I am now well and truly in the clutches of a London cardiac team. I have described how what felt like imminent major cancer surgery was cancelled by the anaesthetist’s concern that my heart may not cope with the 15-hour operation. After several weeks and an, at times, deafening silence from the cancer surgery team, I was contacted by the cardiology department at Northwick Park Hospital in Harrow and scheduled for a TOE on 18th June.
Previously, I have had two echo cardiograms, an ultra-sound scan of the heart, and they have shown that one of my heart valves does not function properly. In fact, it’s quite poor; ‘severe mitral valve regurgitation’. My heart, though, appears to be compensating for this, pumping at 90% of expected output and I have no cardiac symptoms. The local cardiology team in Taunton think I am fit enough for the cancer surgery, but the anaesthetist wants a second opinion, and that’s where Northwick Park come in.
TOE: Thoracic Oesophageal Echocardiogram is a variation on an echocardiogram. Rather than running a probe over the outside of the chest, the patient is asked to half-swallow a probe on the end of a cable. The probe can get close to the heart from inside the oesophagus. TOE, another medical acronym to misremember!
Northwick Park is 150 miles away and the appointment is at 8am. This feels like a very early start may be needed. Fortunately, I have a brother in the London area, so, I book a hotel close to the hospital for the night before and arrange to meet him in central London, once I am discharged. It will be his 70th birthday and I can spend the evening with him and his family and head back to Exmoor on the following day.
I’ve done a lot of hospital stuff in the past year, and it all seems routine now, the novelty has most definitely worn off. Which is quite bizarre considering the actual life-threatening seriousness of my health!
But this is a new hospital and a new procedure. I eventually find the right ward, on floor 9, is placing the cardiac unit on the top floor a subtle strategy to reduce waiting lists…? and am admitted. The nurse and I go through the routine list of identity and medical history questions, and I confirm that I have been nil by mouth since mid-night. A canula goes into my left elbow and a technician rolls an echocardiogram machine in and explains that, although I have had two echoes already, this team want to do their own one. On go the terminal stickers and cold gel and a probe is rolled around my chest and abdomen.
This echo is a bit lengthier, and I watch as the technician highlights various images on the screen and saves them.
As the technician finishes, the supervising doctor briefs me on the TOE procedure. In effect, this simply replaces the probe that has just been used on my outside with a pipe shaped probe that goes down my ‘food pipe’. My throat will be numbed with a spray to reduce the gag reflex and adequate sedation pushed through the canula to reduce discomfort.
And I’m wheeled into the procedure room, where the technician is waiting. The doctor sprays my throat, it’s quite vile and nearly makes me gag; although I find I can’t, so, obviously this works! It tastes of synthetic banana accompanied by a chemical burning sensation. The doctor attaches a sort of strap-on airway, I think to stop me biting on the probe-pipe thing and squirts some sedative into the canula. As I am getting slightly mellow, I am conscious of the technician and the doctor having a bit of a contretemps over how to save data or set the machine? There is a frisson of friction in the room.
My recollection of the procedure is fortunately very blurry. I recall it being uncomfortable, but I am soon back in the ward, in that pleasant state of post-procedure sedated mild euphoria. It’s quite nice, just too dozy to worry about anything. Despite my long and varied life, I have never used any mind-altering recreational drugs (except alcohol), it’s possible that I have missed out!
Through this haze, I become aware of raised voices, indistinct words but most definitely a heated exchange. To my right and across the corridor from my ward, the conversation is escaping from a closed door labelled ‘Unit Manager’. The two nurses in my ward exchange glances and quietly ask each other ‘what’s going on?’ The manager’s door flies open and the technician strides out. I observe all this through my pleasant fog of sedation, with just a touch of concern that I am a patient of a clearly unhappy team.
After a while, a nurse starts the process of discharging me. I am asked to sit in a chair for a while, then to show that I can stand up and walk around and then asked to have a wee. All seems good and the doctor returns for a debrief. He confirms what we already know, I have severe mitral valve regurgitation. He thinks the most effective treatment is open-heart surgery and that I may be a candidate for this but that the team will discuss and take my cancer diagnosis into account; the cancer surgery team are just a few floors below in the same building and it appears that a ‘joined up’ approach may be possible.
I am discharged into a pleasant June afternoon and head into central London to meet my brother and his wife. They guide me through the heart of our capital city, with a walk-through St James Park and past Buckingham Palace. In the evening, one of their daughters prepares a birthday meal for my brother and it’s all blissfully normal.
My sister-in-law accompanies me to Paddington the next morning, it’s several changes and a fair old journey from their home in Southeast London. At some point, a cardiac consultant phones me and tells me that they would like me to come back in! They are considering the surgery and want to check my cardiac blood vessels, ‘We can fix any problems with them at the same time’. This seems sensible, but I am still unclear as to whether they are proposing cardiac surgery or not? An angiogram is booked for next week.
So, it’s back to London this afternoon…
(23 June 2024)
