A Pain in the Heart

by Patsy Collins
^{(creative writers at www.morewriting.co.uk)}
My name is Roger Garland and I'm dying. I'd expected my life to flash before my eyes, that's what's supposed to happen isn't it? Well it isn't happening to me. All I can see is Sally's face. She looks concerned, but then she always is concerned about something.

The pain in my heart is terrible, it nearly masks that other pain, the one in my arm. I know what that means, a heart attack. I wonder if I'll die right away, like my Dad did, or if I'll be kept alive on a machine so the family can say their goodbyes. I don't want that. Better to get it over with. The pain is subsiding, is that a good thing? Or does it mean my heart has given up the struggle.

The ambulance crew arrive and start fussing over me. They seem to be saying I'm not having a heart attack, but they'll take me to hospital. Silly idiots, am I dying or not? They lug me into the ambulance. I'm wired up to some sort of machine.

"Just to keep an eye on things Roger," one of them says.

They ask a lot of fool questions but they don't bother with the siren. Maybe I'm not going to die just yet then.

On the journey, I remember the cause of my problem. Sally. It's all Sally's fault. Played football for the Red Lion, didn't I? Well she'd been nagging me something chronic about my health lately, had to do something to prove I wasn't past it. Didn't work like I planned though, ten minutes in I'm lying on the ground and the goalie is dialling nine nine nine.

Things had been fine until I took early retirement. She'd been a lovely bride, a wonderful wife, tremendous mother. We'd been happy in the beginning, despite the shortage of money as I built up the business. Garland's Gardens has become successful. I decided three years ago, just after my fiftieth birthday, that the time had come to take things easier. Didn't want to be like my dad and not live long enough to retire. My sons took over the business. No more digging, no more carrying stuff, no more coming home exhausted.

At first, Sally was happy too. We'd started going out for meals regularly, and popping down the pub most lunchtimes. We both put on a bit of weight, well that's only natural at our age. Sally said we should take some exercise and eat healthily. I wasn't having any of that. Sally joined a gym, I asked her to drop me off at the pub on her way and pick me up afterwards.

"You could walk there, Roger if you must go. It's less than a mile."

Yes, that was probably when the nagging started. A right pain in the, well a pain is what she became.

She started feeding me salad or steamed fish for my dinner. I wanted proper food. She'd made pies and hot pots and roasts before. That was the kind of food I still wanted. We ate out more. I got to eat what I wanted, but not in peace.

"Why don't you have a jacket potato and green salad with that?" she'd ask.

Because I wanted chips and onion rings and creamy sauce and battered mushrooms, that was why. I've worked hard in order to afford the good things in life, why was she so set on us not enjoying the odd luxury. She didn't like my cigars either. Patches, that's what she thought I should have.

I'd shown her that article in the paper, about how alcohol was good for you. She'd not even read it when she started on that red wine and scotch were not the same thing, said a glass of one was not the same as double shot after double shot of the other. Then she'd found some article in her magazine about eating five portions of fruit and vegetables a day. Five, and yet she wants me to cut back on what I eat. You can't trust what these scientists tell you anyway, what's good for you one day will kill you the next.

All this worrying about what you eat and what's good for you is a waste of time. When your time's up, it's up. My dad died when he was the age I am now. His heart packed up, no reason at all. He was at the bar with his mates, same as always, then wallop. Stands to reason I'll be the same. No point in worrying about it. Sally doesn't like me talking like that. She says if I look after myself, there's no reason I can't live for years.

"Don't you want to see your grandchildren?" she asks when I refuse to go to the doctors for all them tests.

Of course, I'd like to see my grandchildren. The first is due in four months time. I'd hoped to still be around for the birth. Secretly I'd wanted to see them all born, hoped there'd be a few. I wanted to play with them in the park, watch them start school. I still want that, now it's too late.

At hospital, there are more tests, silly questions over and over. They talk at me, but I don't listen. Truth is I don't want to hear what they have to say. Then Sally is with me.

"Oh, Roger my love, I thought you were going to die."

"Me too. Am I not going to then?"

"No, not if you're sensible. Haven't you been listening to the doctors?"

"Some of it. Get some exercise they said. Don't they know that's what got me here? A heart attack because of too much exercise."

"Not a heart attack, Roger, Angina. That's because you suddenly started racing around on a football pitch. Gentle exercise will help, but you've got to be sensible."

Sensible, that's what everyone keeps saying. A sensible diet, moderate exercise, cut down on the drink, quit the smoking. Sensible doesn't sound much fun.

Sally takes me home from hospital and I agree to try, for her sake. My short spell in hospital was long enough for me to miss her and remind me that I love her. I keep the doctors appointment that the hospital recommended. Turns out she wasn't just nagging for the sake of it. She was trying to help, because she loves me too. She doesn't want her family to loose their father, me, too early. Turns out that most of what she said was right.

Doctor has been telling us about the Angina.

"Angina is a pain in the heart, common in people over fifty. More than a million people in the Britain suffer with it. It's caused by narrowing of one or more of your coronary arteries This reduces the blood supply to your heart. It doesn't usually last more than ten minutes and with treatment is often preventable. If the pain lasts longer than fifteen minutes then it may be a heart attack. In that case, call an ambulance, you'll need hospital care."

He showed us a diagram of a heart and what was going wrong in mine. He told me about these bits of fatty stuff clogging up the arteries, just like chalk furring up water pipes.

"The blood supply may be enough while you rest, but not when you exercise. For example, when you walk fast, climb stairs, or play football. If the extra blood that your heart needs can't get through the narrowed arteries, you'll feel pain."

"You've got that right," I agree.

"What is the treatment," my sensible wife asks.

"I don't want to have an operation," I warn them.
"You'd only need that in an extreme case. If you are sensible you may be able to lead a normal life."

Sensible, that word again. I am beginning to see that it isn't so stupid, it is, well, sensible.

"Go on."

"Angina is dealt with in a three pronged attack. The first is to prevent pain, and quickly ease any that occurs. I'll prescribe Glyceryl Trinitrate, or GTN, for this. It comes as tablets or sprays. You take a dose under your tongue whenever a pain develops and it should ease in about a minute. If you're going to do any exercise you can take a dose first, as a preventative. GTN relaxes the blood vessels to reduce the workload of your heart."

"And it'll really be OK, no side affects or anything?"

"If you have any problems there are other medications to try, Beta-blockers, Nitrate and Calcium or Potassium channel blockers. They all work differently, and have different possible side affects. What we'll do is monitor you carefully for a while. Once we know how frequent your attacks are and how well you respond to GTN we'll see if you need anything else. If necessary you can be prescribed a combination of these drugs."

I am starting to get a bit confused with all the technical stuff, and glad Sally is here. She asks him to repeat those names, so the doctor prints off some leaflets from his computer, to explain everything.

"That deals with the pain, we hope. What else?" she asks him.

"Next we have to stop the problem getting worse, limit further deposits of atheroma."

"Of what?" I ask.

"Atheroma, that's the fatty deposits blocking your arteries. We want to reduce them."

"Yes, I see that. What do we have to do then?"

"That's partly up to you, Roger. I'll prescribe statins ..."

"Statins are one of the things the hospital gave me," I interrupt, pleased to hear a term I recognise.

"Yes, they'll help, but there are also ways you can help yourself. That's where the healthy lifestyle comes in."

"I'm getting the idea, be sensible right?" I ask.

"Absolutely. You should stop smoking, I can prescribe patches if you like."

"To her credit Sally didn't so much as smile at that.

"Make sure your blood pressure is checked at least once a year, I'll do that now."
He does, and it's not too bad.

"I'll be monitoring that too. The healthy diet and moderate exercise you will be adopting for the angina should help, but if it rises there is treatment available. You are rather overweight, Roger. That is putting more strain on your body."

"Sally's got me on a diet already."

"Good, you should aim to eat healthily."

"What do you mean by that?" I'm a bit concerned that salad and steamed fish will be all I'm allowed.

"Five portions of fruit or vegetables every day. Plenty of starch-based foods such as cereals, wholegrain bread, potatoes, rice, pasta. Very little fatty food, that's fatty meats, cheeses, fried food and butter. Aim for two portions of fish per week. Choose only lean meat and poultry. Go easy on the salt, and finally watch what you drink, a glass of wine occasionally is fine, but don't go over the recommended 21 units a week."

"I've seen the surgery's dietician myself doctor, so I know what changes to make to what we eat." Sally pipes up.

"Excellent. Now, exercise. You should aim to do at least half an hour nearly every day. It can be anything, try walking reasonably fast, swimming or cycling."

"Won't that strain my heart?"

"No, regular exercise actually helps strengthen the heart and improves the blood supply to it."

"Anything else?" I'm feeling more confident now. It seems like fate isn't against me being healthy, there are actually plenty of things I can do to help myself. I know I can count on Sally's help too.

"Yes, we want to reduce the risk of a heart attack, very important in light of your family medical history. If you have angina, you have a higher than average risk of having a heart attack. This usually occurs when there is a sudden total blockage of a coronary artery. This is caused by a blood clot which forms over a patch of atheroma, blocking the blood supply to the heart muscle. Your risk of a heart attack is much reduced if you take aspirin."

"Aspirin's another thing they gave me at hospital, I've been taking it, but I wasn't sure that an ordinary aspirin could do much."

"Oh yes, you should keep on with them, they reduce the chances of a blood clot."

"OK, I think I'm getting the idea, GTN will ease the pain, living healthily and taking statin will stop them funny named patches ..."

"Atheroma."

"That's them. I stop them clogging up me arteries and the aspirin reduces the chance of a heart attack."

"Exactly right."

"Is there a possibility all this won't work?" I hadn't wanted to think about the possibility, but I've decided it's time to face up to things.

"There is always the option of angioplasty or bypass surgery, if other measures don't help, but I'm hopeful that in your case they won't be necessary."
"You said a million people have got this. Do they all start of being rushed to hospital like me?"

"No, usually the problem comes on more gradually and can be diagnosed by the symptoms. Sometimes we do blood tests and ECGs."

"Thanks for explaining everything doctor. I know what I've got to do now."

"I'm pleased to hear that. I look forward to hearing how you're getting on at your next appointment. Are there any more questions at the moment?"

Sally's got one. "Can he still drive?"

"You should tell your insurance company about the angina. I'd suggest you avoid driving for a while, but as long as you only have the pains whilst exercising, there shouldn't be any problem."

Sally drives me home, collecting my GTN spray on the way. I don't want to read all the leaflets the doctor gave me or sit brooding about possible pain and illness. I want to get out and enjoy life.

"Let's go down the pub, Sally."

"Do you think that's sensible."

"Yes, I do. I'll have a squirt of my mediation, then we'll walk down there. It might take a while, but there's no rush. Someone said they do a nice salmon salad, I think I'll try that for dinner tonight."

My name is Roger Garland, I can be a bit of a pain to my wife, but I'm lucky that she still loves me as much as I love her. We're going to live long and happy lives.