Sometimes a big milestone isn't everything it's claimed to be. In 1968, 13 years before he began his run as Blake Carrington, the patriarchal plutocrat of the Reagan years in Dynasty, the actor John Forsythe turned 50. He celebrated the half-century mark among Hollywood friends, and confessed to one, Gore Vidal (then 43), that he was downcast about reaching middle age. Vidal purportedly asked: "How many 100-year-old people do you know?"
In August 2009, I reached that vaunted halfway-plus point and also felt that degree of reflective melancholy. But there was more. Physically, I didn't feel well. I tired easily and slept much more than normal. One month earlier, when my wife Rachael and daughter Anastasia travelled with me to France on Eurostar, I was frequently short of breath dragging our suitcases at St Pancras and Gare du Nord. By the time we took another set of trains across a sweltering Paris on to our final destination in northwest France, I embodied the hackneyed snapshot of collapse crossing the finish line.
Throughout my life my health had been good. Better than good – enough to withstand the excesses I'd heaped upon it via the passion-turned-vice of great food. I had always spoken of this relationship as a happy love – addicts of all persuasions will recognise the sentiment. For me, it wasn't only about food to eat, it was about food to cook for myself and others, food to read and learn about, food to talk about, food to write about. Consequently my weight had been on a roller coaster for decades, rising then plummeting before the inescapable upward swing. I wasn't ignorant of this folly. I was stuck on a groove in which frustrations take a back seat to compulsion.
A few years ago, a Mintel poll estimated that 13 million people in the UK are on a permanent diet, two out of five of them women and men by a one-in-six margin – so I wasn't alone.
I had pretty much thrown in the towel by that summer. All I had ever done was regain weight I'd lost. I had tried so many diets, from the Beverly Hills to the Rotation and the Cabbage Soup. Many didn't have names. Each mêlée ended in stalemate, with the bulge in the ascendant.
The jeans that stretched to bursting point looked to be compensated by other genes, which appeared to be on my side. Medical check-ups were unremarkable. I wasn't diabetic. I wasn't hypertensive. My blood samples were within normal bounds. Notwithstanding a general loss of energy and an extreme degree of sleep apnoea – which deprived my wife of rest as she timed my spasmodic breaths for up to 45 seconds – I gleefully argued the toss with those who expressed anxiety. Notably my mother, who had agonised for years; Anastasia, who expressed the worry when she was six that I was going to die "like Barry White"; and of course Rachael, who rang alarms for the 16 years of our marriage and to whose Cassandra-like prophecies I responded with a bullishness bordering on the Trojan.
Meanwhile, the pounds had continued to mount. My father-in-law, who lives in Cornwall, used to call me his "partner in cream" to draw attention to the vats of the local clotted variety we consumed whenever I passed by Truro. When I turned 50 that August I reached the summit: 355lb. I'd never been so heavy. We spent the day with friends eating plentiful quantities of Indian food, a buttery chocolate birthday cake made with Guinness, and far too many cold beers, glasses of wine and, late in the evening, champagne. But despite the celebratory air, I was subdued.
I did notice a few disturbing signs around this time. Walking the single mile home after I had dropped off our car for a service, I was breathing heavily while experiencing a light pulsing sensation in my chest. Rachael also noticed this on another walk. Then something stranger – fits of belching, at times uncontainable, accompanied by a more-than-slightly pressurised feeling at the top of my stomach, lasting a quarter of an hour, occasionally in the morning but more often at night. I assumed it was an unpleasant but passing type of indigestion.
Early that September, Anastasia started Year 8. One morning in the second week, amid rush-hour traffic, I drove her to school. The belching, with bursts of gasping, suddenly started and for a few minutes I thought I wouldn't be able to carry on. Though it subsided and we did continue, I'd seen the fear fixed in her face when she asked, "Daddy, are you OK?" It was enough. When I returned home I contacted our local GP. He took my blood pressure, which at 160/100 was a great deal higher than my usual reading, and a blood sample was taken.
A few days LATER, we attended another 50th birthday party, this one organised with military stealth by our friend Sharon Bierer, as a surprise for her husband, Henrik Overgaard-Nielsen – both staunch public defenders of the NHS. Unbeknown to me, many guests noted how withdrawn I appeared. The next day the blood results still weren't back. That evening, a few hours after Anastasia had gone to bed, the gasping suddenly started again, this time unstoppably, and I was sufficiently desperate that I cried for an ambulance for the first time in my life. Within 10 minutes the striped vehicle flashed its sky-blue lights outside our door and I was bundled in while Rachael stayed behind with Anastasia.
When I arrived at the West Middlesex Hospital's practically empty casualty area I was seen by a young doctor with a lilting and distinctly Irish inflection, so wide-eyed and petite that she looked like a minor. A cursory examination followed an ECG, then a chest X-ray, then more blood tests. As I waited for the results, lying by the nurses' station, I began to feel less fraught – which is not to say that I felt right.
When the test data were in hand, I was told that nothing appeared unusual. I was let go with a prescription for Gaviscon, an antacid, and instructed to follow up with my GP. Rachael and Anastasia drove over to collect me, all smiles. I asked for a copy of the blood work and noticed that it was exactly the reverse of what one wants: high low-density lipids, low high-density lipids and the total cholesterol also listed as high. I felt no better during the next few days.
Listening to music late on the Friday evening, I felt a greater pressure on my chest than ever before. I've never swallowed a stone, but the top of my stomach felt as if I had. I howled out for an ambulance. Rachael seemed unsure I needed one, remembering the abortive incident a few nights earlier, but I insisted and she decided to drive me herself. The journey was most likely swift, but what I recall is how long it seemed to take, how profusely I was sweating and how exhausting it was to breathe between the eructing gasps.
It was a mistake to arrive at the hospital without the ambulance. The place was packed to the rafters. It was after midnight and the dot-matrix display announced two-hour waiting times for children and four-hour waits for adults. I staggered to the entrance area, hardly able to speak, and was pointed toward a wheelchair by one of the receptionists behind glass. Sweat was spilling out of every pore. While I sat among the injured and the attending, some drunk, others spouting racial epithets, I was reminded of the scene in the great black comedy film The Hospital, when a character looks over the A&E and pronounces it: "The whole wounded madhouse of our times."
I frantically rose and lurched towards the treatment area where I saw, seated on the central island, the same young medic who had discharged me so gamely a few nights before. I begged her to help me. Her face registered recognition, then shock. She nervously led me to take yet another ECG. When she stared at the scan, even I could see that the customary tiny wavelets of pulse gave the impression of Matterhorn-like peaks, precipices and drops over the printed page. My blood pressure was 160/100 and my resting heart rate was careering at 100 beats per minute. Her hands quivered as she attempted to draw arterial blood and at one point let the syringe drop to the floor, sending a considerable jet spurting across the partition. As I was loaded on to the stretcher, I felt a throbbing pain on my shoulder blade and pressing in my upper stomach.
I was not, even at this last-ditch stage, able to acknowledge what was happening to me. The medical notes show that I was triaged and given aspirin, Cyclizine (an antihistamine to treat nausea), Clopidogrel (an antiplatelet blood thinner to treat clots), Pantoprazole (a proton pump inhibitor) and morphine. Rachael asked the registrar to give her more information and he noted cautiously that there were differences between the current ECG and the one taken earlier in the week; it now appeared to him to be a "cardiac problem". Surreptitiously, he was in contact with Hammersmith Hospital eight miles away and was given the go-ahead to have me immediately transferred there.
At 2.10am I WAS ready to be moved and was given glyceryl trinitrate, another term for nitroglycerin, which despite its better-known relationship to dynamite has been used to treat angina and heart failure since the 19th century. I was still gasping, but not in severe pain. Rachael asked me to give her the home and office telephone numbers of Nathan Segel, my family's doctor in the United States since 1975 – and a high-ranking cardiologist. Rachael remembers that by this point I was speaking a fair amount of mumbo-jumbo, but nevertheless was able to correctly provide both.
What I remember distinctly of that unbearable ride is how hard I tried to take one breath at a time. When we arrived at the deserted entrance – where on prominent display was a sign reading Heart Attack Unit – I finally said to Rachael, "I guess I'm having a heart attack." My gurney was rushed through dark corridors to the cardiac catheterisation suite. Suddenly the place was ablaze with light and activity – the word "theatre" was apt in ways beyond the literal. A solemn-looking and bearded physician wearing a dastar introduced himself as Dr Sethi and coolly said that he was going to introduce a catheter into my right groin in order to look at my arteries. He said he would have to utilise an angioplasty – the now- prevalent technique of widening an obstructed artery by guiding an empty balloon on a wire toward the narrowed vessel and inflating it to re-establish blood flow. He couldn't say more because he didn't know what he would find once the angiogram was underway. All I could do was nod gratefully.
Another doctor took Rachael outside to get her signature on a release form. She hedged a little: things were happening fast, and with the ramshackle experience at the A&E, she didn't know how to assess the level of quality at Hammersmith. (It is, in fact, one of the NHS's centres of excellence for cardiology.) When she told him she wanted to speak to Dr Segel, he didn't mince his words: "Do you understand that this is an emergency? We have 15 minutes to catheterise your husband and we can't make calls." Cardiologists don't like to see a patient wait more than 90 minutes during a heart attack before being treated: I'd waited more than three hours. She signed with alacrity.
I'll always be gratified that I was entirely conscious for what followed. As the angiogram was starting, I wasn't attentive to the certainty that I was dying. Over the years, I had listened to many stories of near-death experiences and was never roused by the Spielberg-brand halo of reverence about them. My grandmother lost one of her kidneys in the 1940s during an operation in which she very nearly perished. Her story, occasionally repeated to the deferential hush of every listener I ever observed, contained a vision of the Virgin Mary standing before her. My grandmother claimed she had asked her directly: "Now?" and the Virgin smiled and said: "Not yet."
Close to death as I was – closer, perhaps, than she had been – and with the reassuring presence not extant in any form, the phenomenon took place all the same: the instant the artery was widened and blood began to flow I immediately started to breathe as easily as though nothing had happened. It was like flicking on a switch. Everything seemed as if it was back to normal. The saviour was Dr Amarjit Sethi. The miracle was modern medicine.
But my feeling of wellbeing would be interrupted soon enough. As the catheter was being withdrawn, the artery ruptured and I began losing a substantial amount of blood, which I could feel pouring down my leg. To put a stop to this, pressure had to be applied with the kind of force that conjured up 15th-century torture at the hands of Vlad the Impaler. The pain was unendurable. Rachael, sitting beyond the suite in darkness and anxious to know whether I'd survived, now heard my agonised (and expletive-filled) cries and was reassured that all was well. Even at death's door, irony is never far away.
I'd had a HUGE myocardial infarction (MI): one of the 124,000 heart attacks that take place in this country every year. I had joined the ranks of the roughly 1 million men and 500,000 women who, according to the British Heart Foundation, have had one – a total of more than 1.5m people to set beside the 2.7m who live with coronary heart disease. What Dr Sethi had done was aspirate a clot in the left anterior descending artery (sometimes called "the widow maker") and placed a stent to restore the flow of blood to the heart. I remember saying to him: "You saved my life." He smiled, but his seriousness didn't abate when he told me that I'd have to lose more than 100lb for starters and take aspirin for the rest of my life.
After he left I was wheeled over to the critical care unit to be monitored. My heart had gone into a pattern of arrhythmia. After an MI, the restored blood flow to an oxygen-deprived heart commonly triggers atrial fibrillation, a disturbance of the electrical impulses which can result in stroke or arrest. So I wasn't out of the woods by any means.
Our friend Sharon arrived soon after. Her mordant reception was the most welcome proof that I was still among the living. Stretched out with my nostrils piped with oxygen and blinking monitors surrounding me, she took one look and said: "You've looked better." Woody Allen once described his staunchest friend as "the person you want to be with when you get the results of your biopsy". I was aware that on this night, Sharon had been the cavalry.
Rachael had the invidious responsibility of going home to tell our daughter what had taken place during our sleepless night. Anastasia listened quietly and cried, but later, Rachael told me, she was angry. The calls started to come, one by one: from Dr Segel (with instructions), from Rachael's family and from mine.
I have little memory of that morning, but I do remember the information that I was being transferred back to the West Middlesex later that day – a confirmation that I was stable. Once at the cardiac care unit I was overtaken by another sort of attack: fulminant diarrhoea so severe that on two occasions I endured the type of mishaps destined to make the nurses wonder whether they were being paid enough. I was weak and in such penetrating pain that I couldn't walk to the lavatory; my groin was a spreading pond of the deepest purple. They resorted to producing makeshift bedpans out of disposable grey cardboard pots, which were somewhat hit-and-miss. I remember being oblivious to the humiliation, but mostly feeling vulnerable, frightened and alone.
I'd almost died and had no inkling as to what quality of life awaited me. Was there damage to my heart? How much? I had no problem accepting that there was a lot to shed of my earlier life if I was to make a go of a new one. No small amount of grief had to do with my daughter. No girl of 12 deserves to lose her father because he is busy eating himself to an early grave. I was chastened with feelings of stupidity and irresponsibility. Montaigne observed that no man is fully mature until he is reconciled to the fact of his own demise. Given that paradigm, the previous 48 hours had provided a lot of growing-up, and little comfort followed on the heels of that knowledge.
On Monday the consulting cardiologist, Dr Pantazopoulos, arrived with the registrar and a bevy of junior doctors. Glancing through my notes, he grinned and said: "Well, I can see that you've had a nice big heart attack." The posse chortled conspiratorially, but I was in no frame of mind to join in. If that was the time to give some sense of where I was going, health-wise, the opportunity was lost. Later a young doctor on the ward arranged for me to see Dr Kaprielian, another consultant. He said I could go home when I felt confident.
But confidence was the thing I'd lost. During the next couple of days, after I was moved to a less-heavily monitored cardiac care ward, I was aware that despite my increasingly stable signs I was emotionally all over the place. Amid the many calls and get-well emails which Rachael had kept me informed about, there were visitors: Sharon and Henrik; my mother-in-law Rita, who came from Cornwall to see me and help Rachael; Anna Steiger, one of my oldest friends, who interrupted her holiday to rush back; and my sister Lulu, who flew in from Israel. Since 2001, Lulu had been covering the tragedies of the Middle East, first Afghanistan, then Iraq, and latterly Egypt and Libya – a never-ending supply of human misery. Now she turned up with happy news. She was getting married to her long-term partner. When I heard that, I started to cry.
Dr Segel had been calling Rachael constantly with guidelines on my care. It was important to have an echocardiogram to find out my ejection fraction – that is, the percentage of blood leaving the left ventricle of the heart each time it contracts. This would indicate what functional damage there was and provide a better prognosis. Healthy hearts exhibit anywhere from 55 to 70% ejection fractions. Anything below 40%, said Dr Segel, was not good news. West Middlesex Hospital performed the first of three echocardiograms I've had since 2009, and the result, at 53%, was better than they'd initially expected. Dr Kaprielian came to tell me himself, and organised my discharge for the following day, one week after my MI.
I saw Dr Sethi privately from then on. After doing some research we learned that he was one of the most brilliant cardiologists in this country. More to the point, he'd been the one who had actually seen my arteries and performed the procedure that saved me. In the months that followed, Dr Sethi put me in contact with a fantastic NHS support group at Ealing Hospital: a sweet rehabilitation nurse from Russia called Tatyana Hodges; an elegant nutritionist, Baldeesh Rai, who spurred on my determination to change my eating ways and lose weight; and most memorably, my physiotherapist, Amir Zamani, a wonderful man – a veteran of the Iran-Iraq War and an expert judoka, as well as an experienced cardiac rehabilitator.
In the year that followed, I did change my ways. I found means to eat no less splendidly but more wisely. I bade bye-bye to beef, lamb, pork and above all butter, and was creative in finding ways to replace many favourite recipes with poultry, fish and olive oil. I increased my consumption of wholegrain foods, especially at breakfast, drank more water than ever in my life, and attempted to eat dinner no later than 6pm. When I met Dr Sethi for my first-year review, I'd lost the stipulated 100lb. I had more to lose, to be sure, but it was more weight than I'd shed in any diet. He had me take a number of tests, which came back vastly improved, in particular the cardiac MRI taken last month, which showed an ejection fraction of 69%, the highest end of normal.
So there sometimes can be luckier culminations than those envisaged deep in the valley after a crisis. Gore Vidal is now 86 and has written memorably of "time's ruthless one-way passage." My own answer to that pregnant question Vidal asked is that I haven't known many centenarians – and only one well: my grandfather, who was born in 1900 and died in 2002. With the exception of smoking, he violated all the current directives guiding good health and was richly rewarded for his insubordination. At 94, he was my best man when I married Rachael and remained clear and positive to the end.
During those final years he often professed that "life begins at 70". It was a way for him to extend some of his extraordinary good fortune to me. He knew – we both knew – that he wouldn't be around to compare notes. It's a nice idea (and scarcely one to rule out) but already my path is certain to be different: necessarily more watchful, rising each morning to the hum of the blood-pressure monitor, the ritual stepping on to the scales, remembering to take my morning medication alongside the invariable wholegrain breakfast, with the awareness that each day is a responsibility – and, possibly, hopefully, a reward.
