We made our first experiment on a crisp sunlit morning with frost on the ground and the warm sun fast rising over the dry lava desert. I set up my sampling equipment with the distant mountains as a backdrop. Solid though they were, they stood flat against the sky like the stage scenery of atmospheric theatre. Science can be a wonderful occupation when there is the chance to work in such a place.
I shared the fine food served at our motel with my NOAA companions: fresh fish from the Snake River and Idaho’s tastiest baked potatoes. At weekends, we explored the Yellowstone National Park, the Teton Mountains, and the country around Jackson Hole. There are few other parts of the American scenery so splendid. We were fortunate that it was late September, well outside the tourist season, and when the trees were already putting on their red and gold to celebrate the fall. I most remember the companionship of the meteorologist, Bob List, with whom I worked, and of a Major in the US Army, whose name I cannot remember, but whose face is still clear before me. One Sunday we went to the waterfall in Yellowstone that roars down into what looks like a miniature Grand Canyon, and which is a favourite spot for visitors. A long flight of wooden stairs, perhaps 100 feet of them, leads to a platform at the very edge of the falls. A damp, deafening, but exciting place, with a breathtaking view and the thunder of the water. It filled me with exhilaration, and I challenged the Major to a race to the top of the stairs. We made it and I just won. We were both breathless, and my legs and thighs in such pain that a few more steps would have broken me, but I felt inordinately pleased. Here was a near sedentary scientist at fifty-two years matching the performance of a fit young Army officer.
In early November I was back again in the United States, this time to visit a firm in West Palm Beach, Florida, who were making ion drift instruments. These are devices similar to the electron capture detector, but lack its sensitivity. We use them because they are more convenient to handle than is the ECD. I was visiting this firm on behalf of UK departments that were interested in picking up small traces of explosive vapours that would reveal bombs in places they should not be. In the evening, after dark, I walked in the warm, humid, tropical air along the beach outside my motel. I might even have walked past Sandy Orchard, as she strolled along the beach from her home, not knowing that in eighteen years she would be my wife. From Florida, I was due at Andover in New Hampshire, some 1300 miles north, where there was to be a conference on the ecology of the chlorofluor-ocarbons. Indeed, I think it was the first conference ever held specifically on this topic, and some time before Rowland and Molina published their famous paper.
I flew from Miami to Boston, where my friend, Jim Lodge, a scientist from the National Center for Atmospheric Research, NCAR, met me. We waited outside Boston’s Logan airport for a car that was to take us to Andover: it was bitterly cold and an astonishing contrast to the near tropical warmth of West Palm Beach. We were shivering, but soon the heat of the car warmed us as we drove north into the New England winter. The conference met in one of those pleasant timber buildings with spacious rooms and polished wooden floors that abound in New England, and we luxuriated in its warmth. If you want to be warm in the North American winter, go to Canada or the northern states. Whatever you do, do not go to California, where the indoor climate can be bitterly cold. Californians believe their climate to be so perfect that they need no heating, and they share this illusion with the inhabitants of the Mediterranean. We enjoyed a vast evening meal that ended with an emperor-sized hunk of cheese-cake. I retired replete, slept well, and the next morning joined Jim Lodge and Ray McCarthy of Dupont and Camille Sandorfy of Montreal University for breakfast, which of course was ample. After breakfast, I collected my lecture notes from my room and started out into the cold air for the short walk to the conference hall, not more than 100 or 200 yards away. Two American scientists, who I did not know, walked and talked with me. About half-way through this brief journey, I experienced an increasing dull pain in my lower chest, just as I had at Salt Lake City Airport and I tried to suppress it, but it grew worse as we approached the hall. I began to fear I was having a coronary occlusion, but when I sat down in the hall, it passed away, and with it my apprehension. I gave my talk about the discovery of the chlorofluorocarbons in the atmosphere and I said that they were at present harmless, but might become a danger if ever they accumulated to the parts-per-billion level. This was because they absorbed infrared radiation intensely and, at those levels, would be adding significantly to the greenhouse effect of carbon dioxide and other gases.
As I walked back to lunch, the pain returned and I began to worry. In the evening, I experimented by walking the quiet road outside the conference hall; every time I walked over fifty yards the pain came on, but went away again if I stood still. I knew now that I was experiencing angina pectoris, but somehow I could not believe that such a thing could happen to me. It was outrageous: after all, I was fit.
Next day I travelled back to Boston and took a taxi from the airport to Lynn Margulis’s laboratory at Boston University. I was due to stay with Lynn and her family that night in their house in Newton, a suburb of Boston. We took the tram outside the University to Newton Station and began the uphill walk from there to Lynn’s house, not more than a few hundred yards away. Soon the pain came on again and, as Lynn walked briskly on, it forced me to say, ‘Slow up, I can’t walk fast, I’ve a medical problem.’ Lynn slowed down and the pain became bearable. When we reached the house I was walking like an old man, with leaden steps, and I turned to Lynn and said, ‘I think I am having a heart attack, do you have a physician I could see?’ Lynn was shocked and said, ‘I am sorry; I thought you meant by a medical problem something trivial like an itch in the crotch.’ She was about to telephone her doctor when Nicky, her husband, said, ‘We can do better than that. We can take Jim to the local hospital in Wellesley where they have a programme for dealing with coronary emergencies.’ He turned to me: ‘It’s only a short distance, let’s go.’ He was a marvellous comforter; calm, matter of fact, and just what I needed.
I remember travelling through the tree-lined streets of Newton to the hospital where I went straight to the desk of the nurse receptionist. Tongue-tied, I found myself blurting out, ‘Can I see someone about chest pains?’ In those days, coronaries were almost epidemic, especially in America, and they were prepared at every hospital for anyone who came in with such a statement. She told me to sit down and soon a young intern came out to see me. I went with him to his office, where he quizzed me and then arranged an ECG and X-rays for me. I returned to the waiting room and sat with Nicky Margulis. The young intern returned and said, ‘We are admitting you at once. Your condition is serious and it requires immediate attention.’ At this, the alarm bells began to ring in my mind. I was more worried about the cost to my family than about death or heart disease. I was uninsured and knew, having previously been a staff member of the Baylor College of Medicine, just how expensive uninsured medical treatment can be in America. I had no wish to put such a burden on my family. I said, ‘I am sorry but I have to fly back to Britain tomorrow. Can you give me something to alleviate the pain of the condition?’ The young intern shook his head and replied, ‘You have three conditions sufficiently serious to require admission. Your blood pressure is too high, you have angina pectoris, and your ECG is not good.’ Nicky Margulis broke in saying, ‘It is his life isn’t it? He wants to go home; it’s a normal, natural thing to do.’ Nicky was a wonderful friend: he supported me forcefully and effectively. In the end, the doctor gave up. He said, ‘Oh, well, there’s nothing I can do, but you must promise me that the moment you get to London you will go to St Mary’s Hospital, report your condition, and let them treat you.’
With great relief, I went back to the Margulis’s house carrying with me a few trinitrin tablets given to me for the temporary relief of the pain of angina. I spent all the next day lying on their floor propped up with cushions. I was afraid to worsen my condition and I thought that just lying still was probably the safest thing to do.
My flight was due to leave Boston Airport some time in the evening, I think about 7 or 8 o’clock. Lynn came home early with much concern and I remember travelling with her in her car to the airport, and a somewhat fraught departure. I remember most clearly the plane, a VC10 of British Airways, accelerating down the runway and taking off. As soon as it was airborne and committed to its flight, a sense of comfort came over me. The anxiety of the past few days evaporated. When the stewardess came round and offered refreshments, I said, unusually, ‘Yes please, give me a double vodka and tomato juice.’ I needed something to celebrate my escape. There is something wrong about being ill thousands of miles from home.
I recall little of the flight to Heathrow but I do remember rediscovering the pain of angina as I walked too fast along the long corridors of the airport to the customs and immigration. My baggage was carry-on only, and soon I was in a taxi and on my way to St Mary’s Hospital. This old and dignified hospital is just by Paddington station in London. I marched in to the casualty department and tried to tell my story. The response I received was wholly different from that at Wellesley in Boston. The young physician who saw me showed cheerful lack of concern and asked why I had not gone to my GP. I replied, ‘I’m doing what they told me to do at the Boston Hospital and, in any event, my GP is at least a hundred miles away.’ ‘Oh,’ said he, ‘Well, we will have a look at you. Are you in any pain now?’ ‘No,’ I said, ‘Only when I walk fifty yards or so.’ He took me into a small room with a bed and the usual hospital furniture. He did the kind of things that physicians usually do, such as sounding my chest with his stethoscope. I never know whether this is to impress or soften up the patient, or whether it serves a useful purpose. Anyway, he did it, went away, and said, ‘I’ll arrange for you to have an ECG and an X-ray.’ Shortly afterwards a young nurse came in and said, ‘Are you the one with angina?’ ‘Yes,’ I replied. ‘Oh that is a terrible pain,’ she said. ‘Oh it’s not so bad,’ said I. ‘Nowhere near as bad as toothache, just worrying.’ She was clearly disappointed. It was my first realization that some women choose nursing as a profession because suffering itself fascinates them. They are not necessarily worse nurses on this account, but it is a sobering thought. Many years later, I discovered that an ability to appeal to this spectator instinct in some nurses could be essential for survival in a busy hospital. They were thorough at St Mary’s and repeated all that Boston had done and took some blood samples as well. At the end, the cheerful intern came in again and said to me, ‘Yes, you have an angina but go home and see your GP some time next week.’ I had been expecting immediate admission to the hospital and at least a little drama. I was also worried about having to telephone home with the bad news that I would not be returning but would be in hospital in London. Yet, here they told me to catch a train to Salisbury, in Wiltshire, as if nothing had happened. What an anti-climax.
This little episode highlights, I think, one essential difference between British and American medical practice. In America, when faced with a medical emergency, the response tends to be ‘My God, we must do something’; in Britain, the response is ‘Nature will take its course.’ In fact, there was little that the medical services of those two nations could have done for me. At that time bypass surgery had only just started and was not nearly the routine and effective procedure that it was to become.
At home in Bowerchalke later that day, I faced the difficult problem of breaking the news to Helen. She was in the early stages of multiple sclerosis and this was hardly the most cheerful of news to give her. I think I just said, ‘Oh, by the way, I had a heart attack when I was in Boston.’ She found it difficult to accept. I looked fit and well and could move around. It must have seemed to her unreal. I recall going to my favourite medical textbook and looking up angina and coronary occlusion. It was a subject that was familiar to me for I had spent my last years at the National Institute for Medical Research working on the biochemistry of coronary artery disease—had even published papers on it. I had also worked for a few years in Houston in the same department as the famous surgeon, Michael DeBakey, but there is a large difference between scientific knowledge of a topic and personal experience. I was not one of those who read medical texts in order to titillate their hypochondria, but this time I read Davidson’s Principles and Practice of Medicine with an unusual intensity; no longer the detached scientist. Here it was in clear print, ‘The patient must be reassured, but some relative must be told that the future is unpredictable.’
I spent the rest of my weekend coming to terms with the idea that I might not have long to live. My body, with which I was on good terms, was also telling me that this was a serious matter. Later I discovered that the occlusion was in my left main coronary artery before it forks into the two branches that feed blood to the left ventricle. In the USA they call this particular lesion the widow-maker, since a complete blockage of the artery at this point is almost invariably fatal.
Monday morning I broke my usual custom of walking the two miles to see Dr Brown at his surgery in Broadchalke, the next village from us. This time I drove. He was the nicest of men, a general practitioner who brought comfort to those in need of him. He never stinted house calls at any time of the day or night, and he had a wonderful way with old ladies and gentlemen. However, the medicine he practised was more that of his student days than the conventional wisdom of 1972. I had tried during the previous years to persuade him to prescribe for my hypertension, but he would not. Insurance companies had twice turned down my applications for life insurance because of high blood pressure, but he just did not believe in medication for hypertension. He would tell me about old folk in Broadchalke who were in their eighties and who had had hypertension for years and seemed to thrive on it. When I told him my news of the heart attack in America he was contrite and arranged an appointment with a consultant cardiologist, Dr Mullen, in Salisbury, for the next day.
In 1972 Salisbury was a city in the early stages of traffic blight. Cars, with their incessant noise and never-ending demand for space and attention, were beginning to turn what had been a beautiful medieval city into a nightmare. Cars, like a pack of noisy smelly dogs, disturbed and fouled everywhere they went. The elegant plan of the old city was giving way to concrete car parks and shopping malls. It was a relief to enter the Close of Salisbury Cathedral—a quiet haven away from the roaring vehicles outside, where, apart from the cars of residents and occasional visitors, it was a place of peace—a place for walking, not driving. Today, with my problematic heart as an excuse, I drove in and parked near the consulting rooms of Dr Mullen, the cardiologist. His rooms were a few yards from the East Gate and near the greensward that surrounds the cathedral itself. It was a sunny day in late November and, in spite of it all, I felt cheerful and full of well-being. It is strange now to muse on the sad day, over twenty years later, when I was in the cathedral again. This time, free of my heart problems, but part of the congregation mourning my friend, Bill Golding. On that cold and bitter day, I was so much sadder.
Dr Mullen was plump and occupied a cosy set of rooms that complemented his comfortable Victorian manner. He arranged for me to visit the Salisbury Infirmary where they repeated the ECG and X-rays. I found it intriguing that the three different physicians who had examined me applied the same set of tests. I wondered if they distrusted the observations of their colleagues. It does not matter for most of the time, but it must waste resources and, where X-rays are repeatedly used, be undesirable for the patient. He confirmed the diagnosis of an angina and prescribed warfarin, the anticoagulant drug which is also an effective rat poison. He also prescribed Aldomet, an anti-hypertensive drug, and trinitrin for the immediate relief of anginal pain. He asked me to come back again in a month’s time. He also advised me to walk slowly, not run, and to take it easy, and in particular to do nothing strenuous for at least a month. It was a great blow to me to have to walk gently instead of striding out heel and toe, as was my wont. I recall telling Helen on a gentle stroll around the village, ‘Well, dea
r, at least we can now manage the same pace.’ It made me realize also the extent of her disabilities through multiple sclerosis.
After a month of this sedentary life, I was deeply frustrated. Then I recalled the experience of that famous clinician, Sir Thomas Lewis. He suffered an angina like mine and came to terms with it by sawing wood each morning up to the limit of pain he could endure, but he went on to live out a full and rich life. If exercise was good enough for him, surely I could do something better than gentle walks to improve the state of my heart. There was no wood to saw, so instead I tried one of my favourite walks, which involved a 200-foot climb up a nearby hill, or as we in England called it, a down. Marleycombe down was a chalk hill covered with turf and it overlooked our village and it was quite a struggle to climb it; ten or twenty paces then a rest, breathless. The trinitrin tablets were effective in relieving the pain but at this stage did little to improve performance. Within a week of daily climbs, I could manage 100 feet up the steep slope without stopping and without angina, and within a month I could climb the whole 200 feet without having to stop. I was well on the way back to health. Soon I found I could walk fast and climb fast, so long as I kept taking trinitrin tablets. Within six months, I felt fitter than I had been before the attack, although without the trinitrin the angina came on after a mere hundred yards of walking on the flat. With the trinitrin, I could do anything. What a miracle drug it is, yet how unsung. Nobel, the explosive maker, who used nitro-glycerine to invent dynamite and gelignite, should have awarded himself one of his own prizes for its outstanding benefit as a vasodilatory drug in medicine.
The whole episode made me realize the value of a brush with the threat of death and of the recognition of one’s own mortality. Until then, I had squandered my time and failed to enjoy each day as it came. Now I knew how sweet was life and how foolish it was to waste a day in pointless work. I never smoked again, whereas before, like Mark Twain, I had given up smoking a hundred times, and no longer did I fool myself with the thought that I could put off the needed walk until next week. No matter how fit I became the angina never changed —without the aid of the trinitrin it came on at precisely the same distance walked—about a hundred yards, and this tolerable state went on without change for almost exactly ten years. It worked so well that often during summers spent on the Beara Peninsula in Ireland, I was able to walk and climb the twelve miles over the mountain tops from Glengarrif to Adrigole. My next battle with disease was at Coombe Mill and happened because of my own carelessness.
Homage to Gaia Page 45