Thursday, January 13, 2011

blocked

Lou is sitting on the bottom step, forearms resting on his knees, hands slack, head bowed, in the posture of a man waiting for an axe to fall. His wife Belle is so frantic, when we come in through the open door a more terrifying version of her seems to tear itself from her body and come running up to us. But she stays where she is, gently combing the sweated hairs of his head with trembling fingers.
‘Hang on, Lou. Hang on.’
Frank turns me straight back out to prep the vehicle and fetch a chair. Outside the chill night air is heavy and damp; the red terracotta tiles are mined with snails.

We help Lou onto the chair. His face looks like a waxworks mask left outside for a year, deeply lined, grey and deathly. He groans through the oxygen mask.

Attached to the ECG machine and the tracings reel off what we expected to see.
‘Oh God. Is it bad?’ says Belle, frantically pulling a mobile phone out of her bag, then putting it straight back in again. ‘Please God don’t let it be bad.’
‘Lou? I’m afraid it does look as if you’re having problems with your heart,’ says Frank, handing me the strip. Belle is so abstracted with anxiety she almost stuffs herself into the bag after the phone. I manage her as positively as I can whilst helping Frank go through the protocols for MI. In a matter of moments I’m driving off to the Cath Lab, our blue lights turning and dancing in the fog.

***

The Cath Lab is a brisk, bright environment. Despite the late hour a PCI team is already assembling, shuffling into the pre op room in their rubber sandals, looking as crumpled and comfortable as their loose red scrubs, cheerful, rough about the edges, like a hockey team meeting for a pre-match rumble in the changing rooms. Lou sits up on the trolley, dizzy with the pain and pace of events. Twenty minutes ago he was sitting on the bottom step of his house, asking his wife to call the doctor; now he finds himself magically transported in the same passive posture, to a strange white place bristling with clinicians, reeking of cleanliness, stripped and gowned, as a seemingly teenage registrar smiles through a list of death and disability. His wife sobs, her arm around Lou’s shoulder. Eventually a nurse lets her kiss him goodbye, then leads her away to the relative’s room.

We take Lou through into theatre and help load him on the trolley. The team divides into those who will do the procedure and those who will monitor from behind the big glass control screen with its banks of computers. From behind the screen we watch as they cover Lou with sheets of blue paper, and swing a large white metal gantry elegantly into position around him.
‘Keep your hands to your sides now, Lou,’ says the Registrar, efficiently prepping the catheter and introducing equipment. ‘This area is sterile.’
The Radiographer begins hauling on her heavy green protective apron, waistcoat and neck guard, like a clinical marine going into combat. ‘Lead up boys. Unless you’ve had the snip, I don’t know. Maybe you don’t care about this stuff.’
‘I’m allergic to babies.’
‘They’re bad for your wealth.’
‘Put some music on. Pronto.’
One of the ODPs pulls a box of loose CDs out of a cupboard and after shuffling through them like a pack of cards tosses the others back and sticks his choice into the system. Seconds later ABBA fills the room, Dancing Queen.
‘Are you gay?’
‘Bi-curious.’
‘Bi-polar.’
‘God – where d’you get this junk from?’
‘It comes free with the pizza.’
‘Hey! Pizza. Call out for pizza. Pronto.’
‘I’ve got pepperoni-itis.’
‘Stop the clock, people.’
‘We haven’t started yet.’

The theatre doors swing open again and the consultant hurries in, breathing hard.
‘Sorry. The route the taxi took was blocked for some reason. How far have you got?’
‘Just in now. You should be getting it.’
‘Well it would help to have the pictures up. Can we get the pictures up, please?’
‘Oops.’
As the consultant unbuttons her gilet and unwinds the flowery silk scarf from her neck, the screen fills with the lucent picture of Lou’s beating heart. The harder, synthetic line of the catheter stands out as it gradually works in from the top. Every so often a puff of marker fluid picks out the delicate blood vessels, the major and minor vessels, tributaries and bifurcations, elegantly branching arterioles like the whorls of a pea plant.
‘Right coronary. I’ll scrub up and we’ll get going,’ she says, then turns to me and Frank. ‘Sorry,’ she says. ‘Hello. I’m Emma, the consultant. Thanks for bringing us the patient. Nice to have you in to watch.’
She hurries out – and before we’ve had a chance to point to a couple of things on the screen and ask the significance, she bustles back in scrubbed up and ready to go, so quickly she must have stripped and changed in the corridor.
‘Good God,’ she says as she takes her place at the table and picks up her instruments ready to begin. ‘Who the hell chose this music?’

23 comments:

Anonymous said...

Such amazing grasp of language... you may have chosen the wrong career. You were born to write.

heathers teas said...

Thank you for sharing your stories. I really love reading them, you have a talent for sharing a moment.

petrolhead said...

I'd love to watch a procedure in the Cath Lab, but unfortunately I've only been a patient when I had my pacemaker implanted. All I got to see was a nurse and a clock!

Did you get to stay for the entire procedure, or did Control pull you away for a job?

Jane said...

Wow that was so dramatic I could feel the adrenalin!
I didn't know that things could happen so quickly.
I do hope Lou recovered.

Re. last post - I don't have a TV and only hope my eyesight lasts so I can still read in my 80's.
I do realise the importance of it when housebound but can't help remembering elderly clients who were desperate for real conversation.

jacksofbuxton said...

It could have been worse I suppose.Sheer Heart Attack by Queen maybe.

I can't stand ABBA.I'd rather drink lukewarm vomit than listen to them.Mrs Jack keeps trying to get me to watch "Mamma Mia"

You'll know if she's succeeded....

"And in other news,a Derbyshire Barber has been arrested....."

Great stuff as ever Spence.

Spence Kennedy said...

anon - thanks for that. One of the (many) good things about the ambulance, though, is the 'access all areas' lifestyle. There's no shortage of stuff to write about!

heather's teas - Pleasure! Thanks for reading (and commenting). :)

hi petrolhead! How are you?
We got as far as watching one of the stents go in, then we felt guilty and left to clear up. It's great to get the chance to see the other side, sometimes. And I think it informs what we do.

jane - The whole angioplasty thing is amazing. Much safer than just thrombolytics, with better, longer term benefits. I think Lou's prognosis was pretty good.

JoB - I'm not mad about ABBA either - although I get a bit weepy in 'The day before you came' what with all that reading the paper on the train, watching TV and smoking cigarettes - the tension's too much, and I just wish he'd just hurry up and come. Passes the time, though.

***

Cheers for the comments!

Nari said...

Great post. I especially loved the way you described Belle's mindset.

Your writing style places me in two different worlds at once: the first is the world of the patient, with the ability you have to allow us a peek into their minds; the second is the world of a voyeur, watching and experiencing the scene form a nice safe distance.

Bouncin' Barb said...

Having had to go through a MI and 8 angiograms resulting in plasties with stents, I'm in awe at how quick this took place. It doesn't work that way over here. I love the banter though because it truly is a job to them while it's your life in their hands. All of you, EMTs and med staff are the most underrated folks. Thanks!

brilex said...

Wow, this one makes me want to cry. This same thing happened to my dad Christmas of '09. Full recovery thankfully, but the Doctors, this is how I imagined them. I actually miss the staff that helped my dad.

Anonymous said...

Anon here again... good point, but even if you don't quit your "day job", you should consider compiling a book. I'd buy it in a heartbeat. I've paid good money to reaad worse writing; you should make a killing.

Spence Kennedy said...

Thanks Nari. I think quite often in these blog posts I tuck myself away behind a screen. It's good to be detached, but I should prob get out more!

BB - Wow! Sounds like you've really had a time of it. Hope everything's good now. The system here seems to be working pretty well - and you're right, it is amazing that someone can be having an MI one minute and an angioplasty the next. The NHS at its best!

Thanks Brilex. Glad to hear your Dad made a good recovery. I'm a big fan of doctors (and not just the cool uniforms).

Hey Anon! I have thought about putting all this in a book format, but I've struggled with the overall shape of it. So far it's just too episodic, and really needs some clearer, stronger 'through line' to hold it all together. Still thinking about it...

***

Thanks for your comments! :)

Bouncin' Barb said...

All that was for my husband who lost the battle to Hepatitis C and not his heart! I'd be curious to know the survival rate comparison between the 2 countries. Thanks for the follow up comment.

petrolhead said...

Spence - YOU'RE the 'through line'! I wholeheartedly agree with everyone who's commented about your writing. It's incredible. You're brilliant on the road, and every time you write about it, it transports me back to when I had the privilege of third manning and seeing first hand what you guys do. If you were to write a book, even 'just' a hard copy of the blog, I know it would fly off the shelves! Keep it up, you're amazing!

Spence Kennedy said...

Thanks PH! I won't give up the day job, as they say, but I'll def carry on taking notes...! :)

uphilldowndale said...

Reading your work is like reading poetry,I love the plunging intensity of you writing.

joan said...

I had an angioplasty when i was 47, had 3 stents and 1 balloon, i watch the procedure on the screen, and the consultant talked me through each stage, it was facinating although could not remember all of it, I work in a care home, and can compare stories from my residents! that was 4 years ago, and feel great! just learned to swim and bodyboard!
all the best to you and your readers

Spence Kennedy said...

Thanks v much UHDD. I like writing the blog - it lets me write quite dense prose. (I'd never get away with it anywhere else!)

Hope everything's good with you. Soon be Spring... ;)

Spence Kennedy said...

Hey Joan. I'm in awe of that whole procedure. So glad you've made a full recovery. I was body boarding last summer with my 9 yo daughter. We had a great time. (I must learn to surf now - I think I'd really love that lifestyle...) :) x

joan said...

Hi spence bodyboarding part 2 this yr! its after my cornwall trip, my son ( a lifeguard) said its about time you learned to swim now! but im not teaching you! It just shows that even with a heart condition you can live life to the full, but not sure on surfing ill stick to shallower water!
by the way i love your blog, excellent writing skills, have you considered writing a book?
Best wishes Joan

Mladen said...

It's amazing how someone's routine sounds incredible to others...

Spence Kennedy said...

Absolutely. I love the contrast between the life & death situation of the patient and the cheerful mechanic demeanour of the clinicians.

Mladen said...

Now I remember how everyone at my mum's hospital (she worked in one her whole life) seemed to straighten up and change focus whenever I used to visit, as if poked by an invisible hand right between the ribs.

I'm not sure whether they perked up or tried to act all serious and professional though - it always seemed to me that they were joking around all the time. Something to level it all out with I reckon.

I don't know if I observed better back then (so I noticed stuff like that) or maybe they were just too clumsy and slow, but I don't see it anymore.

It's probably just me anyway...

Spence Kennedy said...

Respect to your mum for working in a hospital all her life. It's quite a calling - a lovely thing to do.

I'm sure her colleagues learned to trust you and relax pretty quickly. It's always interesting, watching how people are at work. There's nothing better than watching someone using a tool with skill.