I was recently back in Chris Barnard Memorial Hospital and had my second encounter with the demon drug. I thought I had learned my lesson from the first encounter and I’ve documented that somewhere, but that just serves to show how strong this thing is: when I was admitted to the trauma unit, the trauma doctor asked the classic first question, which I am used to by now – “On a scale of 1 to 10, how severe is the pain?”.
In my opinion this is a somewhat stupid question because if you’ve never experienced 10, you won’t know what 10 is and if you have experienced 10 you will be insane at that moment and not fit to judge; and if you have only ever experienced a pain-free existence then even only a 2 will feel like 10. That’s exactly the problem with America’s painkiller-obsessed society but the latter is a whole different subject which I am not going into now. I don’t think I have ever classified a pain sensation as higher than 5 because I know what’s out there, hovering around 7.5 and up and I wouldn’t wish that on anyone.
So I got the question and gave what I considered to be an honest answer: the pain was about 4 – I knew that I could withstand more, I just didn’t know how much.
“I’m going to give you a small shot of Morphine” the nurse said, “just to tide you over”. She was looking down at her surgical tray as she said it, so she did not catch my face, but my by-now kneejerk reaction on that subject was, “I can’t take Morphine. I can take Pethidene but not Morphine” She already had the needle and J-link in her hand and I had to speak quickly to stop her. She hesitated and then put it down. She went away presumably to ask about Pethidine but when she got back she didn’t have any so I presumed that whoever was in charge there had not approved. She inserted the J-link, tested it, and then left it for the next stage of the proceedings. That was Thursday morning.
On Friday I was simply stabilised and kept in the cardiac ICU as my cardiologist was out of the country and his substitute said that he wouldn’t touch my case, considering my history. He said that although he felt experienced enough, he would only intervene in a case of extreme emergency. Being stabilised, firstly, meant being infused with a TNT drip which had the effect of dilating all the blood vessels in the body in order to counteract any obstruction caused by a blocked blood vessel anywhere. It’s a crude but workable system, saving that there are blood vessels in parts of your body – most notably the brain – which are not designed to dilate and if they do, they leave you with a thundering headache: but what the hell, the philosophy goes, if it saves you from a heart attack, it’s a small price to pay. The pain can be managed – with Morphine.
Oh, we're going to have a fine old time in the cardiac ICU tonight: the porters have just wheeled in an enormous lady, clearly out of her mind, nobody seems to know how she got into this condition, she has no family with her, she has bruises on her face, a cough like a death rattle, and every time the nurses turn away she tries to climb over the rails of her bed. Pulling out tubes, knocking things over ... reminds me of something … Eventually the nurses take an extreme measure: they are legally allowed to “restrain” an out-of-control patient who is a threat to themselves or to other patients or staff - this usually involves tying or handcuffing the patient to a bed after a warning, and the restraint has to be removed at regular intervals to see whether the patient will cooperate or not.
No sooner is she restrained than she says that she wants to go to the playroom on the other side of the ward, pointing at a glass enclosed area opposite. Funny, once upon a time when I was in that condition I thought there was an Indian wedding going on in exactly that same glass-enclosed room - in fact, what I was looking at was the late Lumpy Maresky breathing his last with the family around his bed.
This woman’s name is Debbie. She kicks and thrashes and tugs at her restraints, all the while shouting pitiful pleas, “Please help me, help me, help me!” On and on she goes. She looks like a trapped animal. She is about 60. The story goes around that she has all but destroyed herself with a drug overdose - that her mind and her kidneys are gone.
On the far side of this large ward, out of my sight, is a crazy old woman shouting out, over and over,
"Come on girls! All together now!
Happy birthday to you!
Happy birthday to you!
(Mumble mumble mumble)
Happy birthday to you!"
The gentle peeping of the vital signs monitors, the myriad coloured pilot lights shining like unblinking eyes through the jungle of tubes, cables and machinery in the half-light (an ICU is never either completely dark or completely quiet), the snoring of so many tired, sick bodies, each one fighting his or her own battle against sickness or death, punctuated with the desperate gestures of these two loons - it becomes a backdrop for each of us against the rest of us, a metaphor for the constant struggle against oblivion, the struggle that we call life.
Played out over millions of years, across thousands of species both mineral and animal, in the course of which the triumph of life over death will always be barely marginal, nevertheless, life as a phenomenon does seem to enjoy a small triumph. Death is ontological. Life, as a phenomenon, it seems, is eternal - or as close as history will ever get.
The next day Debbie seems to be calming down and her restraints come off more often. Just before visiting time an elderly couple come walking down the ward uncertainly, looking for someone. They are at the foot of Debbie’s bed before they recognise her. If Debbie is 60, this woman looks 95. They have similar facial features. The two old folk have a look of wealth and privilege about them. Debbie’s parents. This is the coldest greeting that I have seen a mother give to a daughter, but Debbie is as excited as a child. Even at 60, she calls the woman “Mummy”. Mummy this and Mummy that. She is not a dying old lunatic now. Her face is animated, her voice is alive. The old woman’s face cracks into a thin smile. She shifts right up against Debbie on the bed, puts her arms around Debbie’s shoulders, cradles her monstrous bloated frame in her arms. She is saying something to Debbie. Her face is so close that her lips brush against Debbie’s temple as she speaks. Debbie’s eyes are closed and her face is a picture of absolute rapture. Her lips move silently. She is copying the words that her mother is saying. Her hands rest in her lap, playing with each other as the hands of a small child often do while mentally preoccupied. A remarkable thing is happening to Debbie’s face - as she relaxes, the creases, wrinkles and blotches are disappearing and the face of a young girl takes shape. The years are being rolled back, and whatever loneliness, pain and unhappiness that childhood may have involved to create such an unhappy adult, are being erased. The old couple got up and left, and I never saw them again.
Two nights later Debbie died in her sleep. I woke up in the morning and her bed was empty. I would like to think that that night, the pure soul of a young girl called Debbie, aged about five, went straight up to heaven. And as for the soul of her old mother - well, in due course that will have to go through the usual selection process!
For me, by Saturday the headache was reaching pretty much unmanageable proportions and in addition to that, in spite of the TNT drip, the chest pain returned. There was now talk of the cardiologist moving the angiogram forward. I didn’t know that he had cut his trip short and was already on his way back to South Africa. But by Saturday afternoon I was pretty much finished and I knew I couldn’t hold out much longer, even though every time they asked that stupid question, “On a scale of 1 to 10 ...” I still wouldn’t go higher than 7. I felt like I had a fever. I thought of my brother in Canada and my grandchildren in Israel and it occurred to me that there was a jolly good chance that I was never going to see any of them again. I could feel that I was going to cry and I tried hard to hold it back but hot tears welled up inside and burned down my face. I couldn’t see out of my left eye for tears. No matter how I wiped them away, they came too fast.
For two days I had had Erin, a young nurse at my side, she almost never left there, except that she went off shift on Friday night but she was back at 7:00 a.m. on Saturday morning, keeping her shit together, talking to me, staying cheerful (I’m sure the nurses in the cardiac ICU get specific instructions about putting on a cheerful mien at all times – it’s more important than you could imagine, even when you know it’s a bit forced). Now, she just lost it and started crying herself. She’s 27. I don’t know how many times she’s been in this situation, but I didn’t think that it could be too many. “Please let me give you the Morphine”, she said, “I’ll make it the smallest dose”
I was done. I couldn’t take anymore and told her to go ahead. I didn’t realise she already had the syringe in her hand.
Now, I need to explain something to people who don’t know this situation: when you go into a trauma unit and it starts to look pretty certain that they are going to admit you to the hospital, they insert a thing called a “J-Link” into a vein: it’s not a full-blown drip because at that stage they don’t know what medication they are going to have to administer (or what combination of medicines). The J-Link consists of an injection needle with a nylon canula (a small flexible nylon tube with the diameter of an injection needle) inside it, attached to a length of drip tube about 10 centimetres long. At the other end of the tube is a sort of nylon junction box, into which you can plug any kind of syringe nozzle just by clicking the nozzle in or out of the plug. The whole apparatus is then taped to your arm in the shape of a “J” (hence the name), and they don’t have to poke you full of holes to run different fluids into you. The link is filled with Normal Saline (salt water with a human PH), because air in a vein will kill you when the air reaches the heart. They can flush it with more saline if blood backwashes into the link. When the whole J-Link is in place they withdraw the steel needle so that all that stays in the vein is this flexible nylon canula, and it’s not uncomfortable. Brilliant!
So when she held the syringe in her hand there was no need for a needle on the syringe: she just clicked the nozzle into the socket and pumped the morphine through into the vein. I could feel the cold fluid enter the vein and run up my arm. I was burning up, and the cold held a promise of instant relief. She then pumped some more saline into the J-Link, to make sure that all the morphine went home. Because I know the stuff I was surprised at how long it took to kick in. It must have been nearly 60 seconds before the pain started to melt away. My world became a distant place – quiet and free, effortlessly I soared above a beautiful, lush, uninhabited valley. Sunlight fell on green and gold leaves. Hidden from sight a brook of pure mountain water gurgled its way through the trees. At times like these, Psalm 104 (“The Hallel Psalm”) comes to mind. It is sheer Romantic Poetry. It could have been written by John Keats. The air was crisp and still, only making a rushing sound in my ears. I was an eagle seeing the world from a great height. The vision disappeared, and finally, I slept.
But there is a price to pay for everything in this world.
In the early hours I awoke. I was vomiting into my respiration mask, and inhaling the vomit. I was hot, sweating, in a strange place bathed in a sickly yellow light. My clothes and my bed were soaked in sweat, pee and vomit, the bed was surrounded by the dark shapes of people who I did not recognise, they were shouting to each other, and the alarm on the vital signs monitor above my bed was screaming its shrill scream. I felt myself being pushed over onto my side. Somebody put an electric fan on my bedside cabinet and the cold air blasted into my face. I hate fans. The head pain was back. Eventually the hullaballoo subsided and people drifted away and I found that I was being attended to by a male nurse with long hair, the gentle voice and features of a girl, long delicate fingers and a goatee. He was wearing a light blue gown. He could have been a Buddhist monk or an angel. With quiet efficiency he stripped me down, bed-washed me, removed all the bedding and replaced it with new stuff. With cool, crisp bedding, dressed in a fresh surgical gown, with a new respiration mask and aware that I was in the company of the kindest of people, I fell asleep again.
When I awoke, I was still in that sickly yellow light place and I recognised it as the place that I had occupied for some of the time in my hospital nightmare (also Morphine-induced) in 2012. It was a replay of the old nightmare. I couldn’t make any sense out of the place I was in – I so badly wanted it to be the ICU ward but the walls kept twisting out of shape, and the dimensions and the proportions were all wrong. This was somebody’s house. I was in a lounge – a chaotic, long room which stretched away into the darkness, littered with furniture which seemed to have been left all over at crazy angles. I was in a bed in a dark corner of this cavernous room. There were people moving around in there but they ignored me and I couldn’t figure out what they were doing. Then the Buddhist monk walked up to my bed. I was so glad to see him. He started arranging things about my bed – with deft, practiced movements he folded sheets and towels and arranged various small glass bottles and instruments on a table nearby. The click and tap of the glass bottles on the wooden table signified calmness, order, purpose. These things made me inexplicably happy.
I was fascinated by a round clock and an oval mirror on the opposite wall – they were large, about the same size, and for some reason they reminded me of Salvador Dali’s painting, The Persistence of Memory. What were they doing in this place? What were they doing? What?
On Sunday morning Dr Levetan materialised and I was taken to the Cath Lab for the angiogram. Just before I was wheeled out of the ICU my real girl nurse - the 27-year-old who cried with me - pulled up my surgical gown and shaved my groin to clear the area where the angio tool would go into the right femoral vein (I have had angio’s on both sides in the past and Levetan would go for the right side, which had been accessed the longest time ago). I was a little apprehensive about a young girl wielding a men’s razor in such a delicate area, but I need not have worried. She had been talking about that shave for two days, we had both pretended that it was no big deal, and I had no reservations about her seeing that part of me - after all, she was a nurse, this was professional, and I have never had inhibitions about nudity.
Levetan used a “balloon” to push open a partly blocked blood vessel and a stent to replace an existing stent which had moved or collapsed. I don’t really remember the rest of Sunday. Monday was a day of recuperation and Tuesday I came home. The morphine seems to have mostly come out of my system but I know that it can hold some surprises (it gets absorbed into the fat cells of the body and then seeps back into the bloodstream at random moments over a period of time and when that happens you get “flashbacks” and hallucinations. It’ll take a few days before I can feel more confident about my sanity).
1 Praise the Lord, my soul.
Lord my God, you are very great;
you are clothed with splendor and majesty.
2 The Lord wraps himself in light as with a garment;
he stretches out the heavens like a tent
3 and lays the beams of his upper chambers on their waters.
He makes the clouds his chariot
and rides on the wings of the wind.
4 He makes winds his messengers,[a]
flames of fire his servants.
5 He set the earth on its foundations;
it can never be moved.
6 You covered it with the watery depths as with a garment;
the waters stood above the mountains.
7 But at your rebuke the waters fled,
at the sound of your thunder they took to flight;
8 they flowed over the mountains,
they went down into the valleys,
to the place you assigned for them.
9 You set a boundary they cannot cross;
never again will they cover the earth.
10 He makes springs pour water into the ravines;
it flows between the mountains.
11 They give water to all the beasts of the field;
the wild donkeys quench their thirst.
12 The birds of the sky nest by the waters;
they sing among the branches.
13 He waters the mountains from his upper chambers;
the land is satisfied by the fruit of his work.
14 He makes grass grow for the cattle,
and plants for people to cultivate—
bringing forth food from the earth:
15 wine that gladdens human hearts,
oil to make their faces shine,
and bread that sustains their hearts.
16 The trees of the Lord are well watered,
the cedars of Lebanon that he planted.
17 There the birds make their nests;
the stork has its home in the junipers.
18 The high mountains belong to the wild goats;
the crags are a refuge for the hyrax.
19 He made the moon to mark the seasons,
and the sun knows when to go down.
20 You bring darkness, it becomes night,
and all the beasts of the forest prowl.
21 The lions roar for their prey
and seek their food from God.
22 The sun rises, and they steal away;
they return and lie down in their dens.
23 Then people go out to their work,
to their labor until evening.
24 How many are your works, Lord!
In wisdom you made them all;
the earth is full of your creatures.
25 There is the sea, vast and spacious,
teeming with creatures beyond number—
living things both large and small.
26 There the ships go to and fro,
and Leviathan, which you formed to frolic there.
27 All creatures look to you
to give them their food at the proper time.
28 When you give it to them,
they gather it up;
when you open your hand,
they are satisfied with good things.
29 When you hide your face,
they are terrified;
when you take away their breath,
they die and return to the dust.
30 When you send your Spirit,
they are created,
and you renew the face of the ground.
31 May the glory of the Lord endure forever;
may the Lord rejoice in his works—
32 he who looks at the earth, and it trembles,
who touches the mountains, and they smoke.
33 I will sing to the Lord all my life;
I will sing praise to my God as long as I live.
34 May my meditation be pleasing to him,
as I rejoice in the Lord.
35 But may sinners vanish from the earth
and the wicked be no more.
Praise the Lord, my soul.
Praise the Lord
2. Salvador Dali: The Persistence of Memory