Crazy Little Thing Called Blood
Every spring without fail, private hospital beds across the country, and particularly in Melbourne, fill with healthy people. People not merely healthy by “hospital standards” (not your standard criteria for “healthy”, I assure you), but healthy by everyday standards. Fit, tall (even Jake King is of average height according to national data), strong young people come in their dozens, to have the latest surgery performed by the best surgeons. This isn’t Hollywood and they’re not actors checking in for “face lifts” or “tummy tucks”, this is Melbourne and these people are footballers, checking in for “shoulder recos” and “syndesmotic repairs” – it’s not the sexiest surgery in the world, but there is still a touch of the glitz to it.
As your hands glisten from the chlorhexidine solution that you used to remove the Staphylococcus bacteria from the patient in bed 4, you may just walk past Chris Judd. You might even shake his hand. You will, of course, then return to your ampoule of antiseptic, for even Brownlow Medallists have germs and even AFL footballers get sick.
Daniel Wells was one of those fit young people who passed between the chemical-washed walls of a Melbourne private hospital at the end of a long and weary AFL season. In fact, I tell a lie, Wells had his surgery before the end of the season – it was reported on the Kangaroos website in late August that Wells would have his shoulder surgery and sit out the rest of the season, which he did. According to the Kangaroos, they wanted Wells to have his surgery performed and rehabilitation completed in time for their pre-season training camp in sunny Utah, which he did. Where’s the story? A footballer had surgery, underwent post-operative rehabilitation and did all this in time to prepare for the next season. There is nothing exciting or “special” here. But there is never anything “special” about what happened to Wells – he got sick, he became a patient.
Every surgery has its risks. Some of those risks play out on the operating table, others manifest themselves playing Angry Birds in the hospital bed, and some take even longer. At some point between shoulder surgery and putting his feet up on the couch at home, Daniel Wells became unwell. He went in for routine surgery (an unsettling term for any medical professional to use) and developed a complication. Clots that most likely developed in his legs had travelled through his veins and to his lungs, causing him chest pain and difficulty breathing (now is the time to panic).
Blood is a phenomenal thing. It carries cells that can fight off infection and electrolytes that keep nerves firing, it filters out the waste and carries all the nutrients. Despite all this, what we think about most when we consider the role of blood is really quite a bland and simple thing: it delivers oxygen. But this is the most immediate of blood’s roles, the one that keeps you alive, not from day to day or year to year, but from second to second. It does more than this, oxygen doesn’t simply keep you from dying, it keeps you running, jumping, kicking and winning games of footy. If I may opine, for a footballer, blood is the key to all their success. A footballer’s blood and, more poignantly, its ability to deliver high volumes of oxygen at a very fast rate, distinguishes them from the mere mortals. When Daniel Wells’ blood started to clot, it was a serious matter for his football future. But then, it is a serious matter for anyone’s future.
Pulmonary Embolism is the term we use to refer to blood clots in the lungs or, when it all seems like a mouthful (it always seems like a mouthful), we simply call it a PE. The fact that blood clots occur in the lungs is not simply a matter of chance, it’s almost a matter of destiny. PE’s do not originate in the lungs themselves, but most often start in the legs. For over 100 years doctors have been quizzing medical students on the three key factors (known as Virchow’s Triad) that lead to blood clots, and for over 100 years the students have been answering that question correctly (you don’t need to be a fast learner in this game). In a nutshell, blood has to have some chemical tendency to form clots, it has to be moving slowly and there has to be some level of damage to the walls of the veins (on the micro-scale). Blood clots form in the legs because, all the way down there, blood doesn’t move very fast. When these blood clots form, they can dislodge and travel up to the heart, where they are pumped into the lungs.
If blood is the engine that powers the Titanic, then the lungs are the workers shovelling the coal for 6 cents an hour. The lungs serve a single purpose: to get oxygen into blood. Blood enters the lungs without oxygen and exits the lungs full of the stuff. Blood clots enter the lungs and that’s where they stay.
Without swift action, and sometimes even with it, a blood clot in the lungs is a deadly thing. Small clots might not be noticeable, until you start to run. Something’s not right, there’s not enough oxygen in your blood and you start to puff after only a few metres. Bigger clots might give you chest pains, you might start gasping for air – you haven’t even gotten up off the couch. The biggest clots require swifter action. These clots are stopping blood from getting to your heart – it’s the same effect as having a heart attack, but even worse. Your blood pressure drops through your boots, your heart is beating but it has no blood to pump. Right now, you need to be in a hospital, and even if you are, ‘luck’ is the treatment of choice.
Evidence shows that when a person has blood clots, even in the absence of an identifiable cause, they are at increased risk of developing more clots. To alleviate that risk, the standard treatment of PE’s includes not simply treating the clots, but using medication that makes it harder for new clots to form. Then, once all seems well and the nightmare is over, they’re left on that medication for up to six months.
In a recent interview with The Age, Wells spoke of his experience. “I didn’t feel like I was going to die at the time, but everyone was saying I could have” he said. The risk with a PE is not so much that it will turn from something more benign to life-threatening. It may be that the clots on Wells’ lungs were never going to threaten his life. The concern is that it could happen again, and that the next time it could be much more devastating.
For Daniel Wells, this has meant a protracted stint away from contact training. You see, a drug that makes it harder for blood to clot will make it easy for the opposite to occur: bleeding. In fact, sometimes this drug isn’t used, when the risk of bleeding is greater than the risk of clotting. Politics is often described as the balance of competing interest. Medicine is the balance of competing risks. For Wells and his doctors, the risk of having another PE is something they’re not willing to leave to chance.
In medicine, like in football, teams must work together towards a shared goal. The doctor in emergency collects the patient and rebounds from a difficult spot, she passes it on to the doctor on the ward who takes on a few hospital administrators (the opposition) to get the patient a bed. This doctor now passes it on to the radiologist, who sizes up the situation and then delivers it to the surgeon. The surgeon lines up the problem and then with full-forward-like precision, viola! It’s not always as smooth as that, but with a bit of coaching and a solid game plan, it can work pretty darn well. This, of course, is where the similarities end. The most glaring difference between medicine and football is significant: to get from emergency to theatre and out, medical professionals must make every effort to avoid and alleviate risk; for a team to move the ball from the backline to the forwardline and then through for a goal, footballers must take risks.
As the pre-season starts and the first bruising tackle is laid, cast your thoughts to Daniel Wells sitting on the sidelines. He’s not injured, he’s not sick. Maybe this is even the fittest he’s ever been. He’s just another patient avoiding a risk, rather than a footballer taking one.