seen.
The potential heart-attack patient from out of town had arrived in the department. Felicity accompanied the man during his rapid transfer to a resus area. Geoffrey Pinnington was a forty-year-old farmer from a rural area well north of the city.
‘I’d been feeling a few niggles all morning,’ he told Felicity in response to her first query. ‘I thought I must have pulled a muscle, heaving hay bales around. I’d just finished my lunch when I started feeling really terrible. I went all sweaty and lost my lunch and this awful pain started up.’
‘Where was the pain?’
‘Right here.’ Geoffrey slapped a hand on the centre of his chest. The nurse attending to the 12-lead ECG hastily reattached a dislodged electrode.
‘Try and keep still for a moment, please, Mr Pinnington,’ the nurse requested.
‘Was the pain just in the one spot?’ Felicity asked.
‘No. It went into my neck and then all the way down my left arm.’
‘Given a scale of zero to ten, with zero being no pain and ten being the worst you could imagine, what score would you have given it?’
‘Twelve.’ Geoffrey smiled wryly. ‘I’ve never felt so bad in my life. I really thought I was about to die.’
Felicity nodded sympathetically. A feeling of impending doom was a common symptom of a heart attack. ‘What time did the pain come on?’
‘One o’clock or thereabouts. Maybe a quarter past.’
‘OK.’ Felicity glanced at her watch. Nearly three hours ago. They were still well within the therapeutic window for an angioplasty procedure which could abort the damage being caused by the lack of coronary blood flow.
‘Give Cardiology a call,’ she directed the registrar beside her. Felicity picked up the ECG trace and scanned it rapidly. The changes were abnormal and clear-cut. ‘Tell them we have a probable anterior infarct in progress here.’ She turned to the junior doctor who was drawing blood from the IV line already in Geoffrey’s arm. ‘We need cardiac enzymes, CBC, electrolytes and lipids done, Sarah.’ Her attention returned to her patient. ‘How’s the pain at the moment?’
‘Not too bad. The stuff the GP gave me was good.’
Felicity nodded. She’d read the ambulance patient report form as she’d walked into the resuscitation area. After a half-hour drive to the local doctor, Geoffrey had been given treatment consisting of oxygen, pain relief, an anti-nausea agent, aspirin and GTN. The GP had then called for an ambulance for urgent transfer to hospital. All the right things had been done and the GP’s note included baseline measurements and a brief medical history that didn’t indicate any risk factors for heart disease. But Felicity wanted to double-check.
‘So you’ve never had any problems with your heart before this, Geoffrey?’
‘No.’
‘No other medical conditions you’re treated for?’
‘No, nothing.’
‘Blood pressure’s always been OK?’
‘As far as I know.’
‘Have you ever had your cholesterol levels checked?’
Geoffrey nodded. ‘Always been fine. I’m fit and healthy, Doctor, and I’m far too young to be having a heart attack, aren’t I?’
‘Unfortunately there are always exceptions to the general rules. Is there any history of heart disease in your family?’
‘My dad gets chest pain sometimes, I reckon. He’s one of the old school and wouldn’t admit to it, but I’ve seen him rubbing his chest and looking a bit grey sometimes.’
‘Do you smoke?’
‘Used to. I knocked it on the head a couple of years ago.’
‘Good for you.’ Felicity had enough information to transfer this patient directly to Cardiology. Baseline measurements and recordings had all been completed by the team in the resus area. When the curtain was drawn back behind her she expected the new arrival to be the cardiology registrar. Instead, it was a woman with two young children beside her.
‘Sorry, Geoff. I couldn’t drive as fast as the ambulance. How are you feeling?’
‘Not too bad, love. Don’t worry.’ Geoffrey smiled at his wife. He winked at his son who was about ten years old but the boy was staring, wide-eyed, at the screens of the monitoring equipment. The younger child, a girl, was clutching her mother’s hand, staring at her father and crying quietly.
‘It’s OK, chicken,’ Geoffrey said gently. ‘Dad’s going to be just fine.’ He held out the arm that wasn’t encumbered by IV tubing and the girl ducked behind a nurse and rushed into the inviting circle, burying her face against her father’s chest. Mrs Pinnington also moved closer and laid her hand on Geoffrey’s leg. Felicity watched as the family drew themselves into a unit again, preparing to cope with whatever was coming next. She answered the querying look Geoffrey’s wife was directing towards her.
‘It looks as though Geoffrey may be having a heart attack,’ Felicity explained. ‘There’s a cardiologist on the way to see him now and they’ll decide what the best course of treatment will be. You’ve done exactly the right thing in getting Geoffrey to the doctor and into hospital as quickly as possible. That means the treatment has much more chance of being successful and that any damage that is occurring can be minimised.’
The cardiology registrar arrived while Felicity was talking. She took over the management of the patient but Felicity stayed in the resus area, listening and watching, for a few minutes. The registrar assimilated the available information quickly. She explained the mechanics of the life-threatening condition Geoffrey was experiencing and outlined the treatment options. Felicity watched as he listened carefully. His daughter was still tucked within his arm and he was stroking her hair. Blonde, straight hair. Not at all like Samantha Petersen’s.
Given the choice between drug therapy and the more invasive but faster and probably more effective procedure of angioplasty, the Pinningtons had no difficulty making a choice, and the staff prepared to move Geoffrey upstairs to the catheter laboratory. It was time for Felicity to move as well. With no urgent cases awaiting her attention, she collected a cup of cold water and stood observing the department for a minute from her position beside the water dispenser. She wasn’t really registering the activity in the department, however. She was still thinking about Geoffrey and his daughter. Or, more specifically, the interaction between them and the contrast it had presented to the way Joe and Samantha had appeared. That easy affection and physical closeness had been non-existent.
Sometimes the frightening environment of an emergency department made people act differently to what they might have done normally, but Joe was a surgeon. He should have been as much at home here as anywhere, and more capable of reassuring his daughter than most people. On reflection, it was hard to believe that the pair were father and daughter. The atmosphere of awkwardness was more like that of a relative or care-giver being thrown into dealing with an unfortunate and unexpected incident. A care-giver who only had limited contact with children, perhaps.
Felicity crumpled the polystyrene cup and threw it away. Maybe Joe was just a father who
