#52: THE HEART

One morning in April 2004, my heart stopped, literally. I was assaulted by an improbable multiracial gang, who drugged me, took a hand-held circular saw to my sternum, opened up my chest cavity and stuffed in some lengths of blood vessel they had ripped out of my left leg and arm. While I was still hovering near death, they were congratulating each other in the nearest pub. It was not a Manson-like sadistic ritual,  a cult killing (for a less graphic and sensational account of the backstory, see this week's extract from FESS at the end of this post, 'A piece of my heart'). Didn't you read about it in THE SUN:  MAD MOB MUG SAD DON HORROR!

In essence, a coronary bypass operation like this is barbaric and miraculous, only surpassed by the heart transplant process (which celebrates its 50th anniversary later this year). The fact that thousands of people have been rescued from near extinction by this process only adds to the potent mythology and iconography surrounding this vital organ. The heart is everywhere in our language, our imagery and most of all, our music.

The heart is the body's pumping station, we know that. But this was forcibly brought home to me in  a Stanmore evening course in plumbing. I wanted to acquire some of those skills so that when I bought a house, I would not be separated from astronomical piles of cash with an ease that Dick Turpin would have envied. I told the teacher about the bypass operation which would clash with the last part of the course; as a teacher, I should have realised what a priceless gift I was giving him: the graphic metaphor. From then on, every session contained at least one reference to David's Heart, a soft version of a central heating boiler in its pumping action, he assured us.

I had to wait only six weeks for the operation. It was a careful time, went quickly and it was not unpleasant, on the whole. Rationalisation quickly steps in to stop you thinking about the actual event in any detail. That is assisted by friends who don't really want to think or talk about it either. When they did they invariably dispatched it very quickly, often with something like 'anyway, it's very routine these days'. For some reason I resented this: I wanted to say "Yes. Very routine for the surgeons, thankfully, but not at all for the patient. It is a unique and monumental trauma to the body for them".

Naturally, because there are casualties in the operation, you are wise to tie up the loose ends of your life, though without actually touring the country, even the world, to say a tearful goodbye to your far-flung friends, just in case. I did write a will, and we did get married, a legalistic precaution that guaranteed my family a share of my pension. Marry in haste...

In the event the operation was fine: as fine as something like that can be. I was reassured to hear that though my arteries had been choked up with cholesterol and a heady residue of Silk Cut Extra and Cadbury's Milk Tray, the heart itself was said to be very strong and 'the heart of a man 20 years younger' ('Beefheart'?.) Naturally this metamorphosed into a gag about 'hoping he wouldn't want it back', which was repeated endlessly, and wound up as an exhibit in the Wellcome Museum of medical science (Ed: that's not strictly true, David...).

So I lived happily ever after (haha) and eternally grateful to the gang of sadistic muggers mentioned earlier, who stopped my heart with drugs somewhat before it would have stopped itself. There is a slight sting in the tale: the grafts don't last for ever. Somewhere between 10-15 years they start to collapse, and then they have to be propped open by stents, inserted in the groin and then shunted up to the coronary grafts, every now and then dropping off a bit of plastic tube to keep the highway open, like a coronary goods train. Or CrossRail, only not starting from scratch and actually boring its way through. Or one of those rigid metal stops that are used in plumbing to stop plastic central heating pipes from...collapsing inwards. There. This is where we came in; full circle, with a plumbing metaphor, only in the other direction.

It's a minor operation, nothing like the bypass job. Mine has not happened yet, but must come soon, as I'm 13 years into the cycle. I'm not worried: it's just routine these days...

The heart as a symbol of love (and loss of love, when it's broken) is arguably the most common icon of all, from Valentines cards to scrawled versions as a signature graphic to end love letters.  Most of us have 'given our hearts' to someone, sometime; most of us have also had our hearts 'broken'. So the heart is a dual-purpose symbol of love and loss, of passion and pain and an all-embracing symbol of emotion. We have love 'in our hearts' for lovers, family, friends, pets and sports teams (though as Jean-Luc Godard said - about the beginning, middle and end of his films -  'not necessarily in that order.' Equally we can be downhearted, stouthearted, cold-hearted, heartless, goodhearted, sweethearts, and much else besides.


Since 1977 we have been city-hearted. Milton Glazer developed a design to serve the New York tourist industry, now copied by every major city in the world, and pressed into service to promote an endless array of other products since.

I have searched in vain for a similar icon to promote the NW London tourist industry. I therefore offer this design, free at the point of delivery, to Brent Council to advertise the unalloyed pleasures of living so close to The North Circular, the M1, IKEA, Gladstone Park (with its annual Gladstonebury Festival), and of course, Wem-ber-ly.

When the tourists flood in, the NW10 economy booms, and house prices skyrocket, I only ask one favour in return for this service: a bench in the Park with this carved inscription:  "David Milner, our benefactor, hearted this place".

A change of heart/ still my beating heart/cross my heart and hope to die/cold hands, warm heart/ eat your heart out/ a faint heart never won a fair lady/ a heavy purse makes a light heart/ empty as a banker's heart/ have heart in the right place/ home is where the heart is/ heart-to-heart.... etc etc etc...

In 1978 Asa Hartford, a professional footballer who played for Scotland, was discovered to have a hole-in-the-heart which had not apparently hindered a successful career in a sport that is very physically demanding. This was a dramatic (not to say counter-intuitive) discovery which led the Press and media to speculate that he might have to leave football to protect his life: to quit while he was winning, having improbably 'got away with it' this far.  

He didn't. Instead he joined the Scotland squad going to the World Cup in Argentina and played as if nothing had happened. However, the legendary commentator, David Coleman, achieved the remarkable feat of 'oral accommodation', putting his foot in his mouth with one comment followed by his heart when he realised what he had said: He described Hartford as a 'wholehearted player'.

  The Tartan Army did not do very well in the competition and returned home early, having not lived up to the Manager's claim that they could win it. Which gave a Guardian sports writer the chance to make the best/worst pun ever. He diagnosed their problem as Premature Jock Elation.

“One ought to hold on to one's heart; for if one lets it go, one soon loses control of the head too.” 
― Friedrich Nietzsche

“And now here is my secret, a very simple secret: It is only with the heart that one can see rightly; what is essential is invisible to the eye.” 
― Antoine de Saint-Exupéry, The Little Prince

“I know I am but summer to your heart, and not the full four seasons of the year.” 
― Edna St. V

One dark, damp evening in November 2003 I went to a home match at Tottenham. So far, so unremarkable. Uncharacteristically I was late (my compulsive punctuality deserves a book in itself) and so I started to jog across the park from where I could see the stadium, already illuminated, and looking like a great ocean liner docked in Tottenham High Road, romantic and floodlit, towering over the surrounding houses. I quickened my pace until I was too breathless for comfort – and I was getting sundry pains. Now, at that time I was rehabbing a flat that I had bought when I inherited some money at my mother’s death. I was doing all the work myself, quite intensively, and over that period more parts of my body hurt than didn’t. So I didn’t place much store by the painful sensations I was getting.

Two weeks later I was cycling past Lords’ on my way home from work, and I became aware of a pain in my left arm. It didn’t go, in fact it seemed to intensify so I stopped. So did it, after a few moments. That seemed to be saying that it wasn’t a muscle/tendon/ligament problem (like I would know about these things). I rode on, but was persuaded to stop again. Then the blinding flash of insight in which 50 years gets stripped away in a millisecond and a memory steps blinking into the light. When I was about seven my parents were given an unwanted subscription to the Reader’s Digest, each one being unceremoniously dumped beside the toilet, as reading matter or emergency supplies. In an article called “How I survived my first heart attack”, I had read that, contrary to popular belief, heart attacks started with a pain in the left arm, not the chest. I froze. The next thoughts and images starred my father’s three heart attacks, his siblings four between five of them, some heart history on my mother’s side, and the terrifying total of cigarettes smoked since age 17. Oh shit. Get a cab.

I didn’t say anything about it to my family that evening: no point worrying them before it was actually diagnosed. But I may have been a little pre-occupied. I slunk off to the GP in the morning and after a lightning discussion, he called a taxi to take me to the Rapid Chest Pain Clinic at The Royal Free. A few treadmills later, angina was confirmed, and I was sent to see the cardiologist. There I was given an angiogram (tube enters blood vessel in groin, pushed all the way up to heart, dye squirted to reveal state of coronary arteries: if possible, stents can be inserted to hold open blood vessels there and then, but because of ‘unusual bifurcations’ stents were impractical.  “Well”, said the cardiologist. “We have 4 coronary arteries. One of yours is 90% closed, two of them are 60% closed and the other one is fine! We can’t do stents so we have to give you a triple bypass. Any questions.”  I like his brisk approach.

Seven weeks passed, rather carefully, and only about six of them were devoted to researching mortality statistics for bypass operations, which turned out to be at a level where there was not a huge risk, but neither was it entirely negligible. There followed some hurried will-writing, and a decision to get married when neither partner really wanted to, purely so that a lifetime’s pension contributions would not go down the toilet.

Come the day, my admission was postponed by seven hours. So I carried a large quantity of very heavy floor tiles from B&Q to my car, and then unloaded them at my property project (well, you don’t want to waste the time do you?)  hardly stopping only to ponder the irony of dropping dead hours before a bypass op, unloading tiles for which there was no hurry as I wouldn’t be doing manual work for another 3 months, minimum.

The Heart Hospital (Hm. I wonder what they do in there.) was a very plush private hospital in the Harley Street posh doc ghetto, which had recently been taken in to the NHS. Now you might expect that the NHS would have immediately spent millions on it, gutting out all the luxury features and bringing it down to the norm for your average local hospital.  But no. Somebody must have overlooked it and it was left pristine, luxurious and probably superior to many other private hospitals. The obvious comparison was with a good hotel: but I had stayed one night, once, in a 5 star one in Manchester while doing expenses-paid consultancy, which was vastly inferior to The Heart.

The Team came round to my room the night before the op. It was very jolly and we had a few laughs. The surprise was that the lead surgeon (listed as David L) turned out to be a 6’6” Indian gentleman, extremely slender, and with the longest, most beautiful fingers I’ve ever seen in my life, perfectly choreographed in every movement.  I could feel my heart purr and say to me “we’re gonna be alright, David, we’re gonna be alright”. As indeed we were. As they left my room, David L last, I said “Goodbye David, and if you’re going off for a drink, make it just the one!” The rest of the team swivelled round like a perfectly rehearsed synchronised swimming team and all looking similarly aghast - “outrageous! No respect or deference! He won’t have that”- none of these things were said but they were inscribed clearly on every face. As for David, he touched me lightly on the shoulder gave me a huge grin and said “I think you can trust us on that”.  I think the expression they use in social work and counselling is ‘I felt held’.

I woke in Intensive Care, slightly disorientated and surprised that there weren’t at least two doctors from Casualty in attendance, preferably Jacq Taylor whose icy heart I would like to melt, and perhaps the blonde nurse with the heart of gold who left the show without telling me. Though one at a time in my state.The time in IC was uncomfortable and had some very painful moments, for example the removal of the chest drains, which was excruciating, and I think requires anaesthetic or pain relief. I was not shy about pointing this out to them, through clenched teeth. There were way too many tubes going in and out of me for comfort – I hosted twelve at one point, I think, and such frequent re-catheterisation by one nurse that people were beginning to talk. I hardly moved, not only because of the tubes but because I felt somehow flattened: it was as though Eddie Stobart’s entire fleet of HGVs had run over me, and then reversed. But there were two ‘highlights’ (if you’re not squeamish or prudish):

My new wife (same person, new title) came to see me on Day2 and sat on a three legged stool near my bed.  “Anything I can do for you”, she said with a smile. Well, I’m not going to pass up a feed-line like that, am I, and so I said “Well, I suppose a quick BJ is completely out of the question?” (I have to confess this was not improv, I had rehearsed this scenario for some time). She laughed (and what a very potent defence against male sexual ambitions is the female laugh). Whereupon, coincidentally, one of the tubes popped out of my head/neck allowing cartoon-like quantities of blood to shoot out.  She fainted and fell off the stool, hitting her head on the marble floor. Two nurses came rushing over to tend to her, completely oblivious to the fact that my life-blood was draining away down the ward floor, probably so that I would probably require a transfusion replacement, while my wife would only need Ibuprofen, at most. But I’m not bitter. 

The other incident took place 7 or 8 days after the operation, when I received distinct signals from my large intestine that, at last, something was on the move.  Oh blessed relief. I made my way to the bathroom and positioned myself on the toilet for the Great Event. I will spare you some of the detail, suffice to say this was a very slow process indeed and at one point it stopped altogether. I wonder if you can imagine having a large cucumber stuck halfway out of your bottom: and being on strict orders not to ‘push’ because of your healing wounds. I can. Eventually there was no alternative: I had to ring the alarm bell and summon a nurse to come and ‘assist’. I was looking the other way, of course, but I think scissors may have been involved, or possibly some leverage system.  I often wonder what she said to the other nurses after her long absence with me: “Honestly, it was so hard I thought he might be passing his spine.”   They really, really are angels, aren’t they?  But if you say that to them, they just pooh-pooh it.