Wheels within wheels

(Hildegard of Bingen Scivias I.6: The Choirs of Angels. From the Rupertsberg manuscript, fol. 38r)

It’s been an interesting few months, healthwise. I’ve already written about the raw shock of finding out there’s something wrong with one’s heart, and that there’s a part of the body – the left atrial appendage – of which, despite having taught students the history of the discovery of the role of the heart, I had never heard. There I also said something about the surgical process I have been through.

So let’s think about the aftermath of that. Recovery, even from something euphemistically called ‘a procedure’ – so much less alarming than ‘an operation’ – in my experience always takes longer than expected. The bruising around my thigh took about 4 weeks to go, and even now the skin isn’t the same colour as the rest of my leg. I felt entirely wiped out for weeks, probably a mix of having had a general anaesthetic, the various drugs given during and after the procedure, and the ongoing emotional stuff around having a heart issue.

But what I wasn’t expecting were the visions.

A year or so ago, I had a posterior vitreous detachment in one eye. That was another experience of finding out there is a part of the body that I didn’t know I have – the vitreous – and it was all very sudden and alarming, so I aborted the trip to London which I was intending to make and detoured to the local eye hospital, where I had a thorough examination and a diagnosis. The main symptom was a large white area in my field of vision, accompanied by a ‘floater’ that looked enormous. Having a detachment is ‘natural’ but that doesn’t make it any less disturbing when it’s happening.

After that I thought, if you’ll pardon the phrase, that I’d ‘seen it all’. Oh no.

Ten days after the heart procedure, I had a patch in my field of vision where there seemed to be… a gap. Around its edges, there were multicoloured shimmering lights, moving in all directions. After maybe half an hour, these lights moved from being a circle to a line (like a floater), and drifted gradually up the field of vision until they disappeared. It was bizarre.

I classified it as ‘one of those weird body things’ and continued my day. The following morning, a repeat performance, but just the circles rather than a line. And the same the next morning, at which point I thought this needed some professional comment. Being in a different health authority to the one in which the vitreous had done its detaching, this didn’t involve a hospital, but instead one of the local hubs authorised to do the checks. I found one in the next town, with an appointment the next day (very good system, by the way, better than turning up in an eye casualty department and then having hours of waiting to be seen).

At the hub, I had the same range of tests as at the hospital, felt thoroughly checked out, and was assured that no detachments were happening. The diagnosis was ‘ophthalmic migraine’; that is, migraine without the headache. Could it, I asked, be connected to the heart procedure? The optician said that it could indeed be something to do with circulation.

I am on an online health forum for people with my condition and found out that other procedures where the heart is entered from the right, with access to the left atrium gained by puncturing the septum, can lead to visual disturbances. Interesting, unexpected, and not mentioned in the hospital leaflet on the procedure. I read a few medical journal articles and then sent a query to the cardiologist. He replied that, yes indeed, after any invasive procedure with a trans-septal puncture, there can be a tiny amount of mixing of right atrial and left atrial blood through the needle hole. When this happens, a chemical produced by the liver crosses into the left atrium; normally, it is filtered out by the lungs, so the left side of the heart never meets it. The chemical is then circulated around the arterial system. I have no idea why it then causes what are technically called ‘scintillating scotomas’ – that’s above my pay grade – but it does. I had another two episodes after those first three, and I hoped they had now ended; but hey, the day after writing this, I had another, although it was over in about 10 minutes.

My interest in what happened has, of course, continued. This is a body thing, and the history of bodies is what I do! The various websites which discuss the phenomenon include attempts to show it using animations; here are the Wikipedia attempts. But they really don’t seem to capture what was happening. My husband referred me to Oliver Sacks’ book, Migraine, which had descriptions to which I could relate. There’s also a video cheerily entitled ‘Scintillating scotomas can be awesome’ which includes something much more like mine at 4:41, but the best video I’ve found is this one. The responses on YouTube show not only how accurate these animations are, but also how reassuring it is for people to realise that they are not alone, with comments like “When I first experienced that I was scared out of my wits”.

After my experience, I’ve been drawn to the visions reported by Ezekiel. In Chapter 1: wheels within wheels, with rims of eyes. Yes, I can relate to that. One translation has the vision “shimmering like a sky full of cut glass”; yes, absolutely, that scintillating effect again. Ezekiel 33:7 has him being called as a ‘watchman’ for the people of Israel, which is of course very neat when the umbrella I now have in my heart is called a Watchman. But those wheels; I will never again be able read them as anything other than a relatively common human physical experience in which I have now shared. Even more like what I was seeing, though, are the visions of Hildegard of Bingen. In the public domain image with which this blog post opens, from Wikimedia Commons, there’s something about the almost-triangular shapes on the circumference which is very much like my own visions. Just animate that, make it shimmer, and you’re there.

The irony here is that, when first promoting my book Immaculate Forms, I did a podcast in a series called A Seat at the Table, which invites you to imagine which three guests you’d invite to a dinner party. One of my choices was… Hildegard. And now we’d have so much more to discuss!