Hazel McHaffie

Hannah Jones

A heartwarming sequel

Well, here it is: Independence Referendum Day up here in Scotland, but rest assured, I have no intention of writing about it. It’s been done to death already. Moving swiftly on …

As you know, much of my life has been spent grappling with difficult choices – not in politics, but in medicine – and blog posts on these issues aren’t always very cheery reading, so I’m delighted to bring you a fantastic story this week that’s sure to warm the cockles of your heart (whatever cockles are).

Hannah's ChoiceLast year I wrote a review about the book Hannah’s Choice on this blog. It tells the real life story of Hannah Jones who, aged just 13, hit the headlines back in 2008 and challenged the courts when she defied medical advice and chose not to have life-saving surgery. And what’s more her parents found the courage to let her.

But then, Hannah was no ordinary 13 year old; she had a wisdom and perspective borne of suffering. Painful medical interventions and sobering prognoses had been her lot from the tender age of 4 when she contracted leukaemia. And now, on the threshold of adolescence, sadly, her heart was seriously damaged and her organs were failing because of the toxic effects of her chemotherapy. The doctors said her only hope was in a heart transplant. But Hannah declined that option, choosing instead to go home and spend her days surrounded by the love of her family and friends. And she was allowed to make that decision. Wow! What a furore that stirred up!

As I reported on this blog, I was surprised and delighted when Hannah’s mum, Kirsty, responded to my review, and we’ve stayed in communication since. Why am I reiterating this? Because this week marks an amazing milestone.

Hannah starts at Aberystwyth University!

This is the same girl who went home to die. Except … she didn’t. Because a year later when her condition deteriorated she changed her mind and had a transplant, only this time the decision didn’t hit the front pages. Life, Hannah had discovered, was too precious to throw away. Those of us who review high profile cases in medical ethics are often limited to a brief period of time when the stories are newsworthy, and indeed I followed this case closely when Hannah was making her choices. But it’s really refreshing to get a longer term perspective. Especially one like this.

Huge thanks to both mum and daughter for giving me permission to share this news with you. I couldn’t be more happy for them. Cause for celebration indeed.A toast

In that same blog last year I mentioned my brother Rob, who also survived against the odds when he was treated for leukaemia and things went badly wrong. He wasn’t expected to see his 51st birthday. Fifteen years later he has just marked his own milestone: retiring from work aged 65. We celebrated with him a couple of weeks ago.

Here’s to them both and all those, who like them, challenge the rest of us to take stock and re-think our preconceived notions, beliefs and opinions.

 

 

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Red roses and beating hearts

Last summer I wrote a piece about teenager, Hannah Jones, and my brother, Rob – both of whom made difficult choices in relation to treatment for cancer. Hannah declined a transplant, Rob accepted.

This week I’ve been in touch with both. Rob I saw in the flesh at a family wedding. Hannah’s Mum, Kirsty, contacted me through my blog – what an unexpected and delightful surprise. Hannah's ChoiceAnd subsequently Hannah herself emailed, and we’ve started up a lovely conversation.  I was impressed all over again, not only by their courage, but the generosity of spirit they show in sharing their stories. Happily both are still alive and a vital part of loving families. But Hannah is feeling rather poorly at the moment so loads of good wishes are winging their way to her.

It’s Valentine’s day today and all this week STV is supporting the nationwide From the Heart campaign, which aims to raise awareness of organ donation. As you know, my current novel, Over My Dead Body, is about this very issue, so my antennae are out there quivering like crazy.

The focus of the campaign is twofold: to encourage viewers to join the organ donor register, and to talk to their loved ones about their wishes. The blurb says that there are ‘currently around 10,000 people in the UK who need a transplant and a thousand of them die waiting every year. Yet only 31% of people have registered as donors – a much lower proportion than some other countries around the world.‘ And apparently, 45% of families say no to donation because they don’t know what their loved one would have wanted. That’s a quite shocking statistic in these days of easy communication, isn’t it?

I like the timing. In Valentine’s week, whatever the state of their own love life, everybody has the opportunity to give a gift that could potentially save or transform the lives of others. And talk to their nearest and dearest.

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Hannah’s Choice

Memories and emotions relating to my brother, Rob, have been flooding back this week. I’ve been reading Hannah’s Choice by Hannah and Kirsty Jones (assisted by Megan Lloyd Davies), a book I’ve had on my wish list for ages but only just recently bought. I read it in one sitting, and then I dug out the letters Rob wrote to me at the time of his illness, and read them again too.

In 1997 Rob was diagnosed with leukaemia. And in the ensuing months he faced some of the biggest questions of his life. Should he go for potentially dangerous treatments – chemotherapy, bone marrow transplant – or not? When one course of action failed should he go back for more? As a fully competent adult in his forties, he was very aware of the relative risks and consequences of the different options. There were no easy answers. Decisions he made would have implications, not only for him personally, but for his young family too. I knew those risks intellectually, but even so I was unprepared for the emotional impact of accepting his choices and then seeing him develop serious complications and battle for his life. I often asked myself, what would I have done in similar circumstances?

But imagine weighing up such risks and benefits not for yourself but for your child, a child who is not yet a teenager. And then imagine if she resolutely maintains she wants to make her own decisions … but her choices don’t square with yours. That’s Hannah’s story.

Hannah's ChoiceI well remember the furore raised by her personal decision not to have a heart transplant, which hit the headlines in 2008. Her choice sparked a vigorous debate about a child’s right and ability to make a life-or-death decision. I was much exercised by the arguments at the time, but somehow I’d either missed or forgotten (not uncommon these days!) what happened after she went home to die, so the ending of the book came as a surprise to me. In case you’re in the same position I won’t spoil it for you.

Hannah faced not one but two life-threatening illnesses: leukaemia when she was four years old, severe heart disease (cardiomyopathy) subsequently. The firsthand account of her treatment makes harrowing reading and reminded me vividly of the agonies my brother endured.

‘Hannah started being sick up to six times a day and had terrible diarrhoea. Her fingernails and toenails had also fallen out to reveal raw red nail beds which I dressed each day with tiny pieces of paraffin gauze which had been chilled in the fridge … She also needed gauze pads placed under her heels, shoulder blades and bottom to stop sores developing because her skin was peeling – the new skin so painful that she had to be handled like a burns victim. For several days we could hardly touch Hannah because she was in too much pain, and even her mouth bled – blood caking her gums, teeth and lips which I tried to wipe gently away.

As I did so, I wondered how high a price anyone could pay for being cured, let alone a child. Hannah was wracked with pain, and although I wished I could feel it for her, I couldn’t.’

The price paid is indeed high. And there are no guarantees.

Hannah grew to hate hospitals. And she hated being treated differently. She didn’t want the ‘Chitty Chitty Bang Bang looks’; she wanted to be told off when she was naughty; she desperately wanted to be ‘normal’. Meeting other children with limited life expectancy she said: ‘… we talked about the here and now, not the future, and that’s what I like to do – take every day as it comes, which means you mostly enjoy them instead of worrying.’

Sadly, early into her treatment things went unexpectedly and badly wrong. After two of the recommended six rounds of chemotherapy to treat her leukaemia, Hannah’s heart became seriously damaged by the toxic drugs – a very rare side effect. Now her parents were faced with an even more stark choice: stop the chemotherapy and risk the cancer returning, or continue with treatment but risk further damage to the heart.

‘How could Andrew and I decide to stop the treatment that was meant to be saving Hannah’s life? But how could we continue the chemotherapy knowing we might risk Hannah’s health in another way? Surely it was an impossible choice?’

A compromise was reached. Hannah had one more round of chemotherapy. The leukaemia didn’t return but the heart problems increased. Her kidneys started failing. She was a desperately sick girl. As she deteriorated her only hope was a heart transplant. By now though, Hannah was herself older, 12, then 13; she had her own views. She’d grappled with illness since she was four, she’d spent much of her life in hospital, she knew pain intimately. And she knew she did not want to remain in hospital; she did not want a heart transplant. She wanted to go home, to be amongst those she loved, to enjoy the simple pleasures of childhood while she could. As she was quick to clarify, she wasn’t asking for the ‘right to die’, but for the right to live her life in the way she wanted – at home with her parents and her siblings.

Her parents showed amazing courage. In spite of criticism, they listened to their daughter, they respected her opinion.

‘… I’d learned that children who have felt death whisper at the edges of their world can become wise beyond their years.’

‘Her gaze was that of an old soul, staring out from a child’s face. It was the same look she had given me a long time ago when she had fought for her life the first time, and in moments like those I understood that Hannah had been to places I could never know.’

Whatever her decision, they told her, they would support her. Indeed Kirsty, her mother, an experienced nurse herself, went further. This journey alongside Hannah had taught her powerful lessons about life and about parenthood, she said.

‘I remembered the moment she was born, the feeling of the tears slipping salty down the side of my face as I held Hannah for the first time. Back then I’d known how lucky I was to have her after waiting for so long. But it was only now I knew for certain that she was not mine to keep or lose: Hannah, like every child, was a gift, not a right. I must cherish her for as long as she was mine.’

But a locum doctor couldn’t accept Hannah’s decision, and he set in train a course of action that added considerably to the strain the family were under. Hannah was threatened with a court order to remove her from the custody of her parents and force her to have the operation. She was required to make her case alone to a child protection officer.

However, whilst there were plenty of strangers who disapproved of their choices and had no hesitation in saying so, the Jones family were supported strongly by the healthcare professionals who had known them throughout the years of their ordeal. Hannah herself, though she hated being in hospital, found peace and comfort in a children’s hospice. When she heard about MPs fiddling their expenses, she drew up a list of things she’d do if she were Prime Minister. Top of her list was: ‘Make the government pay for children’s hospice care like Acorns because they don’t and I think that’s really bad.’

Out of the mouths of babes …

This book is an amazing story of courage and love. And challenging. Would I have had the strength to let my own child of 13 decide to forgo the one treatment that offered hope of a 15th birthday? I don’t know. How can we know until we’re faced with such a situation? But having read this book I have nothing but admiration for the pathway this family chose.

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