Plumbing

The first beads of perspiration appear on his forehead as we attach the monitor leads to his limbs and chest.

"I don't think it's a heart attack," he says, more hopeful than certain, "the pain's in my shoulder, not my chest. It can't be a heart attack, can it?"

As the beats begin to dance across the screen, appearing at regular intervals of just over one per second, the picture begins to emerge. A corner of his heart is screaming for blood, for oxygen, as more cardiac muscle dies every second. The strip of paper that spills out the front of the machine, pink paper with tiny red squares all covered in black lines of the ECG, answers his question and leaves no room for niceties.

"You're having a heart attack. It means that one of the blood vessels in your heart is blocked and we need to get you to hospital so that they can unblock it."

"You make it sound like some sort of plumbing job!"

"Well, in a manner of speaking, it is. They'll plumb their way into your heart, remove the blockage and fix your heart."

He has some medication to relieve the pain, some to prevent the blockage from worsening, some to stop him feeling so sick. His blood pressure is a little low for the first part of the journey to hospital, but his pulse remains steady and constant.

"And you're sure this is a heart attack? I thought you die when you have a heart attack?"

"You can blame the media for that. They need to learn the difference between heart attack and cardiac arrest. One is when your heart is sick, the other is when your heart has stopped."

"So my heart hasn't stopped yet?"

"Thankfully not, otherwise we wouldn't be having this conversation."

The dancing heart beats continue on their way crossing the monitor screen from left to right, looking as though each one is holding hands with a beat either side. Speeding our way down country lanes heading for the hospital, he continues to ask some more questions.

"Is it safe, this angioplasty thing?"

"Of course it's safe. They do hundreds of these every year. You'll even get to stay awake whilst they do it."

"And what if I decide I don't want it?"

"That could be one of the last decisions you ever make." I'm not one for dodging answers to serious questions. 

"Oh."

I look back up at the monitor. Suddenly, one strange-looking beat skipped across, the shape and pace very different from all the others. A messy, irregular beat, it's often the precursor to bad news. Quietly and hidden behind his head, I take the shock pads out of their wrapper and have them ready. Just in case. As the ambulance takes a sharp left turn some seven or eight minutes from hospital, his eyes roll back and the beats on the monitor turn from an organised rhythm into an uncoordinated, mangled mess.

"He's arrested!" I shout through to the front.

"Do you need me to stop?"

"No! Keep going and just get us there in a hurry!"

The pounding on his chest keeps the blood pumping round as much as possible, but it's nothing like it should be. The pads are stuck firmly on his chest and the monitor whines as it charges them ready to deliver a shock. I have one pair of hands where ideally I need two, but the other pair of hands is doing work of equally great importance - getting us to hospital. The orange button lights up, flashing away to tell me that the machine is ready. 

His body jolts up, the useless, erratic beats on the machine register the shock and then proceed to go completely flat, just for a few seconds. More compressions on the chest. Just a few more corners and we'll be there, several pairs of hands will be waiting to help, to take over. 

His body jerks with yet another shock. 

More compressions. 

Suddenly, there's resistance, even a groan as he appears to push my hands away. Not unconscious, but not quite conscious either. Breathing on his own and with heart beats that are once again holding hands. We wheel him off the ambulance and into the lab as he slowly seems to regain his faculties. 

"You're sure this is a heart attack, are you?" Totally unaware of the drama of the last few minutes, he still seems reluctant to accept reality. 

"We're sure." 

One of the lab technicians helps us move him across on to their bed, leaving him surrounded by monitors, machines and staff all dressed in x-ray blocking lead outfits. We move behind the clear, lead-lined screen  as the well-oiled machine of the cardiac team gets to work. One of them introduces himself as the cardiologist and explains once again about the procedure, despite our patient's protestations. 

"It's quite simple," explains the doctor, having tried the softly-softly approach but getting nowhere, "you've already died once. If you wish to do so again, but this time stay that way, then I'll be happy not to operate. However, considering the fact that the ambulance crew have worked hard at getting you here alive, I think it might be worthwhile to try to keep you that way." 

"Yeah," said our patient, "that's basically what he said. Go ahead then. But just one thing." 

"What's that?" 

"I just hope you're as good at plumbing as they say you are." 

Edna and Eddie

Surrounded by his wife, children and grandchildren, Eddie sits in an armchair so huge that it seems to almost swallow him up. 

"I'm alright," he says. "Don't know what all the fuss is about!" 

His face is pale and the sweat is pouring off him, whilst his arms hang down lethargically by the side of the chair. He denies any pain but does admit to feeling a little dizzy. 

"He's had heart trouble for years," says Edna, his wife of almost sixty years. "Never makes a fuss. Always ignores any problems until they get really too much." This time, he'd passed out for a few minutes, giving the family enough time to call for the ambulance before he came round enough to object. 

"I'm fine, I tell you." 

"Let's have a look at you and we can see what's going on. It'll only take a few minutes." 

"Oh. Do what you have to do. But I tell you there's nothing wrong that a drink down the pub with a couple of young ladies wouldn't sort." 

Edna shakes her head and rolls her eyes. "Oh, do stop messing around Eddie. You frightened the life out of the children you know. And me for that matter!" 

It takes only for me to feel for a pulse at his wrist to tell me what the problem is, or at least part of it. 

"Eddie, do you have a pacemaker?" 

"Not yet. They were talking of giving me one a while back when I kept getting dizzy spells, but whatever the problem was went away so they didn't think it was necessary." 

"Ah. I think they might have to think again. Your pulse is less than half what it should be!" Attaching him to the monitor, I hit the alarm silencing button before the irritating whine even has the chance to tell me what I already know. The number 28 appears in a bold yellow highlighted box at the top left of the screen and the flicker of a heartbeat flashes across the monitor only every other second. At least his blood pressure was behaving itself. "You're definitely going to need to pop up to the hospital. Can't have your heart only doing part time labour for full time pay." 

Moments later, the rumble of a diesel engine struggling up the steeply inclined street tells us of the ambulance's arrival. Tanya and Michelle step into the house, bringing a carry chair with them and a smile to Eddie's face. I introduce them to Eddie, explain the situation and tell them what I'd found so far. 

"He says that a drink down the pub with two young ladies should sort the problem." 

"Well," says Tanya, "it doesn't seem to be working so far. We've turned up, and your heart rate still hasn't picked up!" 

"Oh," Eddie replies, "well it might not be beating any faster, but, I can tell you, since you two walked in, it's certainly beating much stronger." 

Edna, for what must be the millionth time in their marriage, shakes her head and rolls her eyes.