Deep Vein Thrombosis – Writer-insighter

Heart of darkness

So far, 36,000 people in the UK have died from the corona virus and if you add-in the untested, as Her Majesty’s Government are understandably in no hurry to do, a lot more have. As I was writing this I got it wrong though. It isn’t 36,000 at all. It’s now 37,048. You can track it here at worldometers.info.

It’s certainly brought out the cliches. I was going to type that I’ve never seen anything like it in my life, but one thing I have seen before is government incompetence, dogma and a total refusal to accept that anything it does could ever be wrong. That part is just like the 1980s again. You turn if you want to.

I’ve been meaning to read everything I have in the pile but it mostly hasn’t happened. I still haven’t read Wolf Among Wolves and I love Hans Fallada. Ditto A Boy In Winter, Austerlitz, even Arthur Miller’s Timebends isn’t getting read. Instead I tried to catch-up on my everyone’s-supposed-to-have-read-Conrad list, given that at least he wrote short books.

Apocalypse Now was the problem.

There was a spare of films about the Vietnam War, from the Deerhunter through Apocalypse through FMJ, teaching mine and Jeremy Clarkson’s generation an entire vocabulary of gooks and slopes, M16s, medevac, fragging officers and the Thousand Yard Stare. Man, the chopper used to fly right over my house. Not in Vietnam but in Finsbury Park, coming down from somewhere north to shoot Kubrick’s Full Metal Jacket in Docklands. Back then we – a collection of girls called things like Laura and Nicky and Caroline, DPG spooks, thick rich boys and ditto moguls (Nay, rarely, not Indian princes, girls who do photo shoots, ya? Because of the way they speak, ya?!?!) called it Full Dinner Jacket at the White Horse in Parson’s Green. What larks!

But only because if you can remember the 1980s you weren’t drunk most of the time. I found it oddly appropriate that when a film-maker wanted to shoot in a tense, devastated third-world hell hole the obvious location was London. But it was a different place back then. The horror. The horror.

Conrad, to point out the bleeding obvious, wrote Heart of Darkness. To be honest, guv, I found the telling a story by telling a story about someone telling a story a bit laboured, quotes and all. But I can’t find a publisher and Conrad did, so what do I know?

Thinking about a post-industrial ruined city? Think London.

What I did find in Heart of Darkness wasn’t on the edge of town but on page 101, appropriately enough Orwell’s place where there is no darkness. It was a passage I very much identified with, because 15 years ago, it happened to me.

I have wrestled with Death. It is the most unexciting contest you can imagine. It takes place in an impalpable greyness, with nothing underfoot, with nothing around, without spectators, without clamour, without glory, without the great desire of victory, without the great fear of defeat, in a sickly atmosphere of tepid scepticism, without much beleif in your own right and still less in that of your adversary.
Conrad, Heart of Darkness, right at the end. Obviously.

That, as I remember it, was pretty much what it was like. A detachment, when you’re really, dying-type ill. A lack of interest in the outcome. I didn’t have Covid-19. I think I actually did in February and March, when I couldn’t stop coughing for about a month, had a temperature of 38.4 and not much memory day-to-day, other than being desperately tired all the time. Fifteen years ago I had something equally fatal, an iliac Deep Vein Thrombosis.

It’s Not All About You

Except when it happens to you, yes it %@&*ing well IS, actually.

I’d been flying around the world too much, I had a vein that had grown too close to an artery and in an airplane long-haul the artery expanded as arteries do. It pressed my iliac vein against my spine hard enough and long enough to stop the blood flowing through it, so it did what my blood does and clotted.

The thing about blood is that while it’s inside you it’s got a job to do and that job means it has to keep moving. The problem when blood in a vein clots mainly starts when the clot breaks up. First it goes to your lungs and can rip them apart. It’s called a pulmonary thrombosis and it really hurts. You’d know if you had one. Coincidentally enough, that’s what kills a lot of people with Covid-19. Three 300mg aspirin tablets – about 25p – would help, but I didn’t know that then. If the clot goes through your lungs without killing you it goes into your heart. That’s fine. It’s getting the clot out that’s the problem, because clots have a habit of getting stuck there. The heart will keep pumping, because that’s all it knows how to do and liquids don’t compress. Something’s got to give and the thing that will is your heart, as for once factually, however many times you’ve said it to people who are telling you to go and try to enter your body parts in someone else, permanently, it doesn’t feel as if it’s ripping apart, it actually is.

Then Mistah Kurtz, he dead.

If you’re lucky. Because if you aren’t then the blood clot will head next to your brain. It can kill you there by ripping it apart again, but if you’ve really lucked out you’ll just have a stroke, and I’m far too old to want to try to learn how to use a spoon to feed myself all over again.

Perhaps all the wisdom, and all truth, and all sincerity, are just compressed into that inappreciable moment of time in which we step over the threshold of the invisible. As Conrad put it.

From reading Hunter S. Thompson – never a wholly reliable source – I used to believe that the last words in Heart of Darkness were Kurtz’s.

The horror. The horror. Exterminate all the brutes.

Although to be fair, that could equally have been said by any Cabinet Minister advocating herd immunity.

We aren’t getting much wisdom, truth or sincerity out of HMG. But when the man who is Prime Minister was elected by people knowing full well he was sacked twice for lying all three are probably fairly unreasonable expectations.

The last words spoken in the book are much more apposite.

We have lost the first of the ebb.

A long time dying

This is the second blog post with something about dying in the title. I don’t want to do it and although one day I’m obviously not going to get out of it, that isn’t today or any day I’ve got planned. No thanks to the GPs at Leiston surgery in Suffolk, who felt that if I only bucked up and stopped moping about dying they could get on with whatever else it was they were doing when they couldn’t be arsed to give me a blood test.

If they had it would have found something I thought I had, on the basis of no evidence other than a word in my head since I was fourteen. Thrombosis. A blood clot. Mine was a rare one, in the iliac vein.

The iliac vein is a big one. It goes up your left leg and crosses over your spine, just about at the back of your belly button. Your femoral artery crosses over it in front. If you fly for more than an hour you ought to read the next bit carefully.

When I was in the womb my iliac vein grew curled around my femoral artery. When I got on an airplane and we went up through the clouds my artery expanded, as arteries do. Hugely. I’ve seen it on close circuit TV. I don’t recommend this and nor does any doctor I ever met. It gives you nightmares for a week. But I didn’t know that then. Just the way I didn’t know my own blood in my artery was crimping my iliac vein tight shut against my spine.

When blood stops flowing it clots. Mine clots fast. Cuts that other people have for a while disappear on me. A couple of seconds of pressure on a cut finger on me and it stops bleeding. Inside me, a big blood clot grew. A deep vein thrombosis.

These aren’t fun. Apart from messing you up when they’re stopped, slowing your circulation right down, the much more dramatic danger starts if they begin to move. Veins bring blood back to the heart, via the lungs. If you get a lump of blood stuffed into your lung, just like a bullet, by the time it’s stopped ripping things up you can be unhappily drowning in your own blood.

If it goes through your lung to your heart the fun just multiplies. The ‘Out” side of your heart has smaller holes than the “In” side. Your blood clot will go through your heart and jam in the exit holes, blocking the artery. Your heart is only designed to do one thing though and that’s pump. Which it will keep on doing until you die. Unfortunately, if your artery is blocked that might not be a very long time coming, because as any Mech. Eng. knows, fluid doesn’t compress. Your heart will keep pumping blood but there won’t be anywhere for it to go. Until it rips holes in your heart, after which it will go everywhere, unlike you.

But that might not happen. Your travelling thrombosis might slide right through your heart, through the artery and go on up into your brain. If you think you had problems before then you didn’t know what a problem really was. With the other stuff you die. Quite painfully and hopelessly, true, but at least quite quickly and nothing much else happens to you. A blocked artery in your brain though, that’s a whole new barrel of evil kittens.

I didn’t want a stroke. I didn’t want to have to learn how to eat with a spoon or shout abuse at the sound of my own name or have someone clean up after me more than our paid cleaner already did when she didn’t skive out of cleaning by standing very, very close to me and smiling a lot while she talked to me for two hours, an arrangement which suited us both at the time.

I didn’t want any of this. And I didn’t want to go on living the life I remembered my mother’s family living, or several of the older males anyway, sat in chairs inside in summer, sleeveless jumpers on, next to a roaring coal fire. Eleven years ago this year I knew exactly how they felt. They got fat and blocky because every time they moved their joints hurt and because they didn’t move their circulation got worse and they got fatter. And colder. And on, more and more miserably, uncomprehendingly on. I thought it was normal. I thought that’s what happens when you get older. When you have a congenital medical condition, it is. They didn’t

I thought it was normal. I thought that’s what happens when you get older. When you have a congenital medical condition, it is. They didn’t know what it was before they died uncomfortably. I do. And I find it very, very hard to forgive a GP surgery that took three years of my life because they simply couldn’t be bothered to do a blood test.

When I was dying

I have to credit the amazing-notwithstanding-that-it’s-true title to a friend. She had pneumonia and because she smoked and I think because a lot of different reasons, she thought she had something else. It didn’t matter. It didn’t hurt. There was just no energy. Just every day the light burned a little lower.

I had it once, about a year and a half ago. I can’t remember anything much of that time, apart from being cold and having no energy and the light seemed strange all the time. Yellow. I wrote an entire screenplay in two weeks, the most productive two weeks I’ve ever had, despite that I was ill.

That wasn’t the time I was dying. That was eleven years ago this January past. The fact that I didn’t die had nothing to do with the incompetence, penny pinching and venality of the GPs at Leiston surgery in Suffolk and everything to do with the genius of my surgeons at Ispwich General, which isn’t a phrase I thought I’d ever be using.

I knew something was wrong. I felt old and cold and slow all the time. My joints hurt and there was something wrong with my feet. For three whole years it got worse, until I was wearing a sweater deep into the summer and two sweaters and the heating on at my desk in September. I just thought it was what happened as you got older. The vomiting was unusual, I thought. Every so often, maybe every three or five or seven weeks or so, I’d be hit with a pain inside me so huge that it dropped me to my knees vomiting. Ten minutes later I was fine. Shaken, but fine and just the little pool of vomit to remind me it actually happened. I thought for a while I might be losing my mind. It made no sense.

I went to the doctor. The word thrombosis had been going through my head for years and I don’t know why to this day. Nobody in my family had ever had one, to my knowledge. I was just over forty. I was suddenly flying long-haul quite a bit, but I had my stupid flight socks and drank water and did all the exercises you’re told to. And still I’d wake up five miles high and know I was dying. A flight from Miami to Limassol via London in Business Class was one of the worst of my life. No amount of free champagne and luxury bedding got rid of the feeling that the sand was running out and most of it was already gone.

The first doctor felt my calves, because in Suffolk that’s apparently how you look for a thrombosis. He didn’t find one but said sometimes doctors never find out what’s wrong with people. Next please.

I tried another doctor after he suddenly retired with a mental illness. This one was a female army doctor. Nothing wrong with you if you can cycle twenty miles, I was told. Buck up.

But I didn’t. The next GP decided to test for testicular cancer. It’s the fashion, apparently. If you’re under 25 anyway. And the doctor gets a little sub for testing for it. Flattering though it was to be mistaken for a slip of a lad albeit one with wonky balls, that still didn’t explain the cold, the joint pain, the vomiting. Who cares? Next please.

By the third December I thought my life had gone on quite long enough if it was going to go on like this. I remember cycling out on an errand and taking a short cut back across a field. I wasn’t sure where I was exactly, the light was fading, my feet were soaked and cold but then they were always cold anyway, but my ankles hurt too and I did not want any more of this. I stopped in the middle of the field for a while, but moved on again. I didn’t want to stay in the field. I didn’t want to be anywhere.

A few days later we went to Portugal. It was nothing. I was cold, sick, hurting and felt alone, the way I felt almost all of that time, which was hard on the person who was there with me throughout. When we got back I drove us to Wales to stay in a cottage with relatives. I recall the drive through the dark. I remember walking on a wet beach. I remember driving back and being dropped to my knees with pain tearing me apart in a car park, somewhere I will never see again. And as always, ten minutes later the pain had gone. Just the memory of it stayed. And the pool of vomit on the ground.

A few days after we got back the nightmares started. I got practically no rest for three nights. The fourth night I woke from a nightmare to go to the bathroom and found my left leg hurt incredibly as soon as it touched the floor. I thought I must have been lying oddly. I thought it would be ok.

When I woke in the morning it still hurt. More. My left leg was about a third bigger than my right leg and the colour of a raspberry. My partner called the doctor, the same doctor who had been insisting there was nothing wrong and it was probably all in my head. Even he had to admit there was a problem now.

I went to hospital by taxi because it was quicker than getting an ambulance out to me in the remote corner of the world I live in. The boy doctor in Casualty was scared witless. He arranged a scan immediately, the thing I’d been asking my rubbish GPs for, because I thought I had DVT – Deep Vein Thrombosis. The boy doctor told me my situation was, as he put it quietly, ‘grave.’ I had been telling his colleagues that for three years.

There was a simple blood test that diagnosed DVT at the time. It cost 80p to administer, but the reason Leiston surgery said they didn’t want to use it was because it sometimes gave false positives. In other words, it told some people they had DVT when they didn’t. If that happened they’d have an ultrasound scan, the kind I was having now.

It turned out I didn’t have a DVT. I had either three Guinness Book of Records DVTs or five massive DVTs. Either way they couldn’t really work out how I wasn’t dead. I didn’t say I’d been there and got the T-shirt. It just felt like that anyway.

I was lucky to find a brilliant surgeon on my ward who gave me a choice: join my experiment or go on Warfarin/Couperin for the rest of your life. Which he said would probably be about ten years because after that on Warfarin you’re quite likely to uncontrollably haemorrhage one day. No choice.

The tale of how I got stented can wait for another day. It didn’t hurt then and unless I get really tired, or get a bad cold, or both, as now, it doesn’t hurt at all. When I have a cold and get tired it hurts in a way painkillers won’t even touch. But at least I’m not dying now. Although, like my friend, I remember when I was.