Homage to Gaia (54 page)

This little episode highlights, I think, one essential difference between British and American medical practice. In America, when faced with a medical emergency, the response tends to be ‘My God, we must do something'; in Britain, the response is ‘Nature will take its course.' In fact, there was little that the medical services of those two nations could have done for me. At that time bypass surgery had only just started and was not nearly the routine and effective procedure that it was to become.

At home in Bowerchalke later that day, I faced the difficult problem of breaking the news to Helen. She was in the early stages of multiple sclerosis and this was hardly the most cheerful of news to give her. I think I just said, ‘Oh, by the way, I had a heart attack when I was in Boston.' She found it difficult to accept. I looked fit and well and could move around. It must have seemed to her unreal. I recall going to my favourite medical textbook and looking up angina and coronary occlusion. It was a subject that was familiar to me for I had spent my last years at the National Institute for Medical Research working on the biochemistry of coronary artery disease—had even published papers on it. I had also worked for a few years in Houston in the same department as the famous surgeon, Michael DeBakey, but there is a large difference between scientific knowledge of a topic and personal experience. I was not one of those who read medical texts in order to titillate their hypochondria, but this time I read Davidson's
Principles
and
Practice
of
Medicine
with an unusual intensity; no longer the detached scientist. Here it was in clear print, ‘The patient
must be reassured, but some relative must be told that the future is unpredictable.'

I spent the rest of my weekend coming to terms with the idea that I might not have long to live. My body, with which I was on good terms, was also telling me that this was a serious matter. Later I discovered that the occlusion was in my left main coronary artery before it forks into the two branches that feed blood to the left ventricle. In the USA they call this particular lesion the widow-maker, since a complete blockage of the artery at this point is almost invariably fatal.

Monday morning I broke my usual custom of walking the two miles to see Dr Brown at his surgery in Broadchalke, the next village from us. This time I drove. He was the nicest of men, a general practitioner who brought comfort to those in need of him. He never stinted house calls at any time of the day or night, and he had a wonderful way with old ladies and gentlemen. However, the medicine he practised was more that of his student days than the conventional wisdom of 1972. I had tried during the previous years to persuade him to prescribe for my hypertension, but he would not. Insurance companies had twice turned down my applications for life insurance because of high blood pressure, but he just did not believe in medication for hypertension. He would tell me about old folk in Broadchalke who were in their eighties and who had had hypertension for years and seemed to thrive on it. When I told him my news of the heart attack in America he was contrite and arranged an appointment with a consultant cardiologist, Dr Mullen, in Salisbury, for the next day.

In 1972 Salisbury was a city in the early stages of traffic blight. Cars, with their incessant noise and never-ending demand for space and attention, were beginning to turn what had been a beautiful medieval city into a nightmare. Cars, like a pack of noisy smelly dogs, disturbed and fouled everywhere they went. The elegant plan of the old city was giving way to concrete car parks and shopping malls. It was a relief to enter the Close of Salisbury Cathedral—a quiet haven away from the roaring vehicles outside, where, apart from the cars of residents and occasional visitors, it was a place of peace—a place for walking, not driving. Today, with my problematic heart as an excuse, I drove in and parked near the consulting rooms of Dr Mullen, the cardiologist. His rooms were a few yards from the East Gate and near the greensward that surrounds the cathedral itself. It was a sunny day in late November
and, in spite of it all, I felt cheerful and full of well-being. It is strange now to muse on the sad day, over twenty years later, when I was in the cathedral again. This time, free of my heart problems, but part of the congregation mourning my friend, Bill Golding. On that cold and bitter day, I was so much sadder.

Dr Mullen was plump and occupied a cosy set of rooms that complemented his comfortable Victorian manner. He arranged for me to visit the Salisbury Infirmary where they repeated the ECG and X-rays. I found it intriguing that the three different physicians who had examined me applied the same set of tests. I wondered if they distrusted the observations of their colleagues. It does not matter for most of the time, but it must waste resources and, where X-rays are repeatedly used, be undesirable for the patient. He confirmed the diagnosis of an angina and prescribed warfarin, the anticoagulant drug which is also an effective rat poison. He also prescribed Aldomet, an anti-hypertensive drug, and trinitrin for the immediate relief of anginal pain. He asked me to come back again in a month's time. He also advised me to walk slowly, not run, and to take it easy, and in particular to do nothing strenuous for at least a month. It was a great blow to me to have to walk gently instead of striding out heel and toe, as was my wont. I recall telling Helen on a gentle stroll around the village, ‘Well, dear, at least we can now manage the same pace.' It made me realize also the extent of her disabilities through multiple sclerosis.

After a month of this sedentary life, I was deeply frustrated. Then I recalled the experience of that famous clinician, Sir Thomas Lewis. He suffered an angina like mine and came to terms with it by sawing wood each morning up to the limit of pain he could endure, but he went on to live out a full and rich life. If exercise was good enough for him, surely I could do something better than gentle walks to improve the state of my heart. There was no wood to saw, so instead I tried one of my favourite walks, which involved a 200-foot climb up a nearby hill, or as we in England called it, a down. Marleycombe down was a chalk hill covered with turf and it overlooked our village and it was quite a struggle to climb it; ten or twenty paces then a rest, breathless. The trinitrin tablets were effective in relieving the pain but at this stage did little to improve performance. Within a week of daily climbs, I could manage 100 feet up the steep slope without stopping and without angina, and within a month I could climb the whole 200 feet without having to stop. I was well on the way back to health. Soon
I found I could walk fast and climb fast, so long as I kept taking trinitrin tablets. Within six months, I felt fitter than I had been before the attack, although without the trinitrin the angina came on after a mere hundred yards of walking on the flat. With the trinitrin, I could do anything. What a miracle drug it is, yet how unsung. Nobel, the explosive maker, who used nitro-glycerine to invent dynamite and gelignite, should have awarded himself one of his own prizes for its outstanding benefit as a vasodilatory drug in medicine.

The whole episode made me realize the value of a brush with the threat of death and of the recognition of one's own mortality. Until then, I had squandered my time and failed to enjoy each day as it came. Now I knew how sweet was life and how foolish it was to waste a day in pointless work. I never smoked again, whereas before, like Mark Twain, I had given up smoking a hundred times, and no longer did I fool myself with the thought that I could put off the needed walk until next week. No matter how fit I became the angina never changed —without the aid of the trinitrin it came on at precisely the same distance walked—about a hundred yards, and this tolerable state went on without change for almost exactly ten years. It worked so well that often during summers spent on the Beara Peninsula in Ireland, I was able to walk and climb the twelve miles over the mountain tops from Glengarrif to Adrigole. My next battle with disease was at Coombe Mill and happened because of my own carelessness.

On New Year's morning 1982 a hazy sun shone from a milky sky and the air temperature was close to –5° C. It seemed a good day to move a load of logs from the pile near the barn. For small jobs like this, I used a small farm tractor made by the Japanese firm, Iseki. I think they had built it for use in rice fields and it was unusual in having a 4-wheel drive. As I drove near the barn, the tractor suddenly slipped on a patch of ice and moved, crab-like, sideways. It fell over the edge of the track and out onto a steep down-going slope of grass and rocks. It turned over once, then again, and stopped precariously on the slope. I was pinned beneath the tractor by the steering-wheel. There was no roll-bar on this tiny tractor. I turned off the engine and with what seemed a vast effort, dragged myself from underneath the steering wheel. Later I found that the force transmitted through my abdomen to the ground bent the wheel itself. I had a feeling that something was wrong, and felt shocked, but I could still walk around and move without pain. I walked over to where Helen was sitting in her golf-cart. I asked if she could see anything wrong with me, anything
out of place. ‘Is my back all right?' I asked. ‘What have you done?' she said, and I explained what had happened with the tractor. In her usual calm and unexcited way she commented, ‘Your jacket is torn right through.'

I decided to telephone our GP and ask his advice, but I had reckoned without the British bank holiday on which days everything stops, even to a large extent the National Health Service. This is especially true of Christmas or New Year's Day. When I called, I reached a sleepy young doctor I did not know. I explained what had happened and told him that all seemed well but I felt odd and somewhat shocked. He dismissed me, saying, ‘You probably have a few bruises. Come and see me tomorrow if you have any further trouble.' Later that day, my thigh began to ache, enough to require relief from painkillers. I felt shivery and nauseous. A local schoolmaster who was visiting at the time said, foolishly, ‘Ah, you have delayed shock.' Like an idiot, and perhaps because I was still dazed, I took his amateur diagnosis as correct. Certainly, the pain passed away in a few hours. Next day I felt well enough to carry on without bothering my GP again. I now know that the accident had so damaged my left kidney that it never functioned again. There is a wonderful redundancy in our body parts and, unless we are contemplating some extreme trial, like crossing the Sahara with a minimum water supply, we do not need two kidneys. One will do, as many people living now who have donated one will know, and it seems to be true even of the brain. There are many carrying on useful lives, even holding down demanding professional jobs, with a third of a brain or less. The loss of a kidney did not seem to bother me, but looking back, I realize that during the next few months I was less active.

The next mishap occurred in early April. I was then a member of the governing council of the Marine Biological Association (MBA), and I was attending the Annual General Meeting at their wonderful old building at Plymouth, part of a fort called the Citadel that stands overlooking the sea at the east end of the green that is the Hoe. The Director of the MBA, Sir Eric Denton, invited me to dinner at his home in St Germans, a few miles west of Plymouth, and after the afternoon session, I walked back to my hotel, the Duke of Cornwall, changed, and at 6 pm drove across the Tamar Bridge from Plymouth into Cornwall and St Germans. Eric and Nancy Denton lived in a beautiful old house, set back from the village road, and immersed in the shrubbery of their well-kept garden. The Dentons had that wonderful
capacity to make their guests feel wanted and at home, and we met in their sitting room—a large and gracious room made comfortable by two vast settees placed on either side of the fireplace. It was so comfortable that I felt as if I were sitting tucked up with my friends in a giant feather bed. Dinner was the best that Devon could provide, which means plenty of cream, and I remember having a second helping of Nancy's trifle, which was very rich indeed. Normally I eat sparsely, but on special occasions such as this, I have always felt that one should enjoy treats and break the rules. It was a marvellous evening and we talked of everything, from cabbages to kings, until about 10.30, when we departed and I drove back to Plymouth and to the Duke of Cornwall Hotel in a warm and pleasant mood. I parked in the side street outside the hotel and began to walk back the few yards to the front entrance. As I climbed the first steps, my angina hit me extra hard. I felt in my pocket for trinitrin tablets and then realized that they were in my bedroom. To my dismay, the lift was out of action, and, as I slowly climbed the two floors to my bedroom, the pain grew worse and had a crushing intensity, something I had read about but never before felt. I began to fear that my coronary artery was now completely blocked, but somehow I reached my room, took a trinitrin tablet, and lay on the bed thinking ‘If it doesn't ease in sixty seconds, I'll telephone for help.' I waited, and it went away. I was relieved, thinking that however bad, it was still an angina, not a blockage. I undressed and slept the night through.

I joined the other MBA Council Members for breakfast. It was difficult to believe as I chatted with them, my fears of the night before. After breakfast as I climbed the stairs to my room—the lift still did not work—the angina came back as it had the night before. This time the pain appeared after no more than a few steps, it seemed, but the blessed drug trinitrin worked its usual magic, and my mind turned to the morning ahead: the final stage of the MBA meeting. I remember sitting in the large dining room on the top floor of the MBA laboratory, with its fine view of Plymouth harbour, Drake's Island and beyond it the sea approaches to Plymouth. The Oxford physiologist, JZ Young, our President, effortlessly guided the meeting through its course. He was a great story-teller and extemporizer and he kept the meeting moving on, like some amiable dog herding us sheep, with instructive barks and little nudges, in his chosen direction. I was to wish for these powers when a few years later I took over as President. He, Sir Eric Denton, and Sir John Gray were essential figures of the
Plymouth laboratories of those days, and represented the strength and excellence of science in England.