Brian is a normal Scottish man in his mid-thirties. He was playing football as he always does on a Saturday, when, quite unusually for him, he felt a bit unwell. He sat on the pitch, and must have looked an awful colour as someone called an ambulance for him. His main complaint was of difficulty in breathing, but he also remembered feeling a tightness across his chest.
Shortly after the ambulance crew attended him, he felt even worse and collapsed. Fortunately, the quick-thinking ambulance staff had already placed some sensing pads on his chest, and noted on their monitor that Brian's heart rhythm had changed into ventricular fibrillation (VF). This is when the electrical signals that cause our hearts to beat become chaotic and the heart wriggles rather than contracts. It is a common cause of cardiac arrest after a large sudden heart attack.
The treatment for VF is to "reboot" the electrical circuits of the heart with a defibrillator, which, in Brian's case, was already attached to him via the sensing pads on his chest. He had hardly faded out of consciousness before the ambulance crew had delivered a successful shock to his heart. You know this has worked when the patient then complains about the electric shock!
"What did you do that for?" Brian asked them.
The subsequent readout from the monitor confirmed a large heart attack, and Brian was rapidly conveyed to the Emergency Department where I met him in our resuscitation room. He was a little dazed and confused (not surprisingly given his brief flirtation with death), and he quickly went with our colleagues from cardiology to undergo an emergency angiogram to see if the vessels supplying blood to the heart muscle required any plumbing work.
As I was talking to Brian's father afterwards, a commonly asked question came up:
"Why?"
Us doctors often start to talk about the exact mechanics of how heart attacks occur, how the electrical signals are affected, what we can do to fix things, and so on.
But I also discussed the bigger "why" - why did Brian have a heart attack in the first place? What has led him to this pivotal moment in his life?
The answer, always, is that we are, all of us, the ultimate product of our lives.
What do I mean by that?
Think of a tree growing from an acorn.
Our parents conceived us, and from that moment (and a little time before), we were dealt a genetic hand of cards. The academics in public health would suggest that the makeup of this acorn of genetic potential contributes around 30% of our overall lifetime wellness. Not only does this genetic recipe hold nearly a third of our wellbeing, but also, as being explored in the field of epigenetics, the things our parents do even before we are born can influence how that recipe is read, and how we are made. Parents, you have been warned - your children may ask some difficult questions!
The acorn needs soil to form a sapling in. This is our environment, our housing, our air, our water, our sewerage, our preventative medicine. This perhaps contributes about 20% towards our wellbeing, so important to be always looking to improve these factors as we strive for healthier lives.
As the acorn grows into a sapling then into a young tree and finally into a big mature tree, it needs nutrients, water, air, and sunshine. These are the things that we do ourselves every day. Eat, sleep, think, act. Every single thing we eat, think, do, and how we rest, all contribute in a tiny way to our overall health to the tune of about 40% of our overall wellbeing. These everyday choices are also thought to modify how our genes are "read" by our cells. The simple interactions of being alive - our habits and choices - are the single biggest determinant of well we will live physically, mentally and emotionally.
And occasionally, the tree will get sick, or damaged in a storm, and then we in healthcare can often intervene to try and get the tree back to health. However, and here is the painful truth, we only contribute about 10% to the overall picture. We can advise on how to improve your choices and start many treatments that may make you better at the point at which we meet you, but do not be seduced by the power of medicine. It is us as individuals that have the greatest chance of making the biggest difference to our health and happiness.
For Brian, he was led to this point by many factors, and we will do our upmost to return him to good health. As it turns out, his father mentioned that he had had a rare chronic disease affecting his kidneys, which may well have made this sudden event more likely. Not all eventualities are under our own control, but perhaps we should take more effort to take responsibility of the things that are? It is likely to make us better at withstanding the occasional storm or lightning strike.