treatment and nursing care, Brian’s condition improved greatly over the next few days, but he was presented with a stark choice – go back home with probably just a few months to live, or undergo surgery which carried a 20% operative mortality but if successful could give him many more years of good quality life. Brian decided to “cooperate with the inevitable” and accept the operation that he had been refusing for so long.

He stayed three weeks attached to monitors in the cardiology centre, not allowed to leave the ward although he was feeling fairly well. Every day we anxiously awaited the news that a place had become available on the surgical unit at Auckland Hospital. On several occasions the proposed transfer nearly happened but was then cancelled – later we would come to understand all too clearly the reasons for this. Brian appeared to benefit from the long rest, and remained in good spirits. He spent much of his time exercising in the corridor, or with his laptop computer composing a self-written obituary for Munk’s Roll.

There is much more to the story, but to avoid making this post too long I will continue next time. Please sign up in the box if you would like to receive future episodes by email. I should add that I am publishing this with Brian’s full knowledge and consent.