‘Did you feel a flutter just then?’ said Alice, softly, as she leaned across me on the couch.
‘Can’t say I did,’ I replied, cautiously keen. ‘My heart didn’t skip a beat, if that’s what you mean.’
‘It did actually,’ she said, snapping the suction pads off my chest. ‘The ECG shows you’ve got atrial fibrillation.’
So, at 65, I find I have atrial fibrillation, or put simply – an irregular heartbeat. No underlying heart disease according to subsequent scans; just a creaky pump. For all I know, it might have been there for years before Nurse Alice stumbled upon it during an MOT to check light-headedness – which turned out to be harmless; yet another symptom explained away by: ‘It’s your age.’
Atrial fibrillation occurs when different places around the atrium (the upper chamber of the heart) produce electrical impulses over and above the natural ones needed to make the heart beat. These erratic impulses make the atrium quiver or twitch, which is known as fibrillation.
I’d never have known this was happening. I didn’t twitch or quiver. There were no other symptoms to make me think something was wrong. Changes in general demeanour were down to my right to become angrier and madder with every passing year – not a quivering atrium. Only now, when I feel my pulse and know what to look for, do I realise it beats smoothly for, say, a dozen beats, then misses one. And after a further ten beats it may do three beats in one.
Four out of every hundred people over 65 have atrial fibrillation. It’s a fact – I asked ninety-nine other over-65s in my part of town: ‘Have you got atrial fibrillation?’ Just so as you know, the other three are Betty Jones (75), Marshal Ginster (70) and the Vicar, Henry Harmondsworth (83).
So – what’s the problem? Well apparently I’m at greater risk of a stroke. With fibrillation, the erratic flow of blood causes turbulence, making the blood form small clots which could move to the brain and cause a stroke. To reduce this risk, they prescribe warfarin (rat poison) to thin the blood so that it won’t clot so readily. It’s a little disturbing that rats are expected to go away and die somewhere after warfarin, yet there’s nothing in the box’s information leaflet saying: ‘Likely side effects – some people may go off and die somewhere.’ There are, however, hundreds of other possible side effects, getting all of which would mean you’d be dead anyway. I guess they know what they’re doing.
Since we all have a different metabolism, the amount of warfarin is determined individually, using a recognised coagulation measure called INR (International Norm Ratio). Typically they aim for your blood to take two to three times longer than normal to coagulate. To ensure the right level, I attend a regular warfarin clinic at my local hospital. A pinprick of blood is sucked from my thumb and a sophisticated machine reads its coagulation factor. Several of us see the bloodsucker at the same time, and our readings are entered in a Yellow Book handed out at the first visit. Looking rather like a Building Society Passbook, we have to keep this with us at all times in case of accident or trauma, so that the emergency services are aware of our warfarin level and current coagulation count. Bleeding – inside or out – is the biggest risk.
These sessions are like a society meeting – Warfarins Anonymous. We all know why we’re there, and empathy is rich. The bloodsucker calls out people’s results as a sort of ice-breaker.
‘You’re 2.6 today, Marshal.’
‘Oh, that’s pretty good,’ he replies.
I’m not sure how this public information sharing fits with patient confidentiality. I’ve never experienced a GP sticking his head round the waiting room door to say:
‘Listen up, everyone. I’ve just got Mrs Maxwell’s urine test results, and her pH reading is down to 7. Good, eh?’
When I raised this privately with the bloodsucker, she said that no-one else had questioned it in her entire sucking career. Probably scared of her.
I’m proud of my Yellow Book – it’s like a badge. I stand out from the rest. In the pub, I ‘accidentally’ leave it on the bar, and people seeing the dash of colour realise they’re drinking with a man of distinction. Great that I can still have a drink, actually – I’d been led to believe alcohol was a no-no if you’re on warfarin, but the nurse who sees you privately after the bloodsucker assured me it wasn’t a problem.
‘Stick with whatever you’re used to,’ she said. ‘We’ll make sure the warfarin level matches your normal lifestyle, but we suggest you don’t binge drink if you’ve not had alcohol for a few days. And the only thing you mustn’t have is cranberries, and possibly grapefruit.’
‘Great!’ I said. ‘I’ll wean myself off cranberry juice, but carry on with the eighteen pints of Carlsberg a night.’
In the high street I parade with the top half inch of my Yellow Book peeking from my jacket pocket like a handkerchief.
‘Wow, that man’s got a quivering atrium!’ I overhear from a passer-by who’s spotted the tell-tale yellow sliver.
‘2.7 in case you wondered,’ I call out.
‘Wonderful news!’ he says. ‘No need to go off and die somewhere!’
And I’m not the only show-off. Of every ninety-nine over-65s I pass daily, three have a yellow sliver about their person. Even the local Age Concern office has got in on the act, a notice in its window saying:
Come and chat about your INR measurement here
Yes, I love my Yellow Book.
But soon I’ll face the greed of the insurance man. I see his pointing finger hovering above me like the Uncle Sam recruiter, saying:
‘YOU have atrial fibrillation! Yes, YOU! Don’t deny it! Hand over £8,000 for your car insurance NOW – or go off and die somewhere! And £5,000 travel premium for your day trip to Calais – because YOU have atrial fibrillation!’
I don’t care. I shall live as long as anyone else. Yes, I have atrial fibrillation, but taking warfarin for life will protect me. I simply have to take a few milligrams a day. Which makes me officially a warfarin junkie.
Paul Costello © August 2013
UTTERLY UNDISCOVERED by Paul Costello
Available through bookshops (ISBN 978-1-907741-30-2) or direct from Fineleaf Editions
A fabulous holiday read!