The end of this story is the best place to begin: The NSTEMI not only did not kill me, I barely knew anything unusual was happening … until everything started becoming visible in the rear-view mirror.
For the non-cardiologists among you, an NSTEMI is a “non-ST-Elevation Myocardial Infarction.” Apparently not as serious or life threatening as a STEMI, it is still no fun, especially when you are as risk-factor-rich as I am: family history of heart disease, overweight, high blood pressure, high cholesterol, too much alcohol, and too little exercise. Holy crap! It must be a minor miracle that I am alive at all! In my case, the culprit happened to be the “left anterior descending artery,” with a high blockage that is affectionately called “The Widow Maker” because it can cause such quick and deadly heart attacks. Mine was 80% blocked. A stent and 48-hours in the hospital did the trick. It was all so painless and fast that I never realized anything serious was happening!
Here’s the story. Twelve years ago, my baby brother had emergency bypass surgery. He damn-near bought the farm. I argued for some cardiac testing and ended up getting a treadmill dye test. Everything looked good, so I kept taking a daily dose of 81-milligram aspirin along with blood pressure and cholesterol medication, and I stopped worrying … for a while at least. The prospect of coronary disease never really appealed to me, so I asked my doc what I needed to do to get a thorough cardiac work-up. “Show some symptoms,” she said. I did not know at the time that my older brother had needed some heart work done too. 100% of my brothers with cardiac disease may have convinced the insurance companies that testing was in order, but it might not have. Apparently, the tests are too expensive and the results are a bit too uncertain and unpredictive. Showing symptoms seemed like my best option … as long as they were not too severe or with too fast an onset. I turned out to be one lucky buckaroo.
In mid-February 2017, Rebecca and I were in Atlanta visiting my mother while avoiding the New England winter. I was supposed to travel to western Michigan for a few days of work in early March, followed by a week in Ann Arbor visiting my daughter, son-in-law, and new grandson. When the Michigan work got postponed until the fall, Rebecca and I found some cheap tickets from Atlanta to Detroit and flew north on February 17 to hang out with the grandboy for a few days.
The next part of the story is pretty irrelevant and stupid, so skip ahead if you want. Allie and Mike had bought a new gizmo to attach to their toilet for spraying the poop from Ronan’s cotton diapers before throwing them into the wash. (See what I mean. This part has little or nothing to do with a heart attack, but I am pathologically scatological, so I hate the idea of omitting it. Plus, it could have provided a good excuse for doing nothing on Monday morning, but it didn’t, and I did something anyway.)
On Sunday afternoon, while lying on the bathroom floor scooched uncomfortably around the toilet, I turned off the water supply and unbolted the water feed line. The shutoff valve was tight, so I muscled it shut before disconnecting the hardware. The line itself had become brittle and was about 2-inches too long. Instead of bending it and risking the prospect of a break and no toilet, I reassembled everything and planned a morning trip to the hardware store for a shorter, more flexible feed line.
Monday morning, I had the full shopping list in my head and sauntered off on my usual Ann Arbor morning walk: 1.5 miles to the local Ace Hardware and back again. But something wasn’t right. I felt a weird tightness in my chest. Not a serious tightness, but more like a tightness caused by muscling a stuck valve from a weird position behind a toilet. I ignored it successfully until I felt some radiating pain in my left arm above my elbow.
“Aha,” I thought. “These are the cardiac ‘symptoms’ I have been waiting for.” With that, I turned back toward Allie’s house and called Rebecca, who had also been walking in the neighborhood. (We rarely walk together since she walks so much faster than I do.) “I don’t feel quite right,” I told her on the phone, “and I want to have this tightness checked out at the hospital.” She walked around the corner and met up with me.
At almost the same instant, Allie called. She had just left a meeting and was driving near her house on her way back to work. I told her what was up. Without a lick of panic, she canceled her lunch meeting and met us at the house. By then, the tightness had all-but subsided, but the die was cast. I was going to get that cardiac work-up no matter what!
Within about 30 minutes of the initial tightness, we were in the emergency room of the University of Michigan Medical Center. Still no panic, but not a wasted second either. Emergency rooms don’t mess around with chest pains in old fat men. The EKG came back normal, and we all got pretty chill and relaxed. We weren’t going anywhere for at least 8 hours, while we waited for a second test of my troponin levels.
“Troponin” is another word I had never heard before and that is now an everyday part of my vocabulary. It is the enzyme that goes up when heart muscle is damaged by a heart attack … or myocardial infarction in hospital-speak. The emergency room measures a baseline level of troponin upon admission and then tests again 8 hours later; that is how long it takes for the enzymes to appear in the blood. No elevated troponin and a normal EKG: no heart attack. Elevated troponin: something’s wrong. Mine was up ever so slightly, but up nonetheless. It was a sure marker of a heart attack, albeit a small one that resulted in little or no tissue damage.
With that information, I was admitted and became an official patient of the UofM hospital. Some of those experiences were right out of the hospital stay playbook; others were a little more unexpected or surreal. At about 1:00 A.M., Tony the night nurse subjected me to a long list of new-patient questions. “Have you ever been physically abused?” “Are you afraid to go home because of what someone there might do to you?” “Are you afraid of being hurt by a caretaker or someone in your family?”
“Wow,” I thought. What must Tony the night nurse’s shift be like when people answer in the affirmative? “Those must be hard questions to ask,” I commented. “No,” he said, “I’ve gotten used to them.”
“No,” I said, “I mean it must be hard when people answer them affirmatively.”
“That never happens,” he said. “People just lie.”
The whole conversation came as a bit of a shock: that hospitals must ask such sad and troubling questions, and that people feel compelled to lie rather than come clean about how miserable their lives might be. It was yet another in a long, long list of reasons to feel like one of the luckiest people in the world. Never in my life would such questions have ever entered my head, yet they are commonplace upon admission to the hospital. Yikes.
Another surreal moment came on Tuesday morning, well before my gurney trip to the cath lab. A team of practitioners, all of whom happened to be female, trooped into the room, and instructed me to get out of bed and drop my trousers. They were the skin-care team making their twice-weekly rounds to check every patient in the hospital for bedsores and skin maladies. Always the cooperative patient, I did exactly as asked. “Beautiful” the team leader gushed; “it’s perfect.”
“Did you hear that?” I cried gleefully to Rebecca and Allie! And to the team of ladies, I said, “Please repeat to them what you just said to me.” They complied. “Wow,” I said excitedly. “No one has ever looked at my ass and said “Beautiful. It’s perfect.” It is a moment I will relish forever, for I never expect a repeat in my lifetime.
Yet a third came as I was being prepped for the catheterization. When the nurse started to remove my outerwear (since I was in the hospital, I was already wearing no underwear), she asked in a not-very-matter-of-fact way, “what’s all these wires doin’ in your stuff?” Apparently the endless tubes and wires associated with IV drips and EKGs had managed to wrap themselves around places where they had no business being. At that moment, I was genuinely concerned that the cardiologist might find enough arterial damage to warrant full-blown bypass surgery, and that, like my brother before me, I might wake up in a surgical recovery room with my chest having been split open. Those fears notwithstanding, we all laughed until we cried. Just like the old Reader’s Digests used to say, laughter really is great medicine!
I have no clue what the staff is like at most hospitals. Thankfully, the University of Michigan Medical Center is my only real point of reference, and its staff is incredible … and I mean everyone! The nursing staff, the technical staff, the housekeeping staff, the dietary staff, the medical staff: it was remarkable what kind, friendly, compassionate, and professional people I met. I wish I remembered every one of them by name. Even the food was delicious. Amazing.
The two who stand out the most were the recovery room aides who stood over my groin pressing on my femoral artery for over an hour after the catheterization. Here’s why: the cardiologist sticks the catheter – a flexible tube the diameter of a ballpoint pen refill – into your chest cavity through a hole in your groin. (Like I said, a lot of this experience was totally surreal.) Before poking that large hole in your femoral artery, however, these sadists spend about 18-hours filling you with heparin, a strong blood thinner. Yep. They turn your blood into something with about the same clotting ability as alcohol, and then pop open one of your arterial interstate highways. Cute. Once the procedure is complete, they work hard at sealing you back up, which requires two distinctly different efforts: you lie perfectly motionless for 4 hours while a couple of aides apply really, really hard direct pressure to the wound for the first hour or two. My wound decided to form a golf-ball-size “hematoma” almost instantly, which gave me no pause whatsoever because I had no idea what it meant, but it scared the crap out of the recovery room staff. They never let up: two bodies and four hands of non-stop pressure for well over an hour. Those ladies were monsters, and 100% professional. I guess when I think about it, without them, I might have bled to death. The pain subsided after about a week; the bruising took almost 2 weeks to heal. It was my only physical reminder of the ordeal/adventure.
The acute part of the experience is now history. I never felt bad or lethargic. Other than the bruising on my groin, I never felt any pain. (Oh wait. Yes I did! They kept sticking EKG leads onto my unshaven chest. Pulling those things off killed!)
Now chapter 2 sets in. A few days after the event, I drank my first — and last — scotch. For those of you who do not know me too well, I have, for all practical purposes, been drinking scotch every day for the past 51 years. I entered Tulane as a freshman at the ripe age of 17 in 1966; New Orleans being New Orleans, I was never once asked for an ID. I started my regular scotch drinking then; I fear it may have ended on February 26, 2017. By the Sunday after the event – a full week since my heart attack, for God’s sake – I had my first drink. On Monday, my entire body went on vacation. I couldn’t budge. Every part of me was exhausted, and I felt utterly hung over. I stayed in bed until 11:00, took 2 naps during the afternoon, went to bed about 8:00, and slept soundly for 11 hours. By Tuesday morning, I was almost back to normal, but I have not had a hankering for a scotch since. I wonder if my drinking days are over. I certainly hope not! Only time will tell.
Not drinking might be a very good thing for now. Through temperance alone, I have reduced my caloric intake by about 200 per day. I have also become much more mindful of salt (less than 2 grams per day), fat, and exercise. It’s been a month now. How come I am not losing weight? This being fat crap is for the birds. I always figured that fewer calories in and more calories out would do the trick. I guess it’s more complicated than that. For those of you with chronic bellies, I’ll keep you posted on what I learn. I weighed 165 in high school. Today, the scale tips at 205. I wonder what size pants I will wear at 160. I wonder if my blood pressure and cholesterol will actually go down. I also wonder if the girls will swoon over me or if I’ll feel like wearing speedos. (Insert smiley face here.)
This week, I met my new cardiologist. I expect we will get to know each other way too well. With his help, I have a whole new list of activities: a treadmill stress test, an echocardiogram, more medications. It’s a good thing that I get excited about making new friends. Every time this adventure opens a door, I appreciate it in a brand new way: Cool. I get to experience it. I don’t think any of this would be nearly as fresh or exciting if I were dead or infirm. Not dying is up there with having kids as one of the greatest experiences of my life.
myinnersociologist 