Cardiac arrest, kidney failure, stroke. Artist Brian Keeley had them all – but survived. Dani Garavelli tracks down an everyday miracle
AMONG Bibo Keeley’s most cherished possessions is a photograph of her husband Brian standing waist-deep in the sea off Islay, his arms stretched upwards in a gesture of utter joy. It was taken on 23 July, 2013 and it is the last picture in which his torso is unmarked by scars. The following day, the previously healthy 50-year-old suffered a heart attack so massive it ought to have killed him; but, by luck, he was helicoptered to the Golden Jubilee Hospital in Clydebank – home of the Scottish National Advanced Heart Failure Service – where he was kept alive by technology, expertise and sheer determination.
For three and half months, his survival was balanced on a knife’s edge. His heart damaged beyond repair, he was dependent on a ventilator to breathe and a biventricular assist device (BiVAD) – to circulate the blood around his body. He suffered a cardiac arrest, kidney failure and a stroke, and underwent a succession of emergency procedures and blood transfusions. His sternum was opened and closed and opened again, and his body was criss-crossed by a dense tangle of tubes and wires. By mid-September, things were looking so bad, the couple married in a hastily-organised ceremony. But then Brian rallied. On 2 November, he underwent a heart transplant operation that allowed, if not a return to his old life, then a rebirth and a new normality.
Eighteen months on, I am in the back room of the couple’s home in Aberdeen. Though the garden is in full bloom, it is no match for the vibrancy of their clothes, which bring a summer vibe to a dullish day. Brian is wearing a Hawaiian shirt and Bibo a floral maxi-skirt and they look as if they have just wandered in off Venice Beach. “Life is too short not to wear bright colours,” Brian says.
Brian and Bibo are artists and the room is decorated with their creations; on one wall, there is a massive painting of them – Brian in a kilt, Bibo in her German national dress – set against the backdrop of a castle. It’s a tongue-in-cheek homage to the grand family portraits found hanging in stately homes.
But I have come to see other, more poignant artworks. As Brian fought his way back to health, the pair decided to chronicle their journey. Bibo took unflinching photographs of her husband at landmark moments, while Brian took photographs of hospital staff members so he could paint portraits of them later. In the end, out of a team of more than 70 involved in his care, he has captured 24. They include surgeons, doctors, anaesthetists, nurses, physiotherapists and even “wee Rebecca”, a member of the catering staff who made sure Bibo was eating properly.
Creating the artworks was a form of therapy; Brian had to learn to use a brush again, and if you look at the portraits in the order they were painted you can chart his progress from the broad basic strokes of the early ones to the more accomplished ones in the last. Together, the photographs and paintings also provide an unprecedented insight into medical procedures which – just a generation ago – would have been the stuff of science fiction.
As well as paying tribute to those who work at the front-line, the artworks raise awareness of the complexity of heart transplant operations. Earlier this month, Brian and Bibo took some of the portraits to Holyrood for the launch of Anne McTaggart’s bill which is aimed at tackling the shortage of donor organs. It seeks to change the law so that instead of people opting in to organ donation – by carrying a donor card – they would have to opt out. Now, however, the couple are preparing for their most important exhibition to date. This week, their work will be on display in the Golden Jubilee Hospital. Not only will this allow some members of staff to see their portraits for the first time, but, also, hopefully, help Brian and Bibo close this chapter of their lives.
As they recount their story, they sit opposite each other, Bibo’s feet tucked up beside her husband, and a box of tissues between them for the many times they will cry, although there’s plenty of laughter too. The way they tell it, their island-hopping holiday was the kind you don’t forget, even if it doesn’t end in near-tragedy. As one of Scotland’s rare heatwaves brought unbroken sunshine, they swam almost every day. On Jura, they had hooked up with another couple spending their nights on the beach drinking whisky as Brian strummed his guitar and they sang raucously along. That last evening on Islay, they sat with the same couple on the pier at the Bunnahabhain distillery, their legs dangling over the edge as the sun set.
When Brian began to struggle with his breathing, they put it down to his asthma and the incense they’d been burning to ward off midges. But the following morning, he curled up in agony in the back of their camper van. Panic-stricken, Bibo drove to the ferry terminal. An ambulance was called and – after a brief stop in Islay Hospital – Brian was flown to the Golden Jubilee; later perfusionist Allan Palmer noticed he still had sand between his toes.
Bibo couldn’t go in the helicopter; instead she had to take a ferry to Tarbert and then drive almost 100 miles. Every so often she would contact the hospital. “I thought I would phone up an hour later, and they would say it’s all under control. Instead, I got someone who said to me: ‘He is one of the sickest patients, if not the sickest patient in Scotland’,” she says. Bibo finally got there at 9.30pm, in a bathing costume and a sarong.
For a detailed explanation of what happened to Brian in those early days it is best to turn to the experts. Consultant cardiologist Dr Mark Petrie, cardiothoracic surgeon Phil Curry and Palmer were all intimately involved in his care from the moment he arrived at the Golden Jubilee.
A Scotsman, an Irishman and a Yorkshireman, they seem like the opening line to a corny joke, which is apposite because they are all possessed of a dry sense of humour. As they have their photographs taken, they suggest the mystery VIP due to visit the hospital in the coming weeks could be Kim Kardashian (though they know it’s likely to be a Scottish government minister). Palmer is dressed in scrubs and orange clogs which make him look part ER, part Guantanamo.
As the on-call cardiologist, it was Petrie who saw Brian first; he realised his heart attack had been caused by the blocking of a major blood vessel, and started to carry out an angioplasty, which involves putting in a stent to open up the artery. As he was doing so, Brian had a cardiac arrest, so he had to be put on AutoPulse, a device which is wrapped around the patient and gives aggressive CPR. Petrie says 98 per cent of patients would have died at this point, but Brian was young and had never previously presented with heart problems, so he decided to do something unusual. He brought the extended team – including Curry and Palmer – into the cath lab (a clinic with diagnostic imaging equipment).
There, Brian was put on an ECMO (Extracorporeal Membrane Oxygenation) machine which provides cardiac and respiratory support, and transferred to intensive care. But ECMO machines cannot be used for long, so, after a week, he was hooked up to an external BiVAD. Even BiVADS are only supposed to be used for 30 days; but Brian was on one for 101, which meant the pump heads had to be changed. “Brian had no heart function,” says Palmer. “When you change the VAD heads, you have to stop [the device] and connect a new circuit, and for the ten seconds it took to do that, he was gone.” Brian couldn’t breathe unsupported either. He needed a ventilator which was connected to his airway by a tube down his throat, so he was put into an induced coma. Later, he had a tracheostomy, so he could be conscious, but he couldn’t talk until he was given the speaking valve that eventually allowed him to say: “I do.”
Brian’s memories of the first month or so are almost non-existent; and even when he became more lucid, he says his world had become an amorphous blur where day and night ceased to exist and time was marked in short bursts of sleep and excruciating pain. Initially, he couldn’t move anything from his neck down, so he was unable to communicate his needs to anyone but Bibo (who became adept at reading his expressions and lips).
Bibo – a tall, slender woman with a surfeit of energy – is a force of nature; staying at the adjoining hotel, she sat at Brian’s bed for up to nine hours a day. She dealt with phone calls – always having to deliver the same bad news – and fended off over-taxing visitors, but despite her exhaustion and the many set-backs, she says she never considered Brian’s dying an option “All the time, I was focused on being positive. When his kidneys started to fail, I said to him: ‘It is important to get your kidneys working again. You know what they are supposed to do. Focus on it; visualise them working’.”
Though there were no “good days”, Brian retained his sense of humour. When his speaking valve was put in for the first time, he broke the silence with the words: “testing, testing.” Even now – when he goes for his heart biopsies (to check for signs of rejection) – he insists on singing: “Take another little piece of my heart.” But he was in a Catch-22 situation. He couldn’t survive without a new heart, but he was too sick to be put on the transplant list. On Friday, 20 September, Curry arrived at his bed with a palliative nurse and told them his life was ebbing away. Bibo and Brian – who had been together 15 years – had talked about getting married, but now Bibo decided they should do it right away.
And that’s exactly what happened. Paul Graham – who provides spiritual support at the hospital – contacted the registrar; some friends drove their passports down from Aberdeen, and the nurses transformed the room into a wedding suite, with organza draped from the equipment and plastic chairs “dressed” with white sheets and bows. Twenty-four hours later, they exchanged their vows. There were flowers, a cake, glasses of bubbly and a dozen guests and the nurses lined their chairs up along the sliding glass doors of the ICU and joined in the crying. Astonishingly, Brian managed to sip some of the bubbly and – Bibo says – a tiny amount of whisky. “It was passed down the grapevine that he had drunk whisky and got better,” she laughs. “That myth was repeated to me several times.”
A myth it may have been, but after the wedding Brian’s condition did start to improve. Having had two litres of fluid drained from his lungs, his breathing strengthened. He was taken off the ventilator and he started eating. Even his kidneys surrendered to Bibo’s indomitable will and began to function again.
In mid-October, he was put on the heart transplant list and the very next day he was told an organ had become available. “I was scrubbed up, nil by mouth, the whole lot, and wheeled into the operating theatre,” Brian says. “The tools were being laid out and there was activity all round me. I was so scared because you know you are going under, and you don’t know if you’ll come back. Then, there was a sudden hush; the organ wasn’t suitable and the operation was stood down.”
What seemed like a setback, turned out to be a blessing because it gave Brian a few more weeks to get stronger. On 3 November, he was told another heart had become available and this time all went well.
Brian’s operation was carried out by Curry. The surgeon explains heart transplants are always fraught because of the timing: the heart needs to be removed, clamped, transported and re-perfused within the three hours. “If the donor heart arrives at the wrong time and we have not got the old heart out – that could be disastrous. It’s a UK-wide logistics operation – it’s very tight and a lot of planning goes into it,” he says.
Throughout the operation, the patient has to be kept alive on a heart-lung bypass machine which keeps the blood circulating round the body. Brian’s operation was particularly complicated because the previous operations involving the BiVAD had left scar tissue making it more difficult to remove his old heart and because the BiVADS necessitate the use of anticoagulants which thin the blood, making a haemorrhage more likely.
Nevertheless, it was a success; there was no sign of organ rejection (though Brian, like all heart transplant survivors, will be on immunosuppressants for the rest of his life).
His recovery was relatively rapid, but he had been bed-bound for a long time so it took a lot of gruelling physiotherapy to get him mobile again. Still, just over a month later, he and Bibo left hospital, moving in with his mother in Glasgow, before returning to Aberdeen at the end of February.
Today, Brian’s gait remains unsteady; he has never regained his full balance and he has constant pain in his legs, but he is well enough to enjoy his life. And he has just returned from his biggest trip since his operation: to see the Scotland/Ireland European qualifier in Dublin.
Perhaps the biggest legacy is psychological. All organ transplant operations come with baggage: a life saved by a life lost is an uneasy transaction. And the heart is so weighed down with symbolism that – 48 years after Christiaan Barnard showed it was possible – the idea we might walk around with someone else’s is still mind-boggling.
Yet, despite his artistic temperament, Brian takes a pragmatic approach. He says his new heart is part of his identity, but he tries not to dwell on the thought of his donor. “It’s not that I’m not grateful. I don’t think anyone can be more grateful than a donor recipient, but it’s such a debt of gratitude, it’s pointless to try to put it into words, it would just sound crass,” he says. Both Brian and Bibo carried organ donor cards before Brian’s illness and they are broadly supportive of the bill, seeing a move which might increase the number of available organs as positive.
The most dramatic change has been their determination to enjoy everyday pleasures. One of the first things they did when they returned to Aberdeen was to return to the beach. “We love it – the atmosphere, the sound of the waves and the light which is different every time,” Bibo says. “For most people it probably doesn’t mean anything. But for us, it’s like: We can go there.”
The pair also believe their experience has invested their art with greater depth. In their front room-cum-studio, evidence of their creative surge is everywhere. On an easel, there is a giant painting of Brian, his chest-wound fresh and raw. Propped up against bits of furniture are all the portraits of the staff members. And sitting on the window-sill is a Viking ship made by Bibo. The ship looks as if it is bound for Valhalla, but the little box nestling in its hull contains – not ashes – but sand from their favourite shore. It’s a quiet, but potent reminder of what could have been; but wasn’t.