TOTALLY WIRED - REFLECTIONS ON A DOUBLE HEART ATTACK AT 50

Lying there attached to drips and wires, full of high-grade junk, with my occluded heart aflame, maybe dying, maybe not, I thought about how nothing ever lasts, about how we will never know, finally, what any of it means, and about how, at the start of a long hot summer which I’d gleefully anticipated dividing between dancing all night at festivals and camping and hiking all over the western hills, I had instead become immobilised, entrapped, and the butt of my own favourite joke: How do you make God laugh?...You tell her your plans!

*****

It was nearing midnight on Wednesday the 8th of July 2026 and I was walking at pace towards my rented room in Scribblestown along the grand stretch of the Ratoath Road, having spent a pleasant evening with Tash and Karl, celebrating Karl’s 48th. We’d finished the evening listening to some of our favourite poets and poetry, including Ginsberg's Father Death Blues, which Ginsberg penned during a transatlantic flight shortly after his poet-father Louis Ginsberg had passed away back in 1978.

Hey Father Death, I'm flying home

Hey poor man, you're all alone

Hey old daddy, I know where I'm going

Ginsberg himself was simultaneously shadowed and inspired by death for much of his life. He had, among other problems,  Bell's Palsy, chronic Hypertension, Hepatitis C, and ultimately Cancer. Despite, and because, of all these fatal worries, he seems to have enjoyed every moment of his life. He never stopped creating, never stopped giving to his friends through his legendary amity, nor to the rest of us by way of his era-defining poetry.

Earlier on in the evening Tash, Karl, and I had stuffed ourselves with a celebratory Indian takeaway. It was a rare treat, and not just because of the cost. I hardly ever gorged on takeaways or indulged in any kind of processed foods these days, the odd bag of jellies or bar of chocolate at weekends aside. My generally healthy diet had me at a consistent eleven-and-a-half-stone or under for the last couple of years. I did a lot of walking - I was on my 111th day of a streak of more than 10000 steps, including many days over 20000. My skin shone, my eyes were bright, and friends and acquaintances never stopped telling me how good, and how young, I looked. I felt better and appeared better at 50 than I had for a long time. Recently I had undergone a thorough check-up at my GPs, including an ECG testing my heart function. My heart and every other organ and vital sign were, according to the print-outs, functioning optimally. Except for one persistent problem - my blood pressure - which remained at the dangerously high levels it had been since at least my early 30s when it was first diagnosed. But wasn't I Iucky compared to so many others of my age and background who were much worse off, apparently, healthwise than me? Few would have predicted from the circumstances of my birth and upbringing that I would enter middle age in prime condition. In fact, a fair few of those I’d grown up alongside and that I counted as kin were dead long ago. The dead friends of my youth are a main subject of my writing and I often shed a tear for them still. I often wonder why I have survived and they have not. I believe, sometimes, that their dead spirits support me through hard times. They often appear in the afterlife of my dreams, sometimes disguised as healthy middle-aged men in pristine white suits. I even fantasize regularly about partying with them again, wherever they are.

Over-confidence in the state of my health allowed me, as I kept walking,  to put the tremendous pain in what I told myself was the upper left of my gut, right where my belly met my gullet, down to a bout of acute indigestion brought on by this evening’s Indian takeaway. The streams of sweat running the length of my torso, back and front, I put down to indigestible oriental spices combined with this alien midnight heat. But then a sudden and profound tenderness in my shoulders forced me, eventually, to unshoulder my rucksack and carry it, with difficulty, by hand instead. This was soon followed by the upstream radiation of the soreness into the back of my jaw and my bottom row of teeth. These troubling symptoms were more difficult to repress or explain away. I knew - how could I not? - they were signs of something serious, a stroke perhaps, or a heart attack. Please not a stroke though!  My worst nightmare is the kind of physical dependence on others for survival that is the result of many strokes. My worst nightmare is losing the fundamental autonomy of being able to choose whether or not to continue my own existence. Imagine not even being able to kill yourself! I had long chosen to elevate my own hedonistic freedom - maximum enjoyment of my earthly and bodily existence - over and above any loyalty to almost any one or any cause else. There was nobody I could reasonably expect to look after a significantly weakened version of me for very long. 

I tried to think to about something else but I couldn't - the pain was too much. I stopped and propped myself against a wall trying to figure out what was going wrong and what to do about it. I tried to relax and took some deep breaths. After a while the pain subsided just enough for me to be able to delve back inside the Indigestion con. Indigestion, right? It was indigestion surely! Never again would I chew on cardamon! But as soon as I started to walk again the pain came back just as bad, maybe worse. Now I started to really worry. I told myself if it hadn't gone by the time I reached my rental I would give in and call an ambulance. I went on - sure it was only another couple of kilometres. I have had a lot of physical pain in my life - tremendous childhood beatings from bullygangs and sadistic teachers, kidney-stones, near-fatal car accidents - so I have a high pain threshold, and an intimate knowledge of the workings of physical pain. I knew that it always passes, that it vanishes without a trace eventually. Unlike emotional trauma, physical pain has no memory. Traversing the futuristic New Reilly’s Bridge the pain started to subside. By the time I was turning into my estate it was only a dull and retreating ache. At my rental I brushed my teeth, wondered what the fuck that was all about, and swore off Indian takeaways for life. I went to bed greatly relieved and I soon fell into a deep and painless sleep.

When I awoke I had forgotten all about the previous night’s walking torture. All I could think about was the seaside date I had planned with Gabi. We’d only just got together, after a party, the launch party for Karl’s new book Song of The Fallen, in fact,  This seemed, so far, to be the kind of low-stress relationship I so badly needed right now, after several years of intense and complicated connections and upside-downing ruptures. I’d gone through a lot of other strains and stresses too - two evictions, a bus crash, several other minor traffic accidents, fallings-out with long-term friends and other interpersonal difficulties, intense and ceaseless workplace and financial pressure... In short, I'd had as many troughs as peaks and I needed an even keel and plain sailing for some time to come while I caught up with myself. I'd run a mile from the first sign of relationship stress or complication, and I was upfront with Gabi about this.

So, on Thursday 9th, we spent a pleasant mid-heatwave day by the sea in Bray, chatting and cuddling.  Nothing and nobody could bother us as the day passed slowly and dreamily around us and through us, like the dreamily lapping waters of the bay. Around 5 O clock we had a picnic and as we were packing up after I felt a sudden stab of pain at the junction of my gut and my ribcage, which instantly brought to mind the previous night's forgotten ordeal. Bollocks, I said to myself, not this again. Again, I tried to convince myself it was a stomach problem brought on by the picnic. Gabi soon noticed my tortured grimace, however, and asked what was up. It's just indigestion I told her, nothing to worry about. But I no longer really believed myself and as we finished packing and climbed the Victorian steps back up to Bray promenade the pain kept getting more intense, more insistent. Are you getting a heart attack? Gabi asked, like some kind of seer. No no don't be silly I gasped, it's just indigestion. But soon I had to ask Gabi to carry my rucksack as well as hers, as my shoulders started to burn with radiated pain. Should we call an ambulance? Gabi asked, clearly alarmed by the increasing pain obvious in my grimace and my halting movements. No no I will just go home and rest and I will be grand. This, by the by, is probably what I would have done had I been alone, and then the likelihood I would have died is far greater; Gabi's insistent presence maybe saved my life.

By the time we’d walked two or three hundred yards along the promenade, I couldn't hold the indigestion line any longer. I need to sit down for a while I said, Im sure I will be grand in a few minutes if I just relax for a bit. We sat on a bench and I frantically geminied symptoms of stroke. To my great relief, it seemed I was not having a stroke. Then I geminied symptoms of heart attack. I think I might be having a heart attack, I admitted. I will call an ambulance said Gabi. No, I said, call an Uber.

After about a quarter of an hour the Uber arrived. I leapt into the back seat and slammed the door. Don't break the fucking door barked the slavic driver. We need to get to the nearest hospital said Gabi. Loughlinstown, I said, we need to get to Loughlinstown. Is it an emergency he asked, matter-of-factly. I don't know I said, feels like it, we’ll see when we get there.

We got there as fast as any ambulance through heavy evening traffic, thanks to the rally-like skills of the taxi-driver. I was barely able to close the door behind me as I got out and I hobbled through to reception declaring I think I am getting a heart attack. Go left and around, said the receptionist, and wait there, someone will be out to you straightaway.

After a couple of minutes in the waiting area a doctor emerged. She took a look at me and smiled wryly. I don't blame her - I don't look old enough or fat enough to be getting a heart attack, but perhaps I do look daft enough to be imagining one. You are fine I'm sure she said but we will do some checks anyway. An orderly beckoned me into a wheelchair and I was wheeled through to the medical assessment unit and laid out on a medical table - this is the point at which I ceased being a subject and became entirely an object, from now on everything was out of my hands, and for a while at least I felt relaxed, I was in the right place, wasn't I? And whatever was wrong with me would be sorted, wouldn't it?

The doctor asked me to describe the pain’s position and intensity. Then she went off to consult with someone else and came back looking much more serious and asking me to remove my shirt. Suddenly there were three or four staff standing around me.  My chest was then partially shaved in preparation for an ECG. This involves the gluing of half-a-dozen electrical receivers to your torso and checks the electrical functioning of your heart. The nurse placing these on my chest was very nervous and barely managed to attach the things properly. She was constantly apologizing. A few minutes after the ECG, which printed out a graph full of extreme peaks and troughs, a bit like my life,  a new doctor appeared, announcing himself as the senior doctor. He said it seemed that I was in fact having a heart attack. They did not however have the facilities to deal with heart attacks in Loughlinstown and therefore I was being transferred to St James Hospital for an emergency procedure. An ambulance was on its way and would be here very soon.

Very soon turned out to be two-and-a-half hours. I'd have been far better off ordering another Uber! Those two-and-a-half hours might have done lasting damage to my heart's ability to pump blood - we will see. During that time the pain in my chest refused to subside no matter what was thrown at it. It turned out to be the IRGC of pain - all but impossible to knock out. I was given two morphine injections, one fentanyl injection, codeine pills, attached to a paracetemol drip, and handed a sublingual nitroglycerin spray. Only this last, which instantly widens arteries - poppers without the fun, essentially - had any impact, and only for a few minutes. 

In the meantime Gabi phoned Karl and Peadar to let them know what was happening. Karl thought it was a joke at first, but as soon as he realised it wasn't a joke he dropped what he was doing and made his way to St James to await my imminent arrival, which turned out to be not atall imminent.  Peadar, a doctor, got all the medical info from Gabi and reassured her, and through her me, that I would be fine. He showed up later with everything I needed - socks, jocks, a book, headphones, toiletries. I didn't tell my immediate family for another couple of hours. I didn't want to panic them.

Clearly, I was in mortal danger during the long wait for the ambulance. At least that is what the medical staff seemed to believe. The second time the ECG nurse came along she could barely talk her lips were trembling so. From our little sideroom Gabi and I could hear the intermittent panic of the staff as the wait drifted on and on ‘Where the hell is the ambulance’, ‘oh Jesus I thought they were already on the way’ and so on. Three or four times, at roughly half-hourly intervals, the senior doctor arrived in to reassure me that I was going to be ok and that the ambulance was right around the corner. 

Honestly, I did not believe I was going to die. But I did reflect on what it would mean if I did. I think the only question worth asking in the face of death is the one posed by Nietzsche in his eternal return thought experiment, Would you live this same life over and over again for the rest of eternity? My answer, then, was an unhesitating yes. I have made many mistakes, done bad things, failed repeatedly, chosen wrongly, let others down, let myself down, suffered tremendously by my own doings and the doings of others. I have had a life of many Marianas, but there have been far more Everests. I have done more good than bad. I have shown and been shown far more love than hate. I have created so much much more than I have destroyed. I consider my life so far to have been among the elite of human existences, easily in the top 1% of those who have ever lived in terms of variety and intensity, in richness of experience. I am a trillionaire of experience and I have few regrets. In fact, I have a nagging feeling that I may regret not having died on that table in Loughlinstown.

While the ambulance was speeding at 170kph towards St James, I was given more injections and a gas-tube to suck on and self-dispense. Yet another painkiller! I had no idea what exactly, and anyway the pain heroically fought on as I got higher and higher.

In St James I was rushed into the high tech Catheter lab, always on stand by for cases like mine, and quickly placed on a surgical table and surrounded by a squadron of frontier-level medical staff. The crack-squad of the busted heart! Further injections followed - a sedative into my neck, more opioids into my arm, blood-thinner into my belly, local anaesthetic into my wrist where a tiny balloon was soon inserted into a vein. On my right the chief surgeon remotely manoeuvred the balloon through my bloodline and up towards the blocked right artery using a little controller that looked like a Gameboy. On my left I could watch all of this happening in black-and-white on an x-ray screen. How 21st century this all was! And the expense - the country was spending tens of thousands of other countries' money just to keep me alive! The whole set-up reminded me of the strange tales of alien abduction, of Alabamans beamed into spacecraft to have their bellies sliced open and their arses probed. At this stage I was very high and drifting off, but they wanted to keep me awake, so they asked me where I was from. The capital of the 33rd county, says I! Where? Clonakilty, West Cork! Ah Michael Collins, said a nurse. We shot that British agent, I imperiously informed them - opioids give you a great sense of your own authority. And then I told them all about Tom Barry and the 3rd West Cork Brigade and their many great victories against Tans and Auxiliaries. Thanks to those flying columns our country is free to be run by slightly less shady and dangerous bastards than the UK and even able to put a few of our laundered billions into saving the lives of old fuckers like me….

When I woke up I was a new creature, of a type that could not have existed for all but the latest infinitesimal fraction of human existence, and which only began to be imagined in the last few centuries. I was part metal. I was part machine. In my heart, at the very core of my being, was an inserted metal tube known as a stent. This would keep my artery from narrowing again, for at least a few years. The stent, along with multiple new medications designed to thin my blood and prevent clotting, to heal my damaged heart muscle, to reduce cholesterol, and, crucially, to lower my blood pressure, would, barring the advent of any of the infinite potential catastrophes in the meantime, keep me alive for another few years, even decades if all went well.

I spent another two weeks in Connolly Hospital, not out of medical necessity, but because of a queue in the public health system. Narrowing had been found in two other arteries and I had to have another angiogram to either insert two more stents or confirm no more stents were needed. This was to be done in the Mater, and there was only one space a day for public heart patients there. The heart unit was very busy, and many were in a worse condition than me. I had no choice but to wait. This was psychologically difficult, in particular because, being noise sensitive in an environment torturously suffused by  incessant electronic noises, I got very little sleep. I complained about the noises and my lack of sleep and got some Xanax added to my ever-growing list of meds. But the situation only really improved when, a week or so into my stay, Frankie brought me in a pair of noise-cancelling headphones. Thank you Frankie, from the bottom of my dodgy heart!  One of the consultants told me that my extreme sensitivity to electronic noises indicated I was neurodivergent. In my own view it's because I spent my childhood and adolescence in an environment where, luckily, such incessant pings and beeps were almost completely absent. I perceive them not ‘divergently’ but clearly - as the invasion of the peace-and-sleepsnatchers that they are.

In hospital I had plenty of time to wonder why, at the age of 50, and at a time when I was by all perceivable indications in truly great shape for my age, I had suffered a double heart attack, something usually associated with people much older and more corpulent than I. 

It was not, as far as I could tell, genetic, not something I had been doomed to by birth. This was the unfortunate case with two others in my ward I got to know a little. One was a lecturer in the social sciences, Christine, in her late 20s, recently married and with an infant daughter, and to all appearances one of those countless young people who, like some in my own family, run 5ks and half-marathons, fuelled by smoothies and bowls of green and grain. She’d had a heart-attack and, after a few days on the ward, a consultant informed her that she had been born with a serious heart defect, that this would require major surgery, and that her life would never be the same again. I don't know how I would have dealt with such news at that life-stage. Dublin is very tough on young families, even without fatal complications. 

But the birth curse was even worse for another of my ward comrades. A retired member of the Irish Army - the official, non-combatant one - he was doomed on both his mother and his father's side, the former succumbing to a heart attack at 43, the latter at 51. Same story repeated across aunties, uncles, cousins, the lot. The Captain himself was now 64. But he had, at latest count, 16 stents. Now he was awaiting a bypass. He was, perhaps inevitably, the best humoured of us all. He laughed for an hour or two without ceasing after Argentina knocked England out of the World Cup. He hated ‘them bastard Tans’ so much I wondered if he was mistaken about which of the Irish armies he had actually signed up to in his youth! But I woke one night at 4am, when there was no football or quiz shows to distract, when there was nothing but electric twilight and whirring and beeps, and I heard him sighing and weeping, discordantly human, into his pillow.

I had a few relatives who had died young, but of nothing cardiovascular - they had died of diseases of despair, poverty, and alienation - alcoholism, suicide, the ravages of homelessness. But most did not succumb to any of these, we are a tough breed of manuals on both my mother's and my father's side, and the majority of my older relatives lived into their seventies or eighties. Despite working hard and, very often, playing hard too,  none had passed away from heart trouble as far as I knew. Who, I wondered, would want to live longer and harder than they had? Perhaps it's cruel of me but when a patient in their 80s or 90s arrived into the ward and seemed to be totally dependent on others, as well as on complicated machines, for survival - whether inside or outside the hospital - I swore I would never allow myself to end up like they had. I do not want to suffer a long post-script of my existence, during which I can do nothing and make nothing, for the sake of deferring the inevitable.

Most of those in the coronary wards were either of the above category - ancient and immobile - or in their 60s and smokers, heavy drinkers, and gourmands of the ultra-processed food aisles. Often they were in the coronary care unit for the second, third, or even fourth time in the course of a year or two. They were to be found in the hospital's laughably overpriced and unhealthy shop stocking up on crisps and jellies, or else crouching outside the hospital entrance smoking by the no-smoking sign within a few hours of admission. It was hard to feel sorry for them, and they showed me another future I could not abide, or expect my loved ones to put up with.

Smoking had, of course, something to do with my own heart trouble, and drinking, and all-night partying. All of these I had started before or when barely a teenager. I took my first drink and smoked my first cigarette in 1987, when I was 11. I mitched off school to smoke hash when I was 14, in 1989. I had tried E and mushrooms and LSD by the time I was 20 in 1995. I am not ashamed of this, and have never made a secret of it, in fact I have writing publicly about it all for decades. But most of my drinking, if not my smoking or raving,  was done in the 20th Century. I had gotten drunk once in my 30s. Like many, perhaps most, of those with substance use issues, I had relapsed during the pandemic, but it was four years now since I had tasted alcohol. I smoked daily, but again far less than I used to. True, I went out clubbing and attended more scandalous house parties than many people my age, and so far this summer I'd had a run of half-a-dozen late nights and early mornings, between birthdays and book launches and concerts and what not. Yet the fact remained that many comparable others of similar age and circumstances drank more, smoked more, ate less healthily, exercised far less, partied hard, and did not get heart attacks at 50! And I generally do less of all unadvisable and unhealthy things nowawadays than I did in my twenties - I'd been nearly nine months off cigarettes before a recent relapse. Besides this, I had reduced my weight from 88kg to 72kg over a couple of years due to diet changes and exercise. Tests in hospital confirmed the healthy functioning of all my other organs and vital signs. ‘But you were so cheerful and happy when we saw you a few weeks ago’ said  Roísin and Rob when they arrived at my hospital bedside. I had visitors every night I spent in hospital, by the way, and countless favours and phone calls. Friends and family really rallied round - I have never felt more cherished, more wanted, and of course I am grateful for that side of the experience.

There is obviously no denying that the cumulative effects of nearly forty years of having much-too-good-a-time much too often,  even considering the huge recent boost to my overall fitness, put pressure on the pumping system of my heart and contributed to narrowing and hardening of my arteries and the build up of arterial plaque which led to my early heart attack. But the underlying cause was something deeper, something even older. 

In my early thirties I was diagnosed with early-onset Hypertension, high blood pressure. Long-term hypertension narrows, hardens, and inflames arteries as well as contributing to ultimately deadly plaque build up inside them. These factors combine to cause heart attacks. Early onset hypertension is strongly associated with traumatic events and situations in childhood. Such events and situations are known to Doctors and Psychologists as Adverse Childhood Experiences. Among those I experienced were prolonged physical and emotional abuse at the hands - i.e. the fists - of lay teachers at the notorious Clonakilty Boys National School. For years, I lived in mortal fear of teachers and of the bullies among my peers that the teachers inspired and encouraged. This situation of long-term biological high alert is described in medical literature as toxic stress, and it poisons you for good. It is famously described and analysed in Dr Bessel Van Der Kolk’s seminal text The Body Keeps The Score, as well as numerous subsequent studies.  

As a result of having no safe place for years at a time as a child, my body-chemistry was put into a fight-or-flight mode that it could not, even decades after the fact, ever completely come down from. I had, before puberty, undergone a permanent and irreversible spike in cortisol and adrenaline which irreparably elevated my blood pressure and my internal inflammation levels, both major contributors to early onset cardiovascular problems. Multiple ACE’s also massively increase your chances of developing numerous other serious conditions, including diabetes, substance use issues, depression and suicidality, obesity, and even certain cancers. I have written elsewhere of the strangely positive impact of living in a world that ceaselessly tried to destroy me - I had to escape into a self-created, safer otherworld and became, therefore, an artist. But my multiple ACE’s made me three times more likely than the general population to develop hypertension in my early thirties and get a heart attack in early middle age. And this was the case regardless of adult lifestyle choices, since it was down to cellular level biological changes in my early years. Even if I had lived a life of a Hindu hermit, a life entirely without red meat, added salt and sugar or processed foods of any kind, a life without smoking, drinking, or raving, I'd still likely have had hypertension at 30, and been a leading candidate for heart attack at 50. Boy am I glad that at least I have, mostly, enjoyed my life - so far!

That said, obviously I now have to quit all forms of excess and eschew bleary-eyed dawns for good. Next time - and I hope there will not be a next time - I might have no-one and nothing to blame but myself. There is simply no safe dose of anything, not even coffee, for someone with a stent and heart disease like mine. To be fair, I haven't had so much as a cup of coffee since July 8th.  

I admit that I do not know if I will be able to continue to enjoy being alive in these new, constrained circumstances. From now on, if I want to maximize my chances of avoiding another heart attack, I have to adhere to a strict regimen of multiple strong medicines, each with their own deleterious side-effects, and totally avoid smoking, drinking, and raving. In other words, during what is perhaps the most psychologically difficult period of my life - and that, believe me, is saying something - I have to resist indulging in any of the time-honoured escape routes virtually everyone of my background and generation uses to get away from the pain and disappointment of living in our time of doom and fall. A large part of me believes things can only get worse for me and for us all, and comes back, over and over,  to the regret of not dying on that table in Loughlinstown, in a deep, morphine assisted existential calm, while medical staff freaked out all around me. When I had looked back on my life with all its fuck-ups and excessive glories and calmly but definitively agreed to live it again and again throughout eternity. It would have been a neat and satisfying closing of a loop, wouldn't it? 

Will I be able to make the same unequivocal affirmation of my entire existence in ten or fifteen or thirty years time? Who knows? I think the odds are against it, but then again I am one of those whom the odds have always been against, and still I persist.

*******

Just one more thing - and this is serious - perhaps the most memorable tip I picked up in hospital is never wank while wearing a heart monitor. It shows up as a sudden increase in heart rate on all the large, noisome screens hung at intervals along the ward corridor and staff come rushing in before you have time to finish off or even hide what you are doing. Everyone from the patients and the catering staff to the consultants will laugh at you all day long!