INQUEST INTO THE DEATH OF WILLIAM SHAKESPEARE
Held on May 14, 1616
We, the coroners of Warwickshire, convene this inquest, under the glory of God and of our King, to ascribe the cause of death of the noted gentleman, Will Shakespeare. He was a leading light of our town of Stratford-upon-Avon, and of our nation’s theater world. Death took him in the evening of St. George’s Day, April 23rd, in the year of our Lord 1616. What sayeth the three learned men of physic, surgery, and the secret arts, who performed the necropsy? What conclusions made you?”
Mr. Pace, village barber-surgeon, arose from his seat and declared, “We knowest that Mr. Shakespeare supped with Michael Drayton and Ben Jonson, and later that evening, he developed ague and fever, and he died. We found the liver to be small, pale, and hardened, like seen in heavy imbibers of Rhenish wine, ale, sack, and other monarchs of the vine. T’is my finding that a wind draft, compounded by a mild effluvia from the bowels, caused by excess pickled herrings, resulted in a hepar decompensation that could not be endured, and that became the death blow.” With that declaration, Mr. Pace sat down.
Dr. Harden then stood, faced Mr. Pace, and declared this initial opinion as plausible, but incomplete; “We all noted the swelling of the rising aorta, squeezing and pinching tubes and the nerve strings passing up to the voice box. Indeed, Mr. Shakespeare
was known to have an occasional croak in his voice. Therein the result of this syphilis, this affliction begotten by the loins’ covetness so many years ago when his face and limbs and corpor were sealed o’er with the weeping pox. A small sore of the upper mouth, the palate, sirs, was found; a predisposing to the open channels into the nose that cause so many afflicted with the late pox to speak through the nose, and to discharge drink and fluids as waterfalls cascading down onto the upper lip. This great pox killed the gentleman.” And Dr. Harden sat down.
The magistrates then looked to Dr. John Hall, physician, and son-in-law, to Mr. Shakespeare. “And what profess you, sir, for you were the third medical man to assist in the necropsy? Dr. Hall looked quickly over his shoulder to his weeping wife, Susanna, a daughter of the deceased, and spoke.
“My father-in-law was known to be with this miserable passion, to be in a great life-loathing melancholy, accountable to the mischief of excess effusion of black bile. For some many months prior to his death, sleep, that sore labor’s bath, nature’s sweet nurse, and the balm of hurt minds, escaped him; his appetite absconded, for he ate what would not even fill a tit mouse, sirs. He overly partook of sack. All these perturbations resulted from London businesses most foul, and because of a disquiet from the Welcombe enclosure affair here in the town. Poisons, and blest infusions tied in silken bags, abounded in the household, derived from herbalists in London towne, and we know for a fact that Ben Jonson, who quenched tottering thirst with the deceased that very evening, carried vials of toxic, lust-inducing, sleep-procuring, and other lethal substances for his own peculiar pertinences. The necropsy revealed the organs to be full and congested and mottled. Galen, sirs, noted just those changes from ingesting the leaves of the yew tree. It is my opinion that Will was tired of this existence, and I could not minister to that mind diseased, I could not pluck from his memory rooted sorrows, nor raze out the written troubles of the brain. I had not that sweet oblivious antidote that could cleanse his stuff’d bosom of that perilous stuff which weighed upon his heart. Death seized him, as was his wont, and he ended it all, the heartache, and the thousand natural shocks that his flesh was heir to. That was his soul’s desire, sirs, that center of his sinful earth. Having his veins run with this cold and lethal humor, the remediless poison affected his organs, that was deadly to the partie, and stopped all functions, rewarding, a merciful, shrouded release for him, nay, but for his family, an unmerciful calamity.” Dr. Hall glanced at his wife, both now with tears, and retook his seat.
The coroners declared that all three learned opinions would be listed as contributory influences to the death of one William Shakespeare, Gentleman.
IT MUST HAVE FELT THE SAME FOR YOU, TOO, DAD, DIDN’T IT?
You were debonair imitating Fred Astaire a half century ago, tap dancing on our kitchen linoleum in your slippers and pajamas with a Lucky Strike cigarette between your lips. Doctors appeared in advertisements back then, promoting that Camels, Pall Malls, and Chesterfield cigarettes were so “mild for the ‘T’ zone (throat, tongue).” I remember, after you began regular visits to our doctor, that our routine was for me to call out in a jocular fashion as you danced “Dad, your heart! Your heart!” I did not fully appreciate how grave your condition was. Each morning you had eggs, thickly buttered fresh pumpernickel bread, and coffee with cream, while you read the Buffalo Courier Express. You would prepare my breakfast, wake me for school, and then you’d go to sleep until late afternoon, ready for your night shift as a cabbie.
You were parked in the cab, waiting to start your first run of the night at Buffalo’s New York Central Railway Station. You probably felt severe pre-sternal pressure pain, and then everything went black, as you died at age 46. The abnormal rhythm stopped your heart on November 9, 1953. Dr. W. had diagnosed angina pectoris – chest pain with exertion due to “hardening of the arteries” – during that past year. Bernie, your friend and fellow cabbie, rubbed snow on your chest, as he tried to help any way that he could. Then Mom got the call at home; I was a 14 year old eighth grader. I’m still proudly wearing your Bar Mitzvah ring that was removed from your finger before we buried you.
Well, Dad, on May 31, 2000, when I was 60, I had my heart attack. I confess I was anxious, and then relieved, when I made it past my 46th birthday. I never smoked. I rode a stationary bike for 30 minutes four mornings each week for 16 years. In addition, I had been following a strict very low-fat diet ever since a chest-pain scare that led to an abnormal stress test with isotope cardiac scan nine years ago. The test indicated an area of low myocardial perfusion from a presumed partial coronary blockage. My doctors and I followed conservative management of the condition without an angiogram. Baby aspirin and a statin lipid-lowering drug were added to my antihypertensive at that time. The stress from my clinical neurology practice of recent years had decreased much of the previous enjoyment that I had derived from my work; fortunately I was able to retire at age 58. I love retirement. I love my family, especially my year old first grandchild who lives with his parents just five minutes away. Holding that baby and kissing his head is my definition of happiness.
On that fateful morning when I “died,” I awoke at 6:30 a.m. to start
a much anticipated day of sightseeing with out-of-town relatives. I performed my ablutions, took a baby aspirin and my antihypertensive medications. While on my stationary bike, however, I began to feel a substernal sensation. This wasn’t alarming because many different sensations (i.e. quick “pulls” in the chest, aches and skipped heart beats) had occurred so often, and disappeared in a second, that I considered them non-consequential. Vigorous activity and strains, such as hauling up and pulling in the sail on my windsurfer, have never caused these feelings. But, as I continued to exercise, the sensation became more intense, a mild pain now. It was even in my throat. Well, I have a great day planned, let’s hope that it stops, I thought. It didn’t. I even reduced the tension to ease the peddling. Even though these symptoms signaled an ominous development, I carried on with my regimen. True to form, the most common first response to one’s own heart attack is DENIAL! I noted a cold sweat, different from my exercise sweating. I was still hoping that all my symptoms would subside; I had a great day planned. My wife returned from her morning walk, but I didn’t mention a thing. I didn’t want to end my exercise before the built-in timer rang or she would suspect something was wrong. DENIAL! Self-destruction? I suspect denial, and of course, the STUPIDITY so characteristic of many physicians experiencing symptoms. Even worse, I thought, I can’t call 911 and have them find me dirty and sweaty (even if shocky), so I took a quick shower and I took another aspirin. By that time I was visualizing spider web designs whenever I blinked. This probably resulted from cerebro-retinal hypotension and I was seeing my own retinal vasculature while my eyes were closed. By this time I was quite weak; I was able to quickly dry myself, and feeling nauseated, walk to the bed and lie down.
I called to my wife and asked her to come upstairs. She suspected from my voice that something was wrong. She found me lying down, gray and clammy. “Will you get my automatic blood pressure cuff,” I asked. “Are you having chest pain?” she asked, handing me the cuff. I said ” welllll”, and then I emphasized “YES!” She immediately dialed 911.
“My husband is having chest pain!” she said into the receiver, her voice trembling. They asked if I was cold, warm, or sweaty? She answered “cold and sweaty.” They advised her to put pillows under my feet. They queried if I was nauseated or vomiting? I responded “nausea.” They told her that paramedics were on the way and she should open the door for them. Before she went downstairs I told her to get me some underwear; then I wanted shorts over those—I had to look presentable. She refused, “you don’t need shorts!” She put our three house cats behind closed doors to keep them out of the way and ran downstairs to unlock the front door. By the time she returned my chest pain was worse. She called 911 again to tell them that I was having more pain, but then there was a knock at the door. “We’re up here!” my wife called. A sheriff appeared and asked my name. I could hear sirens. I was feeling extremely weak just lying on the bed. My wife later told me that I was as gray as my grizzled beard. My wife went downstairs and directed the first three of the paramedics up to me. They gave me aspirins to chew, applied an oxygen mask over my face, took my vital signs, and started an IV. “What’s your name, sir?” one paramedic asked me. I vividly recall that I barely had the strength to respond, or even to move my arms. I heard them report to each other that my blood pressure was 80/60, and then they had trouble detecting any blood pressure at all.
Gazing up at my ceiling I thought, “I’m going to die! Well, I’ve lived a good life. I’ve had three wonderful years of retirement. I have provided for my family. So, if this is IT, then this is IT.” It really seemed so easy to die. I’ll have to remember that the next time.
The paramedics rolled me onto a litter and carried me down the stairs. I could tell that they were straining to carry me. Once downstairs they said something else to me, but I have no more memory until five minutes later as they wheeled me into the local community hospital’s emergency room. My younger daughter, who arrived from her nearby home just as they got me downstairs, heard the paramedic shout, “He’s going out, let’s move!” Cardiac arrest! Once in the ambulance, a single defibrillation jolt apparently converted my ventricular fibrillation irregularity into regular sinus rhythm. In the emergency room I was awake and aware of severe chest pain. More iuvs and an intracath were started. A nurse asked me to rate the amount of chest pain I had on a scale of zero to ten. I was able to consciously deliberate and respond “seven or eight.” “We’re giving you morphine and nitroglycerin to relieve your pain,” the nurse reassured me. The ER physician told me that I had had a hyperacute myocardial infarction, and he advised that this was the time to administer a clot-busting drug. I was clear enough to ask if it was tPA, the clot-buster that we use in neurology for stroke. He said no, that it was Reteplase, a different form of tPA, and then he mentioned the side effects, including possible cerebral hemorrhage. “Go for it,” I said. My wife was at my side, holding my hand. My chest pain was a very severe, constant pressure, without radiation into my arms or jaw. I became concerned that the Reteplase wasn’t working since the pain was unchanged one-half hour later. They told me that they had just given a second bolus of it. After awhile the pain had eased. My third serial EKG was done and the technician gave a thumb’s up sign with a smile, “it’s normal!” Soon I was pain free and I was wheeled to the ICU. I was able to remember everything that was happening.
My diagnosis was an acute coronary occlusion without any significant myocardial damage. Now, in 2000, reversal of lethal ventricular fibrillation, and then dissolution of an occlusive clot, are routine, if the patient is fortunate enough to reach competent care expeditiously. Dad, you were deprived of these miraculous treatments; I’m sure you couldn’t believe that it would be possible. I’m so sorry that you were lost to me when I was 14.
How fortunate I was that every conceivable facet to save my life was in place, at the right time, despite my foolish attempts to thwart them. From this point forward, whenever someone cautions me that some activity is dangerous, or that I could die from doing something, my response will be “been there, done that.”