“Across a Sea of Troubles”

Following on from my previous post about Writing a medical memoir, here is a short extract from my new book Across a Sea of Troubles.

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“I don’t feel very well,” said my husband Brian, and slumped down on a nearby chair. His eyes were rolling upwards so that the whites were showing, and his face was very pale.

I said “I’ll call the ambulance.”

“No.”

It was a fine spring night and we were on Devonport Wharf, having just got off a late ferry from downtown Auckland. We had been attending a ballet performance of A Midsummer Night’s Dream with my mother, Clare, in celebration of her recent 91st birthday. It had been a pleasant relaxing evening and Brian had seemed perfectly alright at the theatre, but now he looked very ill indeed.

Again I proposed the ambulance, and again Brian refused, insisting that he wanted to go home. I looked around for assistance but we were alone on the wharf, my mother having gone on ahead to her own house with some neighbours we had met on the ferry.

I helped Brian onto the bus which took us halfway home, and while we slowly walked the rest of the way, I supported him as he swayed from side to side and had to keep stopping to rest.

At last we reached our house. I turned the key in the front door. As it swung open, Brian fell against it and collapsed unconscious in the hall.

I rang 111. The operator asked me a few questions and told me to check the pulse in Brian’s neck; it was around 200 beats per minute and irregular. She said that help was on its way. Meanwhile Brian had woken up and I sat beside him on the floor until the St John ambulance arrived.

The two ambulance officers helped Brian to move onto a couch, inserted a venous cannula into his arm, and ran an ECG which showed fast atrial fibrillation with left bundle branch block and ischemic changes. After making a telephone call they put up a drip and started an infusion of amiodarone, a drug that slows the heart rate and is used for the control of cardiac arrhythmias.

Brian, having a medical background, was apparently taking a detached interest in the proceedings. But when it became clear that preparations to take him to hospital were underway, he said “I’m not going.”

The senior ambulance man told him “You’re probably going to die if you don’t, mate.”

Brian continued to refuse, until I kneeled at his side and begged him to accept any treatment which might save his life. Then he suddenly said “Oh, alright.” Afterwards, he told me that he had not felt any pain or distress and would not have minded dying.

The local fire brigade came to help carry Brian down the garden steps and into the ambulance, and we set off on the first of the six urgent visits to North Shore Hospital that I was to make over the next few months.

***

Links to book: Smashwords, Amazon US, Amazon UK.

ast-smashwords-cover

My husband’s heart Part 1: North Shore Hospital

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.