The Dun Cow Rib Page 9
Fifteen months later she fell pregnant with my sister Mary. As the pregnancy progressed so the doctors picked up a heart murmur, not from the baby’s heart but from her own. The sinister growl of rheumatic heart disease was beginning to make itself heard. The Carey Coombs murmur. A succession of check-ups confirmed the worst. Her mitral valve had become stenosed, failing to open and close so that blood could be heard gurgling backwards and forwards between the two chambers in her heart’s left ventricle. It was working overtime. She should not have tried to have children, the doctors said. Too late for that.
Evidently she was made of tougher stuff than they feared. The baby girl was born without complications, and mother and child flourished. But back came the dire warnings – strictly no more children. If a second birth proved difficult and her heart couldn’t cope, she would almost certainly die. Quite probably so would the baby. I was being written off even before I was conceived.
In the 1940s doctors and surgeons were universally viewed with veneration. The profession, particularly those as rarified as cardiac specialists – the high priests of both medical and surgical disciplines – sat on pedestals, unchallengeable and unaccountable to their patients, way beyond the reach of ordinary mortals who accepted what they were told without question. Diagnoses, prognoses and decisions were delivered in solemnity and received with almost religious reverence.
Open-heart surgery, in so far as it existed at all, was still in its experimental infancy and would not be an option for another eight years. Besides, Helen felt well enough, perhaps a bit breathless now and again, but no significant chest pain, nothing unduly alarming. And the doctors must have been hugely encouraged that she had apparently sailed through the birth of my sister. Did my parents attempt to assess the risks of a second pregnancy? Or because it was wartime and everyone’s future hung in the balance, did they do what every other young couple was doing, taking life day by day, week by week, hoping for the best, dodging the Blitz and shrugging their shoulders, ‘Que sera, sera’?
I am now astonished that in adulthood I never had these conversations with either of them. But the world was different then; some things were never discussed, emotions were reined in, seldom displayed. Fears and anxieties weren’t analysed, rarely even revealed, awkward questions ducked. A redoubtable British stoicism ruled and kept lids firmly shut – the counselling culture would not be invented for another thirty years.
There were whole chapters of life’s spicy cocktail that simply weren’t mentioned. Sex was an absolute taboo to my parents’ generation, not just unmentionable but unthinkable too. Even well into adulthood there was no breach in the wall, no chink of insight to the tender intimacies of their private lives. In our adolescence it was a denial that proved unhelpful; no one to turn to when blindly we stumbled and fumbled our way into the sexual morass. Years later I used to chuckle to myself when sitting watching television with them both. When a steamy embrace or a bed scene appeared, up went the newspaper and my father vanished from view, suddenly deeply attentive to the day’s stock market wobbles, while my mother pretended not to have noticed and busied herself with her embroidery.
But I know from their letters that the actualité was very different. They were ardent lovers, full-blooded, bonded, rapt. Helen was an unshakable Romantic, loving and demonstrative by nature, and my father, although reserved, even aloof by inclination, was unquestionably all male. And they were in love. From the haze of distant hindsight I am struck by how little I really knew of my parents.
What I do know is that my mother was as soft as eiderdown, kind, gentle, forgiving and always blessed with an inextinguishable positivity. Her personality was ruled by the soaring gift of a generous spirit, not just to her children but to the whole world, always tempered by an invisible core of steel. She had no time for self-pity – although, dear God, she had cause enough – not in herself or in anyone else.
My father was a very different animal. He struggled to express any emotion at all. A brusque and laconic exterior gave an entirely false impression of uncaring insensitivity; in fact, I think he felt things very deeply but was unable to express them, no doubt the product of an austere Victorian upbringing by nannies and governesses. His response to a problem was instinctively pragmatic – find a quick and practical route to fixing it. If there was none available he fell silent, erecting a shield of denial that made him look as though he didn’t care. It took me years to work out that his inability to share deeply-felt solicitudes was a burden he carried all his life. I never kissed or hugged my father, although deep down I never doubted that he would be there for me in a crisis. From his marriage to his death he was an unshakably stolid husband and father, a diligent provider and extremely hard worker for his family. We shook hands and we smiled and nodded to each other for my entire thirty-six years until his premature death. Such serious conversations as we ever had were brief and superficial, skirting around contention, awkwardness deftly avoided.
* * *
I was conceived in Yorkshire at the beginning of September 1945, only five miles from my family’s deeper ancestral heartland. These were times of great national jubilation, despite all the grievous losses, including my mother’s younger sister Priscilla, killed a year earlier while driving an army staff car that skidded on black ice. Hitler was dead; our boys were heading home. The war in Europe was over and at last Japan had conceded defeat. The world’s first atomic bomb, ‘Little Boy’, had been dropped on Hiroshima on 6 August, and the second, ‘Fat Man’, on Nagasaki three days later. The Japanese Instrument of Surrender was signed on the deck of the USS Missouri in Tokyo Bay on 2 September 1945.
I shudder to think that I might have been conceived in the mood of exultation after such apocalyptic devastation, but, in fairness to my parents, the national relief must have been overwhelming after five years of deprivation and mayhem, and it is unlikely that until much later anyone in Britain had any real idea of the holocaust those two bombs visited upon those tragic cities’ blameless civilians. Like many millions of others, my destiny was to be born a ‘baby boomer’.
But such exhilaration as there might have been was to be shortlived. Only three months into the second pregnancy rheumatic heart disease’s unwelcome overture re-emerged. At seven months my mother was admitted to hospital, struggling to carry the burden of a big baby. Worse, her placenta and her well-developed foetus were demanding more and more blood, causing the left ventricle to pump harder and the audible regurgitation through the now badly leaking mitral valve had thrown her heart into arrhythmia – an irregular and worryingly erratic heartbeat. Her whole bed was shrouded in an oxygen tent.
My birth was a close call. Her heart struggled valiantly yet horribly; the pressure in her left ventricle rose to the level of extreme danger. The chances of cataclysmic heart failure must have been very high indeed. But the gods were bountiful, and I emerged into this world a little blue but soon wailing loudly. I was whisked away, but my mother remained in dire distress, doctors and nurses fighting to save her life. She would remain at high risk for three weeks, with a nurse beside her day and night, and under close observation on a post-natal ward for a further six. Nobody knew the extent of the damage to her heart, but it would become evident soon enough. She would never be the same woman again. It would be a very long time before I knew it, and even longer before I properly understood it, but I had almost killed her.
* * *
Who can say when a child’s awareness begins? Awareness needs a time, a place, events, sounds, smells, people, words, things done or not done, placed in order, fitted and received, all the essential marker buoys along the treacherous channel into comprehension’s safe harbour. All children awaken to the world around them in fragments, a baffling mix of receptivity and inattention. Awareness waxes and wanes, like waking from sleep and drifting off again, clouds floating in, seen, then gone again until the next one wafts through. In Cider with Rosie, Laurie Lee’s famous First Light was grass, ‘each blade tattooed with tiger-skins of
sunlight’. Mine was a table leg. A big old kitchen table. In the absence of a playpen in those immediately post-war days, I was imprisoned under that table and a sheet strung round all four legs, fencing me in. That’s all there is to it. Just that. A first flickering of memory.
Then a three-year blank. A long, drawn-out blank of no memory at all, a blank of months yawning into years of staring out while all-uncomprehending, the world revolved around me, a world of immediate preoccupation with the mud-pie moment, a world without place or a name. I saw trees, birds skimmed through, sights with and without sounds; leaves trembled and flashed, light gave way to dark, sun to rain. Nameless voices garbled incoherently, footsteps came and went. Doors banged. My hands and chubby knees knew the grainy chill of flagstones. Buckets clanked, water gushed. A cockroach crawled across my hand. Months passed like the wind turning pages of a book, unread and silent, telling of nothing. Events flooding over me as a bright stream flows over stones, unremembered and lost, a dim and watery oblivion, life obscured behind a feral haze.
Then suddenly, without any warning, everything changed. I am sure I understood nothing of it at the time, but my mother became dangerously ill. In the way that you know instinctively that something is wrong, I had divined that she was the problem. Her illness was never discussed, certainly not in front of us small children. She disappeared to London. We lived our days with the dark vacuum of silence and absence. ‘We’ve arranged for you to go to a new school,’ she told me in a strange voice when she came back. I was not quite six and had no idea what was coming next.
What I can recall only survives as the disjointed fragments of some allegorical medieval fresco uncovered on a church wall, the gaps leaving us guessing at the parable. But those fragments have lived on, unsullied, as sharp and bright as a sunlit dawn: school outfitters to buy uniform; name tapes; wondering why on earth I needed number 18 on everything; trying on new black lace-ups which were too big and made me walk in a clumpy way; watching my trunk being packed, each item ticked off against an inventory – all clear signals that my life was about to change, but still no clue how. Most of all I remember how my mother clung to me, choking back tears, the day she was taken back to London. Not once did it cross my mind that the reason I was being sent away to boarding school was because a dark shadow had fallen across our family.
As a pre-prep, Hampton House School was probably unexceptional for the 1950s. I had never boarded before. It was just something that happened to me, like bad weather – no preparation, no reasons given, no option. My father drove me there in silence. New navy blue blazer with white bindings, a grey flannel shirt and blue tie, grey short trousers and long grey socks with blue turn-down tops and my navy cap with white HH monogram above the peak, I sat on the back seat’s shiny leather the colour of ginger biscuits. I remember fiddling with the rotating Bakelite ashtray under the window; it popped in and out as you pushed it.
He smoked his pipe as he drove and if I close my eyes I fancy I can still see the frantic flick of the windscreen wipers and hear the distinctive whine from the old Riley gearbox. I don’t believe I had formulated any clear picture of what was happening or where I was going, or even why. Yet those memories I have retained are as vivid as yesterday’s, made sharper and in stronger relief, I now realise, by just two things – looming fear of the unfamiliar and the cold slap of loneliness. Everything else has washed out. I was suddenly there without any idea that something was horribly and permanently wrong. Children didn’t get explanations back then.
He carried my old battered trunk, his and his father’s before him, in from the car. Other arriving boys and parents bustled around me as I watched with the detached indifference of watching a bad film. Then ‘Goodbye, dear boy. Don’t forget to write.’ We shook hands. He turned on his heel and was gone.
7
Hearts and minds
In 1903, twenty-eight years before my mother’s fateful journey to Cairo, in a modest middle-class home in Clapham, London, Herbert Brock’s wife Elvina gave birth to their fourth child, Russell Claude, in what would eventually be a family of six sons and two daughters. Herbert was a ‘master photographer’ specialising in weddings, portraits and commercial photography. They can never have dreamed that their son would become Lord Brock, the world’s most celebrated heart surgeon of his day.
Aged eighteen, Russell elected to read medicine at Guy’s Hospital Medical School, passing up with an arts scholarship. Five years later he graduated with honours and distinction in medicine, surgery and anatomy. Aged only twenty-five, Russell Brock could display LRCP (Lond.), MRCS (Eng.), MB, BS and FRCS after his name. He was on his way.
That year he won a Rockefeller travelling fellowship to work in St Louis, Missouri, with the great American thoracic surgeon Evarts Graham – the first surgeon to successfully remove a lung and the first to attribute lung cancer to cigarette smoking. Graham had also attempted open-heart surgery in a bold effort to resolve the commonest of valve complications, mitral stenosis. He failed. All his patients died. It was a pivotal moment in the young Russell’s career and he would never forget Graham’s distress. The experience had handed him a cause forged by the best possible tutelage, and he knew it. In 1936 he returned to London and was immediately appointed consultant surgeon to both Guy’s and the Royal Brompton Hospital in Chelsea. Cardiac and thoracic surgery was now his chosen discipline, both areas of extreme challenge at the cutting-edge of medical science. In 1938 he was honoured with a Hunterian Professorship, the highest accolade in medicine. He was only thirty-five.
By 1947, a year after I was born, Russell Brock had established a thoracic surgical unit at Guy’s and turned his full attention to resolving problems with heart valves. He argued that stenosis could easily be rectified by surgery if only techniques could be refined to keep the patient alive. Surgical grandees at the apex of the profession disagreed. Russell was not deterred. He was on a mission, determined to find a way of performing successful open-heart surgery.
Even at that tender age Russell Brock’s force of character – never taking no for an answer – had established a potent work ethic. He was a perfectionist and unquestionably driven, but always meticulously fair, while famously intolerant of others who didn’t share his absolute dedication – or his views. He abhorred pomposity and sloppiness, and could be abrupt and incisive to a point of rudeness, as well as coldly dismissive of those he considered unequal to the task in hand; but such was his reputation and his unswerving loyalty to those colleagues he valued and respected that his pioneering procedures were very rarely challenged.
He had chosen to focus all his considerable intellect and skills upon the correction of mitral stenosis. He began a series of operations in September 1948, using his finger to break the restrictions in the valve flaps, a procedure he named mitral valvotomy. But he was a consultant surgeon, a wielder of scalpels. All good surgeons need to work with equally gifted physicians. Accurate diagnosis and the medical preparation of a patient for some weeks before what was always a life-endangering procedure was essential for success. In 1950 a brilliant young physician took over as director of the cardiology department at the Royal Brompton Hospital. Dr Paul Wood was forty three, four years Russell Brock’s junior. His textbook, Diseases of the Heart and Circulation, had gained him immediate worldwide recognition as the European authority on heart disease.
Paul Wood had specialised in studying rheumatic fever and its concomitant heart complications. He pioneered the analysis of pulse signals from arteries in different parts of the body and the irregular rhythms of heartbeats, reading the murmurs within the heart vessels in order to achieve accurate diagnosis of precisely which valves were causing the problems. His skill became legendary. With little more than a stethoscope he could build an accurate picture of what state a diseased heart was in. It is no surprise that to this day the cardiac unit at the Brompton Hospital is named after him.
As a man Paul Wood was the antithesis to Russell Brock, an opposing polarity that would bring them
together as inseparable colleagues and firm friends. Paul was an extrovert, revelling in his own individual brand of sarcasm, often witheringly funny, and a taskmaster who took no prisoners. If Russell Brock didn’t suffer fools, Paul Wood shredded them, and yet his students adored him. He could tease out a diagnosis with the analytical incisiveness of Sherlock Holmes, dazzling his audience.
A slight figure, he was balding with a domed forehead and a sharp nose like a beak. Blue eyes boldly flashing, he spoke quickly and with total confidence. He never engaged in tact and pulled no punches, simply not his style. If he was critical of a procedure or a colleague, regardless of rank, he could be fiercely combative, never backing down. And yet in his patients he inspired confidence and absolute trust – a vital psychological as well as clinical preparation for the terrifying uncertainty his patients had to face.
Russell Brock took to him immediately. It was a meeting of minds and causes, a marriage of Titans, the world’s leading heart surgeon partnered with the world’s top authority on hearts. Arriving at the Brompton to work with Russell Brock had handed them both a unique opportunity to develop their skills jointly – to become the finest cardiac team the world had ever known.
* * *
In 1936, the year of Russell Brock’s appointment to the Royal Brompton, my mother was a happy sixteen-year-old skipping about Turkey with her twin sister, having fun at picnics and tennis parties and galloping off into the hills on horseback. In the ten years leading up to my birth she had become a fulfilled wife and mother. She can little have guessed that everything was about to change. I wouldn’t understand it properly until adulthood, but giving birth to me had strained her heart badly and brought into stark focus her heart’s seriously deteriorating condition – an irrational culpability I have felt keenly ever since.