In the Midst of Life

1986 ACUTE HEART FAILURE

To write about my own mother’s death is so painful that I wonder if I can do it at all. I have sat for hours at my desk with a pen and a blank page, and nothing comes but tears and regret. I have shut it out of my mind for twenty-five years, telling no one, unable to dwell on what happened, what might have happened, had I acted differently, what I could have done, should have done, what I did not do, did not know. For twenty-five years I have erased from my mind thoughts of the pain she must have suffered, her fear, her terror, and, worst of all, her anguish at being surrounded by strangers in the hour of her death, because I, her eldest daughter, was not there.

Who can write about their parents objectively? Not me, for sure. The relationship is too personal to be objective. I will say only that my mother loved life and everyone she met. She was full of fun and vitality. It was life-enhancing just to be with her. She was also exceedingly pretty.

In 1986 she was sixty-five and very popular. She had a host of friends, held constant luncheon, tea and dinner parties. She was a brilliant cook and a generous hostess. She swam regularly and enjoyed walking, gardening, and taking her grandchildren on outings. She enjoyed life, and appeared to be in excellent health.

She had arranged to meet some friends for a coffee morning, but did not turn up. They telephoned the house, but there was no reply, so one of them came to the house and knocked on the front door. No reply. The woman looked through the window and saw my mother lying unconscious on the sitting room floor. She immediately called the local hospital, an ambulance came, and my mother was rushed to Accident and Emergency and put straight into intensive care.

My sister and I were informed, and we both arrived as soon as we could. Our mother was attached to a defibrillator, an intravenous drip and other life-maintaining apparatus, with dials and monitors and flickering graphs and lights. The gentle hum of the machines was reassuring, in a way. My sister and I were both trained and qualified nurses, but no longer practising, and medicine had advanced so rapidly that neither of us had seen such hospital treatment, nor did we know what was going on. We were told that our mother had had an acute heart attack.

‘Acute’ is the word to understand, and acute heart failure is quite different from congestive heart failure, which is a slow and cumulative process of heart dysfunction, usually occurring in the elderly. Acute heart failure occurs in a second, with no warning, no history of ill health, and it often attacks relatively young people. There are many possible causes, but the most common is a sudden occlusion (obstruction) of one of the coronary arteries. It is usually, though not always, caused by blood clots, developing in an atheromatous section of a coronary artery. If a clot forms in one of the coronary arteries, the occluded area of heart muscle will die. This is known as an infarction. It is a major catastrophe. Whether the infarction is partial or total will depend on the size of the clot and the size of the artery occluded. Either way, the occurrence is commonly called a heart attack.

Our mother must have had a partial infarction, because she was found on the floor, unconscious, and no one knew how long she had been there. Add to that the time taken for ambulance transfer to the hospital, and several hours must have elapsed. When my sister and I arrived, she was breathing without the aid of a ventilator, but did not appear to be conscious. We stayed with her all night, dozing intermittently in the chairs that the staff had provided for us.

On the second morning she regained consciousness, glanced around her quite brightly, then looked at us in surprise. ‘What are you two doing here? What’s going on?’

We stayed with her all day. She was very weak, and obviously ill, but she talked rationally and could remember everything up until the moment she had collapsed. She seemed very interested in what must have happened, and in all the medical paraphernalia around her. She remembered her mother, who had suffered a heart attack about thirty-five years previously and died.

‘If all this medical treatment had been available for my dear mother, she wouldn’t have died. I was there with my Dad. The doctor came, and said there was nothing he could do. I am very grateful to the doctors and nurses here,’ she said.

The doctor told us that she was out of danger and that we could go home if we wanted to. As my sister had three children to look after, we agreed that she should go and that I would stay on at the hospital with our mother. I stayed with her all evening and dozed in the chair beside her during the night. The machines hummed and whirred, and nurses came at intervals to check a monitor and offer words of comfort and reassurance. It reminded me of my own years of night duty – the night-time holds a beauty and mystery that we do not know during the daylight hours – but I had to recognise that although I was an experienced nurse, the new machines were quite beyond me.

It was Midsummer Day. Dawn was breaking, and soon brilliant sunshine was streaming in through the hospital window. My mother stirred and looked around her. ‘It’s going to be a lovely day,’ she said.

A nurse came in and removed the drip from her arm. ‘You’ve had a good sleep,’ she said.

‘Yes, and I feel a lot better. A cup of tea would be nice,’ my mother replied. Then she turned to me and said, ‘Go and get yourself some breakfast, dear. I’m sure there must be a canteen open somewhere in the hospital. I’m all right. I feel much better.’

The nurse agreed. ‘We want to change your mother’s bed and give her some breakfast, and we will probably get her up as well. I daresay she will be transferred to the ward when the doctors have seen her.’

I made my way to the hospital canteen with a great sense of relief in my heart. She’s going to be all right, I thought. Modern medicine is wonderful. I remembered similar cases of acute heart failure that I had seen thirty years previously. when there was very little that we could do, and when many people died, or survived to be cardiac cripples.

Breakfast was excellent – cornflakes, bacon and eggs, toast and marmalade, coffee – and it increased my sense of well-being. I had intended to go straight back to my mother, but … but … All those fatal ‘buts’ in life; they are as bad as the ‘if onlys’. If only I had followed my first intention. If only I had resisted the call of a midsummer morning, the lure of the rising sun casting long shadows over the hospital garden, the sight of small clouds floating in a clear blue sky, the sound of birds singing. If only I had shut my eyes and ears to the beauties of nature. But I didn’t. I went for a walk in the morning light.

When I got back to the hospital, the door of the intensive care unit was locked. I could hear sounds from within but could not enter. I knocked on the door several times, my anxiety increasing. Eventually a nurse came out and said that an incident had occurred, and I could not be admitted.

‘What incident?’ I asked.

‘A cardiac incident. We are dealing with it.’

‘But I must come in,’ I said.

‘No, I’m sorry,’ was the firm reply.

‘But she is my mother. I must come in.’

‘No. You cannot be admitted. Go to the waiting room and you will be kept informed of progress.’

‘What are you doing? What’s happening?’

The nurse did not reply, but turned back, shutting the door firmly in my face.

I was trembling and crying. ‘Let me in, open the door. You can’t keep me out.’ That is what I intended to say, but it is more likely that I was inarticulate.

Someone led me to the waiting room and brought me a cup of tea.

I cannot remember my state of mind – confusion, panic, anger, self-reproach were all mixed up and churning around. Time passed. What were they doing? A ‘cardiac incident’? That could mean anything. When had it occurred? Why, oh why did I take that walk? I should never have done it. Never. I should have gone straight back after breakfast, and then I would have been there to protect her. I envisaged her, weak and helpless, wanting me, perhaps calling for me, and I wasn’t there. I had abandoned her.

I ran back to intensive care, and banged on the door, calling out, ‘Let me in, let me in,’ but a man came out and told me: ‘No’. I tried to push past him, but he completely blocked my path and held me back. An indistinct picture of white-coated figures, and masses of black machines and wires around a naked body on a bed, was all I saw before the man shut the door. A nurse led me back to the waiting room. She saw my distress and was very sweet. My mother had suffered a second heart attack, she told me, and the resuscitation team were doing all that they could to save her. ‘Don’t worry,’ she said softly, ‘your mother is in good hands. They know what they are doing.’

‘But why can’t I go in?’

‘It really would be best if you stay here.’

And so I did, as everyone has to. No one is permitted to see a full-scale hospital resuscitation taking place.

I sat in numb grief for two hours. Self-reproach amounting to self-flagellation haunted me. If I had not taken that damned walk I would have been with her, and protected her from the violence of resuscitation. But would I? Could I? You never know in life, and it is always easy to be wise after the event. Could I have sat there and watched my mother suffer a heart attack, the symptoms of which I was well acquainted with, and done nothing? Could I have calmly observed her sudden pain, my mother clutching her chest with both hands, gasping, throwing her head back, mouth wide open in a frantic attempt to draw air into her lungs, her colour changing rapidly to a pallor that betokens death? Could I have witnessed this and done nothing? Of course not! In any case, my mother was still wired to cardiac monitoring equipment after the first heart attack, and red lights would have been flashing, warning signals screaming way beyond the confines of the intensive care unit in which she was being treated. The resuscitation team would have arrived anyway, and would have taken over. I would have been told to go to the waiting room, which is where I sat for two long, dreadful hours.

Eventually, a doctor came and told me that my mother was dead. They had done all that they could, he told me gently, but she had not responded.

‘Since death (take my words literally) is the true goal of our lives, I have made myself so well acquainted during the last few years with this true and best friend of mankind that the idea of it no longer has any terrors for me, but rather much that is tranquil and comforting. And I thank God that he has granted me the good fortune to obtain the opportunity of regarding death as the key to our true happiness. I never lie down in my bed without considering that, young as I am, perhaps I may on the morrow be no more. Yet not one of those who know me could say that I am morose or melancholy, and for this I thank my Creator daily, and wish heartily that the same happiness may be given to my fellow men.’

— the young Mozart in a letter to his father