Heart Doctor No. 4

I don’t need the TV news to remind me that Friday 29th April is going to be a special day.  I know from the moment I wake up that today is different.  I’m struggling to breathe properly as I get out of bed.  Light-headed, I sit back on the bed.  My resting heart rate is 140bpm.  Annie and I had been doing a bit of decorating the day before and I put my lethargy down to that.  Each footstep seems considered, as if my body is saying “are you sure you want to do this?”

Mid-afternoon Annie and Emma go shopping for the other big wedding this year and I’m on my own.  I start to get pains in my chest and down my left arm.  Not sharp, dramatic stabbing pains, more like the feeling that Fat School-Bully is sitting on my chest. (He did this to all the kids in my class, just because he could).

As I breathe in the pain is worse, extending from my chest right up in to the back of my throat.  And just like when F S-B attempted to compensate for some hitherto unknown shortcoming in his life by crushing my rib cage, the pain is almost incidental.   It’s the fear and panic that is just as crippling.

What to do?  If Annie were here I could ask her if I’m just making a big fuss and it’ll all go away.  I notice, as I sit thinking about what to do, that my arms are wrapped tightly around my chest, hands tucked under armpits.   I wonder why we do this when we’re in trouble – to give ourselves a cuddle?  My hands and feet are cold and my fingernails are blue.  This does not seem good.

I’ve been reading up about the heart for a project I’m involved with at work; when the heart beats this fast it’s actually beating faster than it can pump – so blood just circulates within the heart itself leaving less to be pumped around the body; hence cold extremities and light-headedness.

This is not a problem when the increased heart rate is short term – as when exercising or from exertion – but mine’s been like this for almost 2 weeks now.  Over time the circulating blood within the heart becomes like a stagnant pool – bits of old blood break off, settle at the bottom and form clots.

I log onto the British Heart Foundation website.  For the symptoms I’m presenting, their advice is unequivocal; call for an ambulance.  Surely not?  I wander round the house trying to decide what to do.  The pain in my chest gets worse – but perhaps that’s anxiety – just me panicking?  Underlining the BHF advice is the notion that a false alarm is better than an ignored one.  I call Annie and she abandons the shopping trip.

She leaves me at the entrance to A&E while she parks the car.  It’s about 5.30pm and is fortunately empty – the results of the post-wedding celebrations have not yet kicked in.  The nurses on reception look me up and down as I shuffle in, arms wrapped tightly around my chest.  I’m wearing a hoody, scruffy jeans and slippers; I imagine them thinking “What is this?”

I try to explain and the receptionist stops me after taking my name and date of birth: “you don’t have to say anything, just nod”.  As she asks her questions I’m aware of someone at my side gently taking my pulse and a porter behind me with a wheel chair.  I sit down and let the system take over.

They take me to the resuscitation area – I’m wired up to various machines, nurses come and go, taking blood, taking measurements, then a chest X-Ray.  After about 2 hours I see a doctor.  It’s not a heart attack so that’s a relief.  She’s not sure what’s causing the pain – the X-Ray shows a lung infection; could be that.  Or something to do with the heart; I am presenting “Angina-like symptoms” but don’t fit the usual Angina profile.  So she’s not sure.  I explain my theory about coughing as a trigger.  Possible; a severe coughing episode, especially to the extent of gagging, releases a massive amount of adrenalin which will rock the boat.

In an attempt to get the heart rate down she gives me a large injection of Beta-blocker; it will do the trick within 10 minutes so she waits and chats about my treatment to date.  She’s appalled and embarrassed by the delays.  She immediately gets on the phone to the Cardiology Unit and tries to persuade them to carry out a Cardio-Version during the Voice procedure.  No luck (even assuming the anaesthetist would have agreed).

And no luck with the drug; my heartbeat is firmly stuck on 145bpm.  A decision is made to admit me to the Coronary Care Unit.  It’s now about 9.00pm and Annie goes home to get my overnight things – and something to eat.  I really don’t want to be stuck in hospital over a bank holiday weekend.  But I have no choice.

And then the bizarre – almost Byzantine – handover procedure.  A bed is waiting in CCU.  But I can’t have it until I’ve been seen by “a medical doctor”.  What is a ‘medical doctor’?  Who was the person wearing the stethoscope, filling my arm full of drugs?  She gave a pretty good impression as far as I’m concerned.

It turns out a doctor from CCU will have to come down to A&E, conduct further tests and satisfy himself that the case is as described by what I can only assume is a ‘non-medical’ doctor.  Papers will be signed and then I’ll be on my way.  If the nurse from A&E simply wheeled the bed up to CCU herself and “something happened to you on the way” no one would accept responsibility.  Or that’s about the gist of it.

About 2 hours later a doctor from CCU turns up.  It’s taken 4 phone calls to get him here.  He wants to try something; he turns my head to the left and then presses his thumb down on my neck just under my right ear.  Hard to begin with – then harder and harder, twisting his thumb all the time.  I start to feel light-headed, on the point of passing out.  He’s ‘massaging’ an artery trying to lower my heart rate.  It drops to about 80bpm and as soon as he releases his thumb, shoots back up again.  He gives that up as a bad job and returns with a hypodermic needle and more Beta-blocker.  I explain it didn’t work last time; “I’ll do it slowly”.   Again no joy, so papers are duly signed and I’m on my way.  It’s just after midnight – some 3 hours or so from when the handover procedure was first put in motion.

CCU is a small ward  – just two bays each with four beds.  It’s also mixed.  In my bay a woman, younger than me, and two men somewhat older.  It’s quiet, not just because of the lateness of the hour; there’s definitely an air of calm about the place.  No bedside televisions, no snoring, wheezing, coughing, crying patients.

I wake around 6.30am to find my resting heart rate is 175bpm.  A nurse phones the doctor and medication is increased.   I settle in to the routine; observations, breakfast and then ablutions.  This takes until lunchtime at 12.00.   Then the lights are dimmed, curtains drawn and we all rest until visiting time at 3.00pm.  It reminds me of nursery school – the after-lunch nap on camp beds.

Annie brings in a small tub of Ben and Jerry’s; I feel like a POW with a Red Cross parcel.

At around 5.30am next morning, for reasons completely unknown, my heart rate suddenly drops to 79bpm and goes back into normal rhythm.  No obvious trigger, no drug stimulus.  Later on I see Heart Doctor No.4.  “We need to get this fixed and stop wasting your time”.  I ask him if, given that the problem has now gone away, I can have the voice op, now scheduled for a few days hence.  No; the general anaesthetic could knock my heart out of rhythm again.  The problem hasn’t gone away, merely the symptoms.  He will refer me to the JR for a Catheter Ablation.  I don’t intend to roll my eyes but I guess it just happened.  I explain the history;

 Heart Doctor No.1 didn’t mention ablation                                                                          Heart Doctor No.2 referred me for ablation (then duly forgot)                                                  Heart Doctor No.3 cancelled the referral

And now he will refer me again.  I have my file with me and he reads through the letters; “I wish all our patients were as organised as this”.  Well someone needs to be.  He promises to get on to it straight away.

He prescribes two separate Beta-blockers and puts me back on Warfarin.  The voice procedure is firmly kicked into touch.  It’s disappointing but I don’t mind if I feel we are getting somewhere with the heart.  It is absolutely clear that my heart is going in and out of normal rhythm in a random fashion.  Triggers such as coughing or lung infections might start the process, but they can’t sustain it over weeks.  There has to be some faulty wiring somewhere – and ablation is the technique for re-wiring.

I’m allowed home at teatime.  Chris and Emma come to visit and Annie shows them my new heart monitor.  She decides we should all be tested to see who has the lowest resting heart rate.  Sure enough – she wins.  She pulls her tee-shirt over her head and does two celebratory laps of the dining room table before cartwheeling through the sitting room. Or perhaps I imagined that bit, it’s been a long day.  Chris groans and turns to Emma; “my mother will make a competition out of anything”.

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2 Responses to Heart Doctor No. 4

  1. wererogue says:

    Geez. This only makes the other heart doctors look like bigger jackasses!

    Best of luck.

  2. LizC says:

    Oh Ian, what can I say? A complete nightmare for you, I’m really sorry. Wish you well and hope to see you back in the madhouse (aka, work) soon! Liz x

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