Another Perspective
The following information is provided by my partner and my sons who were all involved.
David got up - about 2 am, came back to bed with the smell of a cigarette lingering. I don’t like him smoking but nothing I could say was going to persuade him to stop. I knew it was going to be a health scare that would do that. I didn’t know what or when but I was certain something would happen. And then it did.
I dozed off and woke again - something was not right. David was stood up looking out of the window. When I asked what was wrong he said he felt odd and sick. I mentally checked off what we had eaten that day, eliminated the risk of it being food related and thought of what else could be going on. He then came around the bed sat down and I could feel he was cool and sweaty. Before I had a chance to ask he said ‘ my chest doesn’t hurt - but it feels odd - and my neck is achy’
I started to suspect heart and was about to dial 111, then thought nope - this needs an ambulance . As I was dialling 999 David laid back on the bed and said his ears were ringing. I wasn’t hearing or seeing the typical symptoms but I did know that this was a heart attack due to the neck ache and the sweating. The call handler was asking questions - asking if he was conscious. I said ‘ not fully’ as I hoped this would speed up the response time. He opened one eye and said loud enough for the call handler to hear ‘ I am fully conscious’ . I think I mouthed ‘shut up’ to him.
Being an optimist I put the cat in the bathroom and went downstairs to usher the ambulance crew in. Obviously they were not in sight. I went back up to David. Amused to see he had put underpants on - mid heart attack and modesty prevails.
What I should have done was found the aspirin he had in his draw downstairs and given him 300 mg. I forgot this important part of my ILS training from a couple of years ago.
My son Francis was asleep down stairs - he woke and I told him what was happening. He remained calm but wide eyed and a bit shocked.
Just before the crew arrived David said - ‘it’s stopped - I’m ok’. Bugger I thought. He might refuse to go to hospital.
The crew did checks - all ok. ECG was a bit off though, the QT interval was long but it wasn’t a dramatic anomaly. It was up to him if he wanted to go to hospital. I asked about the blood test for heart attack. They said it would be a good idea to get bloods done tonight as the only way of knowing if it was a heart attack was to get bloods within a couple of hours. They definitely were not going to push him into going with them, and were very relaxed about it. I was 100 % sure it was a heart attack and was caused by a clot that had shifted. I could see David was shaken but a bit confused by the lack of urgency. I pulled the ‘what would your boys say ‘ card. It worked . Off he goes agreeing he had to get things checked out. I packed a bag and snacks. He had a fag and off he goes. I’m thinking - they will give him meds and send him home in a day or two. We exchanged a few messages and I fell asleep.
David wasn’t coming home in a couple of days. The blood test he had after arriving at Poole hospital showed he had a heart attack and he was staying in for an angiogram and possibly a stent. He has to be transferred for the angiogram to Bournemouth. David had already told his sons what was going on so I also contacted them and his daughter in law just to let them know how he was that night, that he was calm when it was happening and no huge drama or pain. I was on a weeks leave from work so was ok for the visits and running around.
During Covid each hospital has its own protocol. In Poole, David had named me as his nominated visitor for what he thought was that day. However only one visitor could be nominated so that meant his son couldn’t visit while he was at Poole as he couldn’t nominate anyone else. I did feel bad about this but there was nothing I could do about it. I did daily trips from my home in Gillingham to Davids house to sort out his Kitten Poppie, then to the hospital. The visiting slot had to be booked in advance so I didn’t know day to day when I could see him.
I took in earphones for his phone, a book and cross words, comfortable loose fitting clothes and underwear, collected laundry and spent my hour visit perched on the bed next to David talking about him getting better and plans for the future. At this point I had my ‘professional head’ on and was convinced he would have an angiogram and stent and be back home. Perhaps a few days recuperation at my house. He was on blood thinners so I knew the risk of another heart attack was reduced but not eliminated but he was on an acute coronary care ward so was safe.
I could see the staffing ratio was good. The atmosphere was calm and staff were busy but not rushed. However when two then three days went by and no transfer was organised I got worried He was in a queue and although he was for urgent transfer - he wasn’t an emergency as he was stable.
I had spoken to Davids manager at work to ensure he was up to speed with his situation and to his oldest son -he works in medical insurance so is well connected and very knowledgeable. I started to get concerned that he was waiting for so long for the angiogram. His son too was worried. Just as we were at the point of upping our concerns and turning into ‘Karen’s, we were advised he was to be moved to Bournemouth for the Angiogram.
Now his son had a chance to visit as it wasn’t a single nominated person - it could be anyone visiting but for just the one hour pre booked slot. I picked up Mike and went to his new ward in Bournemouth. Mike went in to see him for half and hour then I went. We shouldn’t have done this as it was only one visitor a day - but at the time we weren’t clear about the visitors criteria.
Again the ward was pleasant. Staff were busy but not stressed very approachable and the atmosphere was calm.
Not long after I left David that first evening in Bournemouth hospital he had an episode of feeling sweaty and odd. His blood taken the next day and showed increased cardiac markers. That was another heart attack so now he was on bed rest. He couldn’t have the angiogram until he was stable again. I think looking back he missed his injection in the transfer - an anticoagulant given once daily via a subcut injection. Possibly it was stopped pre angiogram - but may of been missed by the meds nurse by accident. It shouldn’t happen but does.
Now he had to wait until cardiac markers or Troponin were down before his angiogram. This indicated to me just how critical his situation was. Looking back I can see symptoms of heart disease that I had overlooked due to his heavy smoking. Tiredness - he was always tired, yet his sleep was poor and not restorative. Davids naturally energetic personality and drive compensated for this. He pushed through his tiredness every day at work and at home. Ringing in his ears - that has been more recent. This was probably lack of oxygen. I thought it was tinnitus caused by lingering cold symptoms. Most obvious was clubbing of his finger nails - rounded nails. I asked him the very first time we met how long they had been like that and he seemed to think ‘always’. This is a classic symptom of respiratory or heart disease. He looked so well I decided it was down to him being a premature birth - undeveloped lungs perhaps caused it as a childhood feature although he evolved into a strong and fit adult.
I love walking so I often take David up a hill or to a woodland walk. No phone signal or nearby roads. I thought him being out of breath on exertion was his smoking. It was in fact due to critical narrowing of the arteries. My healthy uphill walks could have killed him. A heart attack miles from a road and no phone signal could have been fatal. To be fair to myself - I am a Mental Health Nurse, not a general nurse. I routinely looked at his resting respiratory rate -generally it was ok. His BP too was better than mine. Resting pulse was always ok too. David has in the past been extremely fit. That very strong heart muscle must have compensated for his very clogged up arteries in some way.
I was still certain he would have a stent and be home soon after - and I was wrong.
The day David was transferred to Bournemouth he was also due for the angiogram and stent procedure in the afternoon. I was confident that it would be a routine procedure and he would probably be home in a couple of days. To hear from him later that day - that the angiogram failed and he was having a bypass graft came as a blow. I didn’t expect that. I messaged David expressing my full confidence that all was going to be well. These operations are successful. I also flicked a mental switch, I’ve turned off my inquisitive and probing forensic nurse head and just accepted he’s having a big operation - I know nothing about the risks or prognosis and it’s pointless me knowing as the matter is out of my control and influence.
I was back to work that week - so I needed to focus. I made my manager aware of what was going on and it was agreed I could work from home and have some flexibility if I needed to go and visit him. In retrospect I should have taken time off work, I do a challenging job and a couple of people on my caseload were very unwell and risky, my colleagues were unwilling to step in and take the pressure, possibly as their own clients were dysregulated and risky due to the Covid effect on mental health. For me it would have been better to focus on Davids and my own well-being. I felt very compromised and looking back, very stressed. Lesson learned is family before work. I should have taken a few days off.
My next visit to David revealed he was to have a double bypass possibly a triple. I was able to accept this without too much trouble and remain calm and supportive to David as I was totally certain he was going to be ok.
His elder son however - works in medical insurance. He knew exactly what the deal was and had decided to manage that information by keeping it from me or his dad and I appreciate him doing that. I would have struggled knowing that the grafting the left descending arteries was more complex and a longer procedure - riskier overall. He also knows about the mechanics of the procedure, breaking through the strernum and going on to a heart and lung bypass apparatus. It’s a brutal procedure. I couldn’t even start to think about it.
Davids brother and I had been in touch - and with the prospect of David having open heart surgery Mike really wanted to see him. We organised things so David was expecting me and his brother turned up instead. It was a lovely surprise for him. Just in time as he was due to transfer to a Southampton for the op that same day.
The ward Nurses realising that I had given up the one visiting slot allowed a second visit. That was so important for both of us just to see each other as it was going to be a strict no visitors at Southampton. Now at this stage David asked me to take his stash of snacks away. So far the food has been good. He should have kept them as the food at Southampton was absolutely and totally shite. Lesson learned is keep hold of snacks.
I called David a few hours after transfer to Southampton. The admission protocols went ok - David and I exchanged a few messages. The phlebotomist who fitted his cannula was transgender and deaf plus had an assistance dog. She came back three or four time to check this and that. LOTS of eye contact and over interest. David didn’t know whether to be afraid or amused and flattered - I think fear prevailed. I thought it was hilarious.
The ward sounded unbearably noisy when I phoned - monitors bleeping non stop, busy and stressful. He had missed his evening meal and no-one had ordered for him so he had to ask for food to be provided. While I was speaking to him I heard a nurse asking what medication he was due - she couldn’t find his meds card so was asking him. I had a mini meltdown on hearing this - surely she wasn’t going to dish out meds based on what the patient was having to remember.
I was furious and David was upset and made this clear "what the f**k are you asking me for ... you shouldn't have to ask me that " I then heard her placating him and apologising. I debated phoning the ward and asking them what was going on, then held off. If they were busy and under stress, me phoning would not help. I know from experience that someone can nip off with a meds card to fax it to pharmacy to order meds just as you need it. But never ever would I let on to the patient or ask them what they were on. You hunt down the card. I had to calm down and think about what I wanted - and that was for him to get through the op safely. It was scheduled for the next day after that he was going to be in HDU and the care would be good there.
I called David later. He’s had his meds but needed to prompt staff to re-attach him to the monitoring equipment. That too had been overlooked. Thinking back to my days on ward work. That sort of shit -show is not about over work or unexpected issues - it’s down to poor management. Another ward that is well led can function with the same pressure and not exude stress and poor practice. I was wasting my time complaining about what had happened. What was important was the post op care. I called Davids elder son the following morning - his younger son was still waiting for a flight home from Saudi Arabia so I wouldn’t flag these issues with him when he was so far away. Mike and I agreed that he would be the single point of contact for the hospital and he would keep me informed as well as his immediate family. I explained my concerns about the admitting ward and he relayed that to the medic and nursing staff and made it clear the post op he was not to go back there.
The next day was his op. I had agreed with my manager that I would work from home and catch up with admin. I spoke to David in the morning - I felt calm and positive and told him he would be home in a week.
Once he went down to be prepped and sedated Mike took over liaison with theatre and recovery staff. He kept me posted every hour or two. All the feedback was positive - everything went to plan. I knew the operation was highly invasive and quite brutal. The sternum is separated - heart and lung put on bypass apparatus - as the heart is stopped. It’s shocked back into life after the grafting. I blanked all this out as best I could. Halfway through the afternoon I had a call from the duty nurse at work. One of my caseload was suicidal - she had been seen by the Dr and had to be referred to another team for more intensive support. I explained to my colleague why I was working from home and that I was in no position to deal with a transfer of care. She refused to deal with this or acknowledge my position. I debated calling my manager - but reflected on the scenario and considered the possibility that the duty nurse may have another urgent matter to deal with and was not coping and just not thinking. I called the relevant team - was met with an obstructive jobsworth - lost my rag and made my thoughts known regards the lack of interagency cooperation and terminated the call. Fortunately the team consultant got wind of that shenanigans and phoned me to say he would deal with the referral and not to give it any more thought.
Lesson learned - I should have had a day off work under the circumstances.
Later in the afternoon I had a moment of panic - fear that something was going wrong with Davids op. I pulled myself together by using the techniques I teach my patients to manage distress and intrusive thoughts and fears. I visualised David coming through the front door in one week and then us doing a coastal walk next spring - focused on the rational and logical appraisal of how fit and young he relatively was to most people having this op and the fact that Southampton is a centre of excellence for the op. That with mindful breathing and some EMDR techniques squashed the fear and set me back to normal.
Mike called to say he was out of theatre and the whole thing went absolutely fine. David would remain under for several hours. We could relax and wait until he comes round knowing he was doing well.