In the Midst of Life

dying, not at all, because I know what it’s like. I’ve been there. It was after the birth of my third son, and I had a massive haemorrhage. An artery in or near the vagina had ruptured and fresh arterial blood was literally bursting out of me, like a fountain or a water jet. I felt myself sinking slowly, slowly downward, like a slow spiral. This must have been the blood and the oxygen leaving my body. I couldn’t have moved if I had tried. But I didn’t want to. I was in a tunnel, a big tunnel and I was walking along it towards a beautiful opening or door or something at the end. It was so beautiful, I could never describe it; not an earthly beauty but peace and quiet and beauty, and I wanted to get to it. I was very near. Another few steps and I would have got to it, which is what I wanted. But then I heard a sound and I felt movement; that must have been when they checked the blood flow and started pumping blood into me. And I looked behind me and saw three little children, and I knew I couldn’t go. So I turned around and went back. But, oh, it was so lovely and I so much wanted to get to that beautiful place.’
     
    —
Joanna Bruce, MBE
    (Jo is my mother’s first and favourite granddaughter)

ACUTE HEART FAILURE
     
    To write about my own mother’s death is so painful that I wonder if I can do it at all. I have sat for hours at my desk with a pen and a blank page, and nothing comes but tears and regret. I have shut it out of my mind for twenty-five years, telling no one, unable to dwell on what happened, what might have happened, had I acted differently, what I could have done, should have done, what I did not do, did not know. For twenty-five years I have erased from my mind thoughts of the pain she must have suffered, her fear, her terror, and, worst of all, her anguish at being surrounded by strangers in the hour of her death, because I, her eldest daughter, was not there.
    Who can write about their parents objectively? Not me, for sure. The relationship is too personal to be objective. I will say only that my mother loved life and everyone she met. She was full of fun and vitality. It was life-enhancing just to be with her. She was also exceedingly pretty.
    In 1986 she was sixty-five and very popular. She had a host of friends, held constant luncheon, tea and dinner parties. She was a brilliant cook and a generous hostess. She swam regularly and enjoyed walking, gardening, and taking her grandchildren on outings. She enjoyed life, and appeared to be in excellent health.
    She had arranged to meet some friends for a coffee morning, but did not turn up. They telephoned the house, but there was no reply, so one of them came to the house and knocked on the front door. No reply. The woman looked through the window and saw my mother lying unconscious on the sitting room floor. She immediately called the local hospital, an ambulance came, and my mother was rushed to Accident and Emergency and put straight into intensive care.
    Mysister and I were informed, and we both arrived as soon as we could. Our mother was attached to a defibrillator, an intravenous drip and other life-maintaining apparatus, with dials and monitors and flickering graphs and lights. The gentle hum of the machines was reassuring, in a way. My sister and I were both trained and qualified nurses, but no longer practising, and medicine had advanced so rapidly that neither of us had seen such hospital treatment, nor did we know what was going on. We were told that our mother had had an acute heart attack.
    ‘Acute’ is the word to understand, and acute heart failure is quite different from congestive heart failure, which is a slow and cumulative process of heart dysfunction, usually occurring in the elderly. Acute heart failure occurs in a second, with no warning, no history of ill health, and it often attacks relatively young people. There are many possible causes, but the most common is a sudden occlusion (obstruction) of one of the coronary arteries. It is usually, though not always, caused by blood clots, developing in an atheromatous section of a coronary artery. If a clot forms in one of the coronary arteries, the occluded area of heart muscle will die. This is known as an infarction. It is a major catastrophe. Whether the infarction is partial or total will depend on the size of the clot and the size of the artery occluded. Either way, the occurrence is commonly called a heart attack.
    Our mother must have had a partial infarction,