A concern of the heart

The last time I was in hospital I was 10 having four teeth removed. All I can remember is lying face down on the bed and the nurse saying “is it a little boy or a little girl”. Yes I was small, prepubescent with long curly hair so maybe it was a fair question. But the scar of that shame is the only memory which remains with me.

Half a century later, I’m still quite small and my lockdown hair is long and straggly again. But my stubble gives away my gender and its greyness reveals my age.

NHS procedures have moved on since the 70s. Now they ask me to confirm my date of birth (age) and full name (gender) at every intervention. Also, I guess to check I am who I say I am and – more importantly- that I still know who I am. So far so good.

Having said that, I did wonder why they asked me to shave my arms, wear a fetching thigh-length off-the-shoulder gown and a pair of special gauze knickers before my cardiogram. I am normally quite comfortable with my feminine side, but this did feel a little strange. Fortunately I remembered which way round to wear the gown. And it did help me appreciate the challenges of protecting ones modesty whilst wearing a dress

But I’m ahead of myself in my story. Let me return to the previous day – Christmas Eve.

1. A routine walk to the GP

I had only visited my GP for a precautionary ECG and a chat about my reflux. They put stickers on my (thankfully not very hairy chest) wired me up, ran the ECG and concluded that my left ventricle could have been under stress. My doctor strongly recommended that I go to A&E in Leicester for a consultation and a blood test.

I wasn’t expecting that.

But hey – let’s be sensible. The sprouts could wait, and it would be nice to confirm my heart was in good shape ready for the Christmas excesses.

So I drove in, parked up and eventually found A&E by following the yellow arrows (I guess red would have been too alarmist).

2. My First trip to A&E

On a day of many firsts, this was my first go at the A&E game. It was unexpectedly calm, quiet and well organised. I always suspected “Casualty” was over-dramatic – for dramatic effect. Nobody was behaving remotely like Charlie or Duffy. Although I’m sure lockdown had helped reduce the traffic.

I sat in an almost empty waiting room on a chair with a big tick on it, suitably socially distanced from nobody much. I was called in for blood pressure, another ECG and the important blood test – although three syringes worth made me wonder why I was doubling up as a blood donor.

Back in the waiting room, I paced around, checked my phone relentlessly and bought a small plastic cup of tasteless muddy coffee from a machine for £1.29.

I was called in again to be told that my ECG was fine and I was probably right about the heartburn and reflux. “Let’s wait for the blood tests” said the Doctor, “just to be sure”.

Back to the waiting room with my phone now on 4% battery.

A little later, the doctor passed by and asked me if there was any history of heart issues in my family. My dad had angina, my mum didn’t live long enough to know, I reluctantly told him, feeling like I was a defendant giving evidence to the prosecution.

But I was more concerned about my phone, needing to keep in contact with my wife. Oh, and important access to the internet and all my apps. I enquired without hope at reception, but a fellow-participant overheard me and loaned me his charger. At 20% all was well again. Just the small matter of my heart nagging away.

3. The Verdict

It must have been 2-3 hours before I was called back into see the doctor. I sat down in the chair and the he asked me in a kind voice whether I would like a cup of tea and a biscuit. This was not a good sign.

He spoke softly. My blood test had 280 somethings of troponin. Anything more than 2 says you’ve had some sort of “heart attack”. He was admitting me to a specialist cardiac hospital across Leicester. In an ambulance.

Wow. How exciting. Another first – my first trip in an ambulance ! And then the small concern of “what do you mean I’ve had a heart attack?”. The evidence was indisputable and the verdict was final. And another – very unwelcome – first.

It was yet another two hour wait before a bed became free. Meanwhile, my wife and two kids drove down, to pick up my car and to leave me food, a bag of hospital essentials and a dose of love.

4. Ambulance to the Heart hospital

As they hugged me goodbye, I was told that my hotel room and limousine were ready. Perfect timing. It was 9pm.

And so it was I was “admitted” into the system. Step one was to designate me as a VIP – a Vulnerable Immobile Patient – no longer permitted to walk. I was put in a chair, wheeled into the ambulance and driven to the other hospital. Disappointingly, but I guess thankfully, no blue flashing lights.

The paramedic who escorted me gave me a whole load of information about troponin – how 280 was high but that he’d once had a guy who was 20,000. He was convinced I’d had a heart attack in the last 24 (pain free) hours. I was convinced that it was after my painful 10mile run 3 weeks ago.

No chair was available at the hospital, so they reluctantly acceded my request to walk 20 meters into the hospital. I’d run 6 miles on Saturday and paced 8000 steps around the waiting room today, so it felt safe. But elsewhere in my head, I was already starting to feel like I could have another heart attack at any moment.

5. An evening in C.D.U

I soon found myself lying in a bed in CDU – Clinical Decision Unit, ready for, well, a clinical decision. My first night in hospital (as an adult at least). And I was tethered to a monitor like a convict.

They sort of assume you know what you are doing and understand the rules. I didn’t. Was I allowed to leave my bed or use my phone, or go to the toilet? I worked all of those out . What I never worked out over the whole experience was “what happens next?”. You just learn to go with the flow, trust the system, and if that fails, to trust the staff. Which you always can. We all say it. NHS staff are brilliant.

Another blood test and pressure reading, a chest x-Ray a weighing and someone doing a good poke around what increasingly didn’t feel like my body. The forensics were complete. And every time – my full name (my secret) d.o.b (ditto), did I smoke, was I diabetic, any allergies, and what was the capital of Eritrea?

It was late. The ward was a loud cacophony of talking, shouting, beeping, buzzing and clattering. The woman in the next bed was having a never ending conversation on the phone. The water cooler was broken and whining like a child. I was beginning to empathise with it.

I was also trying to breathe with my covid mask on and to cap it all, the glaring lights stayed on. At home and in hotels, I demand complete darkness and quiet before I can sleep, and sometimes a glass of wine. I even tried putting my face mask over my eyes and making a face mask out of my sheet.

A young doctor came in to hear my story. I recounted my logical explanation of heartburn and reflux and how I’d successfully self-diagnosed and self-medicated and run 30km last week (did I mention that?)

He listened politely, waited until I had finished and simply told me that I had had a heart attack and I’d better believe it.

Somehow, impossibly, in the midst of this chaos of sound, light, shock and anxiety – and trying to breathe, at around 2am I must have drifted off.

5 minutes later I was woken up for yet another blood pressure test – just in case it had changed in the last hour I guess. Sleep deprivation is a well-known torture technique. I would have confessed to almost anything – even that I smoked and was allergic to the colour green. Or that I’d quite possibly had a very small heart attack

Somehow, impossibly I fell asleep again. I dreamt that a man was standing next to my bed with my written confession in his hand, admitting that I’d been an idiot about the reflux and that the doctors were all right. He was insisting that I sign it – in blood. The man, in his white coat, was grim and insistent.

“You’ve had a heart attack Mr Bottomley. We just need your consent for an angiogram and angioplasty – it’s only a bit risky. Do you have a pen?”

I sat up and made a play of reading the small print. And signed. And impossibly somehow once again slept.

I have to confess I had a little cry in my bed, feeling rather alone and sorry for myself. Inside, I was still that little ten year old, and a little bit scared.

Tomorrow would be Christmas Day and I would wake up at home realising this whole thing has been a nightmare, and open all my presents.

See also – Christmas Day in the C.D.U.