• Graham

The phrase Vertical and breathing is one I have started to use in response to a well-wisher’s enquiry as to the state of my health. Generally speaking, when people ask how you are, they probably don’t want a detailed analysis of your various ailments; the enquiry is really no more than a courtesy call. So I decided that my half flippant, half defiant response would in most cases cover the situation. It was only in retrospect that the two words, since 2014 have been central to my entire existence. So, let us return to


Man “A” sits behind a desk, backlit by a late afternoon sky. Man “B” sits opposite.

It seems that a longish pause has ensued during which time the sun, appropriately if somewhat over-theatrically, has disappeared behind a bank of cloud.

Well, I suppose the sixty four thousand dollar question is – How long?

That rather depends. It obviously varies from individual to individual

A further pause during which patient realises he’s no further forward and Medical Expert realises the ball is still in his court.

I’ve had a patient who only lasted a couple of months.

Metaphorical sun fades ever faster.

But, there again, I have another who is still alive after eleven years.

A faint glimmer of hope –

Mind you she’s been bed-ridden for some time ……… and really rather ill

Yet further pause during which patient realises that this is the extent of the information that is likely to be forthcoming and the ball, such as it is, is now in his field of play.

Well, I suppose at my age, there are a good number of nasty things waiting in the wings that would have got me anyway.

Medical Expert visibly brightens.

Oh, if that were to happen, we’d regard it as a great success!

The illness that both parties have been skirting around is Group 2 Pulmonary hypertension which in simple terms seems to mean (at least as far as I could gather amongst the mnemonics, abbreviations and Latinate contortions) one side of the heart is weakening and thus unable to drive sufficient oxygen through the lungs. The net result: the muscles are starved of their fuel. The consequent outcome is breathlessness as the patient tries to compensate by taking in more air or - if the brain is sufficiently frustrated, or stupid, to try to over-ride this inadequacy by demanding a greater effort - a setting in of virtually paralysis. Or to put it another way, walking downhill is considerably easier than walking up.

The diagnosis was clear. The prognosis was another matter. As the information on offer seemed rather on the frugal side I decided the best course of action was to solicit a second opinion. I was duly informed by the good Doctor Google (who seems less concerned about being sued for giving an unambiguous opinion than most of the members of the medical profession of my acquaintance) the rough or mean average was about three to five years. That, though scarcely a lifetime, at least gave me enough elbow room to indulge in a bout of longish short or shortish long (depending on your point of view) planning.

All this palaver was the climax of a rather convoluted piece of personal medical history. This amounted, in a nutshell, to my left hip being replaced and, some years later my right about to give up the ghost. Expert opinion drew only the cold comfort of - “ I’d better replace the right and (since it also was showing signs of wear and tear) go easy on the left” Sound enough advice but not as straightforward as it seemed. I was in the middle of completing the second volume of Tops of the North, an account of a personal odyssey of some 1000 plus kilometres around the high lands of Northern England. If publishing deadlines were to be met, the walking had to be completed before the book could reach the hands of the printer.

Nor was the walking as simple as it had originally seemed. For practical purposes, the journey had been divided into three parts, but there the similarity to Caesar’s meticulous Gallic expedition ended. The section I had still to complete comprised the counties of Northumberland and Durham and I knew the journey would be more taxing than my ramble through the oft trod Lake District. The reason was simple. A significant part of the land I hoped to cross was grouse moor which had, before access legislation, been jealously guarded and little visited except by the chosen few. As a result there were no rights of way and precious few footpaths. Moreover, no public access meant no public transport.

These hindrances combined to prolong the time necessary for a thorough reconnaissance. A number of sections not only required a variety of sorties to find the best route, making false starts inevitable, but also entailed journeys to and fro from the day’s starting point, doubling each yard of the distance covered. On top of this, the malfunction of my right leg meant, as time went on, distances covered became less and less. The upshot was the right hip gave way almost completely and the left , in an entirely reasonable response to unreasonable working conditions, went on strike and started to come apart at the seams, or whatever holds artificial joints together.

In the end, the book was done and first one joint was repaired and then, eventually, the other, so I found myself in a state of athletic hibernation for the best part of a couple of years. Not surprisingly, having gained weight and lost muscle during my self-indulgent sabbatical, I found, when I got moving again, the going to be pretty heavy. Initially I assumed that this loss of ease of movement would disappear through exercise and that, in due course, I would return to the sort of distances I could do, if not in my salad days, at least at the turn of the century. But to my surprise no such improvement occurred. For some reason I had been reduced to a dull plod and a disturbing hesitancy in movement.

I started to get frustrated and decided that it must be a question of mind over matter and if I made sufficient effort I would break through what I was beginning to consider an entirely artificial barrier of my own slothful making. If I drove myself really hard all eventually would be well. The culmination of this scheme (and nearly of me) came as I approached the summit of a popular local hill. It was only two or three hundred feet to the top and I decided to push to the trig point in one go and as quickly as I could. I made it without stopping, then something odd happened. The whole of my upper body from the waist to the shoulders seized up and all the breath in my body seemed to have been knocked out of me. All motion ceased and if I resembled anything it must have been a member of China’s terra cotta army, petrified in time and space. My next recollection is being surrounded by a concerned group from the local rambling association uncertain whether it would be best to summon the mountain rescue or the mortician.

The expression sometimes used to describe such a physical effort is “bust a gut” and not long after I duly did and had an umbilical hernia to add to me woes. So back to the hospital. After the usual diagnosis, prognosis and hang-around-until–the-NHS-can-fit-you-in-osis, I was sent for the pre-op with a view to the rupture being repaired. So that was it. Hips, Heart, Hernia gone to pot. At least hands and head seemed in reasonable order and as far as I could tell the hamates and hypothalamus appeared to be holding their own.

In the event the hernia turned out to be a bit of a blessing in disguise. Pre-op investigation detected odd goings on in the heart. Various tests followed – a conglomeration of scans, needles stuck in various parts of my anatomy and what appeared to be a combination of a plumb line and fishing rod dropped down my throat – after which the consultant declared PHT was virtually certain. I was packed off to a specialist hospital to see if the consultant was right and whether anything could be done to alleviate the situation. After further tests, it was declared - in the case of this particular type of pulmonary malfunction - he was and there wasn’t.

Given these circumstances, the hernia man was understandably reluctant to continue and passed the buck to the anaesthetist. I duly attended the latter’s rooms to be met by a visibly cheerful soul who assured me that this was a common enough procedure and the chances of there being any problems were practically nil. Then he looked at my notes. As he leafed through the pages, at first casually and then with greater intensity, his optimistic smile slowly dwindled through a frown into a grimace. It turned out that a combination of pulmonary diseases and general anaesthetic could very well leave him having to face some rather tricky questions from the coroner. After shuffling through the papers again, he leapt to his feet in what appeared to be a confused sense of nervous determination and muttering something about having another word with the surgeon exited, in this particular case, stage right.

White smoke eventually appeared and the go ahead was given, but under the limited circumstances of an epidural which meant I might well be aware of what was going on. There would, of course, be no pain but I would probably experience the sensation, as the anaesthetist put it, of someone doing the washing-up in my stomach. I had also to lose considerable surplus poundage. Once all that had been established, I was given a diet sheet, guaranteed to remove a stone in a fortnight, to follow during the two weeks before the operation. This particular à la carte was reminiscent of second world war rationing at its worst – no sugar, pastry or dairy products, precious little protein and as much cabbage and turnip as you wanted. Uncertain of my will-power, I thought I had better get some practice in straightaway and to my surprise found little difficulty in sustaining my efforts. The effect was dramatic. Weeks passed and pound after pound disappeared. Whereas previously I had to pause at frequent intervals to allow the muscles to refuel, I could now walk not only further but faster.

This improvement should not have been all that surprising to anyone used to walking long distances, heavily laden. It was as though I had abandoned a rucksack of not inconsiderable proportions and a large weight had been lifted from my back, not to mention my mind. I began to realise that, given the right attitude, something approaching serious walking in the hills was again a possibility, maybe not as far or as tasking as previously, but definitely a possibility. Yet there was still a little niggle at the back of my mind. I felt I needed an incentive, some sort of target to aim at, not so ambitious that its aspiration was dispiriting, yet sufficiently challenging to get me out of the house when it was easier to stay at home. The circumstances were, as I remembered, similar to when I set out to complete the Munros some thirty odd years before. Such was my determination to succeed, that even though the Scottish weather did its best to drive me indoors and the plod up the hill was not particularly inspiring, the thought of eventual completion and the satisfaction of planning and successfully executing a potentially dispiriting expedition, gave a sense of purpose to what otherwise might have appeared to be walking around in fog bound circles.

But that still left the problem of what the exact challenge should be. After all I only had a limited amount of time at my disposal and matters were certainly not going to improve. It was then that the real or rather relevant connection between the Munros and my present predicament dawned on me. Munro, in effect, decided to make a list on his own terms. It was his decision to have the cut off point at 3000 feet and to decide what was a mountain and what was not. What I needed was something similar where I could choose what to do, not slavishly following some other person’s list – a microcosm of Munros or more likely a wobble of Wilsons. The solution, I realised, was to follow the cri de jour and downsize. But how far down and in what direction? What I needed was a target. What I needed was a list of my own.

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