My next memorable story:-
I had only been working in General Practise for a few weeks and was well aware that patients I saw were either new patients or those who could not get an appointment with their usual doctor and reluctantly were willing to consult with the ‘new’ doctor.
As I was the doctor on call for home visits that day I remember being asked to go out on an emergency call to a patient with chest pain.
I arrived at a block of flats and made my way to the second floor and after knocking the door a distant,weak, breathless voice requested that I should enter. There was Mrs. Evans sitting in a chair, breathless clutching her chest and a look of great dismay at seeing a strange doctor arrive ( patients at that time were used to seeing ‘their doctor’ call at any time of day or night and wanted an explanation as to why a strange doctor was present) I immediately apologised and gave a feeble excuse as to why Dr Llewellyn was not available. It was immediately evident that she needed urgent hospital admission. After a brief explanation of my concern I asked to use her telephone (mobile phones did not exist) as I wanted to call an ambulance. I had read her notes prior to the visit and after arriving took a brief recent history of her current problem. I was aware she had a pacemaker fitted and she had had heart problems and that day had felt very weak, dizzy and tired. Before I had chance to fully examine her she suddenly arched her back gasping and at the same time exclaiming, “I want to change my will, I want to change my will,” and then slumped back in the chair lifeless. I gently pulled her to the floor and started cardiac massage and within the next minute or so the ambulance-men arrived with oxygen and ambu-bag.
She became vaguely conscious and she was carried by stretcher to the ambulance. Her pulse remained very slow and I assumed her pacemaker was failing and she needed to go to Cardiff which was about 20 miles away, as the local hospital would not be able to replace the pacemaker. In those days ambulances were minimally equipped and ambulance-men had very limited first aid training so they relied on the GP to advise the best course of action. Having recently worked on a busy general medical ward I was well versed at stabilising patients before transfer to a specialist unit. Hence, I directed the ambulance to the local cottage hospital and there I put up an intravenous infusion with isoprenaline to maintain the heart rate until the patient reached Cardiff. Giving the accompanying experienced nurse appropriate instructions the ambulance sped off in haste along narrow roads to its destination. In due course Mrs.Evans was fitted with a new pacemaker and discharged after 10 days.
The day after her discharge I was sitting in my consulting room in earshot of reception when I heard a bold voice exclaim, “I would like to see a doctor but please don’t let me see that dreadful doctor that thumped me on the chest and took me to the wrong hospital. I am lucky to be alive!”
Mrs.Evans had had a pacemaker fitted to treat third degree heart block which is a problem that occurs with the heart’s electrical system. This system controls the rate and rhythm of heartbeats. (“Rate” refers to the number of times your heart beats per minute. “Rhythm” refers to the pattern of regular or irregular pulses produced as the heart beats.)
With each heartbeat, an electrical signal spreads across the heart from the upper to the lower chambers. As it travels, the signal causes the heart to contract and pump blood.
Heart block occurs if the electrical signal is slowed or disrupted as it moves through the heart.
Third-degree heart block limits the heart’s ability to pump blood to the rest of the body. This type of heart block may cause fatigue (tiredness), dizziness, and fainting. Third-degree heart block requires prompt treatment because it can be fatal.
I would like to think that I had saved her life but the patient never recognised that. But as a wise old GP told me, “Never expect to be thanked when you think you deserve it but accept the thanks with grace when you think you don’t deserve it!”