Getting to the heart of the matter

Totally chilled and proud of our fashionable footwear. Birthday Massage at the Bush Spa

Highlight of the week: Total chill at the bush camp spa. Massages to the backdrop of hippos laughing

Lowlight of the week: Our teaching session is thwarted at the district hospital. Bumped for a talk about money. Perhaps next week. 

Maximum temperature: 32 degrees Celsius

Rainfall: Still none

I lost my heart in Ashington. Stolen by Keith. Keith has it in a cabinet, on prominent display, to this day.

Hearts are what make us tick. Poor lovelorn Aristotle had no idea what was going on in there. Believing the heart to be the source of intelligence and morality. Aristotle was all heart.

Cardiology seems to attract intelligent clinicians of high moral standing. I might have become a cardiologist. My keen ears easily tuned in to tiny ticks of baby hearts during my junior doctor medical encounters. But my false positive rate was super high, and every patient seemed to be a ticking time bomb, with a badly plumbed heart. Dr Oo cottoned on to my sharp ears and counselled me to put cotton wool in my ears before wielding my stethoscope.

My Achilles heel is thinking outside the 2D box. The foetal heart contorts and folds. Full of secret passages, critical to the necessary adaptations that little hearts make when their owners dive out of the birth canal. My non-plastic brain failed to get to grips with the interior workings of Aristotle’s seat of morality. Echocardiograms are still written in Chinese symbols. I failed to make the grade. Clearly lacking in moral fibre and IQ.

And yet as a paediatrician I have always dabbled with errant hearts. Palpitations is our little medical box. A box containing all sorts of sensations that have little to do with emotions. We have a system of sorting this collection of ills in England. Keith, and his ilk, would see them with a story of woe in General Practice. His ears, dulled by years of scuba diving, would fail to hear murmurs and internal workings of little hearts. But the concern on little and big faces would galvanise his referral pen. You need to see a clever doctor. Keith would declare.

Typically, if the wee one wasn’t unwell Keith’s pen would be wielded. A carrier pigeon would fly to the local hospital and a secretary would give the child with a fluttering heart an appointment to see a clever doctor within 6 to 8 weeks. And during that time the parents would keep a diary of every single beat. Modern post-plague England has changed your healthcare landscape unfortunately. Nowadays that wait is about 6 to 8 months.

Here's where I come in. The clever doctor. I listen. To both the story and to the heart. I read. Both the referral letter and the diary. And if the story sounds both good and bad I bring out the clobber. A monitor for capturing errant tick and tocks. Fancy clobber.

The fancy clobber needs to be worn all day long. Whilst everyone waits for a tick to become a tock. Time passes. And events are recorded. But waits are often long waits. It’s the way the system works.

So welcome to present day Zambia. A place where time stands still. Where Prehistory mixes with modern happenings. We are at a Safari Lodge, checking out staff to stop them from having heart attacks and strokes. We are looking into their futures and understanding their pasts.

I see *Mandy. A 34 year old member of camp staff. In fact, it is her partner, *Tony, who gets the ball rolling: When you see Mandy, can you ask her about her heart palpitations. She won’t tell you herself, but she keeps getting them and I am really worried.

 Mandy fesses up to the worrisome flutters: I have had them on and off for years. But they are worse now. They seem to come on when I bend forwards. It starts suddenly. My heart races. I feel dizzy and unwell. It can last up to 30 minutes. Then suddenly it stops. My gut tells me that Mandy has a dicky ticker. We make a plan. A new Zambian palpitation protocol takes its first steps. Tentative paces.

 Luigi Galvani would be proud of our ECG machine. It looks fit to galvanise any muscle. To make it twitch. But in truth our new ECG machine is state of the art. It listens rather than provokes. It picks up minute electrical signals, created by our heart muscles, and tells us where the signals are coming from. And where they are going to. No wasteful consumables with this ECG kit. It looks straight out of Carry On Matron. All suckers and KY jelly. But it connects to a modern smartphone via an app. Without the benefit of AI. And like it or not we have to read the runes ourselves.

As Mandy wipes off her KY jelly I squint at the wiggly lines. My hackles are up. A tell-tale twerk of the ECG line confirms my suspicions. Mandy is going to need some fancy clobber. And probably an even more clever doctor. One with intelligence and morality. I resolve to phone a friend. Nicky.

Now, Nicky and I go back a few years. We did our very first house jobs together in 1990. Suction ECG machines were state of the art even then. The ECG would be printed out, one lead at a time, on a very long piece of paper. Our immediate boss, a cardiology registrar with an attitude, would not look at our ECG until we had cut up the long strip into 12 pieces. Each short strip representing a different view of the heart. Each view had a designated position when glued onto an A4 sheet. The glue had to hold fast, for our boss had strict rules. His night time slumber could not be disturbed. His on-call room door stayed shut as we slotted the A4 sheet under the door. His verdict final. The runes were read behind a closed door. The secrecy intrigued Nicky enough for her to venture into the specialty created for the wise and the true.

Thirty five years after graduation I reconnected with Nicky at the Biscuit Factory in Newcastle in November 2025. A brilliant event that allowed us all to reshare formative experiences. Nicky told me of her recent retirement, but I quickly put her right: You can expect us to be slipping a few ECGs under your door in the months to come. Last Tuesday I pushed a sheet of A4 under her bedroom door. Please could you come out of retirement to read Mandy’s runes for me?  I plead. Nicky wakes and obliges.

Now is the time for us to set up the fancy clobber. Keith bought a Kardia device for the Valley last year. It’s a bit of wizardry in a match box. A portable 6 lead ECG machine. Always in your pocket, it’s easy to whip out. It connects immediately with your smartphone. You place it on your knee, and stick both thumbs on it. Hey presto: it tells you how your heart is ticking or not. I present the Kardia to Mandy with a flourish. Here is a box of magic. I tell her.

Mandy takes to the Kardia device like a duck to water. Within 4 days she sends me a magical trace that clinches the diagnosis and paves the way to fix her dicky ticker.

Two hundred beats per minute. Too fast to allow Mandy’s heart to fill. Her life force ebbing as she faints. No wonder she feels shocking. Yet the electric image is the key to a fix. Nicky and I have a multidisciplinary team meeting. Courtesy of Mr Musk, and the power of WhatsApp video. Mandy has supraventricular tachycardia. Her heart electricity is shorting out. A favourite condition for both of us geeky doctors. A problem that has a fix! We make a plan. Without Mandy!

Mandy can’t take the smile off her face. Electric signals work overtime around her mouth and her eyes. After years of uncertainty she finally knows the name of the beast in her heart. Our clinician centred management plan hits a bullseye. Mandy is delighted to slow down her dicky ticker until she can find an even more clever doctor to ablate the aberrant electrical alleyway in her heart.

From story to solution in 4 days. Eat your heart out NHS. South Luangwa has the finest cardiology service of them all. The record of Mandy’s heart bounces 5,029 miles and back. Tony definitely stole Mandy’s heart this week. He stole it. Transforming it from the fastest heart in Zambia to a steady dependable, beta-blocked organ. Moral and intelligent. Perhaps my finest 4 days yet?

*Names have been changed to protect identity. *Mandy has read the blog and given her permission for publication

Bush cam photo of the week - Mum brings her baby for a drink

Mandy's heart tracing - going very fast -and then suddenly normal again

A baby hippo and an even smaller crocodile hanging out

Wearing a coat of Nile cabbage

What does it take to get the potholes filled in? Just an election year and a presidential visit. The Chipata road never looked so good

Sunset at Wildlife - it never fails to impress