Last Monday, three days ago now, I lay, conscious, on an operating table at St George’s hospital, Tooting. A tube had been inserted into my artery in the right arm at the wrist, through which dyes and then wires were inserted. On my left wrist a drip had been inserted into vein so that drugs could be injected rapidly. Two surgeons were doing their stuff around the area of my legs, looking up at two monitor screens. A large cylindrical device was being pointed at my chest at various angles. I lay as still as possible, as the surgeons exchanged comments and gave occasional orders to technicians outside the room, who would respond over the intercom. Some music was playing quietly in the background.
The surgeons were doing an angiogram. They were pumping dye into my bloodstream to make the blood flows visible through an X-ray camera and spot any problems with the blood flow to my heart. And they did find a problem. “One of your arteries is completely blocked. This almost certainly caused your heart attack,” one of the surgeons said to me, “We want to insert a piece of wire to clear it.” I consented. The surgeons then completed a procedure known as an angioplasty. This involved using a piece of wire pushed through my arteries to insert an stent, a small length of tube, into the blocked bit to open it up, after first inflating a small balloon to create the space.
It was really only then that I fully realised what had happened – that I had indeed suffered a heart attack, and that as a result my life was in the hands of these two surgeons and their team. Until then I had thought the problems might be some sort of viral attack (as my elder brother had suffered a few years before) with few longer-term implications. The previous evening, my family visitors remarked on how well I was looking – though the medically literate among them could spot the abnormal trace on the heart monitor that I was wired into. This is a shock. I had no indication until then that I was at risk. I take regular exercise; I’m not overweight; I have never smoked; I eat my five a day; I even make sure I have a couple or more portions of oily fish a week; my blood pressure has always been normal; no tests that had been run on me had shown me with anything other than a very healthy heart. It really can happen to anybody.
The problem seems to have started over two weeks beforehand, while we were on an organised tour of Sicily. One night, after dinner, and a day when I had felt slight constrictions to the chest area, I started to suffer acute chest pains. I couldn’t sleep. Eventually, at about 3 or 4 a.m I took some aspirin, and the pain subsided and I got some sleep. I was puzzled at what had caused this episode. The chest pains pointed to a heart attack, but none of the other symptoms did. I wasn’t breathless, I could carry out normal physical activity. As the pain subsided, the idea that it was severe indigestion took hold. Gavascon seemed to help with the contuining mild episodes of pain. The local diet can be pretty acid. The day after the attack I had no trouble in climbing to the top of a stone tower to get a wonderful view of the western Sicilian coast. The next day, though, I felt lethargic and a bit feverish, collapsing into my hotel bed for an afternoon; but a couple of days after that things seemed to return to normal. We continued with the tour, returning home at the end of the week.
The episode has was scary enough for me to go to my GP in the week after we returned. I probably wouldn’t have done this had my wife not insisted on it, though I had noted that my fitness at the cardio-vacular exercises in the gym had fallen rather sharply. My GP tended to agree with my diagnosis of acute indigestion, as he would have expected that a real heart attack would have had more of an impact. But he did recommend that I did some blood tests. This I did last Friday morning, at 8.30 a.m. By midday my GP had rung me to say that one of these tests had revealed a high troponin level, indicative of heart problems. He recommended that I go to St George’s A & E to get an ECG (electro cardiogram – where they put a dozen electrodes on your skin and get traces of your pulse). This I did straight after lunch, expecting to be home for tea. But the ECG showed an abnormal trace. I was admitted to hospital, hanging around in A & E while a bed was cleared. The next step was the angiogram – but that couldn’t be run until Monday. Meanwhile I was kept under observation, with a cocktail of drugs administered by tablet and injection.
Now I am at home in rehab, recovering from the damage to my heart from the blocked artery, and the operation itself – but the prospects for a full recovery are good. But I’ll be on pills for a long time, probably for the rest of my days. At the moment there are six different sorts of pill, but it should come down to less than that after a year. My fitness regime will have to be adjusted downwards so as not to place too much strain on the heart. I am quite lucky though, first that the original attack did not do more damage, and second that the problem was picked up before the blockage to my artery caused more damage to the heart and maybe a more serious attack.
Why me? I don’t hit any of the main risk factors – except that I was not avoiding cholesterol in my diet. In fact I was a heavy cheese eater, and relished meat fat and chicken skin. That will now change. But some peple are just more at risk than others. My physical fitness may have helped reduce the effect – though a bit too well if it had meant that I had avoided having it checked out.
It is customary at this point to praise Britain’s NHS and scorn its critics. I will try and be a bit more objective, after my close observation of the service at work. But it doesn’t come out badly.
Firstly I am immensely grateful to all those many professionals that helped me through the episode. I always felt that they had my interests at heart and they did their best to help me. Nurses, doctors, technicians, pharmacists and surgeons – I can’t fault any of them. I now have very benign feelings towards St George’s hospital, which happens to be my local one – from being a rather anonymous presence beforehand.
Second I cannot fault the overall effectiveness of what the NHS acheived. From the point of that blood test a system was quickly kicked into action that was appropriate at every step, acheived the right outcome, while managing the risks properly. And at points the service was better than good. The surgery was world class; the briefing from the cardiac rehab nurse afterwards was also deeply impressive. The speed with which my blood sample was analysed and acted on was very impressive too.
Effective, yes, but how efficient? Here I was left with a few question marks. I ran into an awful lot of different professionals in my journey, having to repeat my story to up to ten different doctors. This is a warning sign from a process management standpoint – though the need for specialists, 24 hour cover and risk management does not make the matter easy. And there was an awful lot of paper records and documents. It isn’t surprising that there were communication breakdowns; I’m still waiting for my discharge papers. And the whole thing about the service going on hold for the weekend does not feel right either. At least one, and probably two nights of my four night stay were clinically unnecessary. Room for improvement, I would say – and that matters in a tax funded system where overall resources are subject to arbitrary limits.
It is clear though that I was much better off under the NHS system than I would have been under the US one, especially before Obamacre kicks in. I would not have qualified under any of the government funded schemes, and neither would I have been covered by an employer plan. I would either have to to have bought my own insurance plan, which would suddenly have become a lot more expensive. Or I would have to have winged it without insurance, which would have landed me in serious trouble.
But then very few people outside the US think that their system is in any way sensible. A universal insurance scheme, like most advanced countries run, would have caused a little more bureaucracy at the start of my hospital visit, but nothing very burdensome. And I don’t believe that health professionals would be any less caring or professional if they were not working for a state provider. Neither do I beleive that the vagaries of private sector management are any worse than the arbitrary resource management of a nationalised, tax-funded system.
But the NHS did do the job it was supposed to do. And for that I am thoroughly thankful.