Tim's Journal

Tomorrow is the big day. I'm feeling a tingle of anticipation. My Mitral valve repair was originally scheduled for a few weeks ago, but got postponed the day before. I had been getting everything thing squared away on my last day at work when a call came through at 4pm: "we have had an emergency come in and don't have an ICU bed for you". The caller was super nice. She apologized repeatedly and reassured me that they would arrange a new date as soon as they could. I felt a strange combination of disappointment and relief. I had come to terms with what was going to happen and was almost looking forward to getting started, but another week would ease the pressure at work and let me get a few extra things sorted. The reassurance that you are the least unwell person on the waiting list so were the first to get bumped is a comical emotion. My wife on the other hand was less composed. She had been building up the levels of stress and worry to just about bursting point and the cancellation was the catalyst that started the explosion. The release of pent-up emotion that followed was probably a good thing. It became a trigger for a couple of deep and tearful conversations that addressed a series of unspoken questions. It led to discussions of all sorts of things and probably brought us closer. I think these things are often worse for the loved-ones than they are for us patients. It is very easy to look after ourselves as we prepare for surgery but we must not forget those around us. So for a while I was in limbo. Trying to fill my time with little tasks without knowing if I have time to start anything bigger. Not knowing if I could make plans or join family events. Not knowing is quite frustrating for me, but less so for my wife. Joanna is quite happy not knowing and can pretend it is not real if the date is not set in stone. The call to confirm came a couple of days ago and we are all set for the 24th, 7am sharp.

The first time I discussed symptoms was briefly with the GP and it has been a continuing theme ever since: I didn't think I had any symptoms. To set the scene: I am 50 years old. I've always been "fitter than average" without being exceptional all my life. I played rugby for years. I gave up rugby in 2011 after a season of getting battered and realising that I wasn't recovering from the previous weeks bruises by the time I kicked off the following week. I also helped coach my son's mini-rugby team - not as full on as playing, but I was still active enough to run a round with a bunch of teenagers. I've also cycled a lot. I raced a lot when I was a kid, and started up again as the rugby started to decline. Again, better than the average "normal" person, but only ever mid-table in the cycling club race results ( sub 25 minutes for a 10 mile time trial since you are asking ;o). That is, until recently. For various (petty) reasons, I stopped racing in 2017 and didn't really touch the bike for 2 years. I was still busy and active, but not to the usual level. "Do you get out of breath?" both doctors had asked. "Well, occasionally" I thought, "but that's normal for a 50 year old guy who drives a desk for a living... isn't it?". I had just put it down to my fitness dropping off and getting older. And there is the key question: What is "normal" ? I can happily sit on my bike and ride all day at a moderate pace or go for a long walk, but if I start to push a bit then I get a bit breathless. I had moved offices to the 3rd floor and was staring to notice that I was disproportionately breathless by the time I had climbed the stairs. I must be quite suggestible : As soon as the doctors had listed a series of possible symptoms I could feel them all. Just like reading a horoscope I can easily make the suggestion fit what I'm seeing. As I sit here I can "feel" my heart. Nothing painful, but more like a mild indigestion or heart burn. There are occasions when I feel palpitations and my heart "skips a beat". Are these symptoms of getting old, symptoms of having a heart condition, or symptoms of worrying about having a heart condition ? At this point, I was still thinking the solution would be eat fewer chips and be a bit more active.

I live in a small village on the outskirts of a small town in the middle of the UK. The nearest surgery is in the town ( Hinckley ) , but luckily my GP appointment was at a smaller "sister" surgery in the next village. A small waiting room and a single consulting room in a lovely old house. The main surgery is always crowded and noisy, and usually a quite unpleasant place to be, so this was a welcome surprise. The Doctor was calm and reassuring as he read the brief note from the company medic. "It's probably nothing, but lets have a listen". Just as his colleague had done the week before, he listened intently through his stethoscope. Placing the end first on my chest and then on my back and then back to my chest again. Again closing his eyes to try to focus. "Well, there is certainly something there." he said. "Very faint, and a good catch from your company doctor, but definitely there." The appointment was concise and to the point, and repeated the thoughts of the company Doc' . He would pass me along the chain and refer me to the Cardio folk at the hospital.

The company doctor gave me a referral letter to pass on to my GP : "I believe that Tim has a heart murmur and would be grateful if you could consider further investigation, e.g. an Echo" Short and sweet, to the point. Now all I had to do was get an appointment at the local surgery. ( For those of you outside the UK, we have a National Health Service funded "General Practitioner" doctors. They are your first port of call for any non-emergency health questions. They are brilliant, but hugely underfunded and overworked. ) I've been pretty lucky over the years and have never had much call for GP appointments, so this was all a bit new. "Just give them a call" how hard can it be.... Very, it turn out. After a dozen calls and listening to the recorded voice telling me how busy they were and listing all the things I was definitely NOT allowed to ring them about (being unwell seemed to be a questionable reason) until having it cut me off after it decided I had been waiting too long for them, I finally got through. "You want to see a doctor?" said the receptionist with a level of dismissive incredulity that made me briefly wonder if I had rung the Chinese take away by mistake. "I don't mind who I see" I said, "I've been given a referral letter after a company medical and just need to check a possible heart problem". Being in possession of a letter seemed to make the key difference - some form of proof that I wasn't just wasting her time, but the best she could do was a week away. I'm always concerned by how difficult it is to see a GP. I know they are in short supply and really busy, but the process of getting an appointment seems disproportionately difficult, especially if you are actually ill.

It was an ordinary working day, with the exception that I had a company medical in the afternoon. I work in automotive research, and occasionally have to visit our company test track ("Proving Ground"). To do that I need a special Driving permit, and to get one of those I need to have a regular medical check. All the usual stuff, eye test, height, weight, blood pressure, pee in a plastic cup. You know the usual type of thing. Surprisingly it also included an ElectroCardioGram (ECG) which seemed all very thorough. Today did not go quite as expected. While listening to my chest the doctor pauses for a moment, makes and contemplative "hmmmm" sound and listens again. "We'll come back to that" he says, and moves on to tapping my knee with a little hammer. As we come to the end of the session, he asks me to sit calmly on the gurney while he listens to my chest again. "Can you hold your breath for me?" he asks as he presses the stethoscope to my chest and squints his eyes as he tries to listen. "OK, probably nothing, but I can hear a heart murmur. I'd like you to go and get that checked out." That was the moment this journey started. He reassured me that these things were very common. That half the population has some sort of heart noise. With a family history of heart problems ( my father had an arrhythmia ) I was concerned that this may be connected, but he reassured me that the ECG trace was normal and was probably noting to worry about. The key was to get it checked out fully and make sure.