A broken heart and a girl plucked from a flowerbed — just another day in the emergency unit

In the emergency room, every decision could mean the difference between life and death. Dr Anne Biccard’s latest book, One Call Away, goes behind the scenes of a Johannesburg hospital as healthcare workers fight for their patients and ponder life’s big questions. Read an excerpt below.

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Every now and then I make a smoking hot diagnosis in the ED. That elusive but heady moment when you feel like a giant, invincible and all-knowing. It happens today as I rock a case of Takotsubo. This is a rare condition where a patient experiences chest pain typical of a heart attack with an abnormal ECG, but a normal angiogram. It is named after a Japanese trap used to catch octopuses which is, apparently, the same shape as the ballooning heart ventricle seen on an ultrasound of the heart. Takotsubo is caused by emotional distress and is a very real and dangerous physical manifestation. It is also known as broken heart syndrome and is, essentially, a weakness that develops in the wall of the heart, perhaps as a result of the adrenalin surge that follows emotional upset. Theoretically, the enlarged ventricle could stretch and weaken the heart muscle wall so much that it could rupture. The decreased pumping action could allow clots to form in the heart, or death from poor perfusion. Hopefully none of that will happen today.

My lady today got severe chest pain after hearing that her son and grandchildren were in a serious motor vehicle accident. I am busy with the ultrasound when the doorbell jangles and there is the clatter of a new patient on a stretcher coming through the double doors. The paramedics park the stretcher next to me and I ask them for a history, but they seem to know nothing. Not her name, her age or the reason that she is being transported to the ED.

‘Who called you guys?’ I am in sleuth mode. Maybe there will be another mystery unfolding; another magical save from Grim. ‘The neighbour,’ they answer.

‘And the reason that they called?’ I am eyeing this patient with increasing suspicion. In her late teens, she looks drunk or high. Or maybe both.

‘She is not feeling well.’ Suitably vague.

‘What, exactly, is unwell about her?’

‘We don’t know.’ I wonder if they have any medical training as they seem startled by my line of questioning. When they move her over from the stretcher to the bed, earth and leaves shower down from the sheet.

‘Was she outside?’ It is bitterly cold today, a radical change from the recent humidity. A hailstorm overnight caused the temperature to plummet, so maybe she is hypothermic. It is also full moon and I have no doubt that this increases the number of customers in the ED.

It turns out that she was sitting in the flower bed when the paramedics fetched her but that they didn’t think that she had been there for long. How they came to this conclusion is a mystery to all of us. The patient has no identification with her; she only has her hairbrush.

The patient seems quite personable until her mother arrives. Then she gets a hard glint in her eye and all hell breaks loose. At one point she starts hitting her mother with the hairbrush. I eventually separate them and suggest that we admit Miss Hairbrush for sedation and maybe rehabilitation. There are substances on board here as well as some underlying behavioural issues.

Hairbrush is having none of it. She insists that she be allowed to go home, but she is under the age of consent and so her mother and I have more legal say than she does. I make sure that her mother has her cellphone and her cash, so that she can’t go anywhere without our help. Hairbrush gets a slightly scheming look and glances towards the bathroom. She is quick, but I anticipate her move and jam my shoe in the door as she tries to slam it. Our eyes meet and I tell her calmly that there is no lock on the inside of the door – this is not our first rodeo – but if she chooses to close herself in there, I have the key to lock it from the outside.

‘You wouldn’t dare…’ her voice tails off as she sees the intent in my eyes. She skulks off back to the bed and reluctantly agrees to admission.

I feel sorry for her mother, who is going to be tied to this nightmare in some way for as long as she lives. Even if she chooses not to be involved, Hairbrush is going to make her sad and guilty. Parents are essentially guardians, I think. They are responsible for a whole lot of factors in the wellbeing of their children, but basically a child has their own genes and cannot, with all the will in the world, be transformed into something completely other. They can be kept safe and nourished and have their needs met; maybe even a mirror held up for them to understand things and face down their demons, but at the end of the day your child is a separate person to you. When you have a child, to some extent you hand your heart and your happiness to fate.

Quite a few parents have told me that, once you have a child, your heart exists outside of your body. This is profound on many levels to me but it also means that you can be mortally wounded and not actually die.

What a terrifying thought. DM

One Call Away by Anne Biccard is published by Jacana Media and is available at Exclusive Books and other bookstores.