Deep inside Heidi’s body, there was a gruesome unseen reason for the easing of her stomach pain:
The reason that the pain had stopped is that my intestine was dying off – and as it rots, it kills off the nerves that cause the pain. There I was thinking, ‘Oh good, it’s gone off a bit.’ I remember the roof of my mouth was covered in this sort of slime, and I couldn’t get warm. That was the beginning of sepsis.
Wet gangrene was spreading along her small intestine, killing nerves and infecting her blood. Heidi was slowly starting to die. On Monday morning, our childminder Janet turned up to look after our son. She left Heidi in bed and brought her some mint tea. Heidi couldn’t touch it.
It was now twenty-four hours since we’d seen the doctor, and clearly Heidi was worse. I was getting agitated. It wasn’t right, and I knew it. Yet I still didn’t call the doctor out.
Why not? Was I a complete idiot? Maybe. All I can say is that when you’re in such a situation, the wildly unlikely nightmare is hard to imagine and harder to embrace. I had no experience to draw on, and I was still young enough to believe that such tragedies are things that happen to other people. Yet there was another element too – something that would prove almost catastrophic. Heidi is incredibly stoical in the face of illness, something she combines with a very strong dislike of excessive fuss. She hates to put people out, and has a strong will – something I love her dearly for. It means that when she decides on a course of action, it’s very hard to dissuade her.
Yet on that Monday those characteristics had combined into a dangerous form of delay. Heidi – though profoundly ill and feverish – still insisted that her condition was something that could be endured, and that it would all pass. She didn’t want to bother the locum again, and waved away the idea. I hadn’t yet reached that stage of grim resolution that would override her self-diagnosis. If Heidi said she was okay, then she must be. I trusted her with my life. Trouble was, it wasn’t my life that was in danger …
By Monday night, things finally snapped. Heidi had been in bed all day. I locked up the house and came upstairs. It was around midnight. When I arrived in the bedroom, I was shocked by her condition. Heidi recalls the moment:
I remember you looking at me. My hands were really cold and apparently my lips were blue. You said, ‘Look, are you better or are you worse? Because if you’re not better then I’m calling the doctor again.’ You were frustrated with me – agitated. Pacing around. I kept saying, ‘I’ll be fine. I just want to sleep …’
Heidi went off to the toilet to be sick again. I sat in bed in an agony of confusion and rising concern. When Heidi arrived back at our bedroom door she was crawling on her hands and knees, tears rolling down her face. She didn’t even have the energy to climb back into bed.
That was the moment the veil finally lifted. The moment I finally stopped listening and started doing something. It was the moment that probably saved Heidi’s life.
I telephoned the locum immediately. A different locum answered. I explained Heidi’s condition and the previous doctor’s insufficient advice. By now the floodgates of my agitation had opened into frustrated anger. The locum – doubtless busy with a dozen other urgent calls – felt the need to interrogate me further, lest I be wasting valuable time. ‘Look, exactly how ill is she?’ he said. I said nothing, but simply held out the telephone receiver towards our nearby bedroom. At that moment, my wife was giving out a chilling scream of pain that rang around the house. I put the receiver back to my ear. There was a stunned silence on the other end. ‘I’ll be over right away,’ he said. The doctor arrived and examined her, this time listening for sounds of abdominal movement. When he’d finished, he said to her: ‘You’re very, very poorly. There are no bowel sounds – you have peritonitis, but we don’t know what’s causing it. You have to go to hospital, and I’m going to stay until the ambulance comes.’
I asked the doctor what it could be. ‘If you’re lucky it’s a burst appendix.’ I remembered that such a malady had delayed Edward VII’s coronation, and very nearly killed him. It didn’t seem such a lucky thing to wish for.
Janet arrived to look after Dominic just as the ambulance pulled up, the mute blue lights bringing the neighbours to their windows. We got to A&E at around one or two in the morning. They were waiting for us. Heidi was wheeled to a cubicle and the nurse took a sample from her:
I remember doing the urine sample, and it was a deep, dark red – I’ve never seen anything like it. I remember thinking, ‘That’s not right …’
Nevertheless, Heidi clung to a strange and touching hope, based on the date:
It’s 2 March, I thought. It’s the anniversary of David’s birthday. It’s a lucky day.
The nurse fetched some pethidine to give Heidi her first relief from pain since her malady had set in. Heidi drifted in and out of consciousness as we waited for her condition to be diagnosed and prioritised. A junior houseman arrived – newly qualified and courteous. He examined Heidi, and quickly fetched the senior houseman – an irrepressibly bright and enthusiastic practitioner called Mathew – who could barely disguise his relish for the challenges of his onerous job, despite hours without sleep.
‘We’ve got your tests back, and there really is something on,’ said Mathew. ‘You’ve got peritonitis, and your white blood cell count is off the charts. We’re going to have to send for the registrar.’
The registrar was woken from his sleep – just one hour of sleep after a hundred-hour shift, we later heard – and he gently pressed his hand onto Heidi’s abdomen. When the pressure was released, Heidi screamed with the pain.
‘We’ll have to operate,’ he said. ‘We need to open you up to find out what’s going on.’
At about four in the morning Heidi was wheeled through to the operating theatre on an upstairs floor. I followed on – as redundant as I was in the delivery room a year before, but still wanting to be all the things I could for her. It was the junior houseman, Mathew and the registrar himself who pushed Heidi’s trolley – no porters being around at that unearthly hour. She’d never have more qualified attendants in her life.
When we finally reached the doors to the theatre, the registrar quickly produced the necessary consent forms for Heidi to sign. But something on the form made her hesitate.
‘I don’t want a colostomy,’ she said.
‘Heidi …’
‘I won’t sign.’ She was quite resolute.
‘Sometimes it’s the price of life, I’m afraid,’ said the registrar.
‘No. I won’t do it,’ said Heidi.
I shared a helpless look with him.
‘How about if I put this …’ said the registrar. He drew a little symbol on the form.
‘This means that we can open you up and … proceed as necessary.’
The compromise seemed to satisfy Heidi. She signed. I breathed a sigh. See what I mean about a strong will?
Then it was time. As far as I could go. I gripped her hand before she was wheeled away from me through the swinging doors of the operating theatre. My girl. My life. I’d first met her through the doors of a theatre. Would I leave her the same way? I watched her disappear amongst the scrubs and the harsh lights. The doors swung closed.
Mathew stayed behind a moment with me. ‘Go home,’ he said. ‘Try to get some rest. We’ll ring you when she’s out.’
‘How long will it be?’
Mathew thought before he answered.
‘We don’t know for sure. It’s exploratory. If it’s something relatively fixable like an appendix, we should be done in two hours or so. If it’s longer than a couple of hours, it means … something else.’
‘Something else’. My mind tried to comprehend the horror crouching behind the merciful euphemism. Perhaps a rampant tumour. A vital organ obliterated, her body doomed and inoperable. My eyes fixed on the clock. It was four in the morning.
Two hours or so. Relatively fixable was two hours or so. Six-thirty.
I drove home in a daze through the
black dawn. When I arrived back, the house had already started filling with relatives who’d heard the news. Dominic was up. My motherin-law had arrived in the night and needed a bed. I gave her mine. I set up a camp bed for myself in Heidi’s study and lay down, sleepless, to wait for the telephone to ring. I can remember staring at her bookcase as I lay there. It contained all of her favourite literature – her poetry, her plays, her university readers. Her life in coloured spines and copperplate titles.
Relatively fixable was up to two hours. Six-thirty. I looked at my watch. It wasn’t quite five. I breathed deeply. I stared at the copperplated spines and waited.
When the telephone finally rang, it was eleven in the morning. Seven hours later.
Something else.
Something very else.
The nurse was polite, but gave no information except to say that Heidi was out of surgery and I would be told more when I arrived at the hospital. As I drove there I tried to comprehend what had happened. What they might have found. What it might mean for her future. If she had a future.
A nurse greeted me at the ward entrance, kind but reserved. ‘I’ll go and get the houseman,’ she said. The ward was now full of daylight and activity. People brushing past me, busy staff, smiling visitors. Complainers. People having ordinary days. How I wished I was having an ordinary day.
Mathew appeared with the nurse. I smiled hopefully, but he assumed a professional distance from the enthusiasm and fellowship of hours before. ‘Let’s find somewhere where we can talk,’ he said. He and the nurse led me down the corridor to find an available side room where we could be alone.
This was it. I was in that scene I’d watched in a thousand medical dramas. They take the next of kin into a side room to tell them the bad news. This was now my part. A part I’d never auditioned for. How will I play it?
I followed them, unable to breathe. Dragonfly hope flapping its wings desperately against my ribcage. The nurse tried the first room, but it was occupied. Then another – that too was full. We continued along the corridor, the ghastly farce of it stretched out. Eventually we came to a small stockroom. The nurse showed me in.
The room was piled with cardboard boxes full of medical supplies. There was barely room for the three of us to fit. Mathew and I sat on the boxes while the nurse stayed on her feet. There was a moment’s pause. I sat there – ears ringing – waiting for the inevitable, terrible, life-changing words.
‘Well …’ said Mathew. ‘First I just want to say that your wife is a very, very brave and strong woman. Quite extraordinary.’
‘Is’. He said ‘is’. Present tense. Hope like frail filigree.
‘Is she … okay?’ I whispered.
He looked exhausted. ‘The surgery was very long and complex. When we opened her up, we discovered that her small bowel had become constricted and blocked by earlier scar tissue. A large section had become necrotic – gangrenous. The smell was …’
After a moment he continued, professional detachment slicing through the olfactory memory. Their first approach had been to remove about seventy-five centimetres of Heidi’s necrotic small intestine and attempt to reattach the healthy portions of it, but it didn’t work. So then they performed a more substantial right hemicolectomy – removing the existing junction point between her small and large intestines, and then reconnecting the remaining small intestine directly to a newly reduced section of her large intestine.
He took out a Biro and a piece of paper from his pocket and sketched out a drawing of what they’d done. I saw tubes, and cuts, and curling sections of organs and removed appendages. I didn’t understand and couldn’t absorb it.
‘But … is she okay?’
Mathew nodded kindly. ‘She’s recovering in a special-care ward. But she’s still extremely ill. She has peritonitis, and severe septic shock. She was very close to death. The operation was a success, but there’s a real risk of further infection. She’s not out of trouble yet.’
My poor girl. So much to battle. So alone. Mathew must have seen my eyes brimming. He leaned in and smiled encouragement.
‘She’s strong, your wife. Stronger than any of us expected.’
‘Has she got a colostomy?’ I asked. I couldn’t give a damn if she did or didn’t. I just wanted to tell her first, if necessary. Console her in some way. Ease her lonely courage.
Mathew smiled wider, remembering our conversation in the night. ‘No. We managed to avoid it. I expect she’ll be pleased with us for that.’
*
The next thing I remember is the feeling of them putting the cannula in my bladder. I remember shouting, ‘I’m awake!’ and there was a sudden flurry around my bed. My eyes were still closed. I was wheeled into the recovery room, and I heard a voice say, ‘This woman has had very considerable bowel surgery – we’re waiting for a better bed for her.’ I opened my eyes. I saw the clock on the wall saying ten forty-five. I was lucid enough to do the sum in my head. Seven hours. I’d been in there for seven hours …
Heidi lay waiting in the recovery room until a bed became available:
There was a poor little child on the bed next to me covered in bandages. He was crying and crying. I remember trying to reach out my hand to console him. The nurse said, ‘Heidi, don’t worry about that now, just press this.’ It was a morphine dispenser. I didn’t have the strength to press it, so she did it for me. I don’t remember anything after that. Not until much later.
*
The progressive care ward was a dim, low-ceilinged room with no more than half a dozen beds. Heidi’s bed was near the window, but there was no view to speak of. Not that it mattered now. When I entered the room and saw her, it took me a second to adjust to the shock of it. Heidi looked desperately frail – pale as death. It was difficult to see her beneath the mass of tubes and machines crowded in and around her body.
I had a catheter for urine, an oxygen mask, morphine, saline, antibiotics, and they put a nasogastric tube up my nose and down my throat to drain the bile and prevent me from vomiting. The nurses would drain it off at regular intervals. There were so many wires and bags, I thought I must have had a colostomy, but by that point I didn’t care.
She was heavily sedated, which was a mercy. It was the first peace she’d known for days, and her body was still under siege. Heidi would be there with me one moment, and then drift off the next. Then she’d wake again, and it was like she was seeing me for the very first time. The memory of her look of joy and surprise when she saw me sitting by her bed still breaks my heart.
Her close family came to see her over the twenty-four hours, and the shock at her appearance was barely concealed. My son was brought in and held up to the bed. He was too young to know the momentous fight taking place inside his mother, and was happily distracted by the sterile playground of the ward. Heidi tried to smile, her body so weak she could hardly move it. There were brave grins and bonhomie by her bedside, but we all knew the battle wasn’t over. And the nights to come were the worst part of it:
The nights were just so long. The effects of the morphine mixed with fever were awful. Time would stretch out. I’d have frightening dreams, full of battles, fighting wars. I suppose I was metaphorically under attack – my subconscious telling me how ill I really was. The dreams would seem to last an age – but when I woke from them and looked at the clock, only fifteen minutes would have passed. It was torture.
You look at clocks in all the significant medical moments of your life. When you’re in labour, you look at the clock. When you’re really ill, you look at the clock. It’s like sailors navigating by stars – we chart our way through the crises of our lives by time. It wasn’t the blurring of night and day so much as the extension of day and night – the despair of seeing your world shrinking to the hands of a clock. I would live for the moment when your face came around the door.
I knew it – and I was determined to make my face as constant as possible. That was my sole purpose now. In those first days my life became entirely focused on t
hat ward to the exclusion of the world outside. My son was being cared for by relatives, so I could devote myself completely to Heidi. I’d come to the hospital as early as I could, and simply sit there. All day. Staring at my wife while she slept. Watching her dreaming fitfully – so that when she woke each quarter-hour she’d see my face. She’d smile with relief, and know she wasn’t alone. The nurses were wonderful – turning a blind eye to my constant presence out of visiting hours.
Despite the terrible circumstances, these days were a time I treasure. It’s a great privilege to experience the full banishment of one’s own concerns, to mute the endless droning voice of shallow self-interest in one’s mind. I watched her face for hours and hours. Frail and brave and beautiful. I felt a love for her that still astonishes me with its force. There was no outside. No condition on the moment. She was everything to me – and I could feel it as a physical thing. I couldn’t live without her. It was no longer a romantic notion, but a material fact. I didn’t want to. And each hour that this wasn’t the case was an hour stolen from a future I didn’t want to imagine.
One day rolled by. Then another. The medical staff would visit her frequently, checking her temperature, hoping that the surgery would hold, and that the fever wouldn’t overwhelm their best efforts.
She held on.
On the third day, Heidi remembers the nurses coming to take her for a shower. It was the first wash she’d had for days, but it would involve her first serious movement since the operation:
They put me in a wheelchair to take me there, and then they placed me on a plastic chair under the shower head. I could barely move without assistance. It was two young women in their early twenties – I was mid-thirties by this time – and that was the moment I realised what real nursing was about, as opposed to medicine.
Heidi’s eyes fill with tears:
They said, ‘We’re going to do this together, Heidi, because it’ll make it quicker for you, as you can’t be out of bed for long. If you can just hold your catheter bag and your nasogastric bag, we’ll do the rest.’ So I held those two bags in my hands containing my bodily fluids, while they gently washed me. Just to feel that water on my head and shoulders – the gentleness with which they did it. It was just incredible.
Flesh and Blood Page 25
