Friday, August 17, 2007

17th August
This began last Thursday.
I woke up, phoned Susie’s mum, as I always do.
The radio said it was 8.45.
I took my blood pressure, it was down, and went upstairs to make a cup of tea.
When I came down again, I noticed that even this slight exertion had set my pulse racing.
I began to get afraid.
When I went into hospital last June and went through the whole process that led to my heart operation, this is exactly how it began: a racing heart and an intense fear.
This time, too, there had been flashes of this in the past few days and I had ignored them.
I just didn’t want to go there.
I tried to reassure myself by thinking I had been down to the gym on Wednesday, nothing had happened. Surely nothing was going to happen today.
I tried to have breakfast. I tried to live as if nothing was happening.
I wanted to hang out my washing: but by the time I had carried the basket upstairs I had to sit down.
I checked my email.
By some hideous irony, one had come from the Suporn Clinic in Thailand saying that they had decided I was fit and well enough to undergo SRS surgery.
I felt sick.
I went downstairs. Diarrhoea.
So I phone the doctor. By some unheard of chance, it turns out I can see her in 40 minutes.
I get dressed, with difficulty, pick up my i-pod, and leave.
It’s as if history is repeating myself: I have to struggle up the tiny slope opposite the house.
I catch a taxi to the surgery, struggle up the last slope to it, and arrive utterly exhausted.
And it’s the same story: I need to go to hospital, the doctor will write a letter: only this time she calls an ambulance. I start crying. I am so frightened: I am convinced it means I am back to zero, and will need to go through the whole nightmare of the heart operation again.
In the surgery, they are kind.
The two ambulance women are kind.
They give me oxygen, they wheel me down the main corridor and past everyone waiting in the waiting room.
I close my eyes so I don’t see them seeing me.
I’m wheeled past into the lift.
The ambulance is in a car park under the building: and as the lift descends I feel I am being taken down to incarceration.


It’s about midday.
There’s a hitch in the casualty department: all the spaces are taken up.
I’m parked on my trolley in front of the counter like an unwanted parcel.
The usual suffering all around.
After a while, I’m wheeled into a cubicle.
The nurse has to plonk various forms and bits of equipment onto my legs, because there is nowhere else to put them.
She says: “Yes they did ask us what we wanted in this new building and we did tell them but they went ahead and ignored us anyway.”
And that’s how it is in this place. I can’t remember all the countless times I’ve heard that here.
Or will hear it again.
Meanwhile, I’m hooked onto a monitor.
I’ve also had the armband like a handcuff round my wrist.
I’ve become a prisoner: and, quite unconsciously, have started to envy all the free individuals who are walking freely past me.
Unaware of their freedom.

I’ve had an xray. Joking with the x ray man, I also manage to take advantage of a wait in the corridor to phone my agent and tell him we won’t be meeting.
Maybe it’s this tiny bit of regained control, or the discovery that I can still joke, can still work to make each of these encounters as pleasant as they can be made... but i feel a bit stronger. More as though I can deal with this nightmare.
The X ray gets taken away, it’s like the next step in the chain, and I remember there is really nothing to do.

2.30 something. I’ve been given an injection to slow my heart down. It hasn’t. But I do feel sick.
The doctor says she’ll come back to check. She hasn’t.

3.00 ish. She still hasn’t. I feel utterly helpless, absolutely part of the machine.
A cog. I have simply to try to be a good cog.
Take as much entertainment from the situation as I can. Keep observing. Try to make a success of each encounter. Don’t anticpate: that leads to fear. Don’t look back: that leads to frustration.
Live for each moment.

1526 (I have just discovered a clock on my monitor).
No sign of the doctor. No sign of anybody.
I feel hideously uncomfortable.
That’s what these trolleys do to you.
Designed to move in every direction and every possible configuration.
But they forgot people would actually be lying on them.
Sweaty, a bit nauseous.
Various bewildered people walk slowly past.
Other than them, all I can see is:
Signs that say:
Switch Off Your Mobile Phone
Our Staff have the right to work without assault or abuse
Disease Risk: BIRD FLU.
All scattered over the walls at random. Can’t they put up a picture? I wonder. Has it occurred to anyone that desperate, anxious, bored people will be looking at these walls? People still with need for beauty?

I feel abandoned.
There is no obvious way of calling for help.
Apart from screaming.

1536 The doctor walks past, starts guiltily, and promises to come back with something else to slow down my heart.
Meanwhile she disappears with a man being given oxygen.

1545 An unknown enters, says: Its not slowing down, is it?
And goes again.

1550 The doctor returns.
I’m not getting anything different: jusy more of the same.
Do we know why this is happening?, I ask.
No. We don’t. The blood tests aren’t back.
She’ll be back though. In a minute.

1557 She comes back. Whatever she’s given me must be given in small doses, apparently. They don’t want the heart to slow down and stop.

1614 The staff nurse has been in and out a couple of times.
Looking worried: and then leaves suddenly without saying anything.
There’s a queue of wheelchairs and trolleys now outside my cubicle.

1623 Someone tells me they’re trying to get me a bed. And something to eat.

1642 An injection in the stomach. An anticoagulant.
And there is a bed in combined assessment. Just no porter to take me there.

1805 Now I’m in Combined Assessment.
It’s like being in an inner circle of hell.
Or perhaps on the way to becoming a trusty in the system.
In A and E you have nothing.
Some of the bandaged souls I passed on the way out didn’t even have a trolley.
They were sitting waiting in a blank cubicle. Crowded together on plastic chairs.
Here you have a bed. You can access your possessions.
I’ve put my own clothes back on.
I’ve been given something to eat and drink.
I’m even sitting in a chair.
There is even a window in the distance. Even if it does just lead onto a court.
There’s no telephone, but you can unofficially use your mobile.
Assuming you can get it to work.
No telly, no music. Unless you bring your own.
I feel well equipped, with my ipod and my fancy headphones.
I can disappear from the world.
I’m still hooked to the monitor though.
And I feel sick at heart.
What am I to do?
How am I to live?
What does this mean?
Just when I thought I had put this heart nightmare behind me.
If this means I am still living wrong, then how?
And what is to be done?

There is a Pole lying in abed opposite who speaks no English.
He is waiting, everyone is waiting, for an interpreter.

Nine-ish? Losing track of time...
A doctor is explaining that I have a condition called atrial fibrillation. Or perhaps atrial flutter. That something’s gone wrong with the electrical activity in the atrium of my heart. It’s maybe some kind of short circuit. So its beating too fast, and the ventricle can’t keep up.
It happens, apparently, when the heart is abnormal.
As mine is now.
There is a risk of clotting: hence of a stroke.
So I am on anti-coagulants.
And now they are trying digoxin.
Which is having no effect.
They will try something else tomorrow.
If that doesn’t stop it, maybe electrical stimulation will do the trick.

His face is intelligent and kind.
But I’m not sure I can take any of this in.
I am losing heart.

The interpreter arrives. A pleasant, intelligent, sympathetic looking woman.
She listens with obvious skill.
I think of the stories ahe must have been told: toy with the idea of making her the subject of a series of some kind.

0036 Sleep seems impossible.
My bed is broken so I can’t sit up properly.
Yet if I lie too low I start coughing.
If I move incautiously I set off an alarm.
And then if I do manage to turn on one side I’m just aware of a my heart hammering in a broken down kind of way. The whole bed seems to shake with it.
Also I have been told I need to take a pill at 2am.
It hardly seems worthwhile sleeping.
And I need to pee. Sort of.
It’s an endless, a dull debate: should I call?
I decide to wait.

2am has passed and nothing has happened.
About 250, I get the pill, ask for a bottle.
Sometimes I’ve been using a bed pan: but it makes a noise.
And i can hear my neighbour peeing into her commode about a foot from my right ear.
The bottle is silent. And I’m quite impressed I can still use it.

355 and the whole question loses importance: I know I’m going to be sick.
I press the alarm. Everything lights up a livid purple, and it makes a quite colossal noise.
I am sick.
Then I have diarrhoea in a commode.
The stench is utterly repulsive. I feel unbearably aware of it.

“It’s the worse time”, the nurse says. “This time of the shift”. And we commiserate.

0830 I feel like I haven’t slept at all, but I must have done, for the Pole has been replaced by an utterly desperate old woman.
No teeth, sunken eyes, gasping at an oxygen mask. Arm flutters feebly. She looks terrified.
I think, not for the first time, I hope I don’t hang on that long.

A new nurse makes the bed work by yanking it.
I try to negotiate a shower.
Fail, make do with a basin.
It’s all very awkward, but I feel a grim determination to wash and dress and try to look human.

The doctor’s round begins. He speaks in a particularly loud and jolly tone to the gasping old lady, who says nothing.
Another lady is told she can go home: and she transforms.
Suddenly from a straggly haired derelict into a smart looking, purposeful, and very capable lady.
Meanwhile they tell me I’m to be given amidarone. And if that doesn’t work, an electric shock.

Sitting up makes me exhausted.
Lying down, I’m aware of my heart still hammering.
But in a frightening, broken down kind of way.
As if the two halves are not working in harmony at all.
Which, of course, they’re not.

Time passes.
For me, the amiodarone is a possible way out of this hellish situation I’m in.
For the nurses, as they painstakingly start to assemble the gear in the teeth of endless interruptions, it’s a tricky hassle to get together on a busy shift.
It needs a big tuble, apparently. It is quite toxic.
Eventually a very nervous young medical student is talked into inserting the tube.
He tells me my veins seem bigger at my wrists than at my elbows.
He squints at the instructions on the packet in a way that does not inspire confidence.
The nursrs, as they pass, look in quizzically.
They seem to know he’s going to make a mess of it; I get a sense I am a pawn in a long running struggle between nursing and medical staff.
Eventually, on the third attempt, he finds a vein.
Blood squirts everywhere.
“Oh dear” he says, in deep embarrassment, “I have made such a mess”.
And he dabs at it, ineffectually.
No sooner has he gone, than another even younger student appears and has to take a blood sample.
From no one, every person who sees the place will tut at it.
Meanwhile the amiodarone arrives, at last, and is fixed into a drip.
It’s a very fierce drip that bleeps furiously if I dare to move.
But it works:
As if by a miracle, the little ticking monitor by my head which has been obstinately registering 140 all this time, suddenly goes down to 60.
A huge pressure and tension seems to flow from my body.
The delight of it. The intense delight.

1300 The elation passes.
I seem to have been forgotten again.
I am still hooked up to the monitor, still on NIL BY MOUTH because if they were to give me the electric shocks I would have to be anaesthetised.
I need to pee. But I feel unable to ask the nurses, these smart self-possessed young women, for a commode.
I wonder how long it will be before I pass on through the machinery.
My heart sinks at all the obstacles I have to overcome before I can escape.

1630 A charming young doctor appears from nowhere. He tells me he’s from the coronary department. That is the department of electric shocks. I won’t be taken there.
I have learnt by now the golden rule is always when you can to ask. Ask ask ask.
Can I get off the monitor?
When he’s phoning cardiology will he ask?
I feel well and bursting with energy and being shackled feels utterly unbearable

The news is bad.
They want me to stay on till morning.
So I try a tack with the nurses. I need to use the phone, to tell my companion I won’t be going to the Festival’s opening concert.
They have to let me off the monitor to use the phone; and there’s an air of relaxation I decide to exploit.

I nip out along the corridor and stare out a fire escape at the evening.
All I can see is the car park: but I have never seen a sky more beautiful.

1745 I have also now discovered how to unplug my own self from the monitor.
I can’t stop the alarms, but they’ve turned the volume down as low as they can and, in any case, the whole ward is a cacaphony of alarms..

I feel like I have never been aware of how precious and important freedom is before this moment.
I resolve (vainly) never to forget it again.

1945 I discover I am to be moved after all.
And they turn the monitor off!
And there is a bed ready in 104.
Invigorated, i start packing. This turns out to be a mistake.
Because nothing happens.

2132 It now turns out my bed has disappeared. Ward 103 is full.
But nobody knows if it’s full because my bed is accounted for, although I am not in it, or because it really is full.
They’ll phone.

2150 It turns out I do have a bed after all.
But its not ready yet.

Everyone meanwhile is in the usual palaver of trying to bet observations done. Thermometers are a precious item that are passed from hand to hand.

2245 The bed is now ready.
But there are no porters.

2312 There is no porter.
I feel utterly exhausted.

2327 Still nothing. Two beds down is a woman recovering from alcohol poisoning who is blearily asking about the safe.

2340 something. The porter comes. The nurse who accompanies me is unspeakably weary.
This is her first night shift and she’s been on a course all week.
The porter has to work 3 out of 4 weekends.
I make a joke about my notes: they look enormous. Very ominous.
The poor nurse has picked up the wrong ones.

0019 I’m finally left to myself.
The staff nurse who admits me, a charming bluff utterly straightforward shaven headed young man says he gathers I’m waiting for another operation.
I assume he means another heart operation – that they haven’t told me about.
We laugh over this. It turns out he means SRS.
I’m not really up to this conversation: and am slightly taken aback at how much it shows I get gossiped about.
However. I do my best.

Then blessed peace and solitude.

0755 I only wake up once.
A shower.
What luxuries.
I try to enjoy them, and curb my impatience for the machinery to expel me.
As it happens I don’t feel 100% right; but when i try to explain this to the rather distracted young doctor who appears, there is no interest in it.
My pulse is right, my ecg is right, sinus rhythm has been restored.
Suddenly the machinery is all in full gear: by 1045 I’ve almost gone.
I’m waiting for the discharge lounge to come and fetch me.
Which they do; and phone me a taxi from a rather hastily thrown together looking room on the ground floor.
I’m feeling a bit bemused by all this.
My sense of certainty which I still had only a few days ago, has been utterly undermined.
I feel I’ve just confronted the possibility of death or disablement, and there must be a reason for it, and I would like to talk to someone about what it all means.
But the doctor shave not time, or no inclination.
They sum up the whole of this huge experience in four words:
Atrial flutter.
Successfully cardioverted.

And with that, I am sent home.


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