Path ways of the heart


HEALTH:Photographer Charles McQuillan responded to being diagnosed with coronary artery disease by recording his
experience with his camera. He tells his story to FIONOLA MEREDITH

WHEN PHOTOGRAPHER Charles McQuillan felt a sudden tightening in his jaw as he walked through Belfast city centre one morning, he had no idea that his life was about to change forever. He didn’t know it at the time, but the odd sensation in his jaw was the first sign of a serious heart condition. Aged 39, McQuillan had to face up to the fact that he was suffering from coronary artery disease: a diagnosis that left him shocked, disorientated and fearful about the future.

He responded in the way he knew best: he decided to document his experience in a series of photographs, both as a way to understand what was happening to him, and as a way to move beyond it. “I don’t want to be defined by my heart condition,” he says. “For me, taking these pictures is a way of dealing with it – my own form of catharsis.”

After consulting his GP, who immediately realised that something was significantly wrong, McQuillan was whisked off to the cardiac ward. “It was scary. I was the youngest man there by some distance, and I didn’t know what was going to happen to me. Was I going to be able to work again? I kept thinking they had made a terrible mistake, that maybe the jaw tightening was because I was allergic to something. I thought I could bluff my way out of it, or that they had got me mixed up with someone else. There was just this sense of disbelief.”

McQuillan certainly wasn’t an obvious candidate for heart trouble – he was young, didn’t smoke and wasn’t overweight. But Sara, his wife and the mother of their two young sons, Cal and Sean, always feared this day would come. “I knew the family history: both Charles’s father and his paternal grandfather died from heart attacks at the age of 57, while his maternal grandfather had a heart attack and died at 56. So I was shocked, but not surprised.”

On the day he first felt his jaw tighten, McQuillan was supposed to be setting off for Scotland. An award-winning press photographer, he was due to travel there to cover a football game. Instead, he found himself lying in a hospital bed, strapped to bleeping monitors, wondering what was going to happen. But he did find a bit of humorous relief in the subversive behaviour of some of the elderly male patients.

“The black humour definitely helped. The monitors have a range of 100 yards, and if you go any further than that, all the alarms go off. One guy set them off because he went to the canteen, while another did a complete runner, the police had to pick him up. The man in the next bed to me had actually been dead – they had to resuscitate him, he had all the burn marks on his chest. He was supposed to be on a careful diet: salad, lean meat and so on. But every night his wife brought him the most amazing desserts. You’d turn round and he’d be eating a big slice of black forest gâteau. The next night it was an apple turnover. You had to laugh.”

The first step in McQuillan’s treatment was an angiogram to find out exactly what was causing the trouble with his heart. During the angiogram, the patient remains fully awake and conscious while a long, thin and flexible tube or catheter is inserted into a blood vessel in the wrist or groin, and then guided all the way to the centre of the heart. When it is in place, a special contrast dye is injected through the catheter; X-ray images show how it lights up the heart’s intricate network of arteries, and clearly indicates where any narrowing or blockages have occurred.

Once the problem area is revealed, an incredibly fine guide wire is fed into the catheter, which acts like a train track, a kind of mono-rail along which miniaturised equipment can be passed to unclog the arteries. An infinitesimally small balloon may be used to expand the artery, or a small, expandible metal mesh, known as a stent, may be inserted. On occasion, doctors may use an ultra-tiny diamond-headed drill bit to chip through the build-up of plaque, rotating, twisting and turning the guide wire through the complex pathways of the heart.

By anyone’s standards, it’s fiendishly tricky work. “You are effectively working long distance,” says Niall Herity, clinical director of cardiology at the City Hospital in Belfast. “Every single procedure you do, you have a lot of respect for. But for the patient, it’s about as minimally invasive as you can get.”

That was small comfort to McQuillan as the doctors went in to explore his heart. The choice was to have this procedure or have bypass surgery. “I tried to busy my mind: the guy working the X-ray machine was into photography, and I kept talking with him about exposures and apertures, anything to keep from thinking. But for most of the time I just lay there watching the doctors’ faces, looking for clues in what they were saying, trying to interpret every nuance. I knew that the narrowing was at the junction of two arteries, and that made the job more tricky. In all, it took an hour and a half. About three-quarters of the way in, someone said the word ‘perfect’. I felt better immediately.” Inside McQuillan’s heart, cardiologist Mark Spence found a severe narrowing of one artery, and he inserted a stent to widen it: everything else was as clean as a whistle, he says.

Working with a patient who is awake adds a different dimension to the procedure, says Spence, who works at the Royal Victoria Hospital in Belfast. “I like to know the patient is fully with it. If they experience pain, that’s helpful to us: it shows us where the problem area is. If you go in through the radial artery [in the wrist], there’s also a reduction in the complication rate. Most patients can go home the same day.”

The next stage for McQuillan was the process of cardiac rehabilitation, which was not nearly as long, slow and tentative as he was expecting. After an initial evaluation, patients are ushered to their feet and urged to get moving. According to senior cardiac nurse Bernie Downey, it’s all about giving the patients back the life they had before: if you empower these people properly, you make sure it doesn’t happen again. It has been shown to reduce the mortality rate by 25 per cent – if it was a tablet, you’d take it.

So in a room filled with other patients recuperating from heart bypass and stent operations – again, most of whom were several decades older – McQuillan was encouraged to join in with an up-tempo aerobics session, and then take part in circuit training on the cross-trainer, rowing machine and treadmill, all with the aim of getting his heart pumping healthily again.

Bernie Downey says that some people are terrified to move a muscle. “It’s as if you’ve had a broken leg, and you’re finally letting go of the crutches,” McQuillan says. “You’re just gingerly feeling your way, you don’t want to push too much. Mentally, the most important thing is getting rid of the fear.”

Despite his family history, Bernie Downey says McQuillan is one of the lucky ones: if he had been a smoker, he might not have survived. Does he feel fortunate? “In some ways yes, in others no. I’ve seen people younger than me suffer heart attacks – that damages the heart, and you’re left weaker. I’m lucky that didn’t happen to me.

“But the tablets are a daily reminder that there’s something not right. I’m down to five a day, and I’ll be on those forever. I get tired of knowing that I’m not going to get better, that this is something I have to live with. I resent that. Before it all happened, if I had the odd heart palpitation, I’d dismiss it. Now I think – is this it?”

The experience has left him with a keen sense of the brevity of life. “I started adding up what my life as a photographer amounted to – a sixtieth of a second here, a sixtieth of a second there. All gone in the blink of an eye. But you realise what’s important, too. All the things you hide behind, what’s cool, what’s not cool, that doesn’t matter any more. I look at my two sons, Cal and Sean, and I hope that this gene hasn’t been passed on to them. I just want to protect them.”

But living with a heart condition hasn’t slowed Charles McQuillan down. He’s still in the thick of it, snapping away, crouching on the touchline, pursuing politicians, wading into riots. As he says: “It’s probably the best sign that I really am alright.”

How Charles got his pictures in the paper

In order to photograph himself undergoing the surgical procedure, Charles McQuillan used four cameras – one that he carried with him, two that were fixed on tripods at either end of the operating table, and one secured above the bed using a “magic arm”.

As the team worked on his heart, McQuillan was able to switch between the three cameras using a special remote control or transceiver, holding the device in whichever hand he had free at the time.

I did a recce beforehand, so I knew exactly where to position the cameras. I manually pre-focused them on where I knew the doctors or I would be.”

Documenting the operation was a new experience not only for McQuillan, but also for his cardiologist Mark Spence, and the rest of the surgical team, for whom McQuillan has nothing but praise.

“I think they felt as comfortable being photographed by me as I was being operated on by them. There was a sense of mutual respect.”

He says the technical aspect of photographing himself was straightforward. “That was pretty easy and it busied my mind. But the whole thing was quite surreal. I felt slightly removed from myself; it was almost like an out-of-body experience. As a photographer, you’re so used to photographing other people.

“It’s strange to turn the camera on yourself, and when I look at the photographs I can hardly believe it’s me lying there. But it definitely made me feel less vulnerable. I felt that documenting the experience in this way gave me back a measure of power.” FM