Monday, February 13, 2017

Getting my chest shaved in London,
and other adventures in the ER

Souvenir from St. Mary's Hospital in London: the readout showing where my rapid heart beat was halted, then restarted at a slower pace. Click to see detail.

We travel to London for the theater. But a brief visit last week brought some unexpected drama in which I played a leading role.

The story: in the wee hours of Saturday morning, I awoke to find my heart beating much faster than normal.

Also stronger than normal: BAM! BAM! BAM!

I couldn't imagine why this was happening at 2 a.m. I hoped it would just go away, but I couldn't get back to sleep.

So after an hour, I woke up my wife. She measured the pulse as 140, and it showed no signs of abating.

What was up? Was it finally time for my big life-changing health collapse?

Time crawled by. Earlier that evening, we had seen 'Fawlty Towers: The Dining Experience,' a dinner-theater recreation of the iconic British TV sitcom.

Now, lying there, I found myself thinking of several 'Fawlty Towers' scenes set in British hospitals, and also of the episode where a hotel guest dies overnight.

That led me to think of a good option for an epitaph, should one be needed. It's what John Cleese says to three hotel guests whom he mistakes for undertakers.

"Your dress is very modern," he tells the bewildered trio. That would work well on a gravestone, I thought.

I know this sounds ludicrous. But what else would you think about in a hotel at 4 a.m. with your heart racing like you're running a marathon?

Daylight came at about 6:30 a.m. By then I was seriously short of breath and feeling light-headed, so we knew I'd have to get checked out.

One issue: my wife's relatives were scheduled to arrive in London by train at 8:50 a.m. for an action-packed day.

Well, it was clear I wasn't up for that. Just climbing the stairs to the lobby (we were in a lower level) made me feel like taking a siesta.

Fortunately, St. Mary's Hospital was two blocks from the hotel. I felt well enough to walk to the ER. So that's what I did.

My wife would meet the relatives at the train and wait to hear from me.

The main gate at St. Mary's Hospital in London.

So I trudged across Praed Street and entered the St. Mary's campus. A map directed me to the emergency department, and a woman at a desk sent me upstairs. (Yes, I took the elevator.)

The hotel desk clerk had advised I might want to wait for an urgent care clinic to open because St. Mary's, as a large inner-city hospital, could be kind of a madhouse.

But early on a Saturday morning, I was the only customer. No waiting! Thus was my introduction to Britain's National Health Service.

And get this: besides my symptoms, all they needed from me was my name, address, and (because I was a foreigner) my passport info.

I was then put in a wheelchair and rolled down a corridor to the ER, where I was evaluated by several nurses working as a team. Everyone wore the same blue hospital clothes.

Before long, my chest was partially shaved so they could attach sensor contacts to me. I was placed in a gurney and wheeled into a medical room, with my heart racing as fast as ever.

All this before 8:30 a.m.!

Two doctors, Danny and Helen, tried non-invasive methods to corral my pulse: having me blow into a syringe, and then giving me a neck massage. (Thanks, Helen! I mean, Dr. MacKay.)

These had no effect, so the decision was made to use a drug that Dr. Danny warned me had an unusual effect: people who take it, he said, "feel like they're doing to die."

What? They feel like they're dying? What does death feel like, exactly?

What he meant was that the drug, Adenosine, would temporarily stop my heart from beating (for the first time since 1964!), and then very soon after it would start again, ideally at a normal rate.

But that time in-between was what people described as death: with the heart shut down, the body instinctively begins going into shock. The heart restarts before this gets too far, but it can be very scary if you're not prepared.

"Can I have a lollipop?" I asked, laying there, still wondering if this was what Redd Foxx used to call 'The Big One' on the old Sanford & Son TV series. (Wow, everything in life is related to TV!)

Before I got an answer, 6 milligrams of Adenosine were released into me through an IV.

I waited for death...but death did not come.

The verdict: I was a bigger moose than they'd figured. Hence the next step: double the dose!

In went 12 milligrams of Adenosine, and then I felt it.

For me, death felt like a huge weight pressing on my chest, and then quickly morphed into the sensation that there was some kind of strong vacuum pulling at my chest from the inside, trying to collapse it.

I tried inhaling but couldn't. I closed my eyes in response to this, and found I couldn't open them!

But before anything else happened, my heart resumed beating, and at a much lower pulse rate of 90. It would drop further as I returned to normal.

Laying there, I was overcome with a huge sense of relief that was physical and mental. The moment my heart resumed at a normal rate, everything felt right again, finally.

Also I was relieved that I'd have time to think of a better epitaph than "Your Dress Is Very Modern."

After making sure I was stable, the doctors wheeled me into a holding area, where I needed to wait until they got blood test results back from the lab.

The hospital had great wifi, so I updated the wife and wished them all a good time! I would try to catch up later if I could.

The actual Emergency Department within the hospital, which is named after the Queen Mother, a long-time patron.

So for the next six hours, I got to watch the ER of a busy London hospital in action. It wasn't that busy, actually, but still a lot was going on—a broken femur here, a fall with head injury there.

More than once I heard people being asked "Who is the Prime Minister?" or "Who is on the throne?"

At about noon, Dr. Danny and Dr. Helen came by with an update. My results were fine. But because I was going to be on a long flight the next day, they wanted to keep me for one more round of blood tests as a precaution.

Specifically, they wanted to see if levels of a certain type of enzyme were increasing, which would indicate damage to the heart muscle or possibly another cardiac malfunction in the making.

By 3 p.m., the second results were in: I was free to go. And that's when I got my biggest surprise.

After putting myself back together, I asked Dr. Helen what I needed to do next.

"You're discharged," she said. "You just go."

"Go where?"

"Out of the hospital," she said, realizing that I was one of those foreigners who may not understand how National Health works.

"Isn't there some kind of paperwork I have to fill out—disclosure forms or insurance info?"

"You have a discharge paper, which you should bring to your G.P. back home," she said. "Emergency care is provided free to everyone."

There's a phrase you don't hear in U.S healthcare. Free to everyone!

You mean, I just took up eight hours of time in the ER of a major London hospital, and the cost is...nothing?!

Even better—I found out later that if I had travel expenses, I could take receipts to the bursar's office for possible reimbursement. Wow. In Britain, they pay you to go to the hospital!

But what impressed me most was the sheer simplicity of the transaction. No paperwork. No forms. No codes or waivers or disclaimers or disclosures.

And no gigantic billing infrastructure that adds to costs without medically helping anyone.

Of course there are costs. Someone had to pay for the services I received. In this case, it was the British taxpayer.

It didn't seem proper to take photos inside the ER, but I did furtively snap this one shot of my "holding cell," which had a nice view of a canal filled with houseboats.

But that same taxpayer does not have to pay always-rising insurance premiums or cope with massive deductibles like we do.

Example: Last month I had an MRI done as a precaution. The total cost for this two-hour procedure was just under $10,000, of which I had to pay 20 percent.

Thinking about that bill would be enough to prompt a cardiac incident.

But in my case, what seems to have been the culprit in London was me unthinkingly downing five or six cups of coffee during the previous day, and then drinking beer and wine in the evening, topped off by more coffee.

By the time we got back to the hotel, it's no wonder my heart went into overdrive.

But I'm fine now. It's been three days and no sign of any relapse. I even had a cup of coffee today!

So all's well that ends well. Speaking of which, I do need to work on finding a better epitaph...


  1. I am so glad that you are well and got good care. I would, however, remind everyone that your care is being paid for BY SOMEONE. The costs exist and someone must pay them so the next person has the same opportunity. Scheduled surgery and other care is not 'free', not in the same way as your emergency. It gets more complicated. THAT is not bad, either. It is just a fact. My British friends go to private hospitals for the before and after care and to "free" for the procedures themselves. My friends are wealthy enough to do this. Why do they do it? Because private care is better. Public care is cheaper and faster. Just saying.

  2. While residing and working in London, my expatriot daughter was bitten on the forearm be a friend's dog. The wound was severe and infection set in quickly, moving rapidly toward her shoulder. She received expert emergency care with microsurgical treatment of infected blood vessels and tissue. She was seriously in jeopardy for having an amputation. Over a period of 5 -6 weeks, her wound was treated, saving her arm (and fingers). Again, all at no cost to her. Yes, routine care can be frustrating with long queues and waiting times, but emergency care is quick and comprehensive. Thanks to the British health care system, she continues to teach and perform on the flute.