The patient is perplexed. “I play football twice a week, I go to the gym, I have low cholesterol, no diabetes – you tell me why I had a heart attack?”
He is lying on a bed waiting to go into one of the ‘cath labs’ – short for catheter laboratories – at Harefield. We are talking just before his procedure starts.
He is in his fifties and, to my eyes, appears well. Except he is not. Two months ago getting ready for work one morning, he had pain across his chest and in his arms. His son said: “ring the hospital”. He was having a heart attack, was rushed to Harefield and, in these very same cath labs, had a stent fitted to open up his coronary artery and get the blood flowing again.
I look at his wrist and see a tiny, faint mark, like a freckle. This is how they fitted the stent and is what I am interested in today. I want to see how what used to be a major operation on the heart can now be carried out through a catheter – a small tube – meaning the only impact on the fully-conscious patient is a tiny, 2mm hole in the skin.
There are four cath labs at Harefield, run with tight, minute-to-minute efficiency which, when you consider their cost and that they have learnt from places like the airline industry and Formula 1, is perhaps not surprising. They are also stuffed with high end equipment. The newest cost £2.5 million to refurbish and more than a fifth of that went on technology.
If you want to carry out procedures deep inside the body, you need to be able to see what you are doing and so the ‘angiogram’ – essentially a live x-ray of the heart – is now a standard procedure. Typically, the heart and its key vessels are highlighted with a liquid opaque to x-rays that is injected via a catheter and then studied with an imaging detector – one of those large, circular arms that loom over the patient trolley. There are stacks of what look like high powered computers all around the room, and banks of large, ultra high definition flat screens.
Today’s patient is in for a check-up, to see how, two months on, the stent is working. After final checks, he is ready to have some mild sedation and a local anaesthetic. He may only be having a small cut in his wrist, but it still hurts and of course, as the tiny tube is fed through his arm all the way into the chest cavity, he feels it.
I count seven staff in the room – the consultant who is leading the whole procedure, the registrar, a cardiac physiologist, a radiographer, two nurses, and a student who is here to watch and learn. It is a relatively safe, minor procedure, but that safety and success still depends on a highly expert, well-coordinated, team who all know exactly what they are doing.
All of us are ‘leaded’ – that is, wearing thick, heavy lead-filled padding around our chests, waists, and necks, to stop damage from stray x-rays. The whole kit weighs about 30lbs and is a relief to take off after only an hour. I can only imagine what it is like wearing it all day.
I notice the consultant talking to the patient all the way through, telling him what he is doing, monitoring any discomfort, dispelling anxiety. A big advantage of cath lab ‘keyhole’ surgery. It is all rather extraordinary, watching a video of this man’s heart and its vessels, a tube being curled around it, and wires and devices then being fed into this very live, pumping, vital organ, as he speaks to his consultant.
No wonder that more and more procedures are being developed for the cath lab, as against a regular operating theatre, which by contrast is kitted out to handle any kind of major surgical intervention. The advantages of not needing to make major incisions or openings in the body, as well as being able to keep the patient conscious, are obvious.
Today it turns out the stent has done well, but there are other vessels which also need unclogging from the same blockage that caused the heart attack. The consultant decides to use a well-known device with a tiny balloon that is inflated once in position, thus opening up the vessel. I watch all this going through the patient’s arm as he complains of a little pain and the consultant reassures him: “That will wear off pretty quickly – you’ve done so well.”
Suddenly it’s all over. The procedure is a success and has lasted 45 minutes. I am struck by the ‘buzz’ among the team. The consultant tells me: “This is what years of training are all about,” while his colleague the radiographer says: “I’m proud of what we do and just really proud to work here, to be honest. I’ve been here 12 years and I think it’s brilliant.”
And what about the patient? “These people are fantastic,” he says in the recovery room afterwards. “I had terrible chest pain and now it’s gone.” We chat about the possible cause of his heart problems, noting his fitness and active life. It turns out his main occupation is running a business, and there have also been family tensions. So the answer is stress. He also used to smoke, which will not have helped.
The consultant had said to me he sees these cases all the time and calls them the ‘worried well.’ It’s one of those terms that could sum up so much of modern life. And while Harefield’s cath labs cannot do much about the stress in this particular patient’s life, what they can do is unclog his vital arteries, ease his pain, and ensure he lives another day.