Reasons to be Cheerful – Fixing Hearts and Fan Belts

On 26 October, around 5pm, I was welcomed back into the world, specifically into the Cardio Intensive Care Unit at Middlesbrough’s James Cook Hospital by James (not Cook).

James was my intensive care nurse, one year qualified, a Sunday League footballer and a Boro fan excited about a six game winning streak; that much I remember.

The football chat was nice but what I wanted was my wife, Ruth.  James had told her not to come as it had been ‘a bit mental’ in CICU (I know my way around a healthcare acronym or two) due to a couple of helicopter emergency admissions.  It was pretty scary in CICU, sadly I don’t think everyone survived that night.

I found myself there as the result of congenital heart disease.  As an architect I have led several large hospital projects and spoken passionately over the years about the need to join the dots of social infrastructure to promote health equity and create places where people can start well, live well and age well.  I was very aware of the postcode lottery and its impact on health equity – we moved twenty odd years ago to a good postcode but as it would seem, to no avail.

I’d kept myself pretty fit, largely as an excuse to buy semi-expensive bikes, nice magazines and spend quality time cycle networking, ideally through France.  I will also admit to a keen liking for red wine and over recent years had tried to combine that with a largely sausage and cheese free diet.  It turns out that sometimes your fate is set at day one and what you eat, drink and do only goes so far.  I’ll now be a red dot on deprivation statistics having only made it to 54 years old in good health.

After a couple of years of thinking I was struggling with Long Covid, a consultation with a different GP led to a referral for a chest CT scan.  That’s when everything changed.  We’d just waved my daughter off at Heathrow for a year of study and indulgence in Australia and morosely drove back north.

After a bereft day watching our daughter’s flight tracker move ever further from home, Ruth and I caught up with each other on the phone.  Like my dad was, I’m crap on the phone.  I can never think of anything meaningful to say but I hate it if we don’t get to chat.  My dad would usually spend half an hour chatting about football, cricket, and cycling, before proclaiming that was all ‘his’ news and ask what I had for him.

Ruth announced that there was a letter from the hospital that the dog hadn’t fully eaten, did I want her to open it?  Well, I thought, that will give us something to talk about.  However, ‘your recent scan indicates that you have significant heart disease … we need to plan for revascularisation’ was a bit of a conversation killer.  I’m the one who gets emotional but stayed calm, Ruth is steady as a rock but started to crumble.  I’d instinctively known something was wrong, and this sounded serious.

Fast forward to 24 October… our other child also now in Australia and a James Cook (tenuous link) outpatient admission for me to have an angiogram, with a possibility that the angiogram might result in some heart stents being fitted but with a pre warning that it would probably confirm the need for bypass surgery.  I was determined to be positive but that’s easier said than done.

The results were described to me as a very serious narrowing to one of the trunk roads to the heart with an immediate risk that it could fully block which would be “a game changer”.  It also showed an anomaly that another trunk road had been built in the wrong place, a bit like the M74, and a further minor secondary blockage, probably more akin to speed restrictions on the A66.  I was told that stenting may be possible for two out of the three, but it would be complicated to get right and probably not be a viable long term solution.  I needed to consent to surgery.

I could go home to think about it but if I did the advice was I probably wouldn’t make it back.  Cue more emotional moments, a bit of blind panic and an admission to Ward 29 to be kept wired up on telemetry whilst they found an early gap in the theatre list.

A day of prep followed, lots to take in, surgeon, surgical team, anaesthetists, and researchers all introducing themselves, talking me through the process whilst I tried my best not to listen.  The surgeon, Mr Kanani, started talking about cars so I perked up – he was comparing my heart to a broken fan belt in an otherwise good car.

I started trying to picture the car but for some reason fan belt problems took me back to my 1970s Ford Escorts and to be honest I wanted better.  His point was that once the fan belt is fixed then the car is all good and you go back to driving it as you would normally do.

I loved my Escorts but let’s face it – they were shit.  Never started on a wet morning and you often had to hit the starter motor with a hammer to get them going again when warm – not a good reference to move forward with post-op.  I decided to focus instead on my forever cool R-reg black Ford Capri with its little rubber boot spoiler and steel grey Rostyle wheels.  A bag of spanners in reality but brilliantly advertised as ‘The car you always promised yourself’.  And Terry drove one in Minder. That would be more fun.

I was first on the theatre list for 26 October so up early.  Manscaping was required, something to do with infection control and prepping the incision area but I suspected it was mainly so the nurses can take the piss to take your mind off things.  A face mask full of gas was a more effective technique and off I went into theatre with a chest looking like a turkey prepped for a Christmas dinner oven.

So back to James in CICU.  What a lovely lad.  I’ll always be grateful for his care even if I can’t remember much about it.  James handed over to his nightshift colleague by which point my memory was fuzzier.  Again lovely, she sat watching me through the night as the departmental clock turned more slowly than a Darlo defender.  My night was punctured by disturbing dream filled fitful sleeps alongside fellow bypass patient Eric from Hartlepool wheezing “what time is it now?” every five minutes.

Morning eventually provided some relief.  James came back to look after me and casually dropped in that he’d checked Darlo’s stats since the turn of 2023 and agreed with my concise analysis of the previous evening.  Mr Kanani popped in to calmly tell me how he had saved my life, and all was good.  Tracy the Physio introduced herself before convincing me that, yes, I could (and will!) get out of bed and sit up.

They pulled the tubes out of my chest, washed off some of the pink Marsala marinade they had basted the turkey with and wheeled me out of CICU, into the grey Teesside morning light and onto the Cardio High Dependency Unit. Never have I been so happy to see Middlesbrough.

Open heart surgery is unsurprisingly pretty invasive.  I have no more desire to know the details now than I did before, but it is clear there are now lots of things that need to be helped to recover.  What has impressed me most is how every person in the process absolutely knows the importance of their part and without exception delivers it with professionalism, care, and compassion.

From a patient perspective it was interesting to experience hospital recovery in a six bed bay – given a choice I would have opted for a single room without a doubt.  I would have preferred not to have had to listen to Eric from Hartlepool fart his way through every stage of CHDU, but I think we all enjoyed his cheeky old man chat with every member of the clinical and nursing team.  It was good to be able to chat with each other when we hit our tearful moments of emotional crisis.

So, in a way, every member of the six bed bay plays their role too; we are all the football journo’s twelfth man. We certainly enjoyed Eric from Hartlepool’s 1970’s explanation of his concerning heart rate of 145: “well if you keep sending all these pretty nurses to my bed …”.

And his ability to cut through all ranks and roles, so to who we later understood to be the lead cardio consultant in the Trust:

Eric from Hartlepool (EfH): “Hey, you look like Harry Maguire”
Important Consultant: “I can’t play football”
EfH: “I knew it was you”.
To the student nurse on her first morning of placement:
EfH: “What do you like to do when you’re not working?”
Student: “Don’t know really. Nothing. I like pies. I wrote a poem about pies once, it got in a book. Don’t know which one though.”
Me: “Pies and Prejudice?”
Student, nonplussed: “No.”

(Laughing is pretty painful)

Thanks to the amazing team at James Cook Hospital, I am still alive.  With fan belt fixed and a bit more TLC (the doc said I should milk it for a few weeks), this late 1960s Capri is back on the road and driving home just three amazing and, at times, highly emotional days after wishing James well for Saturday’s game against Stoke (Boro lost).

I collect and assemble these thoughts to pass the nights.  Insomnia and distressing dreams are apparently common postoperative responses and I’m enduring both.  I find writing during the voids of nighttime relaxes me and passes the time, so I may share more ramblings as the road to recovery inevitably becomes a journey.

For now, I just feel very lucky and will be forever grateful to my GP and the team at James Cook Hospital. As for the amazing support from family, friends, and colleagues at Ryder, I’ll keep it simple and say a (repaired) heartfelt thank you.