Sunday, 25 August 2019

More heart palpitations

On the evening of the day after my 57th birthday, as I do every day I took a shower and brushed my teeth, then got into bed. It was around 9.30pm by this time, and as usual my heart began to beat fast. What normally happens – now that I have quit drinking alcohol entirely – is that after about two minutes’ time it regularises and I can get to sleep. But this night each time my heart rate fell to a reasonable level it would start going at a higher rate again. After about 20 minutes of this I got out of bed and got dressed with my trousers and a clean shirt and called triple zero. I was shaking uncontrollably by the time the phone call was over.

As had happened three times over the previous two weeks, by the time the ambulance crew arrived at my door my heart had gone back to normal. They rigged me up with dots (the sticky patches that contacts are connected to which deliver a signal to the electrocardiograph, or ECG), and printed out a sample, but by this time my heart seemed fine. When I told the ambo with the long hipster beard that this was the fourth time I had called an ambulance in a period of two weeks, he suggested to me that I go with them to a hospital. I agreed and got my medications from the bathroom, got a phone charger, and put this stuff in my green satchel. We went down to the street in the lift at about 10.25pm.

Inside the ambulance they confirmed that the destination would be the Royal Prince Alfred Hospital in Camperdown and we set off. I was sitting in a seat in the back of the vehicle facing backwards, a seatbelt buckled over my torso. Tito (the bearded ambo) asked me questions and typed away on a ruggedised laptop as we negotiated the streets before we were delivered outside the main building where the emergency department and the resuscitation room are located. Inside the building’s foyer, I sat in a chair next to Tito and his colleague stood nearby. This colleague a bit later got cups of coffee for him and his partner. Tito told a nurse attached to the hospital about my symptoms and then after about ten minutes’ wait we went indoors. I sat in another chair while Tito told another nurse what had happened.

After a while an emergency department nurse guided me to a vacant bed and I lay down with my clothes and jacket still on. I had my satchel over my shoulder and at some point someone suggested putting this article behind the bed. My shoes went under the bed. I wasn’t connected to an ECG at this point, although I would be later once I moved to the acute care ward next-door. As soon as practicable a nurse put a cannula in my hand so that blood could be taken for tests.

While in the emergency department I saw a number of people admitted. There was a young woman in a pair of black jeans and a black top who had a bruise on her forehead above her right eye. She was accompanied in a room near the door by two pairs of police. Evidently something had happened and police were taking a statement from the woman, who was with a young man wearing a T-shirt.

Later a woman named Julie who was complaining of abdominal pains was admitted and put in the bed to my right, behind me. She sounded very crook, in a lot of pain, and her groans filled the space. From time to time a hospital employee would come and take her to get a scan. There was a CT scan and an X-ray and, each time, someone came and wheeled her away as she lay on her bed. It wasn’t clear to the staff why she was in so much pain and she had to explain twice about a blockage in her intestine that had been fixed 30 years previously.

A young woman with a husky, girlish voice and a pink backpack that contained a tan teddy bear came in and was put in the bed to my left, in front of me. She had drunk, she said, three bottles of wine as well as some vodkas. She lay curled up in her bed and the staff ministered to her prone form.

My own blood tests came back negative. The troponim test was the one the staff were most interested in learning as it can indicate whether there is something very wrong with the heart. After waiting for about four hours a young woman in doctors’ green scrubs came up to me and we talked about what had happened. She had dark skin and evidently had her roots in the subcontinent. She asked me a lot of questions and made notes on a computer installed on a wheeled stand. At some point after she left my bedside a man attached to the hospital’s administrative unit came up to me and I signed some papers relating to my private health insurance and to Medicare. I used my mobile phone occasionally to have conversations with people and I saw, while still in the RPAH, that an Apple software update was available.

At 5.30pm I was moved to a bed in the acute care ward. Here, my shoes and bag were stowed, as before, under and behind the bed. I lay down to wait and to rest. A nurse offered to change me into a hospital gown but another nurse said I would probably be going home soon. I closed my eyes again from time to time and, on and off, secured fragments of sleep.

From time to time I also thought about the health system and how it works but whenever I started to become emotional about this subject I would imagine the person walking in the ward in front of me to be someone who would tweet commonplaces about refugees or some other hot-button topic, and the spell would be broken. The man or woman I was looking at would stop being a member of the elect and would revert to being just another ordinary citizen with a manageable array of pet gripes and hobby-horses.

The ward came alive at about 6am when the lights went on. An orderly brought me breakfast on a tray and I ate two slices of white bread with margarine and apricot jam spread on them. I also drank a contained of fruit juice and a small plastic bottle of milk.

I saw an unhealthily-skinny young man in a bed to my left and in front of me, on the opposite side of the ward, complaining about the drink he had been given. He threw a Styrofoam cup onto the floor and said he wanted ice in a proper cup. He would later ask for a jug of water and the staff would have to tell him that only cups were available. When he insisted on getting some juice they were forced to explain that the stock of this item had been exhausted in the ward’s fridge and that this usually happened by about midnight. He started taking off the ECG contacts and the other things linking him to the ward, and although a hospital security guard was called to the ward, the young man finally got a gown put on so that he could go outside to smoke a cigarette.

Julie was in the ward with me, a couple of beds over on the other side of an old man named Brian who was aged about 84 and who had dementia. He would later be transferred to Balmain Hospital. Green curtains were drawn around Julie’s bed and a large number of people came in and out of the enclosure they made, including one man aged in his early 50s who wore a doctor’s dark-blue scrubs. He had a bright orange backpack on his back. At 8.40am he told the poor woman, “We’re hoping to have you in the theatre in less than an hour.” Julie had a blockage in her bowel and part of the organ would have to be removed. “It’s literally life-threatening,” chirped the dapper man in blue.

At some point a new crew of nurses came on-duty and were briefed about each patient by the retiring crew. The nurse who was looking after me from this point in time was from Ireland and had blonde hair. There was also a nurse who looked like an Aussie girl from the 60s who should have been a Beatles fan. On top of her head her dark hair was put up in a shape like a bagel. There was another nurse who had wavy hair that was tied at the back of her head. And the nurse who would take the cannula out of my right hand wore a University of Tasmania fleecy top and was junior to the Irish nurse.

The same doctor as before came around and she told me what the cardiology team had advised her to do. I received from her an envelope with test results that I was to give to my GP. My GP was to put a Holter monitor on me for 24 hours to monitor my heart. In addition I was to make an appointment to see the cardiologist who had done the ablation (the surgical procedure) back in January. I was also to take the beta-blocker prescribed for me 30 minutes before going to bed; this measure had been suggested by the unnamed ambo when the three of us had been in my unit prior to the trip to the RPAH.

In the ward, the Tasmanian nurse carefully removed the cannula from the back of my hand, peeling off the tape that held it in place and, once it had been extracted from my flesh, pressing a patch of gauze over the hole that had been made, to staunch the blood-flow. After the cannula was removed I put on my shoes and left the ward. As I passed her bed, Julie was on the phone to someone. In the waiting room out front, near the street, a young woman was curled up in the foetal position on a bank of chairs and she looked as though she was crying. Outside, I flagged a cab and told the driver where to take me. We used Pyrmont Bridge Road, which was very crowded, and I got home at 9.25am.

It had been a busy 12 hours and now, I reminded myself, I would be able to update my phone using Wi-Fi. But things didn’t stop being a problem with the new operating system installed. It wasn’t just a matter of pulling off the adhesive dots used for the ECG contacts, either. I found to my deep consternation that even lying down on the bed to have a nap in the daytime – let alone trying to get to sleep at night – resulted in heart palpitations. Learning this unpleasant fact, I immediately phoned my cardiologist and made an appointment for Friday the following week (the earliest time they had available). Then I called my local GP clinic and made an appointment for the afternoon of the same day I came home from the hospital. I had to talk with someone who could give me advice as to what to do. How to manage your life when you can’t even lie down?

Because my regular GP wasn’t working on this day I booked an appointment with another man, one I had used on previous occasions. When I arrived at the clinic he was still busy so I took the receptionist’s offer of an appointment with another GP in the same clinic. I had met with her on one or two occasions before and anyway all the doctors use the same patient records during their consultations.

The doctor listened to my story and read the letter that the hospital had given me to pass to my GP and prescribed me temazepam, a tranquiliser. What if it doesn’t work? I asked her. If it doesn’t work you can come back and get a stronger dosage, she said. She took my blood pressure and it was a bit high but that could be explained, she averred, by the fact that I had not slept the night before. I took the script to the pharmacy down the road and got the drug. It wasn’t available in a bottle, the pharmacist advised me, and I said, “I don’t care I just want the drug.” He mentioned the fact that I should only take one tablet daily (the doctor had said to take it 45 minutes before retiring) and that there was no repeat on the script; the printed packet said it contained 25 pills, so: enough to get me to the appointment with the cardiologist a week distant.

Time became something alive under my changed condition as an outcast from the shores of oblivion. As I was deleting email messages in my client software I remembered the hours and minutes in the RPAH the previous night. The email thing was necessary because I had received an email from my ISP telling me that my inbox had reached 75 percent of its limit. I patiently got rid of months of emails starting with the oldest ones in the folder. But that feeling of endless time, time without boundaries, that I had felt the night before as I waited for the doctor on duty to come and talk with me in the wards where I was lying throughout the long night, returned to me as I mechanically clicked on email after email, zeroing in on the trashcan icons in the display window, one by one by one. Click, click, click.

That night I took the temazepam 45 minutes before going to bed. Then at 30 minutes before bedtime I took the beta-blocker. And finally I took my anti-psychotic at 10 minutes before bedtime. I had my shower as usual and got into bed and my heart went fast as expected. It kept this up for about 20 minutes but it got slower and slower until I fell asleep. I slept from 8.30pm to 6.30am and when I awoke I felt like I had been reborn.

The next day, a Friday, I saw my regular GP and we talked about the Holter monitor the hospital had advised putting on to observe my heart function over a period of 24 hours. He said he had already made out an order to give to the pathologists (who operate from the same office he works from) and he took the order that the doctor the previous day had made, saying that he would shred it. He said too that he would follow up with the pathologists to try to get the Holter monitor put on before the appointment with the cardiologist.

I asked him if the palpitations this time were pathological or psychological and he said he didn’t know. Learning more about the heart’s function would enable him to eliminate variables and narrow down his focus onto the real problem. He didn’t charge me for the visit although the doctor the day before had done so. 


marcellous said...

I laughed at this:

From time to time I also thought about the health system and how it works but whenever I started to become emotional about this subject I would imagine the person walking in the ward in front of me to be someone who would tweet commonplaces about refugees or some other hot-button topic, and the spell would be broken. The man or woman I was looking at would stop being a member of the elect and would revert to being just another ordinary citizen with a manageable array of pet gripes and hobby-horses.

That looks rather like a pet gripe of your own. I hope you can continue to keep it manageable. Rather a shame that you let it break the spell cast by the hospital at work. Last two times I was in hospital (4 years ago now) I wafted through on a cloud of morphine and endone and by the end I was quite enjoying submitting to the great machine.

Anyway an interesting read and I hope you can keep the palpitations under control and get to the bottom of whatever is bringing them on and have it treated.

Matthew da Silva said...

Where would we be without our hobby-horses? Have you read 'Tristram Shandy' by Laurence Sterne? Magnificent work of unsurpassed brilliance, never bettered since it was published in the late 18th century. Sterne has things to say about hobby-horses.

Neil said...

Love Tristram Shandy!