Even a GP should listen to his wife
The default response of a doctor confronted with intimations of his own mortality is – denial. So when my wife pointed out over the breakfast table that I was dribbling muesli from the corner of my mouth, I reassured her that this was nothing to worry about. When she also suggested that my speech was slurred, I casually dismissed this, too. I spent a few seconds in front of the bathroom mirror convincing myself that I could blow out my cheeks without difficulty. I did note that I could no longer whistle the theme tune from Z-cars, but consoled myself that it had been at least 50 years since I had last attempted this.
So I continued on the banal routines of a day off work. I cycled down to the bike shop for some minor repairs and did a bit of gardening. When I sat down to reply to some emails, I noticed that I was hitting the wrong keys with my left hand. On further discussion over coffee with my increasingly exasperated wife, she inquired, “What would you do if a patient presented these symptoms in the surgery?” There was no longer any escape and an ambulance promptly arrived to take me to hospital.
I had a full house of the symptoms flagged up by the Stroke Association’s FAST campaign: Facial weakness, Arm weakness, Speech problems – T means Telephone 999. As a result of pandemic fears, the A&E department at University College London Hospital was very quiet, and I was seen promptly by the highly professional stroke team. Scans soon confirmed a “lacunar infarct”, a small stroke, and within a few hours, I was back home on a cocktail of drugs to prevent an extension or recurrence.
Friends and relations have observed that a stroke is scant reward for my virtuous lifestyle – I have been running between 5km and 10km every couple of days through the great lockdown. But, as we say in general practice: ‘s--happens’. Things could have been much worse and, after one week, I am much improved, though still feeling weak and weary. I am doing my physiotherapy exercises and have pledged in future to follow my wife’s advice without hesitation.
The D-dimer risk
Given my recent exposure to patients with Covid-19 in general practice, medical friends have wondered whether, given my low-risk factors for stroke, there may have been some coronavirus connection. Indeed, it has been increasingly recognised that strokes caused by blood clots, causing thrombosis or embolism, are a complication of Covid-19.
Hence it was reassuring that tests for “D-dimer”, a breakdown product of the protein fibrin in blood clots, and “C-reactive protein”, an associated inflammatory marker, were normal in my case, ruling out Covid as a cause. Lacunar infarcts – which appear as “empty spaces” on scans – are caused by blockages in small penetrating arteries, rather than clots in larger blood vessels. This so-called “microvascular” disease, is associated with raised blood pressure – my only significant risk factor.
My TV must-watch
Anybody seeking insights into the peculiar virulence of the coronavirus and its impact on patients and the healthcare system should watch the BBC Hospital Special: Fighting Covid-19. This follows several cases at London’s Royal Free Hospital at the peak of the pandemic.
As patients gasp for every breath, nurses and doctors strive to relieve their symptoms – and discuss difficult treatment options with distressed relatives, now only accessible by video phone.
The documentary also reveals the struggles of administrative staff to provide everything from hospital beds and nurses to body bags and mortuary places.
The desperate efforts required to sustain the hospital’s oxygen supply system in face of unprecedented demand could serve as a metaphor for the wider predicament of the NHS facing the threat of the coronavirus.
The medical and nursing staff are deeply impressive, but the real stars are the patients, ordinary people confronting extraordinary challenges, with quiet dignity and courage. Truly inspirational.
There was no longer any escape and an ambulance promptly arrived to take me to hospital