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?’