But I suppose that this warning will just whet your appetite...
- - -
My [maternal] grandfather had his prostate operated at Hadasa in late 1955. He came back to our flat in Jerusalem to recover, but developed a very severe urgency to open his bowels. He kept running to the toilet, day and night. It exhausted him. Our GP kept prescribing anti-diarrheal medicine. But he did not do a rectal examination.
When he was readmitted to the hospital after several weeks of deterioration, they quickly diagnosed 'spurious diarrhea': he was actually severely constipated, aggravated by the GP's medication.
So they cleared his large bowel manually and with enemas. But when they tried to get him out of bed he collapsed - I suspect that he actually suffered a stroke. He died within a fortnight - in 1956. The GP's wrong initial diagnosis finally killed him.
- - -
In 1961 my aunt Valli, the mother of Amos, died suddenly. She had been perfectly well. One evening she developed severe chest pain and the cause of death was given as a heart attack. There was no autopsy.
Later I remember two facts. Those who had looked at her body [I didn't] commented on curious bruising under the skin at the base of her neck. And shortly before her death, she had had a chest Xray - I think it related to a claim for reparations from Germany. She was informed that there was 'something wrong' and that she should seek medical advice. But no details were given to her.
I think the chest Xray showed widening of the mediastinum due to a dilated thoracic aorta, and that it ruptured, to cause her rapid death. Aneurysm of the upper aorta is less common that in the abdominal aorta. Rupture is almost invariably fatal within minutes. Even now, almost 50 years later, it is still operable only if it is discovered before it ruptures, and even then it has quite a high mortality. The BMJ obituaries of doctors mention quite a number of these fatalities. The government is planning to measure the aortic diameter in elderly men by ultrasound - I had mine done last week, and it is normal: I shall have to choose a different cause of death...
- - -
From the second floor landing of their block of flats in Jerusalem, my father had arranged a string dangling down the central stair well to the level of the house entrance, with a clip at its lower end. First thing in the morning, the newspaper boy would clip the paper to the lower end, and my father would 'fish' the paper up, without having to descend and then climb the two flights of stairs.
In 1968 my parents were visited overnight by my [paternal] aunt Martha. In the morning, my father went out to fish for the newspaper. There was some noise, and my mother noticed that he had not returned. Going out and looking over the banister, she saw my father lying on the stone floor of the basement - three storeys down - a fall of some 30 feet.
It was assumed that when he retrieved the paper clipped to the string, he had overbalanced and fallen over the banister. My brother soon arrived, and he told the police investigators that, as a doctor, he could certify our father's accidental death. So there was no autopsy or inquest - clearly there had been no foul play.
But our father had been prone to depression from time to time. And one of his slippers was found one flight further up - above the flat. So I was sure that he had climbed further up the stairs, to make sure of the total height of his fall, and that he had jumped. I think that being the kind and considerate husband that he was, he had used the opportunity of his sister's visit, when his wife would not be on her own when he died. But apart from the stigma associated with suicide, the diagnosis does not matter.
- - -
In 1976 Daphne and I visited my mother in Israel. It was an enjoyable tour. On the way back from Ein Gev to Jerusalem, we stopped off at Ramat David to visit Judith's cousin Iona and her husband. Then we walked to the highway to catch the bus. The bus was approaching and I ran across the road to stop it. At the last moment, my mother decided to cross the road too. The bus hit her a glancing blow and knocked her down - her leg was fractured above the knee.
The bus driver stopped a passing car and arranged to drive us to Afula hospital - Daphne stayed with Iona. I kept checking her pulse - bleeding into the thigh could have tipped her into haemorrhagic shock. The Xray showed, that the break was just above the knee - routine plating would not be possible. So she was immobilized in skeletal traction with a pin through the upper tibia, to wait for the fracture to unite.
Somehow, by sheer luck, I was aware of the regulations of the Sick Fund that insured my mother: In cases of traffic accidents, the patient had to pay all expenses and then claim back from the driver through the court. But in cases of 'illness', the Sick Fund paid for everything. So in Casualty at Afula, we claimed that she had 'fallen in the road'. I impressed on my mother the crucial financial need to stick to this story. The bus driver had reported the accident, but when the police asked us, we said that the bus had not hit her: she had fallen. That saved her [and us] many hundreds of pounds, because the accident had been entirely her fault: there would have been no possible claim against the bus driver.
The following day, I suggested to my mother, that she should ask for a mid-thigh amputation. It would heal rapidly, and if Afula did not have IPOF = 'immediate post-operative fitting' of a prosthesis, I would take her to Roehampton. But my mother was appalled at the thought of becoming 'a cripple'. Still, I discussed it with the orthopaedic consultant. He preferred to order a customized fixing plate from England.
Weeks later the plate arrived. She almost died during the operation and needed resuscitation. In 1976 the risk, and the prevention, of deep vein thrombosis was not well recognized - my own concern had been for rapid rehabilitation. I had not thought of deep vein thrombosis at the time. She was not on any anti-thrombosis measures. Later I understood, that during the operation, an elastic bandage is wound upwards along the limb to leave a bloodless field for the incision. This had obviously squeezed the clots in her leg veins, like toothpaste, up into the larger veins - causing the clots to travel to her lungs.
But she survived this undiagnosed, and untreated, pulmonary embolus.
More weeks passed. They waited for the fracture fixed under the plate to unite and heal. Finally they decided to try to mobilize her. But the radiographers were on strike, so they got her up without taking an Xray. The leg buckled - it had not healed. They decided to transfer her to a rehabilitation unit near Tel Aviv. After some weeks there, I received a frantic letter from one of her friends, who had visited. She could hardly recognize the remaining shadow of her former self.
Before this letter reached me, she died, from a 'heart attack'. Clearly, showers of pulmonary emboli from the on-going leg vein thrombosis had finally overwhelmed her.
I flew from London for the funeral. As a Jerusalem resident, her death had to be registered there. The death certificate said 'heart attack', and when the registrar asked me about contributory causes, I said nothing. Had I raised my opinion of a pulmonary embolus related to the accident and to the operation, they would have ordered an autopsy and possibly even an inquest. The funeral, and my departure, would have been delayed for no good reason - she was dead. So the Israeli mortality statistics for 1977 are incorrect by 1 case.
For years, we had written weekly letters to my parents, and later to my mother, to report about events. Riding back from the funeral in Amos' car, the bizarre thought crossed my mind: 'I must tell my mother who was at the funeral'...
Unlike others, I do not believe in life after death. I can remember my relatives without the need to visit their graves. I shall not visit Kiriat Shaul, or Bat Yam.
But in the Holy Land, there has been an alleged risk of resurrection. So when the undertaker asked me what kind of tombstone I wished to order for my mother, I said 'the heaviest you've got'.
