Jim Garvin is the kind of student Sailing Instructors really enjoy – he’s teachable, he gets along with everyone and he’s along for the experience more-so than the certificate. Jim Garvin is low maintenance. So low maintenance in fact, that when he had a heart attack on board during a sailing course in the Grenadines his desire to not bother anyone too much almost got him dead.
Jim is a shade over fifty. He’s retiring soon and has a burning desire to buy a boat and see the world. It’s his second time sailing in the Grenadines and his second time taking sailing lessons. He’s also a natural socialite. Anywhere Jim goes he’s happy to strike up a conversation, which he does easily. But he doesn’t spend all the time talking about himself, he asks questions and is genuinely curious about other people and other cultures.
He’s American, really American, and could best be described as a Libertarian as opposed to a Democrat or Republican. I bring this up because Jim’s experience of health care in America may have had an impact on his attitude to the symptoms which led up to his heart attack and then to his desire for treatment.
The day before his first heart attack was spent tacking back and forth in windy conditions from Salt Whistle Bay, on Union Island, around to the picturesque little town of Clifton. Jim got stuck-in, pulling and easing off jib sheets in a series of short tacks. At a certain point he felt the need, understandably, to take a break, which he did, though at that point the joke, the really bad joke, was that he didn’t want to die of a heart attack.
That evening was spent enjoying the night-life in Clifton. Jim is a drinker, not a heavy-one, but a social drinker. He vapes. Vaping is Jim’s way of getting away from cigarettes. He still enjoys the occasional cigarette, though, which was probably not helped by having another smoker on board. Jim also makes a mean bacon and eggs. None of these things can be found on the ‘how to avoid a heart attack’ list.
During the week Jim mentioned (as opposed to complained) he could use some more antacid tablets for his heartburn, which were then purchased in Clifton. On the long haul from Clifton to Bequia, some twenty-five nautical miles, he began rubbing his chest and, for the first time on the trip, complained. The antacid tablets weren’t working.
The sea conditions weren’t great but they weren’t bad. It would be easy to assume that Jim may have been suffering the ill effects of a confused sea and a hangover. But, the fact that the antacid tablets weren’t working and that Jim was rubbing his chest raised the spectre of a more serious problem.
RYA instructor’s must not only take a first-aid course, but they must keep it current if they want to instruct RYA courses. Indeed, the RYA, with its focus on safety, takes the time during the instructor courses to talk frankly and openly about first-aid at sea, including the perils of angina.
What is angina? This is the definition from the American Heart Association: Angina is chest pain or discomfort caused when your heart muscle doesn’t get enough oxygen-rich blood. It may feel like pressure or squeezing in your chest. The discomfort also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.
It may even feel like indigestion.
RYA instructors aren’t medical professionals and, unless they have actual training and experience as a paramedic, which some do, they aren’t anything more than competent first-aiders. Which, in this case, may just have been enough. It helps to have the St John’s Ambulance first-aid app on a smart-phone as well.
The training boat didn’t have angina medication. So, when the subject of angina and the possibility of a heart attack came-up, the answer was to take aspirin. Luckily, because of the instructor’s own cardiovascular issues, there was an abundance of good old fashioned Bayer 80mg ASA on board. Jim took a handful.
Jim’s doctor in Phoenix, Arizona, thinks this may have prevented him going into cardiac arrest.
In Bequia, just south of St Vincent, Jim was finally worried enough to go to the local hospital to be checked. There he was diagnosed by a doctor with Acute Unstable Angina and told to seek immediate attention. The next morning, after blood tests done on the island of St Vincent, Jim’s doctor told him that the results were conclusive – Jim had had a heart attack, possibly more than one.
He flew out to Phoenix for treatment the next morning. After emergency surgery (angioplasty) Jim is doing well. The dream to sail off into the distance is still alive.
Part of the reason Jim was worried about seeking medical help in the first place was his experience of the American health care system and his fear of the cost of a visit to the doctor, especially in a foreign country. It was easier to think he just had a bad case of indigestion. In the end his visit to the hospital in Bequia cost him a fifty dollar donation to the hospital. His blood test cost eighty dollars. Jim was sure, based on his experiences in America, that he would have to mortgage the house for a visit to the hospital.
In the end Jim was lucky. But, as an instructor instructing an increasingly older clientele, the lesson has driven home a couple of useful points:
- Talk to students about their health and their health history
- Over-exertion, especially in warm climates, is dangerous
- Make sure the first-aid kit is complete and up-to-date
- Know where to find medical help
The last (or first) thing to pay attention to, is just because the student isn’t complaining or doesn’t want to be a bother doesn’t mean they don’t need attention.
Best of luck Jim. Hope to see you cruising the Grenadines soon.