A (un)fortunate man

Unfortunately, Mr Blackwell had a heart attack last week.

Fortunately, he called an ambulance and was rushed into hospital. His condition was diagnosed promptly and he was given appropriate treatment, stabilised as was put on the list to have an angiogram to see exactly where the problem was.

Unfortunately, the angiogram showed that the cause for his heart attack was a narrowing of one of the arteries that supplied heart muscle and that he was at a high risk of having another (possibly) fatal heart attack.

Fortunately, the cardiology doctors have the ability to put a stent into his artery and reduce the chances of a second heart attack and he was brought back to have the stent the next day.

Fortunately, they were able to do the procedure and he had a stent placed across his coronary artery. They do this by pushing a catheter up from his groin to his heart. This negates the need to cut open his chest.

Unfortunately in doing so, the cardiologists had managed to roger one of the arteries in his groin. The artery clotted off and Mr Blackwell had the blood supply to his leg cut off. It went cold and pale, and within a few hours, it would have started to die. He could potentially lose his leg or his life.

Fortunately, the CCU staff are trained to look out for such things and they promptly called the on-call vascular surgeon, who quickly decided that Mr Blackwell needed an operation to save his leg. The surgeon calls the anaesthetist (me) to assess the patient’s suitability for surgery. The cardiologists do their bit and perform an echocardiogram on Mr Blackwell.

Fortunately, the echocardiogram shows that his heart hasn’t been too badly affected by the heart attack

Unfortunately, I know that having had a heart attack so recently, a general anaesthetic at this time would put him at a hugely increased risk of having another. I also know that the way our bodies respond to surgery would mean that his heart stent is a greater risk of clotting if he has surgery this soon after its insertion. On the other hand, if wait, then within a few hours, Mr Blackwell will lose his limb and possibly his life, so we’re going to make as best a fist of it as we can.

Fortunately, I know a man who can help and I call the consultant who says he can come down and perform a regional block so Mr Blackwell can have his leg operated on whilst fully awake and avoid the risks of general anaesthesia.

Mr Blackwell agrees to this and the operation goes surprisingly smoothly. He is now recovering from his operation on the ward.

Now, is Mr Blackwell a fortunate or an unfortunate man? I honestly don’t know, I guess it depends on your perspective.

n.b. Fortunately, Mr Blackwell swears that after all this, he’s DEFINITELY going to stop smoking. I was loathe to point out that for years and years, people had been telling him that all this was going to happen.