Absolutely nothing of interest last night, the most interesting job being someone with a two month history of muscular back pain that had been getting worse that day.

“So”, I asked all innocently, knowing full well the answer I would get, “Have you taken any painkillers as the pain got worse?”

I wasn’t surprised by the answer she gave.

Then two calls to two regulars, one of which had only been discharged from hospital three hours previously.  Then finally to a patient who was actually sick, but that would only be because he earlier discharged himself from hospital against medical advice.

There is nothing more disheartening than to attend to a patient, and to see them clutching a little pink slip of paper.  “Why so?”, I hear you ask.

When you visit the local hospital, and the doctors and nurses are finished poking and prodding you they decide if you need to be admitted to hospital, or if you can safely be sent home with treatment.  If you are to be sent home they give you one or two bottles of pills, explain how the pills work, and then write a letter to give to your GP (family doctor).  The letter tells your GP exactly what tests they have done, and the treatment that they have prescribed.

This letter is on a pink bit of paper.

All too often I get called to a patient who has been seen with a minor condition earlier in the day, but after one dose the medicine hasn’t cured them, this is most common in the case of antibiotics, but you will also find people who tell me that the pain has gotten worse, and that they don’t like to take the painkillers the doctor has prescribed.

Inevitably they still have the discharge letter with them.

In these cases all we can do is take them back to the hospital they were seen in just hours ago, so that the doctors and nurses can repeat all the tests they ran the first time.

Sometimes this happens three of four times.  And each time they call an ambulance.

Don’t get me wrong, sometimes things do indeed get worse, and in that case a return trip to hospital is warranted.  But in most cases I come across it is simply the inability of a single dose of a tablet to make your symptoms disappear instantly and permanently.  Still on the up side, it makes diagnosis really easy, all you have to do is determine if the symptoms are the same as the last time they were in hospital, or if they have gotten worse or changed in any way.  If the symptoms are the same, then they are unlikely to drop dead in the back of the ambulance (thus causing a lot of unnecessary paperwork).

I have two or three days off now (don’t ask me how many, I need sleep before doing any serious thinking), so I may raid my ‘Ideas File’.

It is, to put it bluntly, cold enough to freeze the balls off a brass monkey, which is really cold. No matter, it keeps the drunks off the street...well, mainly it keeps the drunks off the street...

I got sent to a '50 year old man, fallen in street. blood from ear'. The location was given as 'Outside Red Lion Public House'. I could guess what had happened.

I pulled up, leaving the headlights pointed at the patient who was laying on the ground covered by a blanket borrowed from the pub. surrounding him were:

A lot of police (about five or six officers).
Two sons, both of which were crying and worrying about their dad dying.
Some bystanders, most of them had come from the pub, and...
One off duty fireman, who was clutching the patient's hand.

"Fair enough", I thought, "best get to work".

The lighting in the street was bad, but my headlights, and some police torches made that a little better. The patient had been celebrating in the pub and had tripped over a kerb while trying to walk home. He had possibly been knocked out, and there was some blood coming out of his left ear.

The first thing that you think of when someone who has fallen has blood coming out their ear is that they may have fractured their skull. With a fractured skull you will sometimes get cerebro-spinal fluid coming from their ear. Cerebro-spinal fluid is the liquid that your brain and spinal column float in, and should not be outside the body at all.

The standard test is that blood and C.S. fluid don't mix, so you'll see yellow streaks in the blood. Given the poor light it was hard to see, so I fell back on an old trick. You stick your (gloved) finger in the blood and if there is C.S fluid in it, the blood will feel 'slick'.

The side effect is that your gloves get covered in blood. It was cold. I wanted to wipe my nose. My gloves were right out, and I wouldn't like to wipe my nose on the cuff of my jacket because it's a disgusting thing to do, and also (mainly) because my jacket is horribly unclean.

The patient also had a large swelling to the back of his head, and because of the way that he had fallen, I couldn't rule out an injury to his neck. In a perfect world I would have liked to have put a cervical collar on him to immobilise his neck, but this is far from a perfect world. A cervical collar only really immobilises a patient if they want to be immobilised, in a drunken or combative patient this will often make them thrash around trying to get it off. So often a better course of action is to tell them to lay nice and still and leave the collar until you need to move them.

The off duty fireman had obviously had a bit of first aid training, because he was keeping the patient constantly talking. This was fine, as it meant I didn't have to talk to the patient too much, apart from assessing him, and getting his details.

The crowd were pretty well behaved, I kept hearing one of them moaning that the disabled ramp to the kerb was the reason behind the fall, and that they were 'bloody dangerous'. I didn't want to mention that walking while drunk was perhaps more of a contributing factor...

I threw another blanket over the patient because there was little else I could do until the ambulance turned up. Unfortunately I'd been waiting a long time for ambulances all night, and I suspected that this would be the same.

My nose still threatened to drip on the patient.

Suddenly behind me was a flash of a high-visibility jacket, "Excellent", I thought, "the ambulance has turned up".

But, no, it was one of our duty managers come to see how I was doing. They knew the ambulance would be some time, and wanted to make sure I was alright.

"Ah", he said, "I can see you have everything under control", and left.

He could have wiped my nose for me...

By now I was losing sensation in various small, but important bit of my anatomy. I looked at my watch and saw that I'd been with the patient for over thirty minutes, I was cold, but at least I wasn't laying on the cold wet floor.

Finally the ambulance arrived, they had travelled from out of their area to attend this call, and I was very grateful for them turning up when they did. We put the collar on the patient, strapped him to a stretcher and loaded him into the back of the ambulance where it was much warmer, and I could remove my gloves and wipe my nose.

Can you see what was uppermost on my mind?

The patient was swiftly taken to hospital, and as I prepared to face the crowd of people and explain exactly why the ambulance took so long to arrive, I was instead mobbed by people who wanted to shake my hand and thank me. None of them were bothered by the forty minutes it had taken the ambulance took to arrive, and they were actually happy that we had done our jobs, accepting that as it was a Friday night we might be a bit busy.

It was only later that I found out that there had been another shooting in the area (some drunk men had been apparently been thrown out of a pub, they then returned and fired a pistol through the pub windows, hitting a barman).

First off, my sympathies for everyone concerned in the murder of the West Yorkshire policewoman. I heard about it when I was sitting in the FRU listening to the news on the radio. We work with the police a lot, and most of them are really good people. I couldn't do their job, as at least most of the time people are happy to see us.

Bit of a busy night, partly I think due to the frost on the roads. I know that I wasn't able to drive too fast, as I was occasionally fishtailing across the road.The first job, aptly enough, was a man who had driven his car into a bus. The car was an utter mess, and I would have wanted to immobilise him in the car and have the fire service cut him out. I say would have wanted because once the crash was over, he'd run off...

So I'm guessing that the car was either stolen, or more likely he just didn't have any insurance, road tax, or a driving license.

A couple of 'nothing' jobs, then another car accident. Some bright spark had decided to borrow his friend's car, and then lose control of it on our main 'A' road. The car, yet again was a write-off, and the driver kept telling me that he was going to 'get done', because he didn't have any insurance... or a driving license.

Can you see a pattern?

I then had to go to a 13 year old child with a progressive and ultimately fatal disease. He was having difficulty in breathing due to a chest infection, and when I got there his breathing was incredibly irregular, and his oxygen levels were only 67% of what they should be. Even with high flow oxygen his oxygen levels were only just adequate.

There was a bit of worry about what I was going to do if he stopped breathing, as he had a 'Do not resuscitate' order, but it was a year out of date.

Thankfully it never came to it, and I was very happy when the crew arrived to take the child to hospital.

My final job was a bit of a nasty one. A young man (a cleaner) was found not breathing in a local supermarket. The call woke me from a light sleep, and as I mentioned, I couldn't drive too quickly to the call. I got there as the ambulance crew arrived, and we were led through the warrens of the supermarket by the cleaning supervisor.

The patient was large, covered in blood and vomit, and wasn't breathing. We attached our heart monitor, and it showed no activity in the heart at all.In the process of doing CPR, everything got covered in bloody vomit. As I type this, my jacket is in a plastic bag, waiting to be taken home and washed.

We got him to hospital, but they were unable to save him.

Once more it was a patient where no-one seemed to know him (no-one there knew his name, although they had been working with him for a couple of days), and I don't think he had any identification on him.

A tricky job for the police.

A busy night, but as my mum would say, "At least it made the time go fast".

The ambulance was only a few minutes away from the hospital, the oxygen had been swapped over for Entonox, and the patient appeared to be stable.

We give Entonox (a painkilling gas that has lots of oxygen in it) to both load up the blood cells with oxygen and to ease the pain, which in turn reduces the strain on the heart.  The other pain relief that we have is Tramadol, or Numbain, both of which can only be given via the vein, and so are a Paramedic drug only.  Both of which are…well…less than effective as the doses we are allowed to give are quite small.

Paramedic in London will soon be getting Morphine, but that is a topic for another post.

Joan was feeling a little better, although the pain was still there, it didn’t seem to bother her as much, and she was sure she was in safe hands.  She felt the ambulance pull to a stop, and the back doors flew open.  Standing outside were two young women in blue pyjamas.

“I wonder where the doctor is”, thought Joan.

The ambulance crew did something complicated to the underside of the trolley that she was laying on, and it slid out into the air.

Joan was trying to listen to what the ambulance people were saying, something like ‘Anterior’ and ‘GTN not given’, strange jargon like ‘BeeEmm’, she didn’t have a clue what they were talking about, she hoped that the nurses knew.

“Hello”, said one of the young women in the pyjamas, “I’m Doctor Rushkov, I’ll be looking after you”.

Joan thought that the woman was too young to be a doctor.

She was wheeled on the trolley into a big white room, chock full of strange equipment.  Nothing seemed to make sense as she was physically dragged from the ambulance trolley to the hospital trolley.  The people around her continued to talk over her head, reeling off numbers and phrases that Joan had no chance of understanding.

“I’m just going to put a little needle in your hand”, said one of the women.

There was a sharp scratch and the doctor started to talk to Joan.

It’s one of the things that we tend to be not that good at – when we have a seriously sick patient, we are concentrating so much on what their ‘numbers’ are doing (blood pressure, pulse, oxygen levels), and on our treatment, that we can sometimes treat them like lumps of meat.

Ambulance crews however have a solution to this.  We talk utter rubbish.  I don’t meant that we lie to our patients, but instead we have a number of stock phrases that are used to reassure, and explain things to patients.  It works pretty well.  It’s not that we don’t want to have a serious conversation with you, just that our minds are concentrating on more serious things.

Of course the seriously ill patients tend not to listen to us anyway, as they are often very frightened.

The doctor, young enough to be Joan’s granddaughter was talking about the treatment she was going to give.  She’d started off by saying that she was too unstable to be moved, Joan wasn’t sure what this meant – why wold she be moved anywhere?  The doctor then mentioned a drug they were going to give her, but that this drug may cause a stroke.  Would Joan give them the go ahead to use it?

Joan just wanted the pain to stop, so she said yes, and within minutes a new bag of fluid had been hung above her head.

There are two main treatments for a heart attack in London.  The first is via a drug called a thrombolytic, this drug is given in a bag of fluid via a vein, it takes around 40 minutes to run* and it ‘breaks down’ the clot that is blocking the artery to the heart.  The only problem with this is that in around 1 in 1,000 patients suffer a serious side effect.  This can range from internal bleeding to a stroke.  For this reason the drug is often given in the safety of a hospital.

Outside of London, some ambulance trusts give these thrombolytic drug to their Paramedics so that they can give them out on the road.  The reasoning behind this is that every minute the artery is blocked, more of the heart dies, and in places where hospitals can often be an hour or more away, it would be better to start the treatment while carrying the patient to hospital.

In London there is another form of treatment, the ‘Angioplasty’.  This is a surgical technique where a device is threaded up through the leg into the heart where it physically clears the blood clot.  This has less chance of a side effect, and works a lot better.  In East London there is one hospital that does this procedure, and because of this ambulance crews are being trusted as better clinicians.

It works like this.  If a patient is having a confirmed heart attack, so you need to be able to read the heart trace ECG.  Then you can bypass hospitals with an emergency department, to go straight to this hospital.  So hopefully more people will survive their heart attack.  It’s a good idea, but a little scary to drive a critically ill patient past a hospital to reach one further down the road.

In Joans case the ambulance crew were so close to the emergency department of their local hospital, and Joan was so unstable, they decided not to go to the specialist hospital, but instead head for the normal emergency department.

Six months later and Joan was still getting out of breath climbing her stairs, she had to take six different types of tablets every day, and often found her ankles swelling at night.  She supposed that at least she was alive, and there were people who had much worse damage done to their hearts.

She had been told that part of her heart had died, and that this is why she was lacking in the strength that she had previous to the heart attack.  Pretty much everyone who had a heart attack felt weaker afterwards, she had been told, but she was weaker than many because of how large a patch of her heart had been damaged..

Every now and then she got a little twinge in her chest, but a squirt of her spray under her tongue, and a little rest soon sorted it out.  She was waiting to have surgery to open up the arteries of her heart, and it couldn’t come soon enough.

And that’s the end of these series of posts, it’s been an interesting thing to write especially as I have just used my normal ‘churn ‘em out’ style of working.  I think it’s worked reasonably well, at least it’s kept the ‘content’ coming while I’ve had my time off.  Tonight I start the first of four night shifts, and with any luck I’ll have some interesting tales of daring-do to relate.

Or maybe a moan about Maternataxis…

*I’m running off my memory of hospital treatment now – things may have changed.

 

…Enter ‘Prostitution’ Mode…

So I got my copy of Blogged: 2005 last night, indeed I am in it, but had I not been, I still would have bought it for myself.

The blogosphere is a wide and varied place, and Tim Worstall does an excellent job of collected some varied posts from mainly UK based blogs to highlight some of the news events of the year.

It covers most big events of the year from the Iraq war (pro, and anti), ID cards (all anti, but then is anyone besides the government in favour of them?), the July 7th bombings, the election (both here and in America), all the way to shaving your man-spuds in preparation for a vasectomy.

One of the main strengths of the book is that if you don’t like the writing of the article, then the next one is only a few words away, and while the majority of the book is based on the political side of things (obviously, as most of the big news events of the year are political) there is still room for bits from non-political bloggers.

I sat up all last night and read it through, cover to cover and I suspect that there are going to be a few new blogs added to my daily reading list.

In a slightly Doh! moment (at 4 am mind you), I wondered why the book stopped at October…

And yes, I’m one of the contributors, and so is Nee Naw (who kept very quiet about it).

Having talked to the publishers (The Friday Project), I can report that they are very nice people who ‘get’ the whole idea of Blogging, so I hope this book does well, both for them and for Tim.

…Exit ‘Prostitution’ Mode…

The EMT (Emergency Medical Technician – like a Paramedic, only not paid as well…) was very relieved to see the familiar yellow form of an ambulance pull up outside Joan’s house.  He went and opened the door, and mimed pushing a wheelchair to the crew getting out of the vehicle.

There are a couple of ways to lose your job working for the ambulance service, one of these ways is to walk a ‘chest pain’ out to your ambulance.  The patient goes on our carry chair, and straight onto the trolley in the back of the ambulance.

The EMT finished telling the crew all that he had discovered, the crew, not being stupid, also only needed to take one look at Joan to realise that she was seriously ill.

They wheeled her quickly to the ambulance, where they explained that they were going to take a look at what Joan’s heart was doing.  Joan didn’t care that they wanted to put sticky dots on her naked chest, she was feeling too ill to worry about being topless.

One of the things that we in a London Ambulance Service can do is a “12 lead ECG”, this is a detailed electrical reading of the hearts activity.  We need to get the patient topless, then stick a number of electrodes to the front of the patient’s chest.  The machine then prints out a pretty little picture of what is happening with the patient’s heart.  Joan’s looked a little like this.

The real skill comes from understanding what all those squiggly lines mean.  We run a two day ECG reading course, where we are taught to recognise the seriously bad things that can happen to someone’s heart.  When we first trialed the reading of ECGs there was a test between the ambulance crews and the junior accident and emergency doctors.  The ambulance crews got more ECG interpretations right than the doctors.

Twice…

In Joan we are looking for something called the ‘ST Segment’. 

In a normal healthy ECG this part of the line should look like this.

In Joan that part of the ECG looked like this.

         

Can you see how the rightmost part seems raised?  This is one of the signs of a heart attack.  For us it is a ‘red flag’ that tells us to get the patient to hospital in as quick a fashion as possible.

The ECG machine spat out a pink piece of paper.  The ambulance crew both read what it meant immediately.  Joan was having a confirmed heart attack.

The driver went through the cabs dividing door an sat in the driving seat, she started the engine and hit the ‘priority’ button on the radio.

“J201 calling priority, go ahead”, came the voice over the radio.

“Afternoon”, the driver said into the mike, “Can you show us Blue into Newham hospital, we have an eighty two year old woman with confirmed MI via ECG, BP is 88 over 50, pulse is 40, O2 sats are 99 on O2, BM is 5.2 and our ETA is two minutes”.

The radio operator repeated it all back to the driver, and finished with, “that’s being done for you now”.

The ambulance attendant was sitting in the back, keeping a watchful eye on Joan, while explaining that they were going to use the sirens to get Joan to hospital, and that when they got there she was going to be the centre of attention for a lot of doctors and nurses.

The ambulance pulled away, blue lights flashing and the driver gave a quick wave to the Rapid Responder who was finishing up both his paperwork and the cup of tea he had in a travel mug.

Now that ambulance crews can interpret the heart tracing of an ECG we have two options as to which hospital the patient can go to.  We can run them to the nearest hospital, where they will receive a drug to break up the clot in their heart, or we now have the choice of taking the patient to the nearest hospital that provides a primary angioplasty service.  An angioplasty is a medical way of opening up the blocked heart artery.

…but more on that tomorrow…

The FRU pulled up outside Joan’s house, the (stunningly good looking, heroic, intelligent, and did I mention GSOH) EMT stumbled out, grabbed his bags and made his way to the front door where he rung the doorbell.

He was met by a woman in her eighties, she was pale, she was sweaty and she really didn’t look too well.

“Sit down luv”, said the EMT, “and tell me why you’ve called me”.

“Well”, she said between breaths, “I’ve got this pain in my chest…”

People who are having a heart attack sometimes look like they are having a heart attack, what I mean by this is that they go into shock.  Shock is defined as a lack of oxygen to the tissues and organs of the body, often this is what happens when you lose a lot of blood, and there isn’t enough blood in you body to adequately keep your organs fed with oxygen.  Sometimes however, you get cardiogenic shock, which is a failure of the heart to pump sufficient amounts of blood to your organs.

Roughly 1 in 10 heart attacks result in cardiogenic shock, they are often heart attacks that affect the large left side of the heart.  The left side of the heart is the part that pumps blood all around you body, so it has quite a lot of work to do.  When the supply of oxygenated blood to that side of the heart is blocked, then the pump starts to falter and die.

This then results in the classic ‘look’ of a heart attack.  The patient is pale and sweaty, they breath rapidly, and look blue around the lips (cyanosis).  Their fingers are often stone cold, and they may be a bit confused.  All this is the bodies response to a lack of oxygen.

The (did I mention heroic?) EMT listened as Joan told him about the pain starting about an hour ago, and that it seemed to travel down her arm.  While he was listening to her he started to assemble an oxygen mask.  Putting it on Joan, he explained that it would make her feel better.

Oxygen is important to the organs, so we want to make sure the patient is getting plenty, this is why we put the patient on oxygen.  It can often make them feel better, although I’m not too sure if this is because of the oxygen, or because someone is ‘doing something’.

While reassuring Joan, the EMT (did I mention he is tall dark and handsome?) checked through her previous medical history, he had a little look at the tablets that she took, and found that she was on a minor treatment for high blood pressure and nothing else.

“Any allergies Joan?”, he asked.

“Only Penicillin”, she replied, “it makes my stomach upset”.

“Alright Joan, I’m going to give you some medicine”.

There are two medicines that we give ‘on the road’ to patients who we think are having a heart attack.  Aspirin and GTN.

Aspirin was discovered to reduce your chances of death from a heart attack by 23%, it works by making the parts of your blood that want to stick together to form a clot (which will then go on to block an artery) less ‘sticky’.  So we give 300mg of aspirin to pretty much anyone we suspect of having pain related to the heart.

So aspirin is given unless the patient is allergic to it, or if they are on a better ‘anti-sticky’ drug.

It is important for me to say, that most patients don’t know what ‘allergic’ means.  An allergic reaction is something life threatening, and will make you incredibly ill.  An allergy is not “it gives me an upset stomach”.  It is really important for the medic on scene to determine if the patient is truly allergic, or just doesn't like taking the drug.

Trust me, 23% reduction in death is worth an upset stomach.

While Joan chewed the aspirin the EMT checked her blood pressure, 88/50, not good.  The other drug that he wanted to give would have to wait.

The other drug we give is GTN (glyceryl trinitrate).  The GTN we give is a little spray bottle, and is again used when we suspect that the pain a patient is feeling is related to their heart.

GTN works by relaxing the blood vessels in the body, it makes then a bit more ‘floppy’ and by extension they get a bit larger.  We are hoping that the blood vessel gets large enough that a bit more blood can flow around the clot, and supply the tissues of the heart with the much needed oxygenated blood.

Unfortunately, the drug has a side effect of dropping a patient’s blood pressure.  so the patient needs to have a fairly good blood pressure to start with, otherwise we might lower their blood pressure so much that the brain wouldn’t receive enough blood and the patient faints (or worse).  In the case of Joan, her blood pressure is too low, so the EMT can’t give the GTN.

The treatment done, all that was left was to wait for the ambulance.  The EMT was getting a bit nervous.  This woman needed to be in hospital, not in her living room.

He breathed a sign of relief, if he listened carefully he could just about hear the familiar sounds of a siren approaching.

Here is the reasoning behind me writing Joan#1.  Every so often I have a week off work.  That often means that I don’t have anything ‘real life’ to write about, and if you look at my archives you may well work out exactly when I have those weeks off…

So the post ‘Joan#1’ is supposed to fill in the gap. Don’t worry, I’m not about to take this blog off in a wildly different direction, I’ll keep writing about the stuff I normally write about – I promise.

I’m back at work on Friday night, so the ‘regular’ stuff will start again then, until then I’m going to inflict two more ‘Joan’s’ on you.  The idea behind the ‘Joan’ posts was inspired by the Michael Crichton book ‘Five Patients’ which describes, in-depth, five patients and the treatment that surrounds them.  It was written in the 60’s, so is a bit out of date now.  I’m trying to do something similar in my usual “short posts, scribbled down, barely edited” style.

So, it’s either ‘Joan #2’ or I’ll inflict on you another post about how I’m getting screwed under the ‘Agenda for Change’ paydeal.

Yes…that is a threat…

Joan was in the garden hanging out the washing, she did the laundry as regular as clockwork.  Her life was normal, and had been so for the last twenty years.  She was looking forward to seeing her grandchildren later that week.  It was a sunny summer afternoon, so the clothing would be dry in no time.

Joan felt a twinge of pain in her chest, it seemed to run down her arm.

“Hmmm”, she thought, “I must have stretched a bit too far”.

Joan, like many of my patients is starting to feel cardiac (or heart) pain, but like a lot of people who get it for the first time, she doesn’t recognise it as such.  Instead she puts it down to overstretching, a touch of indigestion, or something that will go away on it’s own.  Like many of my patients Joan doesn’t consider herself to have any problems with her heart – it has beat healthily for nearly 80 years without a fault, why should it be failing now?

Little does Joan know, but she is going to be one of the 275,000 people in the UK to have a heart attack this year.

But what is a heart attack?  The heart is a muscular pump, that continuously works to pump blood around the body.  All the muscles and other organs of the body need a constant supply of oxygen.  Blood carries the oxygen around the body to the organs, the blood then returns to the heart where it gets pumped to the lungs to pick up more oxygen, before going back to the heart to repeat the process.

Without oxygen, the tissues of the organ die.

As mentioned, the heart is a muscle, and the heart itself needs oxygenated blood.  So as the oxygen carrying blood leaves the heart, some of it is used to bring oxygen to the heart tissue itself.  Should the heart get it’s supply of oxygenated blood cut off, then the heart itself starts to die.

What happens in a heart attack is that one of the arteries carrying oxygen rich blood gets blocked off, and the heart muscle around that artery dies.  The medical term for this is a ‘Myocardial Infarction’.

Myocardial means the muscle of the heart, while Infarction means a reduced blood supply leading to tissue death.

For short we call it an M.I.

We used to think that it was just the lack of oxygen to the tissues that caused the injury, but what actually happens is that the lack of oxygen activates disease fighting white blood cells and these then release a range of toxic substances (mainly free radicals) into the tissue, thus damaging and killing it .

Joan’s pain was getting worse – it was as if someone was sitting on her chest.  She’d had a cup of tea, but that hadn’t helped at all.  She was considering a sip of brandy, the bottle had been untouched since Bill, her husband had died five years ago.  Maybe it would go away if she ignored it.

Perhaps a cigarette would calm her down, she swore she only smoked ‘for her nerves’, so perhaps it would help get her through the pain.

But what causes one of these arteries to get blocked?

Early in life we get small blobs of fat sticking to the inside of our blood vessels, with a healthy diet these don’t get much larger.  With an unhealthy diet these blobs of fat (called Atheroma) get larger and larger, often collecting up different types of material.  These effectively narrow the blood vessels of the body, causing a decrease in oxygenated blood reaching the tissues supplied by the affected blood vessel.

What can happen to cause a heart attack, is that this atheroma plaque can break off the wall of the blood vessel, sending a clot (or thrombus) around the body.  Blood starts to clot around the fatty plaque and the clot gets bigger.  If the clot ends up blocking one of the arteries of the heart, then the blood flow is blocked, the part of the heart supplied by that artery gets no oxygenated blood, and it dies.

Joan is a smoker, which means that she is at least five times more likely to have heart problems caused directly by her smoking.  Smoking reduces the bloods ability to carry oxygen to the organs that need it, partly because the carbon monoxide that is part of cigarette smoke is 400 times more likely to be carried by the blood than the oxygen that the organs of the body crave.

Also, smoking increases the one of the proteins that causes blood to clot, so the blood becomes more ‘sticky’, this helps form the plaques that can burst, sending them floating around the body all ready to cause a heart attack.  Smoking also increases the amount of ‘bad’ cholesterol in the blood.  It is this bad cholesterol that attaches itself to blood vessel walls in the first place to cause the atheroma plaques.

The cigarette wasn’t helping too much.  The pain was still there, and she was finding it hard to breathe.

“Perhaps I better call an ambulance”, she said to herself, reaching for the phone.

…to be continued…

 

 

End of Joan, part 1.  Please let me know what you think, it’s hard to balance heavy medical stuff with making it easy to understand, and there are probably medical people reading this, tearing their hair out at what I’ve just written…

You see, sometimes I make mistakes.

Thankfully not yet of the fatal kind.

However, yesterday I did link to the wrong person.  I can only blame the incoming brain-rot that affects all public service staff.  So in a bid to right this wrong in an honourable fashion I will now direct you to the proper link, and inform you that Tim Worstall is indeed a fine writer, and often makes me go, “Urh?”.

This is a good thing.

Now, time for a cup of tea, then clean my flat, and then to make a start on part one of a series of posts about Joan.