Heart attacks and how they happen
The First Time
It’s a grey Saturday in autumn. The wind whips across the fields, and the rain pelts the tarmac in sheets. The streets are deserted except for the occasional car passing by. It has been more than a year since my work experience in the emergency department at the hospital. I’m 16 years old. Having completed the theoretical part of my training as a paramedic during weekends, I’m now ready for a three-week work-experience placement where I’ll begin my practical training in an actual ambulance team.* I’m walking to the ambulance station to begin my first shift. The terrible weather does nothing to dampen my great expectations, nor does the fact that, in my excitement, I have not only forgotten to pick up my umbrella and put on my waterproof shoes, I’ve also left my packed breakfast at home. Luckily, it isn’t a long walk.
Full of anticipation, I’m excited about my first ambulance call-out. What will it feel like? To be constantly on the go, flashing lights and blaring sirens, with total focus on the emergency at hand — illnesses, accidents, battles against the sheer forces of nature? I am ready to face any challenge! What I do not yet realise is that this is the day that will not only try my self-confidence to the limit, but also severely test my resolve to enter the medical profession at all.
After a few brief introductions in the station, I’m handed my uniform. It fits like a glove, and my chest swells with pride as I put it on. I am also given a handy little pager that will inform me of an emergency by beeping at me. Then I receive a tour of all the different machines and equipment in the ambulances.
As I’m chatting with my new colleague in the vehicle depot, the shift supervisor enters, with a slightly grumpy look on his face. ‘Hello, Mr von Borstel, nice to see you here. I see you’ve been introduced to all the equipment and made some friends,’ he remarks coolly.
‘Yeah, yes, I have,’ I stammer in reply. ‘I’m very grateful for the opportunity to be here!’
He looks me calmly up and down, and a smile slowly spreads across his face. He tells me he has an important and highly responsible job for me. Ten minutes later, I find myself battling manfully against the sheer forces of nature for the first time. With a broom. In the driveway.
Is it a test? Some kind of initiation rite? Whatever: I don’t care. Proudly sporting my safety vest. I do my leaf-sweeping duty in the rain. After an hour or so, I finish my fight against wind and weather, and withdraw to the staff room inside the station. In the staff room, there are couches, a TV, a small kitchen, and a bookshelf, from which I promptly choose some reading matter. Time passes, but there is not the slightest peep from my pager. My colleagues sit calmly with their pagers clipped to their belts, but I can’t resist checking the battery level on mine every few minutes. Where are the emergencies? At lunchtime, we warm up some soup. I wash the dishes. And nothing else happens.
It is unusual for absolutely nothing to happen during a 12-hour shift. Yet with two hours to go, it seems like we’re heading for a shift without a single call-out.
Somewhat frustrated, I move downstairs to the vehicle depot and open the side door of an ambulance. I check the contents of every single drawer once more and try to commit to memory the way the emergency backpacks are organised.
And then, just as everyone has given up hope, it happens. I feel something vibrating on my belt and hear an insistent beeping. A call-out! My colleagues come rushing down the stairs, and a few seconds later we are tearing through the streets with blue lights flashing and sirens wailing. All we know is a name, an address, and the fact that the patient is having difficulty breathing.
Stefan, Sina, and I pull up outside a house. I grab my emergency backpack and the mobile oxygen cylinder, while Stefan takes the ECG machine.* We head straight for the front door of the house. I am buzzing with motivation; nothing can stop me now. Well, almost nothing. My mission comes to an abrupt and premature end when, in my boundless enthusiasm, I run headlong into the locked front door. Steady now! Ring the bell first. A light goes on.
‘I’ll be right with you,’ we hear the voice of an elderly woman from inside. Through the glass door, we see the silhouette of a human figure. She’s hunched over and walks very slowly. ‘I won’t be a minute,’ she says through the frosted glass. We wait. I’m charged like a live wire, but I can’t help but be impressed by the sense of calm emanating from the woman behind the glass.
Finally, we hear the sound of the door being unbolted, and a lady with a snow-white perm opens it. She smiles. ‘Do come in,’ she says politely and ushers us inside.
‘Did you call an ambulance?’ asks Sina.
‘Yes. My husband’s in the living room. He’s having trouble breathing again,’ she sighs.
Weighed down by all my equipment, I trot after my colleagues down a dark hallway and into a barely brighter living room. The window blinds are half-lowered, and the flickering television screen is the only direct source of light. The furnishings in the room are old-fashioned — probably older than I am — but well cared for: a dark wood shelf unit, holding a few books and china plates; the television next to it; a coffee table with a brown-tiled top; and a couch, where a man aged around 75 sits, his face bright red. He is clearly struggling to breathe.
While I switch on the light, Stefan introduces us and immediately turns his attention to the patient. ‘You called us because you can’t breathe properly? When did this start?’
‘I …’ he gasps with difficulty in response, ‘I was just getting up from the couch, when …’ He pauses for breath. ‘It was as if I was being strangled.’
In the background, I prepare the oxygen supply. I have two ways to give the patient this life-saving gas: via a mask placed over his mouth and nose, or via a nasal cannula. The latter is a plastic tube attached at one end to the oxygen cylinder, splitting into two branches at the other end. Oxygen flows out of the branches, which are placed in the patient’s nostrils. The amount of oxygen flow can be controlled by a valve on the cylinder.
I try hard to remember what I learned in training. Six litres per minute is the maximum amount to administer through a nasal cannula. Otherwise, the membranes inside the patient’s nose are in danger of drying out. And in his condition, our patient has enough to contend with without that as well. After all, the oxygen is supposed to aid breathing, not make it harder. I could also opt for the mask. But then he will need at least six litres, or there’s a danger the patient will not get enough of the oxygen. I waver. I might not give him enough oxygen through the cannula, but patients often find wearing a mask uncomfortable. After much consideration, I decide the patient will just have to deal with the discomfort of the mask.
Stefan ascertains the man’s medical history and symptoms. ‘Are you in pain, and if so, where does it hurt?’
‘Here,’ the man wheezes and points to his chest, on the left.
‘Do you have any allergies?’
‘No!’
‘Do you take any medication regularly or have you taken any today?’
‘No!’
‘Do you have any other medical conditions?’
‘Yes, diabetes.’
‘Type 2?’
‘Yes,’
