Flesh and Blood

by Stephen McGann

  Joseph and John were the McGann brothers nobody would ever know. Their names would never appear in theatre lights or film credits. Yet they were the first. The eldest. The lost boys. Now found.

  To my mother, those infants were so much more. They held in their little twin ribs all of the hopes she’d once harboured for her own young life – a life that had been snatched away before she’d even had a chance to grieve for it. She’d been thrust into a marriage lacking in the warmth and respect her love deserved, and had been denied the chance to cradle her dreams in a way that might be cherished by her husband.

  Yet now, at last, she was free. Free to mourn her past, and free to know the peace that comes from the respectful commemoration of a life’s passing. My dad had never managed to suppress my mum’s quiet, steely spirit. And now he was gone, she’d returned to the place where he’d buried her lost innocence. She’d returned to where her lonely pain lay soil-stained and forgotten. She exhumed it. She took that brave young woman in her old, wise arms and cradled her with all the love she’d been denied. She called that young woman’s courage by its name. Made it hers again.

  There are wounds we can see, and wounds we can’t – traumas that we treat, and traumas we prefer to conceal. But all of these maladies must be attended to with equal care if the resulting infection is not to destroy our life and health.

  *

  * http://www.who.int/­topics/­injuries/­en/

  5

  BREATHLESSNESS

  Breathlessness n.

  1. A constraint to normal respiratory function caused by insufficient quantities of oxygen in the circulating blood.

  2. Emotionally induced suspension of regular breathing due to excitement, anticipation, fear or tension.

  MEDICINE

  Breath is the first evidence of life gasping from the womb, and the final proof of our expiry. It is so central to the experience and sustenance of life that we describe it in language ranging from the most detailed medical physiology to the highest human aesthetics. The functions of breathing aid the most fundamental chemical processes in the human body, while the mastery and control of breathing communicate the most profound expressions of human culture through the operatic and dramatic arts. The human voice – the words, tones and articulated emotions that form a bridge between our internal experience of life and the collective family of human society – can’t function without the flow and regulation of human breath through our vocal chords. If we are what we say, then human breathing is the essential rhythmic beat of our projected selves.

  Medically, the action of breathing with our lungs – known as pulmonary ventilation – is a key part of our respiratory system. This is a collection of biological and chemical processes that deliver oxygen to our cells to help provide energy for essential functions and remove unwanted carbon dioxide. Pulmonary ventilation consists of an inhalation and exhalation phase, and is mainly controlled by an internal dome-shaped muscle sitting just below the lungs and above the abdomen called the diaphragm. When we breathe in, our diaphragm contracts downwards, spreading out our ribs and creating a cavity in our lungs into which air rushes via the mouth and nasal passages. The air progresses down past our larynx, through the windpipe or trachea, before branching off into each lung via the bronchus tubes of the bronchial tree – so-called because the incoming air is diverted down ever-tinier branches in the lungs until it reaches the alveoli – millions of microscopic junction points where oxygen in the air is transferred to our bloodstream for carrying to our cells. As the oxygen passes one way, waste carbon dioxide from our bodies passes back to our lungs. When we exhale, our diaphragm relaxes, the ribs spring back to their previous position and this gas is expelled. In all, about a sixth of the air capacity in our lungs is exchanged with each breath. In normal, relaxed circumstances we perform this cycle entirely unconsciously, up to twenty times every minute.

  But, of course, not everything we experience in life is normal, relaxed or unconscious. During heavy exercise, other torso muscles aid the diaphragm to expand lung capacity and suck in much-needed oxygen to cope with increased demand. At high altitudes, our breathing rate can increase to compensate for the paucity of oxygen in the air. And it’s not only unconscious processes that affect breathing. The automatic chemical exchanges that govern respiration can be overridden by conscious and emotion-based human behaviours. If someone to whom we’re attracted walks into the room, we might experience an increase in the rapidity of our breathing. If we then wished to speak to them – or were even inspired to burst into romantic song – we could override control of exhalation to make our lungs funnel air pressure to the larynx and induce sound vibration in our vocal chords. This would combine with modifications to our vocal tract, lips, tongue and jaw to sing notes, articulate words or express feelings: the lovelorn sigh, the lover’s moan, the joyous laugh.

  Our pulmonary ventilation system isn’t just a courier for vital gases. It’s the conveyor of our deepest thoughts and feelings – the primary mechanism for human expression and identity. It sustains and conveys human personality and health through interaction with the environment. When this mechanism goes wrong, it can also be an indicator of both physical and emotional malady.

  Perhaps the best-known medical problems relating to pulmonary ventilation are those concerned with constriction of lung capacity, or breathlessness. One of the most widespread of these respiratory conditions is asthma. Asthma is an inflammatory disease affecting the airways of the lungs. When these become inflamed the breathing can be greatly obstructed, sometimes dangerously so. The chest feels constricted and physical energy is compromised. In the most severe cases it can be fatal, with a quarter of a million deaths worldwide every year. The causes of asthma are complex; there is no cure, and the severity of symptoms can vary from patient to patient. Most often it involves a trigger reaction to common allergens like dust and pollen, or aggravators like pollution or exercise. It strikes many healthy children in their early years of development, leaving them wheezing and weakened.

  The causes and consequences of asthma in childhood can also have a psychological and social dimension. Pre-existing anxiety or stress can exacerbate the physical symptoms of asthma, while the inevitable curtailing of group sporting activities or frequent absences from school may lead to isolation from peers and arrested social development. If a child has severe asthma early in life, forced to spend extended periods in hospital, then how will they be able to engage fully in the intentionally breathless and highly physical world of the childhood street, playground and school?

  Having asthma can also make the young sufferer more prone to other serious pulmonary maladies. A chronic swelling and sensitivity of the airways can place one at increased risk of dangerous infections like pneumonia. Pneumonia is an acute bacterial or viral infection of the alveoli in the lungs, and in severe cases it requires immediate hospitalisation. It causes four million deaths worldwide every year.

  Onset of pneumonia is often rapid; presenting within one or two days. It might start as a simple upper respiratory tract infection like a sore throat or sinus infection, but it soon moves into the lungs, where inflammation takes hold and fluid begins to collect. It produces a thick, congested cough and a suffocating feeling of breathlessness. The very young and very old are at particular risk of pneumonia, and help must be sought immediately if their life is to be preserved. Thankfully, medicine now has the means to help. Before the antibiotic age, pneumonia was such an efficient killer that in 1918 the eminent Canadian physician William Osler described it as the ‘captain of the men of death’.

  A traditional way to help patients suffering from a condition like pneumonia is to use an oxygen tent. This was invented by French physician Charles Michel at the turn of the twentieth century and consists of a tent-like covering placed over the hospital bed to seal the patient inside a specially controlled breathing environment. Oxygen is pumped into the tent, while high humidity is maintained in order to prevent the lungs drying out. The patient�
��s depleted lungs are now able to receive more oxygen with each constricted breath.

  If an asthmatic child can survive bouts of respiratory illness like pneumonia then the long-term prognosis is often good. Half the cases of asthma affecting young children will clear up within a decade. As these children become teenagers, their lungs will clear and become more responsive to exercise. The profound hormonal changes also affecting these young people will soon lead to new and more thrilling lung constrictions: the breath-held thrill of a first kiss, the projected voice in the school play, the lung-bursting joy of a victorious sports-day race. Unfortunately, those fresh lungs can also be compromised by youthful complacency. If a teenager is unwise and easily led, they might inflict serious damage on their breathing by cigarette smoking.

  Smoking amongst teenagers usually begins as a wheezing passport to peer-group conformity, yet the effects are felt long after the peer group has disbanded. Most adult smokers started in their teens, and half of them will go on to be killed by it. Damage to the respiratory system from cigarette smoking begins immediately, as a result of the damage caused to our lungs’ natural cleansing mechanism called the respiratory cilia. Cilia are tiny hair-like projections protruding from our bronchus tubes which help to sweep away foreign bodies and impurities from our lungs. The mucus we produce traps the dirt and dangerous organisms, while the cilia sweep them up to our mouths to be expelled. Cigarette smoking has an immediate suppressant effect on the functioning of these cilia. If we carry on smoking, the cilia will stop working altogether. This is the cause of the classic ‘smoker’s cough’, as the cilia can no longer expel the accumulated mucus that’s gathered in our chest. Yet this is only the start of our problems. A regular smoker’s breathing becomes increasingly congested, which leads to conditions like bronchitis and emphysema, the symptoms of which are breathlessness, fatigue and wheezing. Eventually, the damage can change the very cell structure of the lungs, leading to cancer. The shy young smoker, eager to belong, ends up as a lung-blackened statistic. Flaws in our youthful psychology can have a direct and physical effect on the quality of our breathing.

  The relationship between flawed human psychology and breathlessness is subtle and many-faceted. Anxiety conditions such as agoraphobia, for instance, can induce a profound breathlessness and panic in a sufferer without any physical or rational cause at all. Agoraphobia is an anxiety disorder in which a sufferer fears being exposed to public places where escape might be difficult, or help won’t be available if an attack sets in. Agoraphobia usually appears between the ages of eighteen and thirty-five, and affects up to 3.5 per cent of the population. A common misconception about agoraphobia is that it’s simply a fear of open spaces. The truth is more complex. The term derives from the Greek word agora, meaning a city’s public gathering place – an indication that agoraphobia’s causes are more social than spatial.

  When a sufferer is exposed to a public place or situation in which they feel vulnerable, it triggers feelings of dizziness, nausea or faintness – and a sensation of suffocation that leads to an increase in the rapidity of breathing known as hyperventilation. Hyperventilation removes too much carbon dioxide from the blood via the lungs, which then upsets the acid–alkaline balance in the body. This in turn adds to the agoraphobic’s feelings of dizziness – a vicious cycle that leaves them in a spiral of increasing panic. The sufferer flees back to a place of social safety such as their home and is subsequently fearful of revisiting the place or situation that induced the initial anxiety. Future events can induce a panic simply by their mental anticipation, sparked by the painful memory of that former incident. This interesting phenomenon, known as ‘fear of the fear’, means that once agoraphobia is initiated it can become a self-perpetuating condition – one that anticipates terror more than it experiences it. The malfunctioning mind becomes a prison for the body.

  Agoraphobia can afflict a sufferer for months, years, or in some cases a lifetime. Sufferers are confined to their homes, with any journey outside involving panic attacks, breathlessness and feelings of suffocation. These attacks can occur in the most innocuous and enjoyable of public places – in bars, restaurants or parks – turning places of rest and leisure into places of danger. Worse, if the sufferer’s life or work involves communicating directly with others, such as public speaking or performing arts, then this becomes a source of terrified anxiety. The idea of walking onto a public stage in the critical view of hundreds of strangers is a living nightmare for any agoraphobic.

  Agoraphobia is slow to shift once established. How do we tell our protective but malfunctioning mind that it has nothing to fear but itself? Treatments for agoraphobia require us to unpick and reprogramme the internal cognition that has short-circuited normal behaviour and responses. One effective strategy is to expose oneself by increasing degrees to the conditions that induce panic. Over time, one becomes less and less susceptible – eventually retraining the brain not to associate those places and situations with fear.

  For all of its fear and pain, the malady of my own teenage agoraphobia brought about one of the most positive experiences of my life. It taught me at a formative age about the power of the human mind and will – its ability to serve or constrain our best interests and intentions. It left me with a lifelong interest in neuroscience and the complex workings of the brain. It forced me to embrace my fragilities; not as shorthand characteristics, but as the valuable constituents of a larger and more complex personality. My malady became a teacher, a catalyst for empathy and the source of a wiser strength. The thing that stopped my teenage breath eventually became the means for me to breathe more clearly in adulthood.

  Breathing is an exquisite mingling of body, mind and spirit that sustains and conveys the human personality through an interaction with our environment.

  Breathing is the sound our humanity makes.

  HISTORY

  Learning to Breathe: The McGann family, 1960–1983

  The winter of late 1962 and early 1963 was known as ‘the Big Freeze’. It was an extended period of arctic conditions that lasted well into the spring. Huge snowdrifts blocked streets. The sea froze. In a small terraced house in Birstall Road, Liverpool, a heavily pregnant Clare McGann sat out the cold with her three young children, Joseph, Paul and Mark. Her husband Joe trekked through the snow to his shiftwork at a copper factory on the outskirts of the city. Clare had given birth to three kids in under five years. Now there was another. Soon she’d add a fifth. She inhaled motherhood like fresh air. It energised her. It surprised her with its force. It motivated her in ways the changing world couldn’t yet see.

  As the Big Freeze went into February, Clare McGann went into labour. The midwife was called. By the time the woman had struggled on her bicycle through drifted snow her mood was less than charitable. My mum told me that she was grumpy throughout my delivery. It’s funny to think that the baby she delivered would later play a doctor in a television drama extolling the bedside virtues of sixties bicycling midwives, yet his own birth would be afforded no such virtue. My first breath in the world was a wailed apology for any inconvenience caused. That’s showbiz.

  When my birth was announced there were apparently dissatisfied murmurings from the in-laws. They were impatient for a girl. Mum’s response was iron love smelted in defiance. ‘You were beautiful!’ she said. ‘Perfect just as you were – and you were mine.’

  To be honest, what I looked like when I was born can politely be described as ‘bonny’. Less politely, it looked as if I’d been inflated like a balloon in the hands of an overenthusiastic children’s entertainer. I was nine and a half pounds in weight – the heaviest child my mother had given birth to. The modern average is seven and a half. The mothers around my pram cooed delightedly. ‘Ooh, what a bonny baby!’ The word was synonymous with ‘healthy’. I wear that title with pride because a child that was bonny was a child that was taking its food – growing strong. At the turn of the twentieth century, 145 children in every thousand were dying in Britain before the
y reached their first birthday, according to the Office for National Statistics.* The post-war welfare state had reduced this number to fewer than thirty, yet the bitter memory of personal loss was still carried as inherited fear in those mothers’ heads. To eat was to thrive.

  The McGanns were thriving, if modestly. It was a hundred years since they’d stepped onto the Liverpool dockside from Ireland. For most of that century they’d merely subsisted – but now they were recipients of a system of nationalised health, welfare and education at the height of its post-war confidence: well funded, well regarded and fired by progressive zeal. For thwarted scholarship kids like Joe and Clare McGann, the system offered their children protections and opportunities that they’d been denied. They were going to grab them with both hands.

  The little terraced house we lived in was bought, not rented. Joe McGann was the first holder of a mortgage in our family’s history. The house had been purchased for the princely sum of seven hundred pounds – a serious undertaking for a factory worker in 1960. It had three modest bedrooms up a steep flight of stairs, a cramped living room, a front parlour, and a tiny kitchen that ran out into a back yard with an outside toilet. Away from the fireplace, and in the days before central heating, the house was freezing – a cold that penetrated the sheets and misted the windows, congesting our chests and stealing our breath. But it was ours. Our little piece of the world.

  My first few years of life were full of clear breath and sunshine. It would be more than two years until my sister Clare was born, and so for a time I had my mum’s undivided attention: a rare luxury in a family of our size. I never went to nursery, and so was the full recipient of Mum’s ecstatic zeal for parenting. I was introduced to the world through her shining eyes, and wouldn’t be exposed to the feral squint of the urban playground until I was five years old. Those times were idyllic, though I’ve often wondered if their warm insularity was a hindrance to me later on; a dependency on the breathless love and security of home that left me ill-prepared for the wider world and the changes it necessitated. Perhaps it was significant that my later teenage problems saw me running back in panic to the safety of that house. The redbrick womb that breathed for me when my life was at its zenith of simplicity – an umbilical bond that required no gasping breaths of courage or defiance.