Tag Archives: diagnostic dilemma

Being a patient doesn’t come easily.

12 Apr

It’s 9.10 pm and I’m lying in bed roaring with laughter watching re-runs of Terry and June on UK Old when suddenly I notice that my heart is racing.  Surely this can only be a response to the raucous humour before me?  Whilst Terry and June continue mining comedy gold, I notice that my heart’s still beating with all the irregularity of a politician’s expenses claim. I’m not overly concerned about this because patients often complain of “palpitations” (which can mean just about anything) especially when they’re in the silence of the bedroom, he’s forgotten to take the Viagra and consequently she’s aware of no other distracting stimuli than the forceful contractions of her heart.  An ECG and a check of thyroid function is usually all that’s required coupled with much reassurance.

The following morning I’m consulting at work when my heart suddenly begins to feel like it’s leaping out of my chest.  An interesting patient problem, a fascinating diagnostic dilemma or any other pleasing alliterative anxiety, you ask?  Alas no, this is one of those: “I think my tablets might not be agreeing with me because this year’s daffodils are not what they have been” – type issues.  I begin to feel slightly faint and hurry to encourage my patient to leave by promising to stop their simvastatin if the crocuses suffer a similar paucity of efflorescence and dash upstairs for the event monitor.

Clamping the little device to my heaving bosom I record the kind of ECG trace which is so abnormal that a first year medical student wearing a blindfold would be hard pressed to miss.  I fax the trace (anonymously) through to our local Consultant Cardiologist who rings in person two minutes later (never a good sign) to enquire if it’s my heart that’s beating to the rhythm of a former Soviet state’s national anthem.  “I’ll see you at 12.30 tomorrow Nick and in the meantime if it happens again and you feel at all unwell, it’s 999.”  Terrific.

The following day I’m waiting in Cardiology when one of my own patients appears for his pacemaker check.  “I didn’t know you had heart problems doctor?” he enquires pulling out a spiral reporter’s notebook and a dictaphone ready to return to the village and publish his astonishing discovery as an exclusive in the parish magazine.  There is worse to come as I lie on the examination couch having an ECG and echocardiogram; I reluctantly accept that I have now crossed to the other side, no longer am I wearing the tweed jacket (with the pleasing coordinating tie featuring country scenes) I am stripped to the waist and covered in ultrasound jelly: I am a PATIENT.

I am shunted into another room where a technician (who is clearly delighted that she has been asked to forgo ten minutes of her lunch break – and who can blame her?) roughly shaves my chest in readiness for fitting a 48 hour ambulatory ECG.  Wielding the razor with all the finesse of a drunken sheep shearer she takes hair and a couple of millimetres of skin for good measure before reaching for the bottle of (presumably) concentrated acid to “remove any grease from your skin otherwise the pad won’t stick.”  We finish with her (quite literally) sanding down the now viciously stinging area before applying the electrodes.  Spotting the Black & Decker nail gun I wonder if she’ll go the whole hog and staple them in place but thankfully after a few cursory instructions she sends me on my way, my portable black box recording my every heartbeat.

Over the next couple of weeks the trace is analysed and I’m treated to an exercise tolerance test. I stand on the treadmill, displaying the injuries sustained from the ambulatory tracing and looking like a stigmatic on Good Friday before being treated to an ever increasing workload as the speed and slope of the treadmill are increased every few minutes.  It is negative and I breathe a sigh of relief as the consultant informs me that it’s probably been a viral infection of my pericardium triggering runs of fast atrial fibrillation.  I need no further investigation or treatment unless I fancy a trial of beta-blockers.  I don’t.

I hadn’t been especially worried if I’m honest, having suspected this diagnosis from the start, but it was sobering to be on the other side of the fence for a while.  Doctors don’t consider that they will ever make the transition to patient, we see ourselves as somehow immune from illness and disease and for the first time in years I have some insight into what it is to be the recipient rather than the donor.  I’m grateful that this potentially worrying symptom was promptly and thoroughly investigated, my only complaint being that the scars from the 48 hour monitor stayed with me for over two years and seriously dented my chances of gaining that lucrative modelling contract for Calvin Klein’s new GP country underwear range.  I suppose, under the circumstances, I should be thankful that I don’t have life-limiting heart disease (and that I managed to land the job of creative consultant on the forthcoming Terry and June The Movie).