The Boy Who Gave His Heart Away: A Death that Brought the Gift of Life. Cole Moreton

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      Eight

       Martin

      When his phone rang at home at five-thirty on the Wednesday morning, the doctor who would take charge of Martin’s care at Nottingham was already awake. Harish Vyas was an early riser, no matter what time he had gone to bed. He answered quickly, so as not to disturb his wife and four sons asleep in their home in a village to the north of Nottingham. This was his sanctuary, the place to which he came home after the long days and nights that so often ran together on the ward, but he was always ready to return to the hospital at a moment’s notice. If there was one thing you could say about this comfortably built man in his mid-fifties with his swept-back hair and greying brush of a moustache, it was that he really cared. Other doctors knew how to detach themselves from work and walk away at the end of the day for their own survival, but not him. ‘I am an emotional being, that is who I am. I have chosen not to fight it. I cannot help becoming involved.’

      Dr Vyas was in charge of the children’s intensive care unit at the Queen’s Medical Centre in Nottingham, with a dozen patients at any one time, and he felt for every family. He knew the names of mothers, fathers, sisters and brothers, grandparents and carers and sometimes even pets, and once he was involved in an urgent case he found it hard to leave the hospital. ‘I could go on without much sleep for five or six days at a time, easily. This is really personal. You talk to the family, you stick with them and you don’t want the baton to be passed on to somebody new, for their sake.’

      The unit required hard work and very long hours and needed a certain stamina and commitment. Working together in this environment produced phenomenal loyalty among the doctors and nurses. The ward sister knew he would come. She had only called because it was really important.

      ‘A young man of sixteen is coming to us from Grantham with significant neurological features. It could be a bleed on the brain. He is going straight for a scan and then to theatre.’

      Sixteen years old. The same age as one of his own sons, sleeping safe. Harish Vyas thought of that as he drove up the hill away from his village and down to the hospital, through the dawn. It was only three hours since Martin’s collapse. ‘The brains of children are very different from adult brains,’ the doctor says now, looking back at that moment. ‘They have such amazing resilience. I saw a young girl who was brought in after a wardrobe fell on her and she was crushed. She had multiple fractures and a bleed in the brain. When she came to the emergency department, she was squirting blood from her nose. After surgery, I brought her over to our unit and ventilated her and, to cut a long story short, she is now back to normal. So children do surprise me. But Martin was, perhaps, a bit old.’

      The brain is a fragile thing. Squishy to the touch, it looks like half a ball of fatty, uncooked sausagemeat bound up in clingfilm. It weighs three pounds, the same as a big bag of flour, but doesn’t feel that heavy in your head because it actually floats around, suspended in a salty fluid. This odd lump of white and grey matter is – by some miracle – the place where our thoughts and feelings occur, but it is also the beginning of the central nervous system that controls every part of the body. From here, the orders go out to make the heart beat, the lungs breathe, the tongue taste, the eyes see, the nose smell, the ears hear and the skin feel.

      All this is done by 100 billion nerve cells which need oxygen to survive and thrive. Without it they begin to die, and that can cause headaches and seizures, take away the ability to speak, paralyse the body or ultimately kill. That vital oxygen comes from the lungs and is carried in the blood pumped up by the heart, through the neck to the head, where the arteries wrap themselves around the brain like an intricate cradle of incredibly thin fingers. At the tip of each finger is a patch where the blood gives up the oxygen and takes away carbon dioxide, turning purple in the process. Then the old purple blood is carried away by a spidery network of veins, back down the neck to be pumped again through the heart and lungs and refreshed.

      Sometimes, disastrously, the arteries or the veins just burst. The blood floods between the brain and the skull. This bleeding is what the emergency neurosurgeons at the Queen’s Medical Centre in Nottingham could see had happened to Martin as they examined his brain scan in the early hours of Wednesday morning, although they could not yet be sure of the cause. It might have been the result of a head injury, like the one suffered by the little girl Dr Vyas was talking about – perhaps if he had fallen out of bed in the night. Or possibly a condition called Arteriovenous Malformation, a tiny tangling of the veins and arteries that could have been secretly lurking in his head for years, even since birth. They did know that he was bleeding heavily – catastrophically, in medical terms – and the blood had formed a clot that was pressing down on his soft brain like a butcher’s thumb.

      There was no time to waste: it was three or four hours since Sue had seen Martin collapse and the surgeons suspected his condition was getting worse by the minute. They could not wait for his mother to arrive at the hospital, to explain to her what the scan had shown and to ask her permission to act, so they took Martin straight to theatre. There, the surgeons drilled a hole in the skull to let some blood flow out and to relieve the pressure and they sucked out the clot as best they could, hoping that the brain would stop swelling. If it did not then it would continue to get bigger, pressing upwards against the inside of his skull and downwards through the brain stem, the three-inch stalk that connects the brain with the spinal cord and controls vital functions like the heart rate, breathing and sleeping. Drugs were used to paralyse Martin and keep him from writhing about, because any movement was going to make things worse. A very high dose of morphine stopped him feeling any pain. He was being kept in a coma for his own good.

      When Martin came back from surgery, he was put on his own in the room nearest the entrance to the intensive care unit. Reserved for the most serious cases, Cub 2, as the little sign with a cheeky monkey said, was away from the rest of the ward so that fretting mums and dads whose sons or daughters were close to death did not have to see the other children, who were mostly getting better, and the other children and their families did not have to see them. Sue and her parents were shown a kettle and supplies in the family room for hot drinks and a microwave to heat up food if they felt like eating, which they did not. They sat on two sofas staring at the television without seeing anything, minds hazy with the interference of anxiety and fear. Harish Vyas could see the distress on their faces as they stood up when he entered the room.

      ‘Would you like to sit down?’

      He introduced himself and offered tea and biscuits, knowing that even in moments of high anxiety, people often have an urge to sip a drink and perhaps taste something sweet. There were no takers this time.

      ‘Can I ask what else you have been told?’

      Something about a bleed on the brain said Sue, and the doctor agreed.

      ‘The most likely event is that the blood vessels СКАЧАТЬ