Ben, the cardiology registrar, is a really nice guy and I like him a lot. Trouble is, every time me and Ben are on call at the same time, we have major drama to deal with.
This evening, I admitted a man called Jim into hospital. Jim is 85 years old but still independent and lives by himself. In the afternoon, Jim had been to the post-office and as he was leaving, Jim passed out. Now, I don’t know if any of you have recently been to the post-office but I have to say that every time I visit one, I end up seething with rage or in tears. Why does it have to take the best part of the day just to post a parcel? Mr Angry knows how I feel and, to be honest, I don’t blame Jim for passing out.
Jim was a little embarrassed by the whole episode, but felt pretty much back to normal. Jim is a big Chelsea fan and was desperate to get out of hospital so he could watch tomorrow’s FA Cup final. I asked Sharon, the nurse, to do an E.C.G. recording that showed the Jim had an irregular heart rhythm that Jim had had for donkey’s years. But it also showed that Jim’s heart was beating very, very slowly indeed. I figured that this was probably a side-effect of some of the medications he was on and, as a precaution, I asked for Jim to be put on a cardiac monitor so we could keep an eye on his heart rhythm.
I’m seeing my next patient about half an hour later and Jim’s cardiac monitor starts beeping. Sharon says “I’ve just walked away from him, he’s fine – the monitor’s faulty, I’ll go turn off the siren” and leaves the room to see to Jim’s monitor.
A couple of seconds later I hear Sharon shout,
“CAN I HAVE SOME HELP PLEASE!”
Jim wasn’t fine at all. The siren was going off because Jim’s heart had stopped beating. Jim was dead.
I run to Jim’s bay and commence CPR with Sharon and another nurse goes off to get the crash trolley. The other members of the cardiac arrest team arrive and we start advanced life support, as we’ve been trained for.
We shock Jim. Basically we electrocute him in the hope that his heart will start beating again.
Jim gets a pulse back. Slowly, over the next 20 minutes or so, Jim becomes more and more responsive until he is able to utter the words “Where am I?”
Those words made me feel happier than any words have made me feel for a long time. We saved Jim’s life. If this had happened in the Post Office, Jim would have been dead. If Jim hadn’t listened to the advice of the paramedics to “have it checked out,” he’d be dead. If I hadn’t asked for Jim to be put on a cardiac monitor, he’d be dead.
As it is, when I finished the shift, Jim was sat chatting to his daughter on the coronary care unit. While he probably won’t get to see the FA Cup final, he’ll at least be alive to listen to it on the radio and, as Ben told me, “you’ve go to be happy about that.”
(For those medics among you, the initial ECG that Sharon did showed A.F. with bigemeny at an effective rate of 36 bpm. He had a VF arrest and reverted back to bigemeny after one shock.)