A necrotic crisis like this can occur as a side-effect of acute intestinal obstruction. An intestinal obstruction is a condition where the passage of digestive waste along our intestines suddenly becomes blocked. The intestines connect the stomach with the anus, and serve the key function of absorbing nutrients and water from the food and drink we consume, while discarding the waste products. Food is pushed along the eight metres or so of our bowel by a synchronised and unconscious process of muscle contractions called peristalsis. It passes through three sections along the way. The first is the small intestine, which absorbs most of the nutrients in our food; then the large intestine, where water is removed from the waste, thereby creating a stool that’s eventually passed on to the rectum to be ejected.
The intestine can become blocked in a number of ways. It might be obstructed by a cancerous tumour that forms in the abdomen. It may be caused by a condition called diverticulitis – a severe inflammation of bulges in the lining of the bowel. It may even be the result of a foreign object ingested by the patient. Yet one of the more common causes of intestinal obstruction is the presence of abdominal adhesions.
Abdominal adhesions are fibrous bands of scar tissue that form as a result of previous surgery, and can attach themselves to organs and tissue in the abdomen. When a patient’s abdomen is cut open and operated on, injury to the internal tissue will inevitably occur. A gluey substance called fibrin forms over the internal wound to help seal it, but this can sometimes collect into a permanent sticky adhesion that then attaches itself to nearby body parts. If these bands of scar tissue attach themselves to the intestine and pull it out of shape, then it can become knotted like a twisted water hose, cutting off the flow of waste. This will lead to the complete breakdown of the digestive system, and require urgent medical intervention. But that’s not the only problem. The adhesion can also cut off the blood supply to the twisted part of the bowel. This means that the intestinal cells get starved of oxygen, and become necrotic. Gangrene then spreads along the blocked intestine and perforates the intestine walls, becoming infected or ‘wet’ due to the highly microbial content of the bowel. Peritonitis – a serious inflammation of the lining of the abdomen – will likely follow. If untreated, the patient will soon slip into septic shock; their body overwhelmed by the infection now assaulting their immune system. From perfect health, a sufferer can be dead of an intestinal obstruction within a matter of days.
This kind of malady is no respecter of wealth, age, celebrity or talent. Singer Maurice Gibb of the Bee Gees died suddenly following a constriction to his bowel in 2003. Elizabeth Branwell, the Brontë sisters’ much-loved aunt, fell ill with a bowel obstruction in 1842 and succumbed in the most agonising manner. Without the mercy of modern surgical intervention or painkilling drugs, she took a whole four days to die. Her nephew Branwell Brontë, who was at Elizabeth’s bedside, described the horror of it: ‘I am incoherent … I have been waking two nights witnessing such agonising suffering as I would not wish my worst enemy to endure.’
In 1956, US President Dwight Eisenhower was taken critically ill with an intestinal obstruction. Adhesions were discovered from an earlier operation on his appendix, and his life was saved by timely emergency surgery. Surgical intervention to repair a constricted and necrotic intestine usually involves cutting away the gangrenous parts of the bowel and stitching the shortened healthy parts back together in a procedure known as an anastomosis. Yet even if this is successful, a patient won’t be clear of danger. The associated infections caused by a bowel obstruction are, in themselves, enough to kill. Septic shock claimed the lives of actor Christopher Reeve, boxer Muhammad Ali and composer Gustav Mahler.
It’s sobering to think that scar tissue left by an earlier surgeon’s good intentions can go on to wreak such damage in our abdomen. Perhaps it was the earlier removal of a troublesome appendix, or the timely excision of a cancerous tumour. Or, if one is a woman, it might have been to increase the chance of new life, by removing obstructions to conception.
Endometriosis is a condition in which the tissue normally seen in the womb lining or endometrium develops abnormally outside of it, in places such as the fallopian tubes or ovaries. This alien tissue can block the normal functioning of the reproductive system and prevent conception. Endometriosis is an incurable condition that affects an estimated two million women in Britain. In some cases endometriosis can lead to the growth of an endometrioid cyst – a large, non-cancerous lump of endometrial tissue that accumulates around a woman’s ovaries and renders her infertile. These cysts can grow to many centimetres in diameter; however, if they’re surgically removed, a woman might gain a priceless window of fertility before the endometriosis reasserts itself once more.
Yet the scar tissue that results from a procedure to bring life into the world can ultimately be the agent of a life’s destruction.
Death and life are intimate dance partners in the music of time – the double stave on which we write the libretto of our collective history. Every narrative requires an antagonist to move its hero to action, and an inevitable coda by which their actions are given meaning and structure. We all die. Maybe soon. Maybe not for many years. Yet implicit in the fact of our expiry is an acknowledgement of the unique and transient melody that precedes it. Everything that dies also lives, and life is the single orchid-frail composer that pens the deathless music of our family through the ages.
HISTORY
The Boat that Didn’t Sail: Heidi and Stephen McGann, 1990–present
I married Heidi in the summer of 1990. It was a beautiful day. The setting was an Anglican church in south Liverpool where Heidi’s ancestors had married and been christened. To a keen family historian like myself, it seemed especially fitting. It was also the union of an Anglican with a Roman Catholic – an ecumenical service involving so many different clergy on the altar that it was surprising the bride and groom could even squeeze on. We were amused to watch the church’s divided congregation during the service – groom’s Catholic relatives to one side, bride’s Anglican family to the other – ostentatiously crossing themselves or not depending on the petty distinctions of their faiths. But everybody was united in all the important things. Two families were joined, and a new branch of McGanns was created at its junction point.
I remember signing the register in the church. I placed my erratic signature on a public document for posterity once again. I recalled my barely adult scribble on my father’s death certificate six years before, and felt the gentle turning of cogs marking the passage through the documentary milestones of my genealogical lifespan. In centuries to come, a descendant might retrace this small breadcrumb trail of legal documents as the only clear evidence of my life. The only information left of me, like the bleached bones of some ancient villager found by archaeologists – a fragmented skeleton from which a living human must be invoked. As I’ve done the same thing with my own ancestors, I find the idea strangely comforting. There’s humility and practicality to it. All that lavish passion and struggle we experience in life dissolves away like soft tissue in soil over time, until only the bare documentary bones are left – a modest skeleton whose story future generations are free to imagine for themselves. Our immortality is a distracting fiction. Narrative is the privilege of the living, not the dead.
My brother Mark was my best man, my sister was a bridesmaid, and my other brothers entered into the spirit of the occasion wonderfully. Despite the tensions that could simmer in those days, there was always a love between us. There were also new McGanns. Joe had a young daughter now, and Paul a son. There were separate partners, separate homes – separate families to forge with our common surname. Despite the cramped public persona our chosen career had chained us to, the boys were beginning to feel the same cogs turning. We were all growing up, and this meant growing away from each other. Old hierarchies were dying, and deep down we all knew it was a death that served a greater good.
Champagne flowed, tears fell, and music played. Afterwards Heidi and
I honeymooned in Tuscany before returning to our newly purchased cottage in rural Essex. We were both twenty-seven years old, and life was full of bright new narratives.
One professional narrative that came to dominate those first years of married life had been brewing for some time, and it had a moving resonance for my family and its history. The genealogical work I’d done up to that date brought me back time and again to the subject of the great Irish famine of the 1840s. All the Victorian Liverpool records I’d traced were haunted by the ghost of that one cataclysm. Although I didn’t yet know where in Ireland my family came from, I was curious to find out more about the events that led to such a mass exodus. The Irish famine had never been included in my school’s history curriculum, and despite its huge influence on western history, no major screen drama had ever been made on the subject. So, being young and filled with reckless optimism, I set about making my own.
I took a research trip to Kerry with my brother Joe, and we developed the idea of a television famine drama based around a rural Irish family – to be played, conveniently, by the McGann brothers. I went home and typed up a treatment for a TV series, and the brothers formed a production company to develop it. We gave the company the name of the little park near Birstall Road where we’d played as children, and where I’d struggled to confront my agoraphobia. We partnered with expert Irish co-producers Little Bird, and in the early nineties BBC Northern Ireland agreed to fund and broadcast it. The brilliant Allan Cubitt was recruited to write the scripts, and by 1994 we found ourselves filming a major four-part fictionalised historical drama about a rural family enduring the horrors of the Irish potato famine in 1847. It was called The Hanging Gale.
We filmed The Hanging Gale for four months in the beautiful county of Donegal in Ireland’s wild northwest, and we were supported by an astounding range of Irish screen talent – not to mention wonderful supporting artistes, local businesses and communities. Their involvement really mattered. We quickly realised why nobody had attempted to dramatise these events in Ireland before. The famine was still an open wound – a source of historical, personal and cultural pain deeper than any story some long-emigrated Liverpool brothers could tell. Yet our sincerity was real. We wanted to tell a famine story as authentically as we could, and tell it to audiences that had likely never heard it before. Owen, Susan and their children deserved no less.
So, in the strangest of ways, my family’s history came full circle. Our famine was repeated; not as tragedy, but as public theatre. The McGanns who’d fled that island in penniless starvation a century and a half before now returned to it as chauffeur-driven, make-up wearing, cosseted TV actors. The blighted potatoes we farmed were props. The pitiless deluge that fell on us was delivered by a rain machine, and not by grim fortune. Narrative is the privilege of the living, not the dead. The real pains our ancestors suffered were now the narrative property of those who followed. Many of the characters in the drama died, and those who didn’t emigrated like our forebears had done. My own character met a gruesome death, hanged on the gallows as an Irish rebel. It was grimly fascinating to watch a stuntman dressed as myself descend through the trapdoor to hang, wriggling on the noose. A narrative apoptosis – the programmed death of a character to serve the greater dramatic good.
The drama was a great success, with high ratings and awards to follow. Yet, looking back, it marked another kind of family death – unseen at the time but nonetheless appropriate. The Hanging Gale had been perhaps the best chance my family ever had to collaborate in a true ‘family business’. We had an opportunity as co-producers to use the experience gained to collaborate on new drama projects – to work together as a single team on the cerebral and collective challenges of film production, and not simply compete as separate actors. When I attended the BAFTA awards in 1996 I was asked by a very senior television executive, ‘What are you boys going to do next?’
It was already pretty clear to us that there was never going to be a ‘next’. We’d had a great experience making The Hanging Gale – it had been moving, funny, challenging and rewarding. We’d all worked hard, and we’d come away with shared memories that we’ll keep forever. And yet bringing the brothers together to work on one large-scale project had made it obvious how separately we now saw ourselves – how far that public family persona really was from the private needs of its members, and how different our interests and our talents really were. Ultimately, any true family business requires a degree of collective endeavour and distribution of skills; something we simply weren’t able to muster. Seeing this demonstrated so clearly in production meetings or publicity engagements was, I think, a good thing. Our shared past contained necrotic elements that it was wise to cut away. It was an orderly apoptosis that enabled new growth to form in the separate families we made, and with the separate partners we’d chosen. Although the brothers would work together again in future years, it would always be with the modest ambition of colleagues, and not with any illusion about a collective professional destiny.
Heidi was my family now. Like Owen and Susan all those years before, we’d embarked on our own journey to a different future. We’d abandoned city living for the timeless peace of rural Essex, far away from relatives. Heidi had expanded her career from theatrical playwright to television scriptwriter – regular, well-paid work that helped to smooth out the all-or-nothing nature of my actor’s employment. The money that The Hanging Gale brought in enabled us to move into a larger house in the nearby market town of Saffron Walden. The property we purchased needed the sort of building work that only the young feel equal to – tearing up floorboards, demolishing walls, freezing in unheated winter bedrooms while we waited for central heating, and cooking meals on rickety gas stoves while earning the money for a kitchen. Yet that freezing old house was full of new promise. It had four bedrooms: our room, a study, a guest room … and one more. A nursery?
We’d been married for five years, but up till then we’d never felt financially ready for a child. Our previous old cottage had been too small to contemplate a baby in it, and my frequent absences for work had meant that no serious plans had been made. That said, we’d abandoned contraception eighteen months before, and we took a fatalistic view of pregnancy. If it was going to happen, it would happen. However, now we had a new home and a designated nursery, and it seemed like the perfect time to try in earnest.
But as 1995 rolled towards its end, the hoped-for pregnancy didn’t materialise. It wasn’t a cause for immediate concern. We knew that conception doesn’t arrive to strict order – there are many couples who find this natural process elusive, and there are many biological reasons for it. But when Heidi did the sums in her head, she felt the lack of results warranted further investigation. She went to see the doctor.
Her GP examined her and said, ‘I think you’ve got an ovarian cyst.’ A visit to a specialist followed, and ultrasound confirmed the presence of a huge endometrioid cyst on her right ovary. We were stunned. We cupped our hands into spherical shapes and tried to imagine how something ten centimetres in diameter could grow undetected in an abdomen for so long. Heidi had minor pain, but nothing much. She was lucky. There are different kinds of cyst – some fast-growing and fluid-filled, twisting and bursting inside and causing unseen trouble. Her cyst was solid, slow and benign – the result of long-term endometriosis. Yet this cyst had laid siege to Heidi’s reproductive system and it had rendered her infertile. The specialist was hopeful, though. If it was surgically removed it might present us with a short window of opportunity for conception. We wasted no time. Heidi was admitted to hospital in late October.
The severity of the surgery took us by surprise. It was a major procedure – akin to a hysterectomy or a Caesarean section. The surgeon had to cut through multiple layers of abdominal tissue in order to access the problem. It resulted in a long, movement-restricted recovery for Heidi. But it was successful. There was a short window of opportunity for us to conceive – maybe six months, the specialist said.
&nbs
p; Heidi came home to recuperate in a house that still looked like a bomb had hit it. She was sad to place her fingers on the deeplying, still-livid scar that now interrupted the smooth line of her lower abdomen. But I loved it, and I still cherish its now-almost-indiscernible shadow. When we’re young we think of a scar only in terms of a blemish: a permanent defacing of some assumed perfection. But youthful perfection is really just the bland white canvas on which we later smear a more vibrant description of ourselves. Scars are like strokes of a palette knife, tracing out small features that give sense to the whole. Or like one of those archive records I love: a permanent certificate of a moment of experienced life. It might be just a minor incident – a gash from a nail or a trivial accident. It may be major – like a surgeon’s wound or the signature wheal of survived trauma. But like those modest registers of death or the names on crew lists, each one has a story to tell, and collectively they build into a portrait of narrated life. Life isn’t the featureless canvas a scar defaces; it’s the sum of scars that give the blank canvas purpose.
By Christmas Heidi was feeling better, and we knew the time for idle procreative fatalism had passed. We’d been given a lucky break as potential parents, and we intended to seize its yielding flesh with every convenient free hand. The clock was ticking. It was time to make a baby!
We were successful almost immediately. In January Heidi brandished a positive pregnancy test. A hole in one! We were overjoyed. We tried not to get too excited. Early days. But we allowed ourselves to imagine the house echoing with new cries. Sadly it wasn’t to be. After only six weeks, the pregnancy terminated naturally. We cried real tears for that unformed little vessel of our hopes. It was easy to feel despondent, after the travails Heidi had endured on our account. Yet there was consolation too. We now knew that conception was possible. We just had to be organised and resolute. Try again.
Flesh and Blood Page 23