TEN – Riding the T-wave

“Have the courage to live. Anyone can die” – R Cody

Anyway, that is all a bit deep, I know, so let’s revisit me, as was, waking up in the Accident & Emergency ward at St Helier’s Hospital. A hospital, I might add that was new to me and so supplemented my already significant knowledge of medical facilities across this fair country of ours. In fact, I am thinking of approaching the Tourist Board. Medical tourism might well be the next big thing. Look out for my guidebook – coming soon to a hostel near you. Walks across the Pennines and where to stay in Aberdovey will pale into insignificance. Even Countryside Walks in London will seem mundane.

But, back to the nitty-gritty (such a lovely hybrid of a word). And so it was, as I awoke, a moment of ignorance, bliss almost, and then reality flooding back in. Cricket whites, the belting sun, a pounding chest and Fido on the boundary. The now depressingly familiar beat of a heart monitor told me that I was back in the land of the white coats. There was an oxygen mask covering my mouth and as I reached up to remove it I felt a sharp pain in my arm. A drip tied me to the bed. (Prior to my time in hospital, a drip had been nothing more than the nerd who sat at the front of the class and volunteered for anything and everything; and normally got it, initially from the teacher but later from the rest of us at break-time – oh happy days, where the head-boy was born in the same macabre image of the headmaster and systematic persecution of the vulnerable may as well have been on the curriculum – spot the public school boy. OK, ok, I was the drip!

Anyway, reverting to the story – I dropped my hand and looked around. Though I had never been in this room before, the surroundings were very familiar, bed, blanket, curtain, chair, even the beeping of the heart monitor in the background. Cardiac Rehab if I was not very much mistaken!

This background beeping, though familiar, had an unfamiliarity about it that puzzled me for a moment. Then it struck me, it was beeping far too fast. I looked up at the flashing number at the corner of the screen … 130… 129… 131… This was very nearly twice its usual rate! Immediately I checked my pulse… much faster than it should have been. Something very serious must have happened for my heart to be this distressed. Further memories of the cricket match came back to me, although at this time I was unaware of the full course of events (though this didn’t mean that they didn’t happen!).

The first doctor I saw after my re-awakening was a junior one who spent most of her time asking questions about the defibrillator in my abdomen rather than my underlying medical condition. How big is it? How does it work? What does it feel like when it shocks you? Can you feel it? Where does it go for its holidays? I felt like the bearded lady or the boy with three nipples. I guess in 1993 implanted defibrillators were front-page news. Front-page medical news, in any event. Doubtless, 99.999% of the world had no idea that there were people walking around with their own electricity generating systems implanted in their stomachs.

Once the doctor had exhausted the defibrillator subject, I was expecting her to move on to the question of my medical condition. But no, there was clearly something else troubling her. What could it be? You could have knocked me down with a feather when she finally asked me. There was a lot of umming and aahhing but finally she got it out, (a small proportion of you, readers, will snigger at this point – these will be the prep school boys among you – no girls will snigger, no matter what their educational background).

“Tell me, why were you wearing two pairs of underpants?”

For a moment I was silent. I had completely forgotten about the two pairs of underpants. I was tempted to spin her a yarn about it being a mason or a public school thing but I didn’t have the energy or, to be frank, the imagination to carry it off, so I stuck with the truth. I was a pervert! No, seriously, the reason I was wearing two pairs of underpants will be obvious to any cricket players out there. It is all to do with the modern day cricket box. In order for it to function effectively and offer the apposite protection it must maintain a cosy, tight fit. Clearly, if it is only loosely fitting it would not only be less than satisfactory but also potentially dangerous. A loose box may of itself crush that which it is designed to protect. Many years ago, boxes came with straps that kept the box in position. Nowadays they tend to stand alone. Therefore, they need something to hold them in place. What better than two pairs of underpants? The box is simply slotted between the two and, hey presto, it sits neatly in loco.

The non-cricketers among you will no doubt hold that one pair of underpants is surely just as effective as two. The box can simply be slotted au naturel as it were, between the naked groin area and the one pair of underpants, with the latter keeping it in a nice tight position. But, and it is a big BUT, you have to remember that these boxes are shared between team-mates. Therefore, any extended period of box-wearing tends to result in the area becoming increasingly sweaty. There is nothing worse than going in to bat and being handed a sweaty box. These will often also be hairy. Hence the two pairs of underpants, hygienic as well as safe! End of mystery.

[Note – even if you have your own box, there will always be one chap wandering around trying to borrow one – in a team game, how can you say no! Inevitably, he will bat before you.]

The hairs, by the way, will always be curly.

It was well over twenty-four hours before I met my old friend Sinus Rhythm again. Until then, my heart continued to beat at an abnormally fast rate. I stared at the monitor, hour after hour, willing it to come down. But a watched kettle never boils and it was whilst I was asleep that Sinus finally slipped back into my life. I can’t tell you how relieved I was when the first thing I saw upon awakening was the little number 72 flashing comfortingly on the monitor above my bed.

For those of you who take your heartbeat for granted, here is a little bit of medical gobbledegook to get your head around. If you’re not interested, skip it:

In a normal heart rhythm, the sinus node generates an electrical impulse which travels through the right and left atrial muscles producing electrical changes which is represented on the electrocardiogram (ECG) by the p-wave. (The atrial muscles are the top two chambers in the heart). The electrical impulse then continues to travel through specialized tissue known as the atrioventricular node, which conducts electricity at a slower pace. This will create a pause (PR interval) before the ventricles are stimulated. (The ventricles are the lower two chambers of the heart) This pause is helpful since it allows blood to be emptied into the ventricles from the atria prior to ventricular contraction to propel blood out into the body. The ventricular contraction is represented electrically on the ECG by the QRS complex of waves. This is followed by the T-wave which represents the electrical changes in the ventricles as they are relaxing. The cardiac cycle after a short pause repeats itself, and so on.

Therefore, on an ECG in normal sinus rhythm p-waves are followed after a brief pause by a QRS complex, then a T-wave. Note the T-wave – that’s when you can motion good-bye to your cup of tea in hospital because the tea lady always comes round when you are away from your bed.

Normal sinus rhythm not only indicates that the rhythm is normally generated by the sinus node and travelling in a normal fashion in the heart, but also that the heart rate, i.e. the rate at which the sinus node is generating impulses is within normal limits. There is no one normal heart rate, but this varies by age. It is normal for a newborn to have a heart rate up to 150 beats per minute, while a child of five years of age may have a heart rate of 100 beats per minute. The adult’s heart rate is even slower at about 60-80 beats per minute.

Got that! This is what the white coats are talking about at the end of your bed when they stand huddled over your ECG. Now you can join in and stun them with your knowledge of the T-wave and the QRS complex. Crackanory on steroids.

Which takes me on to the big joke of the time. Shortly after old Sinus and I had become re-acquainted I was visited by my erstwhile cricket companions. These were the group who had suffered every moment of my agonising death. As they trooped into the ward, they couldn’t get the obviously scripted first question out quick enough.

“How did you feel when you woke up?” They were torn between being on their best behaviour and the joke that so obviously existed between them.

“Fine.” I realised immediately that there was more to this question than met the eye. It was so oddly phrased.

They said nothing, so I asked the obvious question, “why?”

“You didn’t have a head-ache or anything,” they continued, exchanging mischievous glances.

“No-o-o,” I answered wondering what they were talking about.

At this they burst into giggles like naughty schoolboys, “or a hang-over,” they continued.

“No-o-o.”

“Your lips didn’t taste funny?”

“No-o-o,” I repeated. Doubtless they would tell me what this all meant in their own time.

Eventually they let me in on the secret. After my heart had stopped and before the ambulance arrived there was much consternation as to what should be done. As you will recall, I received the kiss of life from an ex-employee called Dave, (I am ashamed to say I cannot remember his surname, though I do remember he worked in the mechanical workshop), who was trained in first aid and gave me artificial resuscitation including the kiss of life. He had recently left the company under its recent redundancy programme, (a programme, by the way, that to my shame I was instrumental in putting together). He was an alcoholic and used to return to work in the afternoons somewhat lathered up. Needless to say, a mechanical workshop was not the best place for someone in that condition. He was put on the redundancy list and his employment terminated as such because of this drink problem. In fact, redundancy had nothing to do with it. Like many other companies, it was standard practice to use redundancy as a cheap way to clear the dead wood, (there is an irony in this that I may or may not mention later). Meanwhile, Dave’s appearance in the cricket match was as a ‘guest’. Anyway, the joke was that a couple of kisses from Dave would have been enough to make even the most resilient drinker incapable of navigating the length of any white line. Hence, the questions about waking up with a head-ache or a hang-over.

I never saw Dave again and I have no idea what he is doing now. I didn’t look him up after I returned to work because I was too involved in the recovery process. What a feeble excuse that sounds as I commit it to paper. Dave, if you’re reading this, many thanks. It is possible that your quick thinking and expertise helped to save my life or at least my brain function, (to any others who know me – on this latter point, no correspondence, please).

Another thank you also to Doctor Peter Safar, who is credited with the rediscovery of mouth to mouth resuscitation in the 1950’s. Prior to his work, the many different remedies used to resuscitate people sound like something out of Hieronymous Bosch. These included using hot ashes to shock the body back to life, flagellation, rolling victims down a hill in a barrel and tying them to a trotting horse. All things considered, without Dr Safar, I wouldn’t have given much for my chances. Though it might have been a bit more fun.

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