Chapter two Sunday
In the morning the pain had returned, it had gradually surfaced after a restless night, and no amount of Rennies helped
Mary decided to ring Helen for advice, but thought better of it, when she realized the time; she would wait an hour until it was 9.0 am
Suddenly in mid thought, there was a muffled cry from the front room. As she rounded the door, the sight of Ronnie writhing around in his chair, made her vision collapse as if she were driving through a dark tunnel.
Sweat was pouring down his forehead and the color had drained from his face. As she moved closer, she could hear the breathing rasping sounds, coming from his chest.
Ronnie “what on earth is the matter” she said moving closer.
“I can’t breathe” he rasped, as tried to sit up. Suddenly without warning, he vomited all over her skirt, still clinging on to his chest; he slumped back down in the chair.
Mary felt helpless and confused, nothing she did, seemed to help and she slowly realized she needed help.
Leaving the room she rang Helen
Helen answered to the sobbing voice of her mother; she listened quietly, between the sobs, to a confused story, and soon realized her father was likely having some form of heart attack.
Calmly she suggested her mother go back to Ronnie and simply comfort him, by holding his hand, she reassured Mary help was be on its way
As Helen dialed 999, the thought of losing her father swirled around in her mind. My god she thought, he was only seventy two years old, too young to die from a heart attack. “Hello emergency services, which services do you require”? The female voice offered.
Ambulance service please Helen said without hesitation. In the few seconds that passed, her mind was cast back to a childhood memory - Ronnie swinging her around in their small garden and tickling her, as she tried to escape. Tears were now running down her face, as she realized a truth, nobody wanted to face, the inevitable loss of your parents.
The click on the line and the calming voice of an operator suddenly sounded, “Ambulance service, how may I help”. Helen quickly detailed Ronnie’s symptoms, followed, by their address. Within seconds the telephone call ended and an ambulance dispatched.
Helen sat down at the bottom of the stairs drained of any thoughts, she felt numb and a growing feeling of sickness began to rise from her stomach.
Across the other side of Manchester, the familiar yellow and green colors of an Ambulance navigated the busy roads. Weaving through the heavy traffic, it made its way to Ronnie and Mary’s home. On board were two very experienced Para Medics- John Rainer, the driver and seasoned Para medic for over ten years. He had trained at the Local Manchester General Hospital as a general nurse and during his fifteen years of training, had worked in the accident and emergency department, before qualifying to become a Para Medic. His colleague Stacy Owens had recently qualified as a Para medic, having worked in a Medical emergency ward, for over eight years. With blue lights flashing and siren blaring, they continued to battle the traffic.
Within ten minutes, they arrived outside the front door of Ronnie and Mary Jackson’s home and quickly set about unloading all their equipment, including a stretcher trolley bed.
It didn’t take long before all the neighbors started spilling out of their front doors, mingling at gates and on pavements, as if waiting for a sidewalk show to begin.
Mary like most of her neighbors couldn’t help to hear the siren as the ambulance made its way up their street and was at the door, long before the Para medics had time to knock
“Hello Mrs. Jackson?” John said greeting Mary at the door,” my name is John and this is Stacy, we have come to help your husband Ronnie” he declared.
Although still confused and considering they hadn’t met, Mary was quietly impressed by the Doctors knowledge of both her and Ronnie. “He’s in here Doctors” she added as she led the two Para Medics into the front room. John pushed the Trolley up and over the small front step in to the hall, carefully trying not to spill all the equipment, they had arranged on the light green bed sheets.
“The Doctors are here Ronnie” Mary said, as she shuffled in to the room.
Call it intuition or just plain experience, but as soon as John and Ronnie’s eyes met across the room, John new straight away Ronnie Jackson was in trouble.
Both John and Stacy knelt down either side of Ronnie’s chair and began to check his pulse and respiration.
Airways look clear Stacy noted, as she gently examined Ronnie’s nose and mouth
“Arrhythmia” (irregular heart beat) John continued, as he removed a stethoscope from Ronnie’s chest
They lightly unbuttoned Ronnie’s shirt, which clung to his body, like a film of plastic, silently they guided him to the Stretcher trolley stationed in the middle of the room. After removing all the equipment, they helped him on to the bed, taking off his slippers.
Mary gently squeezed Ronnie’s hand, as he lay ashen faced on the trolley.
“Ok Mary, we need to take Ronnie to hospital for more tests, but before we go, can you tell us if he has ever taken Aspirin” John inquired. “Only for headaches and his arthritis” .Mary replied”
“That’s great, we need to give Ronnie a few tablets to ease his pain, could you get him a small glass of water, please Mary”
Before her return they had treated Ronnie to a small spray of GTN (Glyceryl trinitrate) given under his tongue, to help ease the problems with his heart, quickly followed by a combination of Aspirin and Diamorphine tablets, washed down with the water
As John administered the medication, Stacy was busy attaching a twelve lead ECG monitor to Ronnie’s chest and within seconds the image of the trace clearly confirmed their suspicions, that Ronnie had in fact suffered a full blown ST elevation Myocardial Infarction ( Heart attack) and now the clock was running down within the Golden hour of treatment .
The telemetry of Ronnie’s ECG (Electrocardiogram) had been wirelessly sent over the airwaves, to the Para Medic head quarters, where a resident expert was on hand to interpret the data. Confirming that Ronnie was indeed suffering a heart attack, he telephoned a number, which would set in motion an alert system to call in a team of interventional cardiologists to treat Ronnie within the hour.
As Ronnie was being moved in to the waiting Ambulance, Helen appeared in the doorway, looking worried and full of questions, she kissed Ronnie on the forehead, before turning to the Para Medic’s “how is he” she asked? “Doing well and stable, but we do need to get him urgently to the hospital, for treatment “John declared.
As the Ambulance retraced its path to the hospital, Stacy was busy attending to Ronnie in the back.
The pain in Ronnie’s chest had eased, but a kaleidoscope of memories raced through his mind - one minute he had indigestion –next a crushing pain in his chest, his mind had cast him back thirty years, when as a foundry worker, he was racing through a crowd of fellow workers, his clothes ablaze-a giant cauldron had exploded and a rain of deadly molten metal had showered the workers. He had suffered third degree burns to parts of his arms and legs, the pain of that day had haunted him all his life.
But this was different- a pain that radiated throughout his body-gnawing at his very soul fighting for every breath, helpless and sweating held down in his chair, by a hidden force.
Helen sat with her mother, both trying very hard to make sense of the last hour.
”Let me make us a nice cuppa tea, before we go to the hospital mum-best let the ambulance get there first-so the Doctors can treat Ronnie- no sense rushing through all that traffic.”
At the hospital a team of Interventional Cardiologists and Nurses specializing in treating Heart attacks, had assembled in a theater, known as a “Cardiac Catheterization Laboratory”
Doctor David Willard a Consultant Cardiologist was heading up the team alongside his trainee, Doctor Suresh Patel. Both Doctors studied the ECG trace of Ronnie Jackson, sen
t electronically by the ambulance crew.
“Leads V2 and V5 clearly show “ST” Evaluation, looks like it may be from the Left Vessel” Dr Willard offered.
“I agree” added Dr Patel
“How old is Ronnie Jackson”, Dr Patel inquired
Seventy two, No previous history (of Heart problems) and non Diabetic, Sister Anne Hopkins replied
“Ok Team, I think were agreed, we have a Primary PCI on the way let’s get everything ready” Dr Willard urged
A Primary Percutaneous Coronary Intervention (PCI) is a treatment given while a blood clot is forming in one of three main Arteries of the Heart - known as the Left, Right and Circumflex. This is an urgent procedure performed to open up the Arteries and restore the flow of blood. Oxygen supplied via the blood flowing through these Arteries is essential for the Heart muscle to function normally.
The Ambulance quickly made its way through the Manchester traffic on route to the hospital, in the back Ronnie lay quietly as Stacy monitored his condition,
“Not long now Ronnie nearly at the hospital” she reassured him.
Ten minutes later, the ambulance entered the grounds of the hospital and went directly to the Accident and Emergency doors. The trolley holding Ronnie was gently lowered from the Ambulance.
“Ok Ronnie you’re in expert hands now” said John as he passed the paper work of Ronnie’s treatment to waiting staff.
“Thank you for all your help Doctor” Ronnie added as he was whisked away from the stationary Ambulance.
Two minutes later Ronnie’s trolley arrived through the doors of the Cath Lab and in to the care of the Cardiology team
Sister Hopkins took charge of Ronnie as he was gently transferred on to the operating table and began to explain, in simple terms what was happening around him.
“We think there is a small blockage somewhere in your Heart Ronnie and Doctor Willard and Doctor Patel are going to correct the problem” she explained.
“But before we start we need to ask you some questions” she added.
As Sister Hopkins and Ronnie exchange details about his medical history.
Doctor Patel quietly administered a local anesthetic to a small area of Ronnie’s Groin, followed by a small incision in his Femoral Artery, in to which, he placed a small plastic sheath.
Sister Katie Rowley gently arranged a small cannula into the back of Ronnie’s hand and then attached a bag of ringer’s solution to maintain his fluid levels.
With everything going on around him, Ronnie’s mind was at sea, drifting on a mist of memories. Images of his daughters drifted before his eyes, giggling and screaming as he chased them around the garden.
His wife Mary standing in the background watched on, with an approving smile.
A heavy weight was pressing down on his chest, as if the hand of God were trying to force his last breath, he found himself making a private appeal, offering up some sort of bargain, in the hope of coming though his ordeal.
Seventy two years- I have so much more to offer my grand children he pleads silently.
A tear gently rolls down his face as he realizes the gravity of his situation
Lights please, a voice calls out, somewhere in the room and slowly the mood changes, as the fight to save Ronnie’s life begins.
As if the matinee in local cinema were about to start, the light gently fades.
A mechanical whirring noise sounds around Ronnie’s head, a large imaging device in the form of a white drum attached to arm, moves slowly - gliding like a ballerina, across his chest.
Standing beside the operating table, the green gowned figures of Doctors Willard and Patel are now gazing at the television monitor hovering over the table.
Slowly the grey and black x-ray images of a beating heart come in to view.
A road map of Arteries surrounding Ronnie Jackson’s Heart spread out across the screen.
“There”! Doctor Willard exclaims, as he points at the image, I think we’ve found our culprit.
A large Artery to the left (the circumflex) of the image, clearly shows, a series of obstructions down its length, interrupting the flow of blood around Ronnie’s Heart.
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