Sultana's Dream

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Sultana's Dream
April 2012


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How My Brother Died

The day after Mason died the police handed us the New South Wales Coroner's Certificate. The sudden and shocking death of my 31-year-old brother was summarised in four cold words: Cardiac Tamponade, Aortic Dissection. No, we had no idea what it meant either.

My brother wasn't sick. At least not as far as we knew. A few days before his death he complained of some chest and back pains but two visits to his GP only yielded the advice to rest up and go to the hospital if the pain got worse. For his part, my brother googled his symptoms and the best Dr Google could do was advise him that he possibly had pesticide poisoning. The GP agreed. So two days before he died my brother told me that he was not feeling a hundred percent because he had eaten too many mandarins!

At ten minutes to three on the afternoon of Thursday May 21, 2009, my brother was feeling tired so he went to have a nap. Sometime between 3pm and 4pm he left us for good.  

An aortic dissection is a tear in the heart. It is a rare condition that is either genetic in origin or caused by hypertension. Since my brother did not have high blood pressure and given that my father died from heart problems, I think it is safe to say that my brother was born with his condition. It lay dormant for 31 years and then, for some reason, the tear began to bleed. The bleeding led to the ultimate cause of death - a cardiac tamponade, which is an emergency heart failure caused by the accumulation of fluid in the pericardium (the protective sac in which the heart is encased). Not all cardiac tamponade is caused by aortic dissection. Sometime the sac fills up with fluid as a result of trauma.

In my brother's case, we have no idea what aggravated his condition. It could have been stress; it could have been the fact that he had recently put on weight after a back injury. It could have been nothing at all. But for some reason, the tear in his heart started to bleed. When the sac filled up with blood, the heart had no room to pump blood. So it simply stopped beating.

We don't know if my brother struggled and tried to get up. We don't know if he knew he was dying. We don't even know if he was awake or asleep when it happened. All we know is that his death would have been quick. My mother found him in a peaceful position. One arm resting on his stomach, the other behind his head. I like to take this as evidence that his heart gave way whilst he was asleep. I like to think that as far as he knows, my brother is still asleep, that he is still waiting to wake up, knowing that when he does he will be getting dressed and going to his brother's house where he has been invited to dinner.

It has been almost three years and I am still having trouble accepting that my brother is really dead. As I type these words on the eve of what would have been his 34 birthday, I kid myself that I am talking about someone else. Could it really be possible that I will never see him again? That he won't ever greet me with a kiss on both cheeks - and it always had to be both cheeks. Even when I would try to cheat and give him a quick peck on one cheek, he would grab my arm and pull me back. We are Lebs Ruby, he would say. It's always two cheeks.

I don't even remember what his last words were to me or vice versa. All I remember is we had lunch in the house he still shared with my mother, the house we all grew up in. And without any of us noticing, he quietly slipped to his room to have a nap. I remember standing outside his door as I was leaving with a mixture of annoyance and concern. 

Why did he go to his room without even saying goodbye? That's not like him. Should I go in? Should I see if he is okay? No, he must be tired, I'll just let him rest....

In the weeks and months after his death I was filled with so much anger. Anger at the universe. Anger at myself for not going into his room to see if he was okay. Anger at his GP who wouldn't send him to the hospital despite the fact that she was aware of the history of heart problems in my family.

But you canít stay angry forever. At least I couldnít. The police told us that the GPís reaction to the news was total surprise. It had simply not occurred to her that he was in danger. It was just one of those awful random things that are so rare they can only happen to other people. The coroner said they see one case of cardiac tamponade per year. One case. In 2009 it was my brother. Who was it in 2010, I wonder? Who will it be this year? Has it already happened?

It kills me to know that somewhere out there is a young person, most likely a man, who is a walking time bomb, whose heart has a tear in it that will one day start to bleed. He might complain of chest pains, but given his youth, given the fact that the symptoms are so vague and given the fact that the condition is so rare then his doctor will probably not be too worried. And then one day he will suddenly collapse and not get up again.

Or maybe, like my brother, he will feel tired, go to sleep and never wake up.

And still my heart aches. It aches for myself and my childhood, which died with him that day. It aches for my brother who was struck down in the prime of his life. It aches for my mother whose final years will be spent, not in golden retirement, but in mourning the loss of her youngest baby. It aches for his colleagues at the police station who still send us cards on his anniversary and whose grief that day, as they formed a guard of honour at his funeral procession, was as real and raw as ours. And it aches for the family of that young man I don't know and will never know, who will also be in for a world of pain like they could never imagine when their beloved son, brother, cousin and friend dies suddenly and leaves a great big vacuum where his life used to be.

Ruby Hamad