feels he’s in the care of someone who means him well, he will automatically feel better. If the patient is confronted with someone who is nervous and agitated, on the other hand, he will become increasingly anxious himself. Simply responding sympathetically to the patient’s immediate needs is a great help. If the patient is cold, cover him with a blanket; if he has difficulty breathing, open a window. It has been proven that such simple actions can increase the patient’s chances of survival, even in seemingly hopeless cases.
The same is true, of course, for stroke patients. That term is going to crop up several times, so let me explain it briefly here. A stroke* occurs in almost exactly the same way as a heart attack — only in a different organ. Our brain is permeated by a network of vessels that supply it with blood. This blood supply is important because our grey matter is made up of nerve cells that can only work if they receive sufficient oxygen via the blood. If one of the blood vessels in the brain ruptures, bursts, or becomes blocked, the area of the brain it supplies will no longer receive an adequate supply of blood and will die — unless the blockage is removed at once. By analogy with heart attacks, strokes are therefore also sometimes referred to as brain attacks.
Strokes can have very different consequences, depending on which blood vessel and which part of the brain are affected. Small blockages often go completely unnoticed, but if the area of the brain responsible for speech is undersupplied with blood, patients’ speech may become slurred and indistinct, they may begin to say strange things, or they may lose the ability to say anything at all. When someone suffers such a cerebral infarction, time is of the essence. Within just a few hours, damage can become irreparable and permanent since, like the heart, the brain has very limited regenerative powers.
Of course, the best thing is to avoid any infarction — either cardiac or cerebral — in the first place. Treatment and care may be very good these days, but they are still unpleasant and dangerous. And it is, indeed, possible to reduce your risk of suffering a heart attack. Although, there are two factors we cannot influence: genetic predisposition and gender. Men are considerably more likely to suffer a heart attack than women. It’s not until they have gone through menopause that women’s risk increases, for which they have the change in their hormone balance to thank. But there are a whole range of factors that we can influence and that can increase our risk of suffering a heart attack immensely. If we avoid these risks, the danger is reduced. It can be that simple!
*An unusual situation for someone my age, but I had great enthusiasm!
*A device for recording the electrical activity of the heart in the form of an electrocardiogram (ECG). See also, ‘If You Can See the Steeple, the Graveyard Isn’t Far’, p. 157.
*Latin for ‘strangulation in the chest’; a temporary obstruction in the blood circulation of the heart, which is often associated with narrowing of the coronary arteries.
*See also, ‘Quit Playing Games with My Heart’, p. 168.
*Also known by many other names, including cerebral infarction, cerebrovascular accident, or cerebrovascular insult; formerly also apoplexy, palsy, or, in Latin, apoplexia cerebri.
Russian Roulette with the Heart
The connection between smoking, drinking, and an unhealthy heart
A Tar-Covered Road to the Heart
Why do we spend thousands on something that makes us stink, forces us to stand shivering in pub doorways in the winter cold, and causes us to die an early and unpleasant death? Why do we smoke, when it puts our cardiovascular system under extreme stress?
It’s all the fault of dopamine, the pleasure and reward hormone in our brain. In our head, every cigarette is like a wonderful reward; it feels to a tobacco addict like a shot feels to a heroin junkie. This may be a simple answer, but it’s no help to someone trying to give up smoking. Thankfully, however, we have public health warnings such as: ‘Smoking causes ageing of the skin’. Boom! That really hits home! After reading that horrific warning for the first time, I felt awful, and my next cigarette was no pleasure at all. But was this any help to me? Of course not, because in such cases, addicts will simply increase the dose of the drug to force their brains to give them the reward that they crave, to make them feel better about the bad news.
I must admit that I set an extremely bad example myself when it comes to smoking. In anatomy lectures as a medical student, I saw smokers’ lungs that were as black as a tarmacked road, and, working as a paramedic, I met people whose smoking habit had left them confined to a wheelchair or bedridden with severe chronic lung disease. But all this was not enough to put me off enjoying the occasional cigarette in the pub — despite the fact that smoking really is one of the few habits that brings absolutely no benefits; although those of a rather cynical frame of mind have argued that smoking benefits the state pension system by causing smokers to die an early, if medically expensive, death. Smokers are playing a game of Russian roulette, only without passing the revolver on, since the lungs are far from being the only organs affected by the more than 4000 toxins contained in tobacco smoke.
What exactly happens when we smoke, and how can it be so damaging to our bodies? Cancer! That’s the first thought that springs to mind. Of all the substances we breathe in when we smoke, at least 40 are known to cause cancer. The biggest risk is that of developing the kind of tumour known in common parlance as lung cancer, which doctors refer to by the much more elegant-sounding term ‘bronchogenic carcinoma’. This happens when some cells in the bronchial tubes begin to mutate and, with time, are no longer able to perform their normal function. The affected cells then try to make up for that loss by constantly reproducing. They divide and multiply incessantly, creating a tumour that eventually impairs the functioning of the lung. If these cells then also find their way to other organs via the bloodstream — when we say the tumour has ‘spread’ — our entire body is affected, and death is the final result. If we know all this, how can we be so stupid as to keep on smoking?
Nicotine is the guilty culprit. In small doses, it causes a moderate release of adrenaline, the well-known stress hormone that stimulates us, suppresses hunger pangs, and increases alertness. What a wonderful natural drug! However, nicotine’s main effect is to cause the brain to release dopamine, the pleasure hormone we met above. Nicotine also causes both heart rate and blood pressure to rise.
When I was 18, I did an experiment on myself to observe the constrictive effect of cigarette smoke on our blood vessels. A friend of mine happened to own a thermal-imaging camera, so I used it to film my own hand while smoking. Before I lit up my cigarette, the surface temperature of my skin was 32 degrees Celsius. But even after only one puff, that temperature fell to 30°C. And after I had smoked the entire cigarette, the temperature of my hand was fluctuating around the 28–29°C mark.
So nicotine and tobacco smoke are addictive substances whose effects on our body are not only long-term; they have some pretty immediate impacts. Causing our blood vessels to constrict can be very serious: if a smoker already has a narrowing of one of the coronary arteries, a single cigarette may be the straw that breaks the camel’s back, causing the artery to close completely — and the smoker to keel over with a massive heart attack.
As well as nicotine, two other important substances contained in tobacco smoke are tar and carbon monoxide. The latter is a colourless, odourless gas that binds to the red blood cells, greatly reducing their ability to take up oxygen. They are able to do this because erythrocytes (you remember them, I’m sure — the RBCs) take up carbon monoxide much more easily than oxygen. In the most serious cases of carbon-monoxide poisoning, the gas displaces oxygen from the blood corpuscles to such an extent that the resulting lack of oxygen is life-threatening. This explains why many people who want to kill themselves choose to do so by deliberately inhaling the exhaust fumes of a running car engine, which contain carbon monoxide.
Smokers will notice dark-coloured mucous when they cough. The substance responsible for this discolouration is tar, which blankets the cilia in our lungs. Cilia are the little hair-like structures whose