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Those unforgettable affairs of the heart

For weeks the Belfast Telegraph’s Paul Hopkins felt unwell, then one day he almost collapsed. When doctors told him he needed major surgery, it was the start of an extraordinary physical, and emotional, journey

My heart is broken. And, as I peer at myself closely in the misted mirror, drawing the cold blade once more across the soaped-up skin, I feel like the condemned man, having his last shave — to be clean for the waking; to be clean before his Maker? — and about to have his last meal and make his last deal, choking on his own self-pity in the hope of a last-minute reprieve.

Please God, let it be all right, I say to no one in particular as I rinse the razor round and round under the running water.

My heart is broken.

Five weeks ago, it is a Tuesday, and I awake to prepare for the the day ahead. Nothing out of the ordinary. Until, having showered, I am dressing and, sitting on the bed, bend down to tie the laces of my brogues. I come back up and, suddenly, I have no breath, cannot find any, begin to panic, thinking: “What the f*** is happening here? Bloody cigarettes.”

Somehow, looking back I don't know how, I manage to make it to work (foolishly), make it through the week, searching for air, for release from the tightness in, of all places, the pit of my stomach. Stopping every 50 yards. Nodding off in my office to the understandable amusement of colleagues.

Lying down at night brings no release and my thoughts race ahead in tandem with the increased, unnatural, rhythmic racing of my heart and the unnerving feeling of trying to breathe with some sort of semblance of normality. But I am far from normal. I persevere until the following Monday and a visit to my GP ends in an appointment with a cardiologist. More than a month away is the first slot available. I cannot be that bad, I think, if there is no urgency for the cardiologist to see me.

I am convinced it's my lungs that are in trouble, and that soon they will open them up, sigh deep sighs of resignation, mutter something about “Do these guys not read the big print on the cig packets?”, close them up and give me the time-scale. How I do it, I do not know, but I head back to my work for another week — to Belfast, 100 miles from my native Dublin and to a rented two-bed apartment in the leafy south suburbs of the city, now my second home.

My traditional uniform of work, my suits, no longer fit me around the waist. It is like overnight I have been given a prosthetic to play the fat guy in the school play. This — overnight. What is going on? I ask, as I replace traditional pin-stripe suit with low-hung jeans. The bus and the 12-minute walk are replaced by driving to the office, where even the two-minute walk from the car park is an effort. But I keep going. Colleagues tell me I look ghastly, ask if I am ok. Just need an MOT, I say.

The end of that week I return to home in Skerries, in north Co Dublin. Three times on the 90-minute, familiar drive, I have to pull over to the hard shoulder for I am continuously nodding off — something unknown of me.

My wife tells me I look awful. My three adult children tell me I look awful. Even the dog looks at me crooked and she's almost blind but she must sense something. Looking back now, I misjudged their genuine concern — mostly in an effort to hide or dismiss totally my own growing concern.

“But, you know, I am doing something about it,” I reassure them, almost — no, actually — in anger. “Seeing the cardiologist. He'll sort me out.”

On the Sunday I am alone in the house when I am seized by a fit, gasping with untold effort to find air, like a trout snatched from the stream. I feel like I am smothering, have entered an alien atmosphere where oxygen is no longer the stuff of life.

This is it, I think. This is how I go. The end, by Paul Hopkins, aged 56, of little consequence and for reasons unknown to him at the time of expiration.

I somehow return to a normality, a normality of sorts, but it is not the normality of every day; it is the normality of the last two weeks.

Shortness of breath, the wrench in the pit of my stomach. Feeling strangely outside my body one moment and invaded the next. Yes, on reflection, invaded is the word — invaded by some unknown force that is slowly, very slowly, smothering me.

“I know. You can't fool me. I watched The X-Files,” I say to myself, “all those years ago with the kids.”

Monday, my feet still touch the ground but with growing effort. So, it is back to the GP where there is alarm at my deterioration, the doctor giving me another going over.

“We must get you to hospital immediately.”

Within an hour I am in the Rapid Response Unit of the Cardiac Centre at a Dublin hospital.

Four hours of tests take place: echoes, ECGs, blood tests, respiratory tests, more blood tests, X-rays, ultrasound, biopsy, more blood tests. After which I am told: “You have heart failure.”

“Failure?” (“Failure — then I must be dead,” I think to myself.)

Explanations pour forth. Heart failure covers myriad malfunctions of the heart. In fact, any malfunction, however minor in the relative scale of things, is “failure”.

I hear myself saying: “So, doc, give it to me straight. I can take it. Like a man. I don't even have to lie down.”

Only I say no such thing. Instead, I cross my legs, throw my right arm back over the chair, and say, rather nonchalantly, “So what are we talking about here?”

The condensed version: I have a tear in the mitral valve of my heart. I have massive fluid retention because the tear or leak, instead of the mitral valve allowing my blood — my blood — to flow through my heart the right way, totally in the right direction, to feed my body and its other vital organs, is allowing some blood to flow back the wrong way, putting extra strain on the heart muscle which will eventually weaken its pump function.

The consultant looks at me across the desk.

“Had you not come to us, you could (or was that “would” he said?) be dead in six months.”

“There,” I say to myself, “I told you I was ill.”

In truth, I am in shock.

“Is it lifestyle?” I ask, “my smoking?” Only hours earlier I had been frighteningly honest about my alcohol consumption, which, it just shows you how stupid one can be, I still thought there and then was not excessive. Never missed a day's work in my life because of alcohol. And that's the truth.

“You are extremely stressed ...”

“What, me? Stressed? Under pressure, maybe. Stressed? Never. Huh!”

“... (and I paraphrase here) but in 20% to 30% of people with heart failure there is no obvious cause.

“This is called idiopathic.”

That's it. Explains it all. I'm an idiot-pathetic. At least for once I can't be blamed, I thought, but knew I was fooling nobody.

And that the pinstripe not fitting is explained.

“The build-up of fluid has affected the lungs, the liver, the stomach (the fat guy, I muse). Or there could be separate reasons for these (conditions). We need to bring you in and investigate further. And we are possibly looking at open-heart surgery.”

“When?”

“Today.”

“Can we leave it 'til tomorrow? I haven't got my toothbrush with me.”

For someone who has never been in hospital in their whole life — save for a 20-minute microsurgery jobbie on a busted knee, and I wasn't even born in a hospital but in a private midwife's house — the next day was to prove the beginning of an awfully big adventure.

That Tuesday began three weeks of intensive, at times invasive, prodding and probing of one middle-aged Caucasian with a lifestyle that is dubious to say the least. There is the inevitable angiogram, more echos, diuretics until I was peeing like an elephant, pulmonary tests, sonic probes, biopsy, and the daily blood takes and intravenous drips that leave my bloated body black and blue, however sweet the nurses' bedside manner.

But amid all this, what shines through and keeps me going is the wonderful, intuitive care of those looking after me.

From consultants to surgeons to registrars to anaesthetists, sisters and nurses and nurses' aides, technicians and technologists, down to the trolley men and the tea ladies, I have never come across more caring and patient people. There are indeed angels of mercy and patience and kindness working among us.

When it is firmly established that open-heart surgery will be the recourse, I am told, jokingly, by one or other of the team: “Sure it's routine. We can do it with our eyes closed.

“Please don't have them do it with their eyes closed,” I plead, my hands clasped in prayer.

The running of the health system is far from ideal, and the bureaucrats who dictate and follow policy can seem at times, and rightly so, an incompetent and uncaring collective. And so we rightly give out, find fault, criticise and labour our points about inefficiency. But these other people working with, and within, this inadequate system — shortage of staff, shortage of funds, overcrowding, beds in corridors — look after those of us in need in a way that would make one Jesus Christ embrace them to his core.

Those in hospital, for however long or whatever reason, share a commonality in that we are all broken bodies, even minds, waiting to be put back together again by men and women into whose wonderful hands we commend ourselves.

And if there is a kind of institutionalisation of hospital — and there has to be, for it to run smoothly — there is also a sort of institutionalising of human contact within its confines, in that we patients play out our role in a predictable, almost cliched, fashion which, after five weeks “inside”, I believe is an important part of our need to survive. For our broken selves to be mended, so we can go home.

And so cliched conversation is centred on one's illness, one's “procedures”, one's medication, one's “It's the Big Day tomorrow”. It is not inane, it is not morbid. It is in fact normal and healthy and part of the mending process. The other part of this patient bonding process is that you manage to collect, often offered, albeit in short-story form — time being of the essence — the lives (and sometimes loves) and ups and downs of fellow broken brothers. That, too, is part of the catharsis.

The man from Mullingar who once sat beside Joe Dolan in school, and how a taxi man on the Westmeath man's wedding day nearly left him standing at the altar because he, the taxi man, had “a bit of a fondness for the drink” and failed to pick up the bride. This man, now 70, has had heart trouble since his 40s.

Or the working-class guy, not yet 40 and with a wonderful wife and two lovely children, who has been in and out of hospital all his life and borne it all with such matter-of-factness “because I've been luckier than others” that I feel blessed to have been in his company.

There was the quadruple-bypass man, who had incidentally never smoked nor drunk in his life — what a lotto life is — who had found love lovelier the second time around, 15 years ago, with a beautiful young woman from a chance meeting, a whole other story in itself.

The heart as metaphor: I learn a lot during my time in hospital, not only of the physical mechanisms of the heart that life itself depends on working properly, but I also learn, or rather re-learn, those other affairs of the heart: love, kindness, even pain and sorrow, the latter which, even in darkest moments, took on whole new meanings, meanings that breathe a whole new stuff of life into relationships with my children and family and friends.

I get out-of-the-blue phonecalls from two of my oldest friends whom I haven't spoken to in years — how did they know? It's like we've spoken only yesterday. Nightly calls from a friend which are so wonderfully understanding, with great empathy, that they ease me into the Land of Nod.

I even learn in the process, in the catharsis of it all, to love myself again. Which, I now see with the wonders of 20-20 hindsight, has for years been something beyond my ability. It is I who broke my heart. In the end it is only I who can fully mend it.

And so after three weeks, with all eliminating tests proving negative and all secondaries caused by my wonky mitral fully fixed, my body is at its optimum for my Big Day.

At high noon today I go down. Through that tunnel, with its alien lights, to the Big Room where a bunch of people who really don't know me from Adam will make me whole again.

My shaving finished, I run my hand over the smoothness of my skin, look at myself with a sort of amused wonder. At the complexity of it all.

And then I wink at myself and say, to no one in particular: “Go knock 'em dead, kid.”

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