Interview HA02

Age at interview: 54

Age at diagnosis: 54

Brief Outline: Heart attack, 2003. Thrombolytic (clotbuster) drug, six days in hospital. Current medication' aspirin, atenolol, ramipril, simvastatin, GTN

Background: Senior Manager, Local Government; Married, 3 children

He felt he had to get on and do things, but watch out for signs that he was doing too much.

But I suppose the important thing in terms of recovery I think is not to do ridiculous things, but also I think not to be over cautious and over worried because you know. I mean the reality is that if you are too cautious and over protect yourself you're actually counterproductive. That the things you need to do are actually to lead a normal life, to exercise. That mollycoddling is not the answer.

You know, you shouldn't be doing weight lifting for example because that's, that's going to really mess you up. But I can understand possibly why some people are scared and frightened of trying out things. And the day that we came out of hospital, we went for a walk in a local arboretum. 

And for the first mile or half mile or so I was thinking am I feeling anything and the reality is you're not. I mean that you have to be monitoring if you know, you don't do things that feel wrong. But I think that the other thing is that you can't spend your life protecting yourself from things that you have to do as being part of your ordinary life.

Talks about the "treadmill" test.

I wasn't given the modified exercise test, which is basically a very simple treadmill exercise. And the reason that I wasn't was because there was some irregularity on my ECG. It wouldn't actually show that up. I was worried then that I would be somehow in this catch 22 where because I couldn't have the exercise, I couldn't go home. But the cardiologists felt that there was no reason for that, and indeed, I'm now scheduled to have a full exercise test in a few weeks time. 

I mean, I think the point about the modified exercise test is that it really is a fairly fundamental low energy walking exercise and I suppose it was perfectly obvious that I was able to do that. I think the full exercise test is more challenging. And it gives more of an opportunity through the ECG, as I understand it, to get a much clearer picture of what's going on in your heart.

He felt calm and reassured by the nursing staff, the high-tech equipment and by his prompt treatment.

I wasn't at that point sure whether I was likely to have another one. And you know and what, and you know, I was fairly sure if I was to have another one then that was likely to have very serious consequences. But I was calm and whether that calmness was just, came from within me or was also to do with the sort regime and indeed things like diamorphine, I don't know.

And I think it's, I mean my, the bleakest part was when I was on the bed by myself and nothing was happening but that was a fairly sort of narrow window of time really.

So that having received that sort of emergency treatment, I was then taken through to the cardiac care unit which I, actually was next door to the place that I'd been receiving treatment in Accident and Emergency. And I mean that was a very, again a very reassuring experience. It was impressively hi-tech if you see what I mean; there were lots of, lots of things happening.

Very impressive nurse managed regime. Very impressive sharing of information from the very, you know, explaining everything from the very outset. And obviously, and I suppose the reassurance of being in a cardiac care unit of that sort, apart from the fact that I had a sort of a residual memory that the two most important survival factors were, speedy intervention and post-intervention treatment within a cardiac care unit, they were more likely to result in positive outcomes.
 

Describes the monitoring and interventions during the first few hours in the coronary care unit.

I mean just the unit itself, just gave an impression that this, that you were, that contingencies were there to be dealt with, you know. I mean it's rather a sort of intimidating number of things attached to you. 

And I'm someone that, you know, hadn't been near a hospital for, I mean the last time I'd received any real hospital treatment was for something like an appendix and you know, when I was about five, so maybe nearly fifty years ago.

So lots of high-tech interventions you know. I was attached to an ECG machine that was permanently operating, a blood pressure machine that kicked in every fifteen minutes. I had an oxygen mask on. I had a drip into my vein which was producing, which was providing long-term the drug which is, they called the clot buster. 

So I had lots of different things wired up to me but apart from that I felt okay. And you know, I mean, I was aware that I was going to be in this situation for quite sometime, i.e. monitored.

The monitors and wires attached to him were gradually removed after the first two days in the coronary care unit.

It was really just a question of waiting until such time as I was given greater freedom to move because I mean, I think I was very conscious of being very restricted. And that first night, the idea that one could sleep while having (a) all these things attached to one and also the machine that every fifteen minutes sort of pumped up, you know. So I didn't really get any sleep that first night. And also there was a lot of sounds of other people, some people in distress, lots of things going on.

So, but I remember actually being, what I really wanted to do more than anything else was just to be able to, you know, walk to the loo and walk to the shower and I wasn't allowed to do that for two days really. But for the first two days I was immobilised. There was a gradual loosening, if you like, of the frequency of the monitoring. 

As you know, the first positive stages when the mask came off, and I just had little tubes put in, and then really positive was when I didn't have any oxygen at all. And it was just, you know, that when the blood pressure monitors came off, and they were just looking at my blood pressure every few hours rather than constantly. But, you know, I was able to receive visitors, I could read, talk, do all those sort of things.  
 

He felt so well when he came home that he had to be careful not to do too much.

I mean the book suggests, there's a book that we're given, suggests that you may feel let down when you move into the medical ward, and you may also feel insecure when you come home, and neither of those things have happened to me. And indeed since I've been home, I've, although my wife who was off for the first ten days, was at great pains to restrict my movements, I've felt actually, I felt as though I was able to do more than I have been doing, but at the same time not to over exaggerate it.

Although at any one moment you feel as though, well I could just be living normally. I had noticed that you know I've, I've had a need to rest. Just you know, not for very long but I sort of, I need half an hour's rest if I've been doing something in the morning and maybe half an hour in the early evening. 

So it is my body's way of saying you know, take it a bit easy. But you know, what I've been encouraged to do is to build up the amount of, well, aerobic exercise, meaning at this stage I think, just sort of good, good walking. And to build it up so that I, within a couple of weeks will get up to about five times a week of half an hour which I mean it's. So it's actually quite useful being off to sort of to do that. So I've certainly been walking about an hour a day.

And of course the other thing that I have to avoid is upper body exercise, lifting things. And that's, that comes home to you, even just if you lift something relatively small. I think you're aware of it. But that again is something you have to sort of be quite disciplined about. Because if you feel fine it's very easy to think oh I'll just move this sofa or something, you know, and particularly if you're at home and you're not normally at home.

He was concerned at first but making love with his wife became very important after facing a near death experience.

I did have a conversation with my wife about it and there was this rather funny thing in, I don't know whether it was, yeah it's in one of the booklets that you get about rehabilitation where it says 'if you're able to go up two flights of stairs, you're able to make love' which I think was quite amusing, because it rather puts into perspective this activity. 

I think that I can understand a concern about sex but actually what happened, it's interesting that what happened when I came out of hospital very closely mirrored what happened when my wife was diagnosed with cancer. And I think this is a fairly common, I mean, I gather it's a fairly common psychological consequence is that rather than turning away, one's, suddenly sex, sexual contact became very important. 

And in fact, since I've come out of hospital, I've had rather considerably more sexual activity than I would normally have had. I'm someone who's been married seventeen years etc., you know. But I think that's partially the closeness thing, and it's partially you know, I think it is that thing about death, having the proximity to death, having that effect, I gather it's a sort of fairly common psychological effect.

What that did though of course, what it has done is quite helpfully, at least at this stage - suggested that I'm not having that side effect, but of course I'm aware that, I mean, there may be an accumulative effect. But the first time that we made love I was aware, you know, I was conscious of 'oh my God you know', but that's about the only time I've thought that. But of course it's actually rather ridiculous because one's doing a lot of other things like going, running up stairs etc.
 

Explains what he was told and why he agreed to have the thrombolysis (clotbuster drug).

I was then ushered into a cubicle. There was a consultant immediately present, as well as nurses. A lot of things then happened very quickly. But one of the things that needed to happen I think, was for the consultant to explain (a) what had happened to me but (b) what was required. 

When he said I was having a heart attack, that the next few hours were crucial and what was really important, if possible, was to try and attack the clot that would be in my, the part of the heart that the clot would be in. I'm not physiologically terribly well tuned I'm afraid. 

He explained, I mean I was very impressed actually because he squatted down and spoke to me at my level. He explained that there were risks attached to this process, which I think is called thrombolysis. There was a one percent risk of spontaneous bleeding, which I said is hardly, that I'm not really concerned about that. 

He said there was also a one percent risk of stroke. But he obviously pointed out the risks of not taking this treatment were much more significant. And that if it could be effective early enough, it could minimise the long term damage to my heart muscle. So I clearly was happy to agree.

He plans to reduce his out of work commitments so that he can spend time at home relaxing.

I mean we're both very busy but I did all the cooking, and ironing and those domestic tasks. And I suppose I was, characteristically I'd work, come home, do those sort of things and then probably not really actually relax until about ten o'clock. I've been forbidden from doing those sort of things and my wife who hadn't really cooked for about sixteen years, has started cooking, assisted by my son. 

My son's started doing the ironing. I mean these are only probably temporary but I think what it will probably do is reduce the, I mean both of us are probably going to strip off some of the, as well as being very busy at work, we also have quite a lot of other committees and school governorships and those sort of things.  

This sort of brings you up with a shock about what's important so I think both of us, well I am going divest myself of a chair of governors that I am at a school. My wife's taken six months leave of a voluntary organisation with the homeless that she does quite a lot with. And I think generally we'll probably try and make some adjustments to lifestyle that way. 

And I've set my, it's been really nice, if unusual to, I normally read lots of books on holiday and don't get much of a chance to do that when I'm not on holiday. But I've been reading a lot obviously since I came out of hospital and indeed when I was in hospital. But I'm going to set myself a sort of project of probably trying to make sure I read a book a week, because to do that will involve carving space to do so. 

He made an effort to avoid losing his temper with his children, not wanting them to remember him like that.

The other side of that of course is, you know, you can't have a brush with mortality like that without it having some effect. I mean, I mean I was always reasonable, I mean I wasn't one of these people that just assumed that I was going to go on forever really, but you know, I think you know one has to make sort of plans in a different way.

And therefore, and I suppose something that's really, you know I'm by no means an ogre but something that struck me which is again a bit of a clich' that you really wouldn't want your child's last experience of you being when you were irritable and snappy or whatever you know. 

And sometimes getting kids to school you know, I can be irritable. So something I'm very consciously doing now and I hope will continue to do, is be much more careful about those sort of minor irritations. And also being much, well I mean I think I was quite expressive anyway but I mean it's really quite important to express very positively you know, your feelings about people. 

Because, I don't know, it would just be so awful to, had I, you know because in fact actually we had a bit of a, I had a bit of a go at my daughter because she didn't want to go to school. And she was, well she didn't not want to go to school she was just, was doing the irritating thing and kept changing what she wanted to wear and things. And it just struck me as being awful if that was her last experience of me. So I'm trying to be a nicer person.