A last minute addition  to the newsletter - this is a patient’s story written by  MOONSHINER

How often do we read of the 60`s being a decade of major change in our society? How has that change been reflected in our treatment as heart patients?  I had my first infarction (heart attack) away back then and this is my personal view of the past 40 years.

It was only about 1960 that Cardiology was established as a specialty in the RVH with patients concentrated in wards 5& 6. Previously heart disease was treated as a general medical condition by consultants who handled a variety of illnesses. Patients were allocated to a consultant rather than to a ward. About the middle of the 60`s the intensive care cubicles were installed in the ward and the cardiac ambulance service with its portable defibrillators was introduced. In both local and national newspapers there was frequent mention of the leading world-renowned heart facilities at the Royal Victoria Hospital led by Frank Pantridge. However, the most notable event of the decade occurred in December 1967 in South Africa where Christian Barnard carried out the first successful heart transplant. This must have really captured my imagination for exactly one month later I had my first heart attack!

       Today it is not unusual to meet very young people with heart problems but back then it seemed to be restricted to older people and so at 23 years old I seemed to have been a bit of a surprise-package!  I was a rare specimen and it seemed that every doctor and medical student in the hospital examined me. Unfortunately not one of these examinations produced an alternative diagnosis. After the few day`s bed-rest and two weeks convalescence, which seemed to be the norm at that time, I was discharged in much the same way as patients now. I may have been physically well enough to be out of hospital but I had not adjusted to what had happened and had absolutely no idea as to what to expect of my illness.

       I felt 100% and did not see any difference between me and my mates. Having only been a smoker for 2 years I simply did not believe that my heart attack was totally down to cigarettes. It seems incredibly stupid now but I was out playing football again the Saturday following my release!  My smoking and drinking if anything increased, as I reacted to the idea that anything might be wrong. Incredibly I was able to continue playing football with no suggestion of chest pain while I yo-yoed in and out of hospitals with severe angina attacks. It almost seemed that I was suppressing the angina that my activities would have been expected to engender until it built up into a mass surge which could no longer be controlled. Whatever the reason I landed in hospitals in various parts of the country over the next 5 years.

       Hospitals then were rather different from today. The overwhelming odour of disinfectant was powerful enough to clear the lungs within a few minutes of arrival! The starch in the bed-linen was abrasive and the beds were very uncomfortable. However, there was a much more relaxed atmosphere with a greater tolerance than could be possibly entertained today. In those days everybody seemed to smoke and, although we were constantly advised against it, patients (and staff!) were no different. Although open smoking in the ward was banned most patients would regularly disappear for a smoke! One of my mates regularly used to visit with a 6-pack which we would share on the verandah of the old hospital! My breath must have alerted people to this but never a word was said. Today I would probably, quite rightly, be slung out!

       At that time heart patients were wrapped in cotton wool but clinical studies were being made in London on the effects of exercise on cardiology problems. I suggested that, since I was young and essentially very fit, I would be an ideal candidate for these studies. Nobody wanted to know so I devised my own hospital fitness routine. The roof girders on the verandah did not quite enable chin-ups but one could still do pull-ups!  The stairway to the Caves Restaurant provided the means for stamina training. Nowadays there are organised aerobic classes for those that want them.

Student doctors used to train on the wards. Every morning, prior to the consultant`s round, a bunch of them would congregate round the foot of the bed to discuss your case. They would analyse the symptoms, work out treatment and decide on a prognosis for when the consultant questioned them. How such a bunch of pessimists could ever hope to make people well is beyond me! It was normally a great relief when the consultant made his appearance! It is amazing to think that probably some of those guys are now consultants!

More importantly, student nurses were trained on the wards with occasional 6 week blocks of classroom work. While on the wards part of their course was to do projects on individual patients. I was the subject of a number of these projects and through talking to the students (who were pretty much my peers) about the effects of heart disease on my life I was pushed into thinking about what was happening and how I was reacting. We were learning the basics of cardiology together. Sometimes I wonder how some of those students fared in tests when they wrote about some of my wilder ideas. However, the benefit was that when I had my next heart attack in 1973 I was more able to handle the situation.

       On this occasion there were no doubts that I had had an attack with noticeable physical impairment which had slowly developed over the years. At this time, I was planning on getting married so I was really at a crossroads situation. Thankfully at this time I had absolutely brilliant support from my GP who gave hours of his time to discussing my difficulties, having children, employment prospects, likely progress of the disease. My girlfriend and I had even more intense discussions on the subject with the end result that we did marry. Our basic reason was that we were as entitled as anyone else to make a life for ourselves. Heart disease is only a difficult part of life which might make the pursuit of our hopes and dreams harder but didn`t actually change the essence of our dreams. Like all of you, I have heart disease and have no option but to make the best of it, but it speaks volumes for my wife that she has accepted the uncertainty and problems over the years.

        Nowadays, virtually everybody you talk to in the cardiac ward seems to be in line for some sort of surgery like stents, by-passes and defibrillators but at the beginning of the 70`s recuperation seemed to be the order of the day. At this time the by-pass surgery which now creates huge waiting lists and such press comment was simply in its infancy. Throughout the 70`s when I would start to flag there would always seem to be another new drug to get me going again. By-pass surgery is now an every-day practice. We all know the miracles of defibrillators. As I write Tom Christerson is living at home having been discharged from hospital in April 2002 following the trial implantation of an electronic heart on 13th Sept 2001. Phenomenal advances have been made in medicines, diagnostic and surgical techniques and electronic devices over the last 30 years.

        Not only should we relish these developments but we should also note that consultants, doctors, nurses, technicians and probably a range of other people have had to absorb all this progress so that they can use it effectively in their day to day work. I once got hold of a book on nuclear cardiology which I assume was about those tests which use radio-active material. I can`t be sure because I only understood about 10% of the words. No matter how intelligent the people may be I rather suspect that many of the advances require several hours of hard study on top of day to day activities.

        However, the excitement of the new can produce unbalanced reactions. I was eventually considered for by-pass surgery about 1980 and ended up with the most bizarre situation in my life. After the test sequence it was evident that the surgeon did not think he could safely operate and my own consultant was in agreement. However, the ward doctor was advising me that I should insist on the operation and that if I was not going to pursue the operation I should cease work immediately. I didn`t think I was at the stage where I needed to gamble on an operation that the surgeon didn`t fancy!  Work was better than all the drugs prescribed because it was an enormous lift to know that I was handling a difficult position extremely well in spite of the heart problems. I loved what I did and seemed to have an enormous capacity for work even if I regularly ended up having to take some time off. You will all know it is easier to do more when enjoying yourself. It was an extremely difficult time when I actually did finish working a decade later.

         In the mid-90`s I eventually got put on the waiting list for by-pass surgery. I was deteriorating fast and it should have been no surprise to anybody that I eventually collapsed in Frames while having lunch on 18-03-96. Fortunately, my wife and an unnamed nurse from Royal Maternity Hospital kept me going until the cardiac ambulance arrived.  Again the surgeon wasn`t keen to do the by-pass but at this stage it was something that had to be attempted. Two months later I breezed through the operation and a month after that I was fitted with my defibrillator. Since then I have had two shocks but I can still write this twaddle and continue to make plans in expectation of a long future. I write this because 17-01-03 will be the 35th anniversary of my 1st heart attack.  There have been times when things have been very black but my wife, daughter and myself have succeeded in making a happy life for ourselves. You are alive until you are dead so make the most of it!  HAPPY CHRISTMAS TO ONE AND ALL!  -  written by MOONSHINER