Back Online 23-01-2020

I've been way for a while, having had a triple heart bypass in February of last year. Here is the text of an article I wrote for Times about my experience, which includes the material they cut and doubtless some of the typos they corrected. Since writing the article my physical fitness has increased steadily, but my brain remained foggy thanks to 'pump head' / post-perfusion syndrome, a common but poorly understood range of cognitive problems caused (probably - though there is some distpue about this) by having been on a heart-lung machine. The only advice I got from medical professionals is that, whilst the evidence is entirely anecotal, most patients take a year to get over major surgery. Lo and behold, at 11 months after the operation, my mind was returned to me and I began writing again.

If you get to the end of the article... I did that run a few weeks ago.

"On 12th February this year I found myself in a bed in the Cardiology Department at the John Radcliffe Hospital in Oxford wired up to a heart monitor round the clock, waiting for a double heart-bypass. I’m 56, I’ve been a vegetarian for decades and I like few things more than running for two hours through unpeopled countryside, so this was the kind of adventure I wasn’t expecting for another twenty years at least. I now realise that I’m a very lucky man. I’d experienced no chest pain and no breathlessness and if it weren’t for a CT scan that showed up my severely narrowed coronary arteries I would sooner or later have collapsed on a remote section of the Thames footpath and not been found for a long time. I sent our friends a group email explaining all this and ended by saying, “Also: material!” because it’s one of the few career benefits available exclusively to writers and artists. Your partner walks out, your house burns down, you’re sent to prison… and it’s grist to the mill, which it isn’t for florists and pilots.

I was assigned to the surgeon Mr Farid and his team. As the days ticked by and I waited for an empty slot in his timetable so that I could have my sternum cut from top to bottom with a circular saw and my chest cranked open, it dawned on me that a gripping account of the experience required jeopardy and excitement, whereas for the sake of my sanity, my wife Sos’s sanity and the sanity of our teenage sons I had to remind myself repeatedly that despite its grisly nature this was one of the commonest and most successful operations in the world, that the risk was minimal and all being well I would, eventually, be fitter than I was three years ago. 

It is borderline compulsory after coming this close to dying to make the kind of inane, life-affirming statements you find painted onto pieces of driftwood on the walls of seaside holiday rental cottages. And perhaps I’m about to do just that, only more seriously and in greater detail. But I want to make some permanent record of how lucky I am. Not a retrospective revaluation of all the things I’d hitherto taken for granted but a list of all the good things made manifest during one of the most difficult periods in my family’s life, from that life-saving CT scan, which seemed a mere formality at the time, to where I am now, sitting on the sofa in two jumpers, full of drugs, the big wounds scabbing over, and finding myself, when I’m not pole-axed by fatigue, able to string a few words together.

This is, quite literally, a counting of my blessings.

Blind Luck. I came close to killing myself accidentally on numerous occasions over the past eighteen months. Initially I was unable to run up steep hills, then unable to run up small hills, then unable to run on the flat without stopping every few minutes. I felt no discomfort, only the strange sensation of someone squeezing my fuel-line then letting it go a minute or so later, a sensation that turned out to be an eerily accurate description of what was happening inside my chest. Ignorant of the risk I was running, I thought I could solve the problem by sheer force of will, and, indeed, if I persevered with a combination of running and walking for 40 minutes or so then the fuel line opened up and I could run properly. My GP, too, was puzzled at first. Might it be asthma? A hiatus hernia?  Nevertheless, he sent me for that CT scan just to be sure. So thank you, Dr Schuman. Along with Mr Farid and his team, I owe you my life.

The NHS. This bears repeating ad nauseam. Our hospitals have been aggressively underfunded for a long time. Nevertheless overworked and underpaid staff mostly provide an amazing service with kindness and patience. But the patience and the kindness are incidental to what makes our health service one of the most generous, efficient and humane organisations ever created. If you pay tax then you helped save my life. In return, the tax I pay may help save your life one day. And the tax we both pay will help save the lives of those who are too poor to pay any tax at all. I do not have the words to express how profoundly grateful I am to live in a society in which we look after one another in this way.

The absence of fear. I have lived, for decades, with what is, at long last, a relatively well-medicated mood disorder. Bipolar 2 is what it says on the tin, though I rarely use the phrase, not least because it claims too much commonality with Bipolar 1 which is a merciless destroyer of lives. Nevertheless, besides the constant emotional rollercoaster, it has torn two large chunks from my life: year-long breakdowns in which I knew, beyond a shadow of a doubt, that I was dying, in the first instance of multiple sclerosis and in the second of skin cancer. During the latter period I could neither look at myself in a mirror, nor wear t-shirts and shorts, nor take a shower with the lights on. I was afraid in the way you might be afraid if you were trapped inside a sinking boat in the middle of the Atlantic, except that the boat was my body and the fear was relentless, day after day, week after week, month after month. But when, three months ago, I found myself afflicted by a genuinely life-threatening condition I felt only the occasional flutter of panic and occasional waves of melancholy resignation.

Lying in hospital for ten days, it was the profound strangeness of what was about to happen that occupied me most. While under general anaesthetic I would, to all intents and purposes, cease to exist: no dreams, no sense of time passing. And the question of whether I lived or died would be settled in my absence. I would carry on existing afterwards, or I wouldn’t.

Before my angiogram I was rereading Jorge Luis Borges’ The Garden of Forking Pathswhich features a novel-cum-labyrinth created by the narrator’s ancestor Ts'ui Pên wherein each time a character is forced to take a decision time splits into several alternative futures, the plot branching over and over into an expanding multiverse where all possible outcomes exist. After the angiogram I looked up and saw, on a screen, an x-ray of my heart, that winter tree of vessels against the storm-grey of the heart. In the drug-muffled strangeness of the days after the operation these three things fused - the branches of the story, the branches of the tree, my temporary non-existence - so that even now when I cast my mind back to the operation I imagine myself entering the heart’s dark garden not knowing whether I am going to find the path which leads back to the light.

The reality was, of course, more mundane: 4mg of Temazepam; a kiss from Sos, a brief hullo to the anaesthetists, then I was emerging from a deep fog thinking, “That’s Sos’s silhouette. She’s had a haircut and it looks great.”

 People. One of the pleasures, for me at least, of being in an NHS hospital is finding myself in the company of a randomly selected group of people I might never meet in my insular daily life, from the surgeon who remembered me from school to the elderly man born into a family of twelve children who was given up by his parents and spent most of his childhood in the workhouse in Woodstock. A man whose bed was diagonally opposite mine on the cardiology ward worked in Southeast Asia and was going to be homeless if and when he was discharged after his heart operation.

Most of all I’ll remember the nurse Lisa, whose nine-year-old son Ashton had hypoplastic left heart syndrome. Ashton had undergone major surgery at birth and again at three and half years old. Lisa showed me some extraordinary photos of him after both operations. He now has a heart that uses only two chambers and is waiting for a transplant. Sos got me a copy of Curious Incidentfrom home, I drew a dead dog on the flyleaf, using red biro for the blood oozing from the forkholes, and sent it to Ashton via his mum. He sent me back a message, “Be brave and don’t worry,” and a double bypass really did seem for the rest of that day a very minor procedure.

Friends. I’ve always known that we had good friends, but I don’t think I’d ever fully understood how fortunate we are until we had them visit one after the other, in hospital then at home, as if our favourite people were passing in front of us on the Generation Gameconveyor belt (it would be invidious of me to say who was the fondue set and who the teasmaid). Several other patients had no visitors the entire time I was in hospital. 

Our friends brought flowers, cards, books, tea, dhal, biscuits, biryani, Czech matchbox covers, a personally hand-bound sketchbook, LRBs, a terrifying glossy magazine containing nothing but kitten pictures… Shortly after I was discharged my editor Clara Farmer and the head of design at Vintage, Suzanne Dean, came to Oxford with the first - and very beautiful - hardback copies of The Porpoise,which I will no longer be able to promote in person and about which I must be interviewed recumbent in my armchair like Barbara Cartland. Suzanne and Clara bought something else too, and I knew in my bones what it was when they handed me the box.

Eighteen months ago Isidro Ferrer, an artist and illustrator from Barcelona, made a small sculpture of a poodle from distressed black wood with a curving section of model train track for a tail. The object was photographed for the cover of the Vintage Classics edition of Curious. Suzanne had persuaded Isidro to let the object go. It’s sitting on the mantelpiece right now and it is one of the very few presents I’ve cried while opening. 

Music. Two commendations in this category. Autechre make experimental and doggedly uncommercial electronica with debts to hip-hop, musique concrète, and Stockhausen, among others. I’m 95% sure they’re not your cup of tea but I find their music gripping, seductive and often sublime, so I downloaded their latest four-disc album before going into hospital. The music is purely electronic; it therefore has no acoustic and conjures up no studio, no concert hall, no room of any kind. Rather it seems to occupy a place outside the physical world, so that sometimes I would drift off listening to it and picture machines of prodigious size moving slowly through the vacuum of deep space. In the days after the operation, I too seemed to occupy a place outside the physical world and the NTS Sessionsbecame the soundtrack of that peculiar journey.

My biggest debt of gratitude, however, is to The Appearance of Colour, a sweeping, melodic and very un-Autechre album by John Metcalfe. One night after the operation, compelled by a cocktail of machismo and poor judgement, I decided to try making it to breakfast without painkillers. At some point in the small hours the tube draining my partially collapsed lung shifted and I felt as if someone had pushed pieces of Lego into the gap between my lungs and rib-cage. I stuck my headphones in and called a nurse and The Appearance of Colourand the contents of that blessed blue syringe of oral morphine just about kept the pain at bay till daylight. When I listen to the album now it still has a fuzzy morphine glow to it, which is, I have to say, not unpleasant.

Modern Medicine. Heart surgery proper didn’t begin until the 1890s, a period during which the accompanying drugs sound almost as terrifying as the procedure itself: injections of strychnine; enemas of hot coffee and whiskey. Previously the heart had been seen by many as a spiritual as well as a physical organ and therefore inviolable. More practically it was an organ placed unhelpfully inside the ribcage, it jiggled constantly and reacted very badly to being interfered with. A hundred and twenty years later surgeons can operate inside the heart of an unborn child while it is still inside its mother’s womb. They routinely and self-effacingly describe their work as plumbing. It isn’t.  It’s borderline science fiction. That I could be sliced open, that an artery could be cut from my chest wall and be redirected to my heart, that a vein from my lower leg could be repurposed to make two new arteries to carry oxygenated blood between my aorta and my coronary arteries and that this could make me well again astonishes me on a daily, sometimes, an hourly, basis.

I’ve read two books about the heart and heart surgery since coming out of hospital: Heart - a Historyby Sandeep Jauhar and The Matter of the Heartby Thomas Morris - and I recommend both. I now know a little more about how and why I’m still alive. I won’t retell the story except to say that it involves many highly skilled doctors, some of them powered by near-pathological confidence and one or two by a reckless disregard for their own safety: the first man to put a catheter inside a human heart, chimney-sweep style via the artery in the wrist, was Werner Forssman in 1929 and the wrist and heart were his own; many dogs were operated on and died, not all of them in good ways; and many very ill patients agreed to experimental procedures knowing that they would probably not survive but that they might be able to help other people in the future.

There are four other contenders but the widely acknowledged inventor of the Coronary Artery Bypass Graft (the “cabbage” as it is known in-house) was the Argentinian surgeon René Favaloro and I mention him here partly in gratitude and partly because of the operatically sad end to his story. After helping save so many thousands of lives he returned to Argentina. The country was in recession and the medical foundation he set up found itself in deep financial trouble. In despair at a government that refused to help and institutions riddled with corruption, he put a bullet through his heart in a hotel room in Buenos Aires on 29th July 2000.

Sos. We didn’t need a near-death experience to make us aware of how we feel about each other. We’ve been unfashionably in love for 29 years. And in fact we’ve already done the near-death-experience, a road accident in the Black Mountains 16 years ago in which Sos, pregnant with our second son, very nearly died. On that occasion she did the physical trauma and I did the PTSD. We decided to swap this time. When she got the phone call to say that I was out of theatre five hours after our pre-med parting she cried, and laughed at herself for crying, and carried on doing both for the next two hours until I was breathing for myself and she was allowed to cycle to the John Radcliffe hospital still crying and laughing. Then I came round and saw her silhouette.

She visited me twice every day and quite apart from her company, she saved me from hospital food (anyone in favour of NHS privatisation should be made to dine exclusively on food provided by Carillion for a month). I suspect that those thermoses of pea and lime soup and butternut squash dhal were the best things anyone in that building ate while I was there.

The Thames. Some days I can do little more than stare at the wall. Indeed I’ve written this article as a list because I can only think in single paragraphs. In spite of this I feel unexpectedly robust. But the mood swings come back inevitably and sometimes those angry, churning lows coincide with days when I have no energy whatsoever and the combination is singularly unenjoyable. I wish I could turn to books but reading has always been impossible in that state of mind, and being a literary snob doesn’t help (I’m halfway through both Annie Ernaux’s The Yearsand Samanta Schweblin’s Mouthful of Birds, neither of which are wolf-downs). Trapped, the rain-sodden, wind-swept Icelandic TV crime series, has helped, as have Diazepam and iphone Scrabble, but they are only palliatives. If I can somehow get myself out of the front door, however, a walk along the banks of the Thames as it flows through Port Meadow never fails genuinely to lift my mood. It is, without a doubt, the most beautiful place inside an English ring-road: the space; the quiet; those majestic black poplars; Canada Geese; a Little Egret; sometimes a cormorant. Every time it blows the human complication away and returns me to my simpler canine self.

And as I’m writing this I realise how I am going to measure my recovery. My walks will get longer, to Kings Lock, to Swinford. When the scars have healed properly I’ll start to swim in the river again. Then I’ll run, a little further each week until I can get to Pinkhill Lock, then Farmoor Reservoir. One day I’ll run to Bablock Hythe, uphill to Cumnor, along the Chilswell Farm track and down to South HInksey. I’ll meet the Thames south of Oxford and close the loop by heading upriver to home. Nineteen miles. And I’ll be myself again."