Blue lights and sirens
This week: It all started on Thursday; Load and go; Blue lights and sirens; Next steps; The positive news;
Thank you to everyone who enquired after my health when they realised that there had been no blog last weekend. Your concern is much appreciated.
We have had a cool, very wet fortnight. There was 66mm last week and 54mm this week, so 120mm in a fortnight. However, today the sun is shining again.
It is warm in the sunshine, but being that the sun is at its lowest point in the winter sky, we only have sun until 12:30
Here is an update on my last ten days and it may well not be what you were expecting to hear.
It all started on Thursday
This was not what I expected. I had been doing odd jobs on Thursday morning, made some mushroom soup for lunch, and then sat down in front of the computer at 14;00, intending to listen to the BBC News.
Suddenly I felt as though I had indigestion and I was wondering if the mushrooms were off. I had a compelling, overwhelming urge to go and lie down, now, IMMEDIATELY.
There was no pain, just discomfort between my shoulders, like a colic. No shortness of breath, but as I climbed into bed I felt cold and started to perspire slightly, but only for a minute or two.
I was starting to think that this was not normal so snapped on my blood pressure cuff. 140 over 80, so higher than my resting average (125/60), with a pulse of 75, so nowhere near a critical threshold and anyway I hadn’t been resting.
I’ve taken my blood pressure ever week for years, so have a good idea what is normal and what is not. From my very basic medical training, Pre-hospital Basic Life Support, I was running through what I was feeling, but couldn’t find an answer.
After about 40 minutes I felt a bit better. However I had a tremor in one hand which would not stop. So I decided to go over to my neighbour who is a nursing sister, for advice.
She decided that the best idea would be to go to the local minor injuries unit at Jelsa where there is a doctor.
Once there, immediately I was hooked up to an ECG and just a minute or two later, after some phone calls, the Paramedic said, “We’re taking you to hospital. The helicopter is on its way.”
I had thought she meant the hospital in Grad Hvar, but the HEMS aircraft meant a trip to Split.
Load and go
In the HEMS world we use a phrase “Stay and play or Load and go”. With highly qualified ATLS doctors and paramedics on aircraft, there is an optimum time to stabilise a patient (stay and play), and then get airborne to a trauma centre (load and go).
I was given under-the -tongue medication, then a tablet to chew, had a canula threaded into an arm vein and was loaded into an ambulance for the 500 metre trip to the Jelsa helipad at the playing field. I was still wired for sound and had a portable ECG and defib between my knees.
Croatia was given EU money in 2024 to establish four HEMS bases to cover the Adriatic coastal region and islands, and the inland industrial centre around Zagreb. We have a new yellow Airbus H145 dedicated aircraft based at Brač airport.
I was transferred to the aircraft stretcher, loaded through the rear clamshell doors, locked in place and we were off. The HEMS paramedic asked me to hold the bag-valve mask – a resuscitation device.
It is strange the things that go through your mind – I was thinking, great! DiY resuscitation… I also felt a fraud because I had had no pain.
I have to say I wasn’t overly impressed! I’m used to sitting upright when flying, not lying down. The aircraft certainly rattled and vibrated much more than the MD902 Explorers’ I am used to and there seemed little space inside the cabin.
After about a 20 minutes flight, we landed at the hospital helipad in Split. It certainly beats a 2 hour ferry journey though.
There was another transfer onto a land ambulance stretcher, still with the defibrillator/ECG attached.
The helipad is only a kilometre from the Split University Teaching Hospital campus, but I was a little surprised we were running on blue lights. This is the second largest hospital in the country and is the regional trauma centre.
At the trauma centre, it was a trolley dash through A&E and straight into RESUS. Suddenly I was surrounded by three doctors and two nurses who started pushing more canulas and needles into veins.
What stood out was the “well practiced” team work. Few words were spoken, just well oiled efficiency.
I kept being asked about my pain level. I had none and felt a complete fraud, because I really didn’t feel especially ill.
Then the team leader said, “Look, I’ll be straight with you. You are having a Myocardial Infarction. We are prepping you for immediate transfer to the regional cardiology unit. The surgical team has already been called out.”
On the Resus wall clock it was 17:15.
Blue lights and sirens
A little knowledge can either be useful or dangerous. My limited training told me that having a heart attack was not good. But I still didn’t feel bad, just some slight discomfort between my shoulders.
I have also seen a lot of death certificates with “Myocardial Infarction” as the cause. However I had none of the symptoms I had been trained to look for?
Then it was another trolley dash to a waiting ambulance with a doctor, paramedic and nurse.
The blue lights came on, then the siren. 17:20 is rush hour traffic in Split. OK, so this is perhaps more serious than I appreciated.
At the cardiology unit, it was straight up to the 8th floor ICU. A doctor used an ultrasound to confirm what was suspected and after a change to green scrubs, I was immediately taken down to theatre, where everyone was gowned up.
At 17:40, the surgeon was starting to thread a catheter into my right radial artery.
With the surgeon on my right, I had a huge 92″ screen on my left so I could see what was going on. I think I might have been given a local anaesthetic in my wrist, but didn’t feel it, in fact I couldn’t feel anything, only the hum of the x-ray head as it moved automatically.
I had a front row seat as Dr Josip Borovac installed a stent into my left main coronary artery, which was completely occluded. At 18:10 it was over and I was on my way back to the ICU.
One thing about hospitals is that you can always see people who are a lot worse than you are. The ICU was very noisy with machines and alarms.
The staff were excellent, knowledgeable and attentive however it was not an environment for sleep – apart from being still wired for sound, which was uncomfortable.
Talking to the ICU doctor, he said, “Look, you shouldn’t be lying here in front of me. You have never smoked, a long-time teetotal vegetarian, fit, not overweight, so none of the usual indicators. That suggests a strong genetic or stress component is the cause.”
I didn’t sleep much and watched dawn break over Hvar, wishing I was back home. On Friday I was moved to a general cardio ward, feeling as though I had been in the ring with Joe Bugner.
By Sunday I felt a lot better.
Next steps
The cardiologists were in and out several times a day, clearly taking an interest in every patient, listening and answering questions. Dr Borovac put me on five strong medications – some little 2 gramme tablets and others the size of suppositories! These are to restore heart function and reduce the underlying cause of the clogged arteries.
I made him laugh when I told him on Monday afternoon that I thought I was becoming a cat.
Sleeping or dozing for 20 hours a day, with the rest of the time spent patrolling the corridor, close to the wall, eating or finding a bathroom… I noticed my walking speed was increasing.
On Saturday I was definitely doing a “slow march”. My Monday, I was back to my standard Infantry rate of 120 paces per minute. So some measurable improvement in my energy levels. Later in the afternoon, the surgeon came back in and said the latest blood work had shown a significant Iron deficiency and he was putting me on an IV.
It looked like I was getting an infusion of Turkish Coffee! My arms are like a mature Swiss Cheese. Every possible vein has been punctured, so when the IV stopped working, nursing staff resorted to using a canula for a baby to enter a tiny vein. This worked but I am black and blue from the intra-dermal bleeding.
When the results of doppler ultrasound on Tuesday came in, they were not good. I have lost around 60% of heart muscle function. At some point in the future I may need a micro AED implant, but for now Dr Borovac thinks the enzyme medication I am on will rebuild function.
I was discharged on Tuesday evening.
In a long conversation with the surgeon, especially about any limitations, he said “Just be sensible”.
I am going to have to slow down, because on a scale of 1 – 5, this has been a level five event.
I had a very good discussion with Dr Borovac and now have an understanding of my limitations and a care pathway for improvement. For a while I need to be careful and slow down (difficult) but I don’t need to and must not become sedentary.
I must say that my treatment at every stage has been exemplary. Highly trained, knowledgeable staff, always prepared to help and answer questions. No one could ask for more.
The positive news
I don’t feel ill. In fact I feel well, far better than the test results say I should. Perhaps just a little tired. The are some strange after effects though. Everything tastes “odd”, even bananas?!
On Friday I made some Garlic Mushrooms for tea, to try and shock my taste buds back into operation.
Sautéed in Olive oil, with red onion and four large cloves of crushed garlic. Topped with chili tomato sauce, an easy and flavourful dish. I couldn’t taste the garlic or the onion, just the tomato sauce…. I guess my taste will come back in due course.
This event definitely has left some strange after effects!
When I arrived home, the first spring bulbs are in flower. The Narcissi I planted in September are bobbing their heads in the bright winter sunshine. Nearby the Winter Cyclamen are in flower too.
Although we are still a fortnight away from the northern Winter Solstice, already renewal is taking place and the earth around my home is breaking out of winter dormancy.
With a warm and sunny week forecast for next week, I am looking forward to seeing what I can get out and do.
If I don’t attack the weeds, they will attack me…
The felines are pleased to see me. Not that they were not well looked after. Just they get “better looked after” when I am at home. I have my Floof Wizard, a “Simon’s cat” on my knee at the moment and he has never been a knee cat. They knew something was wrong…
Because of my “new normal”, there will be no blog next week, so my next missive will be in a fortnight, on the 20th December, the week before Christmas. NCG