Nabokov and the Angiogram: A New Chapter in Health Fiction
My story begins in the summer of 2004 on a cricket pitch in North Yorkshire. At the age of 48 years old I’d just bowled 12 continuous overs. The ball was swinging outside off-stump and seaming away—perfect conditions for my style. Six chances were dropped off my bowling through incompetent fielding and, feeling pretty tired, I stalked away to sulk under the chestnut trees on the boundary–where I experienced a distinct pain in my chest.
My first reaction, presciently, was that it was my heart, but within a few minutes the pain had passed away and I went in to bat without incident—except a summary stumping by the preternaturally long-armed wicket keeper. I thought nothing else about it until I experienced similar chest and shoulder pains whilst cycling and playing tennis. My GP referred me to the cardiology unit at my local hospital where I underwent an arduous treadmill test with ECG, followed up by an appointment with a consultant cardiologist.
The cardiologist reviewed my ECG print out and said quite distinctly, ‘Well, there’s nothing wrong with your heart.” I’d been reading Nabokov’s ‘Lolita’ in which the central character—Humbert, a near-paedophile—experiences ‘intercostal neuralgia’, a form of referred pain that mimics the symptoms of angina. The consultant listened to this with a tolerant smile and admitted that this was a possible solution to what remained a mysterious set of symptoms. Her words remained with me throughout the next few years as a handy rebuttal to any idea that I might be ill.
I left the hospital, reassured my wife and family, and enjoyed telling the story of the cricket match, the dropped catches, sulking under the trees, and the way that a fictional character from a novel had provided my diagnosis. I’m a writer and teacher of creative writing, so there was a kind of reassurance in this narrative structure. I’d made my symptoms into an amusingly self-deprecating story. I’d given a set of mysterious and alarming symptoms a reassuring narrative form and conclusion. I was active, had a good diet, understood the risks and, as a result of that virtue, fate had dealt me a reprieve.
Five years later, whilst walking across the University campus I experienced a sudden and disabling recurrence of a pain that seemed to spread from my chest into my left shoulder, or from my shoulder into my chest. The pain came again when I was playing cricket, tennis and cycling. A visit to the same GP ensued and I related the original incident—cricket match and Nabokov included. An examination followed and we agreed that I should try physiotherapy for what we both agreed was referred pain from the shoulder area. My local GP practice doesn’t offer an ECG, so the check on my heart function at this stage was purely auditory.
The first questions the physiotherapist asked me where about my heart. I was able to reassure her that my cardiology tests (which I now put at a fictional 3 years ago, not five, having forgotten the original dates) had proved negative. Months of physiotherapy ensued without much improvement. I continued to play tennis, and to cycle through the pain barrier. My main symptom at this stage was shoulder pain—I had negligible chest pain, little shortness of breath and none of the other symptoms that might suggest angina.
Upon returning to my GP, an MRI scan was arranged to see whether or not a herniated spinal disc might be referring pain into my shoulder and chest. To a writer, the experience of the MRI scan was fascinating. The way it felt like lying inside a giant tube of toothpaste, the way it is better to keep eyes closed, the way the machine sounded like a pod of hump-backed whales calling, the way any piece of metal in one’s body would be dragged gruesomely though and out by magnetic force. It was another good story and possible material for my own writing.
The MRI scan was followed up by a meeting with a neurologist, who was quite puzzled by my symptoms and could find no connection with the routine ageing of my vertebrae and the pain I was now regularly experiencing. She had my medical records to hand and reminded me that my cardiology tests had been held 5 years ago. She suggested that I revisit them. I remember walking away from that appointment, taking tiny steps to the car park, because the pain was now so severe. Denial was by now becoming difficult, even for me, and at least part of me recognised that I was exhibiting classic angina pains.
I immediately booked myself into my GP practice for blood tests and made an appointment with my GP. A weekend of chest pain intervened and I spoke to a senior partner at the practice. No doubt I rehearsed my sporting interests and the fact that my father had lived to be 92 and my mother 87. My older sister had experienced a heart attack, but most of my family—many of them heavy smokers—had died of cancer. The doctor reassured me by saying that, ‘It doesn’t sound as if this is your heart.’ But from that day I began to take low-dose aspirin as a precaution. But the clock was ticking against me.
When I turned up to see my GP, he’d been called away to an emergency. We spoke on the phone later, agreeing that I’d attend the cardiology unit for new tests, ‘Don’t worry,’ he said, ‘It doesn’t sound as if it’s anything to do with your heart. Sometimes we never get the bottom of these things.’ I was now more seriously concerned because I’d booked a holiday in France with my partner and son. I chased the hospital appointment after a few days and found out that I’d been lost from the system in the aftermath of a new computer suite being installed. The appointment was re-instated and I went on holiday. The week in France was divided between days when I felt severely restricted by pain and days when I happily walked 6 miles around Paris. Strange and disconcerting.
We returned home on Thursday by which time I was taking phone calls about work on the train. I worked all Friday and Saturday afternoon to catch up with my backlog of work. On Saturday evening I experienced such painful symptoms that I went to A&E at the local hospital—an eighteen mile drive from home. The hospital confirmed that I’d undergone a ‘cardiac event’ and into the system I went, from cardiac care in one hospital to the cardiac unit in another. I asked a number of doctors whether my original cardiology tests could have missed something—‘unlikely’ was the answer.
When I was wheeled into the theatre for an angiogram, I still half believed that the consultants might find nothing—my unsolved mystery—or at the most might have to fit a stent. Instead, I was told that I had advanced heart disease with all four main arteries compromised. One artery was 90% blocked and surgery was the only solution—if I proved ‘viable’. ‘Don’t worry’ said the consultant, with a smile, ‘you’ll be playing cricket again next year.’ Days of uncertainty ensued until I’d gone through a series of routine tests. A quadruple by-pass was then performed and, at the time of writing, I’m now 3 months into recovery, walking and cycling again.
When my GP asked me if I’d experienced any psychological effects, I replied that I’d accepted that I might die and had experienced no depression on that account, but that my over-riding emotional state was still one of disbelief–for which, I added wryly, there is no prescription. Despite the scars on my chest and leg and the occasional twinges of pain or discomfort, that it still the case. Somewhere deep in my psyche I had refused to make the transition from feeling that I was a fit and competitive man (for my age), to the recognition that I was dangerously ill. The more I recover, the more I deny my sick self and replace him with my risen self.
Such a stubborn psychological condition might be enviable to a hypochondriac. But my state of resistance or denial and my eloquence in spinning a powerful narrative of self had undeniably influenced my GP and delayed my diagnosis. Doctors have their own emotional needs and, at some level, I believe that my GP didn’t want me to be ill either. Through some kind of male intimacy, it was as if I’d infected his judgement with my need to be competitively fit and his need to support that comforting delusion.
Fortunately, I have an ironic self as well as my other selves, and the story I’ve told here—a story of vanity, resistance, near-idiocy, selfishness, denial and delayed revelation—is my new story. It is my refurbished or revised story of a self that acknowledges the wry twists and turns in a plot that now has even more satisfying narrative complexity and structure. I’ve added a few of my wilder morphine-visions and hospital anecdotes too, just to embellish it a little if my audience is willing.
There were few ‘typical’ heart-attack victims in my hospital experience—like many of them I wasn’t grossly overweight, had a good diet, understood the needs for a healthy lifestyle, and exercised regularly. My symptoms were only marginally atypical, so why did I get so dangerously late to arrive at what now seems like a routine diagnosis? There were some systemic failures in the primary healthcare system—particularly lack of routine follow-up to the original cardiology tests. But I also accept that I was complicit in my own delayed diagnosis because I had such a huge investment in being a well-person and told that story almost until the end—literally.
The bloody-mindedness that brought me so close to death or disability through denial and the creative re-configuration of the facts is now helping me to get better through a vigorous exercise routine. Characteristically, perhaps, I renounced the idea of joining an exercise group. What me? Doing step aerobics with a lot of flabby heart-attack victims in polyester tracksuits? You can’t be serious…!
Graham Mort, January 2008.