In this world where we live, there should be more happiness…

If you are of a certain age, and from certain parts of the world, Christmastime means Morecambe & Wise on the television. Even though it’s almost 30 years since Eric Morecambe died, their BBC shows from the 1970s remain a high watermark in television comedy. Looking at the tv listings for this week in 2013, there are three different Morecambe & Wise compilation shows on the BBC.

I recently read Little Ern, by James Hogg, a biography of Ernie Wise. As an emergency medicine doctor, the moments that stuck out for me were those recounting Eric Morecambe’s heart troubles.

Eric Morecambe had his first heart attack in 1968. He began to feel unwell during a week-long live engagement, which worsened as he drove to his hotel after a show. Unable to continue, he had to stop and get a passerby to take him in his car to the nearest hospital. According to the bio, he checked in to the hospital, was confirmed to be having a heart attack, and then… nothing happened.

Ernie Wise was contacted, and told it was possible that Eric wouldn’t survive the night. Ernie contacted Eric’s wife and they went to his bedside. He made it through, and slowly recovered. He was advised to rest for six months and was discharged. Eric Morecambe was only 42 at the time.

He had no intervention, no drugs, no cardiac rehab. Eric did modify his lifestyle after the heart attack: He gave up cigarettes and started smoking a pipe instead.

In 1979, he had his second heart attack. This time he underwent a seven-hour bypass. The world’s first saphenous vein coronary artery bypass graft had only been performed 12 years earlier. The 1979 Morecambe & Wise Christmas special was curtailed and so instead of the usual singing and dancing, the duo were interviewed by David Frost for most of the hour.

The biography outlines that by 1983, Eric’s health was failing again. He was short of breath, and had cardiomegaly on his ECGs, so we can assume his ejection fraction was shot. I recall in spring 1984 seeing Tommy Cooper die of a heart attack on live television. Eric Morecambe was watching it too and was concerned for his own health. The next month, after stepping off stage following an evening in conversation with his friend Stan Stennett, he collapsed and died. He was only 58.

It initially seems hard to fathom in 2013 that someone having an acute MI would just be put in a hospital bed to see what happens, but that’s how strokes were managed until recently. I know there is a debate still going on about stroke management by thrombolysis, but at the very least it seems wholly intuitive these days that an active pathology should be met with an active response.

The last decade has been the sepsis decade. How to recognise it, how to respond to it. Is there an active pathology we are overlooking today that needs a similar response as the ones we give MI, stroke and sepsis?

I often describe emergency medicine as “real time” medicine to new junior doctors to try and explain that the severity of presentation might not always be an emergency. The real skill is to develop the ability to diagnose, act, respond and plan in real time to any acute presentation, from cardiac arrest to minor sprain. For both EMs, emergency medicine & Eric Morecambe, timing is everything.

Happy Christmas!

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