Enough time has passed that I’m no longer completely freaked out by this, so I’ll explain in some detail what I meant in my recent update by “heart attack.”
By which I meant that I had a heart attack. Like, in my heart.
Let’s start by hopping into the Way-Back Machine and going to a little time I like to call “the week after my birthday, on a Tuesday night in mid-April.” Or something. Anyway, let’s set the scene: It’s after midnight, we’re in bed, the lights are off, two dogs are snoring on each side of us which fills the room with the white-noise of safety, and I’m asleep.
I find myself being pulled out of my dream state by an incredible sense of generally decentralized pressure. As I’m coming to, my sleep-addled brain draws the conclusion that Roxanne, our 120 pound Great Dane, has climbed onto the bed and is attempting to sleep on my chest. I thrash about a bit as I try to push her off, only to discover that she wasn’t on me, or the bed, or even my side of the room…in point of fact she was on her own bed in the corner, and probably looking at me like I was insane.
Then I decide that I must have become wrapped up and bound in the comforter. Amy refers to this phenomenon as “being burritoed” and has accused me of doing this to her on purpose in the past, so obviously she was trying to get some kind of explanatory revenge…except that the comforter was in a wad down under my knees.
At this point I came to the only remaining logical conclusion: our mattress was possessed by a poltergeist…
Actually, that’s not true; after I realized that I was not being crushed by the dog or bound up in the bedding I pretty much stopped trying to figure anything out and the emergency alert system in my brain took over. I tried to sit up and discovered that my entire left side felt like a single intricately connected web of utter pain. From the jaw joint directly below my ear down my left side, to the last nerves at the tips of my fingers and down my leg to the utter ends of my toes my left side was a singular and fathomlessly deep well of anguish. A physical hurt so excruciating that the muscles on my left side made absolutely no attempt to respond to my brain’s instructions to contract or relax. This made sitting up difficult. I sort of flop-thrashed until my general body position was sort of propped up on my right arm at about a forty-five degree angle from both the surface of the bed and the space between Amy and the floor. My left side probably looked like I was practicing poses for the Mister Universe competition.
Which was about the point when my movements woke Amy up and she started asking questions, like “what the hell is wrong with you” and “I’m calling the ambulance.” Actually, the last one wasn’t really a question, but I treated it like one. “No, no…I’m alright,” I said through a half-clenched jaw. She looked at me dubiously. “I’m sure it’s just indigestion. I’ve had ulcers before.” I knew it wasn’t indigestion. Or ulcers. I felt like there was a giant vice grip crushing my rib-cage in a line directly below my sternum. Ulcers feel like someone is boring into your chest wall with a dull spoon attached to an electric drill. This was not that, but I was sure it was “nothing” and certainly didn’t merit the hundreds of dollars an ambulance ride would cost.
“I’m feeling better” I lied.
“You don’t look better.” She reached over and took my left wrist in her hand to check my pulse rate. I still lack words to sufficiently describe how much that hurt. As she held my wrist and counted the heartbeats I felt the tension on my left side begin to release. The pressure in my chest began to decrease in waves so slow they were almost imperceptible, like the tide going out on a wide beach.
“You’re white as a sheet. I’m getting you an aspirin. Don’t worry, it’s coated.”
I made a non-committal sound and she got up and went into the bathroom to dig through the first aid kit. The pain had receded enough that I was able to fully sit upright and begin to measure my breathing. I felt like I’d been punched in the jaw and the bones in my forearm had split in half like hot-dog buns, but my leg was only throbbing and responding to movement requests again. I realized that I was gripping my left wrist in a sort of vain attempt to crush everything under the skin back together.
She stepped back into the room with the light from the bathroom door illuminating her from behind and obscuring her face. She handed me a small pill and I briefly thought that if one was good, maybe a couple dozen would be better, but I didn’t say anything. I swallowed the pill and she took my wrist again to check my pulse and between rounds of counting said “I really think we should go in to the Emergency Room.”
“I really do feel better.” I said. “I’m sure it’s nothing.” I still didn’t sound convincing.
“I’d rather you see a doctor. If we don’t go tonight, will you promise to call the doctor in the morning?”
“Yeah, I promise.”
Over the next half-hour I perked up, my heartrate settled, and I convinced myself it had been nothing.
The next day I kept my word and called the doctor. “Are you seeing new patients?” I asked. “We moved to the area a couple of months ago and I promised my wife last night that I’d call.”
“We are taking new patients for two of our Doctors; we’re scheduling for six weeks from now. What symptoms prompted you to call?” Her voice was very southern-sweet with that undertone of a receptionist who was already tired of taking calls before ten A.M. on a Wednesday.
“Well, I woke up with this incredible sense of pressure in my chest; and excruciating pain in my jaw, arm, and leg in the middle of the night last night. My wife made me promise I’d call a doctor since we didn’t go to the ER.”
There was a long pause on the line.
“Can you be here at three-o-clock this afternoon?”
“Yes I can.”
And I was.
Weight was higher than I thought. Blood Pressure was pretty good. Heart Rate was elevated, but not bad. The nurse called on a technician, who wheeled in a mobile EKG and set about untangling the electrodes. Without looking up she asked me to take off my shirt, which is exactly what I hate to do.
She stuck something like a hundred adhesive backed electrode buttons in a seemingly random pattern scattered all over my chest and sides. She hooked the different electrodes to wires haphazardly hanging from the EKG machine and turned it on. It immediately began spitting out a stream of paper that folded onto itself in an ever growing pile. After no more than thirty seconds (about one tenth of the time she spent hooking me to the machine) she flipped it off and walked out of the room.
And then no one came back for more than half-an-hour. So I read a book on the kindle app on my iPhone.
When she finally returned she unhooked me from the wires, pulled off all the adhesive buttons (in a reminder that I’m glad waxing is not yet “a thing” for guys) and asked me to follow her. To the room with “the big machine”. Where we repeated the entire process again, untangling the wires, slapping adhesive buttons on me in a random scattershot pattern, and then hooking me to the machine. Except this time she told me they were “going to let it run awhile” and walked out the door.
Cue the second half-an-hour of reading while a disturbingly large stack of paper grew in the bin at the bottom of the machine.
The next person to walk in was the doctor. He smiled, shook my hand, and then turned off the machine and turned his back to me as he flipped through the pages and circled a peak and a valley on every few pages. This went on for several minutes.
“Mister Rogers…” he chuckled to himself as many people do, “please tell me about the event you experienced last night.”
“Well doc, today might be a beautiful day in the neighborhood,” (I love to riff off the name when people notice) “but last night kinda sucked.”
And then I explain it in all the detail I could muster.
“Well Mister Rogers, if you look at this read out, I can tell you that you clearly had a heart event last night. Your EKG readings show signs of disruption to the normal rhythm and potential damage. I would like to prescribe some medications now, and we need to schedule you with a cardiac specialist as soon as possible.”
This was when I realized that I still strongly dislike it when doctors use phrases like “event” and “damage” and “specialist as soon as possible.” This wasn’t the first time I’d heard it, but it was the first time I’d heard it about my heart. Neurological issues (like I’d already had) don’t kill you in a hurry…heart issues aren’t known for waiting around.
Which is why my specialist consult was scheduled for the following Tuesday. If you’re not familiar with the American medical system, let me explain that despite what some people want you to believe about market driven healthcare, specialist schedules are not easy. I’ve seen waits in the months and not even batted an eye. Four business day’s later was basically the fastest specialist consult I’ve personally ever heard of outside of a hospital setting.
I really like the specialist. Great doctor, good bedside manner, very personable and explained the EKG results very clearly. He also explained the next steps where I would have an echocardiogram and a stress-test. He told me that they would give me specific instructions for the testing and that we’d review the results when they came back. He was also the first person to explain that I had a “heart attack” and not just “an event.” We talked about what I could and could not do in the short term from an exertion perspective, we talked about my cholesterol results, and we talked about a reasonable diet plan and potential causes for the heart attack.
And I got a prescription for a heart medication and nitroglycerin tablets. Which was the moment I finally freaked out. Until I got the nitro tabs, it was just “a thing” that happened, not a heart attack. Thirty-six-year-olds do not have heart attacks. Thirty-six-year-olds do not need nitroglycerin tablets on hand. I’m a bit ashamed to say that I took a picture of the tablets and posted it on Facebook with a caption that equated to “wah wah wah, my life sucks” during a moment of pique with the universe…but I came to my senses and took it down after a couple of minutes. I don’t like to put negative mojo into the universe, and that post was not from a good place.
The echocardiogram and the stress-test were scheduled for the following Friday at a specialist facility in Lawrenceville, about twenty miles away. I took “loose fitting, comfortable clothing,” my running shoes, and a book.
I don’t think I spent more than five minutes in the waiting room, even though the facility was quite busy with many elderly people either alone or as couples waiting together for their time with the staff. I was the youngest patient by a solid three decades. Everyone else there was safely eligible for social-security and it weighed on my mood.
“You shouldn’t be here” said the ultrasound tech. “You’re the youngest person I’ve seen here this month. We had a twenty-eight-year-old last month, but he had a heart transplant as a baby. You’re the youngest newbie I can remember.” She was very sweet, and very pleasant, but she didn’t do anything to make me feel better about the big picture. In fact, when I was dressed and sitting in the chairs outside the stress-test rooms, I found myself dwelling on everything and facing down a very bad place.
“Mister Rogers, come on back. I won’t even make you change into a cardigan sweater.”
I chuckled at the short blond leaning out of the open door. She waved me in front of her and swiped her access card at three sets of doors as we made our way to the back of the building.
“Take off your shirt and put your things in this basket, then we’ll get an IV run and the tags on your chest.”
“Should I put on my running shoes?” I asked
She smiled a wry smile. “You don’t need those yet.”
The IV went into the back of my hand, which is approximately my least favorite place ever. She put the adhesive buttons on in a deliberate pattern and went through an obviously practiced sequence. Then she led me down the hall to a room with a sort of CAT-scan machine and motioned for me to get up on the sliding tray. Another technician wrapped a white strap around my ankles, and then asked me if my legs were comfortable. They slid a foam wedge under my knees and then he had me put my arms over my head. At that point they strapped my arms down to the sliding gurney and I started to wonder where the treadmill was.
“Do I run after this part?”
The male tech who was placing the line in the IV in my hand just chuckled.
We don’t have you run, we’ll slide you into this machine, take some pictures of your heart, and then we’ll give you some medicine that will simulate exercise. Don’t worry, we have a defibrillator right here.” and then he pointed at a large red box on the wall to my right.
And with that they slid me into the machine.
The first twenty minutes were no big deal, just lay there and listen to pop-hits of the 80’s while watching a little blue light go from right to left every two seconds. The the male technician’s voice came over the intercom, “we’re starting the medicine now, and we’ll take some pictures of your heart as it’s working. Just about eight more minutes.”
And then they chemically induced a grand-mal panic attack. I really can’t describe how bad those eight minutes were. It was, without a doubt, the worst thing I’ve ever been involved in medically. Had I not been strapped down I would have FREAKED THE FUCK OUT AND FUCKING JUMPED OUT OF A FUCKING WINDOW TO GET OUT RIGHT FUCKING NOW!!! For eight minutes. You know how time slows down when you’re upset? When time simply can’t go any slower? Like you could count to one-thousand in between ticks of the clock? Imagine that experience along with the fastest heart-rate and highest blood-pressure you’ve ever had, while chemically convinced that you’re about to die while trapped in a little tube that’s making the most god-awful noise you’ve EVER HEARD and all you want is to get out of it RIGHT FUCKING NOW!!! For EIGHT MINUTES.
At the thirty-second mark I was convinced that I was going to die.
At the one-minute mark I was actively pleading with them to kill me and get it over with.
At the four minute mark I was perfectly willing to recount my sins and plead for mercy from whatever devil had bound me in that hell.
With two minutes to go “Never Gonna Give You Up” came on the radio and I was convinced that my life was a great cosmic joke leading up to my being Rick-Rolled at the moment of my death inside a spinning metal tube.
At about the eight minute mark my heart-rate was down to only being “right after the most strenuous physical exertion of my life” levels, which was a huge improvement. Also, my ears were ringing.
The male tech came back into the room and slid me out of the machine. He looked down at me and said “How do you feel? And remember, be honest, this is for posterity.” Best moment for a Princess Bride quote EVER.
As he removed the IV line and unstrapped my hand he said with a straight face “You were without a doubt the best patient we’ve had in months. I really appreciate how controlled you were.”
“Why did you tell me to bring running shoes?”
“Oh, they do that so people won’t freak out. If we told sixty-five-year-old men that we were going to strap them to a table and chemically accelerate their heart while they’re inside a machine, no one would ever show up.”
“I know I wouldn’t have.”
“Exactly, and you were a stud. How do you feel?”
“I’m still really jittery.”
“Yeah, the meds do that. If you want to know a trick, go drink as much caffeine as you can. They’re from the same chemical family, but the caffeine molecules will knock the molecules from the medicine out of the receptors, leaving you with only a caffeine buzz.”
It should be noteworthy that the buzz from three 20 oz. cans of Amp was significantly preferable to the buzz from the medicine. Once I was less twitchy, I climbed into the car and drove home, knowing that I’d get the results the following Tuesday.
Actually, the results got here in the mail about a week later. I keep the envelope in my desk. I’ve read it about five times, and discussed it with my GP and two different specialists. So here’s the Reader’s Digest version:
Pulmonary Valve Regurgitation
Mitrial Valve Regurgitation
Enlargement of the left ventricle
Enlargement of the left atrium
So, broken down a bit, the left side of my heart is larger than the right side which is creating an imbalance in the pump action, and causing two of the valves to leak back blood during the contraction phase of the heartbeat. My heart attack was very minor in it’s lasting damage. The Echocardiogram didn’t indicate any visible areas of disruption and beyond the issues already identified, I don’t seem to have suffered significant long-term damage to the structure or muscles of my heart.
The down side is that I have Mitral Valve Regurgitation along with the complications of left-side enlargement of the atrium and ventricle. Namely dyspnea and the continuing potential for congestive heart failure.
In fact, I’ve had dyspnea for an unknown amount of time for the last five years. After we all had pneumonia in 2007, I’ve had times when I simply couldn’t catch my breath. I felt like I was still having breathing problems, perhaps some sort of asthma that was left over after the fluid in my lungs cleared up. I went to not one but two different breathing specialists, both times I was told that my lung capacity and blood oxygenation were excellent. Nothing that could explain my occasional intense sense of not being able to catch my breath. A feeling that would come on at the strangest times, like driving, or sitting at my desk, or taking a shower. It felt like pneumonia, breathing in but not catching my breath.
Now I know it was my heart leaking blood back out of my Mitrial Valve.
My doctor’s been pretty honest. Baring an accident or a significant infection/disease/etc…I know that heart failure will be what kills me. At some point the congestion will become life threatening and we’ll look at next options: pacemakers, ventricle assists, valve replacement, heart transplant. As of today, no medicine fixes it. No exercise will make it go away. No amount of wishing will make it better.
On the other hand, it won’t kill me tomorrow. At least, it’s not very likely.
So first things first, I get an entire second opinion. Stress-test and all. I’m so excited!
But I understand why it’s important.
The other thing is pretty simple: health insurance is my friend. From this point on, I’ll be on beta-blockers and keep nitroglycerin with me for the rest of my life. I’ll always know that I’m one bad day away from a hospital stay. I’m a really bad day away from the heart transplant list. If you ever wondered who it is that lives or dies by the “cannot be denied for a pre-existing condition” clause in the health-care law, you’re reading his words right now.
I’m an otherwise healthy (if heavy) thirty-six-year-old man. My blood pressure is pretty good, my cholesterol is under control and getting better, and I’m getting more active and looking again to get my exercise on. I’m not going to sit back and wait for things to get worse, I’m going to focus on being as otherwise healthy as I can, within the limits that I’m now going to live with for the rest of my life. I don’t really know what those limits are yet, but so help me, I’m going to find them rather than wait for them to come find me.
And I’m not going to mope about it. Lots of people wonder what will kill them, baring an accident I already know. Which means I can face it down head on. That sure beats waiting for it to sneak up on me. I’m not dead, and I’m not dying any faster than anyone else. There’s still decades of life left to be lived, and I’m right back to marching out there to live it.
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