Thursday 11th June 1992 Morning surgery 08:40

“Good Morning, Declan!”
“Good morning, Dr Roberts!”
“Declan, I’ve got a 60 year old man who has had severe, central chest pain for the last hour. It is radiating up into his throat. He is slightly breathless and sweaty. He’s . . . to be honest, Declan, I think he is having a heart attack.”
“It sounds very much like it, Dr Roberts.”
“Do you want to know his clinical observations?”
“I don’t think that’s necessary. We need to get him into hospital as soon as possible. Have you called an ambulance?”
“It is on the way. They estimate an arrival time of 6 minutes.”
“Is he on oxygen?”
“Yes, I’ve set it at 4 litres/minute.”
“I think you can increase that to 8 or 10 litres/minute if he doesn’t suffer from chronic obstructive airways disease, Dr Roberts.”
“I am always very cautious about oxygen.”
“Have you tried an angina spray?”
“He’s had two puffs, Declan. It has given him a bad headache but it’s starting to help the chest pain.”
“What about aspirin?”
“Aspirin? No . . . mmm . . . I thought I would phone you first. I will give as aspirin as soon as we’ve finished and I will increase the oxygen.”
“Excellent,” Declan said, “right . . . it will be 6 minutes before the ambulance arrives, 5 minutes for them to scoop and stabilise and another 8 minutes before he is here. He should be in the Emergency Department by 11.37?”
“I would think so, Declan.”
“OK . . . I will have the thrombolysis team waiting for him in ‘resus’. I think I will mobilise the Air Ambulance. I would like them on standby in case we need to transfer to Liverpool. Anything else, Dr Roberts?”
“No, Declan, I think that’s everything.”
“Thanks then, Dr Roberts.”
“Thanks, Declan.”

I think he is having a heart attack.