Intimations of mortality

This ‘retiring academic’ identity is all very well, and most of the time it feels right. In a year which saw the publication of my first ‘trade book’, Immaculate Forms, and some really enjoyable opportunities to promote it by podcasts and radio programmes, I was starting to forget about the less pleasant aspects of ageing. But they have now surfaced.

Several years ago, I had a pre-diabetes scare, which was reversed by losing about 15kg (strategy, successful thus far, described here) but which still means an annual health check at the GP’s surgery. In September – the month of book publication – I had my usual invitation, and called in at the surgery to pick up one of the forms on which they like you to record blood pressure for a week before the check happens. The receptionist was a bit reluctant (‘Oh you don’t need to do that – just do it in the machine over there when you arrive’) but I’m quite pushy so she eventually passed a piece of paper over the counter.

Good patient that I am, I started the tests on the home BP machine bang on time. Fine, bit on the high side but not scary. Three days later; scarily high (top one 192). And persistently so, with a slow pulse. Phoned the GP’s surgery, saw one of the doctors, and was immediately put on blood pressure pills. Started them at once. Three days later; BP reasonable but pulse scarily high (121 beats per minute). Phoned the surgery and was told I needed an ECG that day or the next one. Well, the next one was when I was down for the pre-diabetes annual visit anyway, so they fitted in an ECG as well. All rather impressive.

I know that, for these tests, the doctor usually rings later the same day when she or he has had a chance to look at the results. But … nothing. I thought that was a bit odd, but I had a busy evening in London recording for The Infinite Monkey Cage, so I put all my health concerns behind me and had a wonderful time. The following day, still nothing from the doctor, so on the bus on the way to the station for another London trip I opened up my newly-acquired NHS advanced app. And there it was. ECG result. Atrial fibrillation. And all sorts of other terrifying claims, like signs of an earlier heart attack. The doctor had tried to phone but had used the landline number; we stopped having a landline months ago and registered this with the app, but I’ve since found that the NHS central info and the local surgery don’t entirely connect.

I phoned the surgery and made an appointment with a GP.

After that, it all moved quickly. The GP confirmed the AFib but said the ‘earlier heart attack’ stuff was generated by AI (!) and didn’t mean anything. But, although AFib is remarkably common, especially as we get older, it should mean blood thinners, which I can’t take because of the hereditary bleeding condition for which I am under the local Haemophilia and Thrombosis Centre (soon to be renamed the Bleeding Disorders Centre because it includes people like me who don’t have haemophilia). So, off to the cardiologist, who – after looking at the initial ECG, noting that it was 24 hours after I’d noticed the high heart rate so it may well have been a very long episode, and reading the results of a 14-day heart monitor, which revealed various short bursts of AFib which I hadn’t even noticed happening – recommended a procedure involving a small umbrella called a Watchman to block off the left atrial appendage (LAA).

That was a moment. I’m a historian of medicine and the body and I had no idea that there is a part of the heart with this name. It reminded me of the moment when I was studying posters while taking a friend for some gynae tests, and discovered there is an area called the ‘transformation zone’ between two parts of the cervix. It was the same feeling: I have this in my body! But I had no idea! Let’s be fair though; if you do a search just for ‘images of the heart’ the LAA doesn’t even merit a label (a bit like the clitoris in the history of gynae images – more of that in Immaculate Forms)! The LAA is a sort of windsock-like flappy bit which is left over from the early formation of the organ, and has some functions in producing a hormone, but in my scenario becomes a source of risk. This is because, when the heart is having an AFib session, blood pools, and – even in someone with dodgy coagulation – can collect and form a clot, which may then travel out and cause a stroke. If the LAA is blocked off, this dramatically reduces the risk of stroke, and means you don’t need to take the ‘blood thinners for life’ route.

I had the Watchman inserted a week ago under general anaesthetic, via a femoral vein. It’s all very clever indeed. And now I take various drugs while we wait to see how it all settles down. It doesn’t stop the AFib so drugs may be needed long-term for this; but the AFib becomes less risky. Cardiology, more than any other area of medicine, is all about balancing risks.

But I am now at the point where I am thinking about all this. There is a serious mental shock in going from ‘I’m basically healthy’ to ‘I’m a heart patient’. That was acknowledged by the GP and by the cardiologist, but I feel like I am still not entirely processing this. When I went for a routine dental appointment, and (remember, I’m a good patient) I told the dentist I’m now on various drugs, she labelled me ‘a heart patient’ and gave me a short talk on why excellent dental hygiene is even more important in people like me. I have a little card to carry explaining about the umbrella thing, to be used when going for MRI or going through metal detectors. I have to face it: I am indeed a heart patient. That doesn’t mean I like it. And as someone who is willing to change my lifestyle if that helps, it isn’t much use to find out that I am already doing all the things which people are supposed to do when they have AFib.

As I adjust, I oscillate between two forms of knowledge: medical and cultural. First, the heart is just a pump; it does its thing, and keeps trying to do it even if there’s a problem. But… it’s the only one I have. I have taught students about William Harvey’s discovery of the role of the heart and the circulation of blood many times, but that was before I had this new relationship with my own heart. Second, the heart is freighted with an enormous amount of cultural baggage. In his radio series after a quadruple bypass, This Old Heart of Mine, Giles Fraser called it the most symbolic organ of all. Valentine’s, broken hearts, heart of gold, take heart, big-hearted, speak from the heart, have a heart to heart, her heart rules her head, or that wording used in some Christian circles about someone ‘having a heart for’ a group of people or a cause. It’s not the heart itself that’s the problem for me – the cardiologist says it’s perfectly healthy, doing what it should, but it has an electrical glitch. But the heart is where it’s all happening.

And then there’s the commonly-stated point about medical misogyny: that heart attacks in women manifest differently from those in men. I thought this was a Fact until recently; that women are less likely to have the classic symptoms and so are less likely to be given an ECG and less likely to receive an accurate diagnosis. It turns out that this idea is in itself likely to disadvantage women; the evidence for that is here. The problem seems to be that, in the earlier research, people were asked about their symptoms after the confirmation that they had had a heart attack, and that confirmation influenced their responses. Asking for their symptoms when they arrive at the hospital produces a different list. What is gendered, though, is the idea that heart attacks are a Man Thing; they are not.

And then there’s cause. As a historian, I’m interested in causes, but there is no reason why I have AFib. My mother had it, so I could blame family history. There’s some evidence that being White increases the risk, but that could be because Black people aren’t given the tests early enough to discover it. Overall, it’s probably more helpful to say that I just do have it; that it’s good that it showed up on that ECG, and that it’s good that it’s been found now.