Carry on, cardiologist
First it was his bowels, then his heart: Andrew Gimson on the delicate procedures that followed a minor medical scare On a Friday morning earlier this year I kept an appointment with Dr Mark Hamilton, a consultant physician and gastroenterologist at the Royal Free Hospital in Hampstead, to ask him about a bowel complaint.
I was in two minds about whether my symptoms were significant enough to justify taking up Dr Hamilton’s time. It seemed to me that if I went to see him, I might be yielding to hypochondria, but if I did nothing, and I turned out to have the early stages of a still curable cancer, my wife would be furious. She speaks very highly of Dr Hamilton, who has treated her for ulcerative colitis. About a year ago she had a colonoscopy, and I formed the distinct impression that she would not be satisfied until I had undergone the same procedure.
On the way to hospital, I felt a pain in my chest, but attributed this to a rather contemptible anxiety about seeing Dr Hamilton, and decided not to tell him about it. He examined me, and after listening intently to my chest, told me I have a heart murmur. It seemed unreasonable at this point not to tell him about the chest pain, which I had never experienced before. He said he wanted me to have some tests, which could be carried out most quickly in the accident and emergency department.
The cardiologist who saw me in A & E said the first tests were fine, but he wanted to do a second blood test, 12 hours after the pain started, and a stress test on a treadmill which could not be carried out until Monday. I was admitted to Langton Ward on the eighth floor, from whose window I could see about ten minutes’ walk away the tiny street where I live. I felt as if I was in a castle — or a very brutish, unromantic fortress — gazing down at the dwellings of peasants. The staff lent me some orange nylon pyjamas with short sleeves and gave me some wonderfully bad food. For almost the first time in my life, I had the unfamiliar experience of being waited on hand and foot.
At 8.30 that evening Dr Hamilton came to see me, just as he had said he would, and strongly advised me to stay in hospital for the weekend. I had already formed a very high opinion of his judgment, and it seemed to me that it would be grotesquely rude, and also rather imprudent, to reject his advice, so I agreed to stay in. But I said that I really needed to get back to work and would be very grateful if the last tests could be carried out on Monday.
It was fascinating to observe some of the difficulties with which the NHS must contend: not least the difficulty of looking after and investigating people like me, a 46-yearold man who might not be ill at all.
There were four other patients in my room. My neighbour on my right, an Irishman in his sixties, was suffering from acute asthma. He said ‘life would be wonderful’ if he could breathe, but he had been unable to keep off smoking after he was discharged from hospital a few months ago, because every time he went to the pub it seemed unnatural not to have a drink in one hand and a cigarette in the other. The Irishman said the five of us were ‘a good crew’ and remembered with horror the junkie who was in his ward last time, who stole from the other patients, kept them awake all night and was visited by his junkie friends from South End Green, just outside the hospital. The junkie insisted on making jam sandwiches for himself at four in the morning, was filthy dirty and abused the staff, though a Nigerian nurse was fierce with him and got him to have a shower. ‘A nice fellow, but the drugs,’ the Irishman concluded. My neighbour on the other side was an elderly Muslim man, whose food was brought in by his family. I discovered that his father had been killed while serving in the Royal Navy in 1943. The poor fellow coughed and retched dreadfully whenever he went to the lavatory.
At 10.30 that night my wife brought in a bag of the things I needed. I was looking out for her like a child waiting at boarding school for visitors from home.
We were woken at 6.30 the next morning by a nurse who came to take our blood pressure and temperature. Dr Hamilton called on me at 7.45 a.m. and asked if I had had any more symptoms, which I had not. I found myself saying to him, ‘You’re up bright and early’ — a remark which I felt, as soon as I had uttered it, verged on the impertinent. He made some inaudible reply, did not seem offended, and strode off like an energetic landowner to look at another part of his estate.
At 9.30 a.m. I was given an injection in my tummy to thin my blood. The nurse warned me it would hurt, but it stung about as much as a nettle. I had these twice a day, and my blood pressure checked four times a day. Events pressed in rapidly, so that even though the role of patient is largely passive, one felt quite busy, rather as if one were on a cruise with a large number of organised activities, not that I have ever been on a cruise. I slept a lot — I was certainly very tired — but I also read Waugh’s A Handful of Dust for the first time for 25 years, and saw more humanity in it, and much more pain, than I did in my heartless youth. On Saturday and Sunday afternoon my wife and our three small children visited me, and we went to the café downstairs.
On Monday morning the pace quickened. I rose very early and shaved and showered, hoping that my last tests were going to be done. At 9.40, the 81-year-old widower in one of the beds opposite went off for his operation. He smiled bravely as he was wheeled out. I felt as if we were seeing him off to the front.
An altercation took place between the staff nurse and a visitor to my Muslim neighbour. Staff nurse: ‘Hey, you are not supposed to be here. The visiting hours are two till eight [in the afternoon].’ Young man: ‘I’m just bringing him his coffee. I’m drinking my coffee.’ Staff nurse: ‘This is not a coffee shop.’ A woman came by with the menus for the day’s food and sympathised with the Muslim for making his own arrangements: ‘I’d rather eat my own food too.’ The extremely jolly black woman who came in to clean the ward got cross with the Muslim for leaving dried blood on the basin in our lavatory: ‘It’s not nice.’ A few minutes later the cardiologist I saw on Friday swept in and took me off almost at a run. We went down in the lift and he rushed along a corridor, I struggling to keep up in my dressing gown and slippers. I thought it would be rather ridiculous to die of a heart attack while running for a test. The point of this haste was to use the Echo machine before a queue of about 50 out-patients. Grease was put over my chest and the cardiologist rubbed a stubby instrument over me and looked at a screen on which my beating heart could be seen, the valves opening and shutting like frogs’ legs. He said the valves were fine but he could see a bulge in the wall that runs straight down the middle of the heart. He consulted two technicians about whether they thought blood was passing through the bulge.
We proceeded to the stress test. I was wired up for the ECG by a man who first shaved my chest, and I had to walk on the treadmill at three levels of speed, looking at pictures of mountain scenery ‘clad in winter splendour’, while I myself was watched by two rather unprepossessing medical students. The cardiologist expressed great surprise that I had never been on such a machine in a gym, and said the results of the stress test were only moderately satisfactory. He took me back to the Echo machine and with some difficulty inserted a needle into one of my veins. I nearly fainted, and was also sweating profusely, but he said this was a vaso-vagal attack and quite normal. After this he injected dye into me in order to see whether blood was passing through the wall of my heart. It was not, but he thought I might have coronary artery disease, which meant they would have to do an angiogram, which duly happened late that afternoon.
This was by far the most extraordinary test, carried out by a team of about six people. A nurse shaved a small part of my pubic hair and a doctor, chatting merrily the while, inserted a piece of wire into my groin under local anaesthetic and ran it up into my heart, whereupon an image of my arteries appeared on a television screen. They looked like a beautiful river system, great thick channels narrowing to delicate tendrils which flowed away to nothing, and they were completely clear. The doctor advised me to go on drinking whatever I drink.
Some months later Dr Hamilton gave me a colonoscopy and found a small polyp, which he removed. In all I have been looked after by at least 100 people. I am grateful for their prompt and scrupulous investigations, but horrified by the amount of money I must have cost the taxpayer. It does not seem right to me, or remotely sustainable, that all this should be paid for from public funds. I shall have to go on having colonoscopies. My wife is delighted.
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