Serious as a heart attack, Part I

“Mr. Durden, you’ve had a heart attack”. Dr. Stone, whom I had known for decades, gave me the fish eye as he shared this little item of information with me. Part of me was stunned as I received this verdict but part of me was not. I had been dealing with chest pain for years and now, at last, I knew why. That might sound odd to a rational person; three years of chest pain which came on with exertion should be enough to alert anyone to a cardiac problem. The problem with that analysis however is that A. None of us, or at least very, very few of us are entirely rational, and B. Human bodies are just not at all as predictable as we would like to believe. But let me begin at the beginning.

Three years ago, while helping friends move from their condominium to a rental house where they would live while looking for a house to buy, I felt great as I hauled tables and lamps and boxes of all sizes down a flight of stairs and loaded them into a truck. I was happy and perhaps a little bit proud to be able to hold my own at 63 years of age with guys half that old. We emptied the condo and unloaded our cargo into a storage unit where it would rest for a few weeks until the rental was clean and empty and ready to be reoccupied. When those few weeks were up the call came to reverse the process and move my friends into their new nest. A crowd of us duly showed up and the work of transferring the household goods back into trucks and then into the new house began in earnest.

But something was different this time. After carrying, or helping to carry, several items I felt a distinctly uncomfortable pressure in my chest. I tried to ignore it, but the pressure was not to be ignored and so I sat down several times to let it subside before resuming my labors. At the end of the day I forgot about it and proceeded to go on with my life as I always had done before. But the intermittent pressure was not interested in going away. Climbing stairs, walking up a hill or carrying heavy loads would trigger the pressure which I was finally beginning to call pain, and at last I went to see my naturopath.

My naturopath, Dr. Marsh, is a very smart guy. He knows that there is much that can mimic heart disease and conducted or ordered tests to evaluate for food allergies and sensitivities, a chest x-ray, and ultrasound of the gallbladder and a few more diagnostics and concluded that he could not rule out a cardiac problem. I was then referred to a naturopathic cardiologist who ordered a stress EKG. That test came up positive for the heart as a likely source of the problem. The doctor suggested that I get an angiogram to confirm that I had a blockage or one or more of my coronary arteries before proceeding to fix the problem with surgery.

I didn’t like that news at all. Other than minor dental work I have never had surgery of any type and had no interest in doing so now. Also, the thought of doctors threading a catheter up an artery from my groin into my heart and squirting dye into my coronary arteries to make them light up under X-ray to demonstrate a blockage did not sound like a stroll in the part either, so I began looking around for an alternative and found it in the form of a Thallium Stress Test. This test is performed by injecting into a vein a radioactive isotope which likes to find it’s way into heart muscle, and then walking the patient at a nice clip on a treadmill to get the heart pumping at a higher rate than usual. Then, after resting for a while to allow the isotope to settle in the heart muscle I was laid on a table under a very special camera which detects that isotope. The result: no defect in perfusion of my heart muscle with the blood it needs to remain healthy.

A clean bill of heart health was exactly what I wanted to hear, and I concluded that whatever my problem was it was not heart and I would just have to work through it, so I took long walks, climbed hills, and tried to condition myself so that I could shake the uncomfortable pressure out of my life and get on with being a senior citizen superman. The plan worked, sort of but during the last year some other changes began to show up, and even though I continued to refuse to add two and two together the signs were there if I had chosen to read them.

First and most significantly, my energy level began to drop. I have always been an active guy and the barest hint of some activity to engage in with friends was all that I needed to launch me full tilt into chopping wood or playing frisbee or hauling sound equipment at my church from the theater where we meet to an upstairs office down the street where it rested during the week. A bad shoulder which is the result of thirty years of performing ultrasound exams was the primary indicator which ended my church tear down activities but I certainly didn’t mind avoiding the chest pain which inevitably accompanied that activity as well. Slowly I came to accept that there were activities that I simply could no longer do, ascribed it to my age, and settled down to learn to live with it.

More worrisome to me than my decrease in energy was my decrease in interest. I still continued to read and walk and meet with friends, but the verve was greatly diminished. Walking three or four miles in Hawai’i on a vacation was still a pleasure, but walking the same distance on the familiar streets of my own hometown was no longer tempting enough to draw me out of my chair and onto the pavement. There was always a good excuse; the weather was bad, work had been tough that day, or I had already done enough extracurricular activities that week. But the weather was no different than it had been the previous thirty years that I had lived here, my work was in fact easier than it had ever been, and my other extracurricular activities had never slowed me down before. Slowly I came to enjoy sitting in my chair reading a book on history or theology or philosophy more than sitting in a chair at a pub discussing those topics with friends.

This progression of changes finally came to a head on a Wednesday a little less than one week ago as I write these words. I had eaten on Tuesday night at about seven and after finishing dinner went outside to water the front lawn and pull some weeds in my vegetable garden in the back. Upon returning to the house I felt the old familiar pressure and expected it to quickly go away.

Throughout the night I would awaken and go to the bathroom or get a drink of water and it would not go away. Upon rising in the morning I got dressed and walked to work, and it did not go away. I came home and helped prepare to go to a picnic with friends and it did not go away. While chatting with those friends I was invited to throw a football, fling a frisbee, roll some lawn bowling balls but I declined; I just didn’t feel like doing any kind of activity and the pressure would not go away. At one point several people walked up a hill at about a 20% incline to a field above us and I looked at that small hill with the absolute certainty that I could make it up there but had no interest whatever in paying the price in pain that it would require to do it. Turning to my wife I said “I’m tired, let’s go home so that I can get some sleep.” And still the pressure would not go away.

We arrived home and I brought in a few items from the picnic. I began to walk down the hallway towards the bedroom and bathroom and the realization hit me all at once: I was not going to lie in bed one more night with my chest hurting. Halfway down the hall I wheeled around and said “I think you had better take me to the E.R.” “Would you rather go to an urgency care clinic” asked my wife who knows how little I like being a patient. “No”, I replied, “I know that they would just send me to the E.R. (probably in an ambulance I thought, but didn’t articulate that vision). Let’s just cut to the chase”. I grabbed a book and put a few supplies in my book bag and we rolled down the driveway and up the street towards the hospital only a few locks away.

When we arrived at the Emergency Department main entrance we could see that the little parking lot was full. My wife let me out and went to park somewhere further away. There was a small line of people in front of me who presented with a variety of issues. They were asked all the right questions and were duly processed and went to take a seat in the waiting room where they would await their turn to be seen. At last I stood in front of the open window. “What’s going on with you tonight sir?” asked the the young woman sitting behind the counter. “Chest Pain” I replied, and before another sixty seconds passed I was ordered – and I do mean ordered – to sit in a wheelchair which almost magically appeared behind me. Sixty more seconds and I had a blood pressure cuff inflating on my arm and an EKG tech awaiting his turn at me.

In ten minutes’ time I was lying on a bed in room 71 hooked up to a variety of monitors with a phlebotomist waiting her turn to draw a few tubes of blood. The blood draw completed I now had two needles the caliber of the Alaska pipeline inserted into my veins, one in each arm. What followed was a ritual dance of X-rays, more blood work, and waiting while calls were made, and finally Dr. Stone appeared from behind a curtain and said to me “Mr. Durden, you’ve had a heart attack. It was a small one, the EKG was read by the machine as normal but some of the waves just don’t look right to me. And the blood test confirms it. The cardiac enzymes level indicates that you’ve had a small heart attack. You’re going to be going to the cardiovascular intensive care unit tonight, and then tomorrow morning you will have an angiogram. If they find the problem perhaps they can put a stent in the vessel to open it up and you can go home. We can hope so anyway.”

After a gathering up of stuff I was rolled out of Room 71 on a gurney and taken to the fourth floor where a big, soft bed and a bank of glittering and beeping monitoring devices awaited me. I made the transfer to my new bed, was introduced the the night RN, George, and soon was alone in a darkened room with a couple of IV pumps pushing fluids and medicines into my veins and wondering how in hell I ever got here and where my life would lead next.

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