I’ve been asked to jot down a post about my heart attack for February, heart health month. For patients, docs and emergency responders can read this post, written when I was actually having a full blown, massive myocardial infarction. Below is a rough draft, a work in progress, it was written quickly and clearly needs to be punched up. I know you guys are probably tired of hearing about this, but if you are so inclined, maybe a peek behind the creative curtain will result in anecdotes, and suggestions that will make it somewhat readable.
A few days ago I was in a doctor’s office. That’s when a text came through telling me an old friend had just died unexpectedly. The details of his death pointed to massive heart attack, he was probably dead before he hit the floor. The news stressed me out in more ways than one: two weeks earlier I suffered a major heart attack at age 50. I’m talking 100% blockage in a primary coronary artery. The kind that’s sometimes referred to as a widow maker, the classic myocardial infarction where the patient grabs at his or her chest and hits the deck, bowels voided, like a sack of potatoes. But my heart attack was different, it felt like someone punched me lightly in the pit of the stomach followed by several episodes of indigestion, the sensation was just above the belly button and radiated down and to the right of all places.
It was right before New Year’s Day, I’d been eating the usual holiday fare, lots of it, and working out hard. What would you think, life threatening heart attack or well deserved indigestion? Why some people barely know they are having a heart issue at all and other patients experience extreme pain and all kinds of distress is a topic of debate among cardio-pathologists to this day.
I’m adopted, so family history is not a guide in my case. But if you told me a month ago I was going to have a massive heart attack, I would have laughed and pointed at you! I was a light smoker and I had gotten a bit overweight over the last few years. But being out of shape was unusual for me, I spent most of my adult life in gyms or outdoors.
My passion was technical rock climbing. Back in the early 80s, before the advent of climbing gyms and movies showcasing the sport, being a serious sport climber meant insane amounts of aerobic activity. A typical climbing day involved getting up at the break of dawn and walking, often for miles, often at high altitude, often grueling marches with large packs full of heavy climbing gear up the sides of enormous talus fields. Repeat day after day. All through my twenties and thirties into my early forties, my idea of a weekend fun away from climbing was aerobic classes with intimidating names like Body Blaster or SEALs for Civvies.
There’s little doubt, that cardio conditioning probably carried over into my late forties when the inevitable weight gain and slower lifestyle underscored that I was mortal after all. Doctors call it collateral circulation, but it just means lots of cross connecting arteries and veins develop in the muscles and heart. That’s one reason your stamina goes up when you work out consistently. Genetics may have conspired against me, smoking is a terrible burden on anyone’s cardiovascular system, but a lifetime of activity almost certainly helped offset those risk factors.
I’m lucky. So lucky I’d like to believe in some sort of innate cardio superiority; it isn’t just appealing, it’s downright seductive. I AM SUPERMAN! But it’s also bullshit. What saved my life was medical science or, more specifically, the hard-working nurses, administrators, the engineers who design the things like x-ray machines and MRIs, and of course the physicians those professionals work with. In the United States the term medical science is almost a synonym for comprehensive health insurance.
My friend that wasn’t so lucky. He didn’t share my lifetime workout addiction. He also was in between jobs, had been for a couple of years thanks to the Great recession, and he had exhausted most of his savings by the time he died. I have about the best employee sponsored insurance available. The day I felt a weird tweak just below my sternum an appointment was made. I chose my PCP specifically because she had been a staff doctor on a military base for ten years and had seen tens of thousands of patients in that time, with a definite bias toward men of all ages.
My cardiologist would soon tell me several times she read my EKG with the skill of a cardiologist: my heart was so well conditioned that even at age fifty it could have faked out a less experienced family doctor. He took out my initial EKG and pointed out the indicator: it was one itty-bitty tiny wiggle on the EKG that caught her eye, a feature shorter than a four letter word in this post. It wasn’t that up and down big spike you see, the one that stands out when you think of an EKG. It was a single little “u” shaped deal in between them on one lead that should have been a little more “v” shaped.
That’s it, the rest of the EKG was completely normal. In fact the rest of the EKG indicated a powerful athletic heart. She was thorough, even though her suspicion was a gall stone or a hernia because those two possibilities fit the symptoms I was having way, way better than any heart trouble. But that teeny little u-shaped deal caught her eye, it bugged her, that’s the reason she referred me to a heart specialist, just to be safe (And that’s the reason she’ll by my primary care physician until the day she retires). My insurance was good enough that I had a topnotch cardiologist in network, there was no arm wrestling with a bean counter, no protected wait for approval of the tests he ordered. The echo sound showed an ejection fraction slightly lower than it should have been, the stress test results offered further subtle hints.
The day came when the cardiologist reviewed me results. You could have knocked me out with a feather when he reached out and gently put his hand on mine, and said my test results might be consistent with what he called a mild heart attack, or at least one waiting in the wings. Again my insurance was good enough that getting a heart cath approved wasn’t an ordeal, it was just a matter of scheduling.
If you’ve ever had a heart cath you know what I mean, but for those who haven’t and may be facing one, honestly, I’d rather be cathed than have a root canal as far as discomfort. But my cardiologist was probably almost as surprised as I was hearing the initial news when the dye first lit up the arterial networks and showed a blockage almost an inch long, crawling all the way down my coronary artery and into two diverging branches. He had to rout it out, like drilling through congealing cement clogging a pipe. And he told me later a funny thing happened, which I have no memory of thanks to anesthesia. Right when the stent went in, the moment they first saw the blood surge through, I gasped and shouted out “Whoa!”.
They were immediately concerned and asked me, loudly and several times since I was tightly wrapped up in the sublime arms of Mr Fentynal and the Lady Versed, why I said that.
“Did something hurt just now?”
Reportedly I said “No!,” took two or three deep breaths and exclaimed with glee, “I feel incredible!”. My cardiologist explained to me later, after my head cleared, “There’s no way you could have known when that stent first opened like that, we didn’t say anything and you were in twilight land anyway. That was blood flow returning.”
The first clear memory I have is telling the tech in recovery that I was pretty sure I wouldn’t need the traditional wheelchair, that if he wanted me to I could have walked from one bed to another on my hands. The sensation of having that blood flow restored, probably for the first time in weeks and after it had been slowly pinched off for months or years, it’s tough to put into words but here goes: Imagine jumping into ice-cold water, that feeling where a giant invisible hand grips the torso, you gasp as the chest seems to constricts. Go it? Now run that in reverse, that’s what it felt like. I didn’t notice the symptoms of reduced blood flow to the heart and probably the effect of that reduction on my brain and body, that had all come on too slowly.
But suddenly taking those symptoms away, oh baby, that was quite noticeable. Like going from dead drunk to sober in the space of a few seconds. My vision is sharper, I’m so energetic it’s almost too much at times, almost like a raving healthy feeling mania. I can barely sit still, my libido, well let’s just say it’s restored. And the coolest thing of all, it’s as though someone reached into my brain, dialed my memory and IQ to the savant setting.
Two weeks before the cath I had run ten miles just for fun, so they expected I would do well in rehab and let me sign up for as soon as possible. First day in cardio rehab, eval time, they put a heart monitor on me and wanted me to go ahead and get the rate up to a modest 140 beats per minute (BPM), with the warning I should stop if I felt anything the least bit odd. I walked a leisurely mile, no luck, heart rate stayed under 100. They turned up the angle higher, the treadmill sped up, soon it fast enough that I had to break into a slow, comfortable jog. It still took another three-quarters of a mile to hit the BPM they wanted.
The cardiac nurse looked at me, clearly satisfied, and said “We see this from time to time but it’s not the norm, maybe one case out of a few dozen … You’re very lucky.”
Now, make no mistake, I will be paying for the rest of my life. I’ll be on blood thinners for a bit, I’ll be on high blood pressure meds and statins like Lipitor for life, I can obviously never smoke again, good riddance, but it also means no fried shrimp and french fries, no cheese burgers or chocolate milkshakes so thick they can only be eaten with a spoon, no more heaping plates of BBQ ribs! Those and hundreds of other meal choices are no longer menu options for me and they never will be again. The way it was explained, I can taste all those things from time to time, but I’ll never be able to eat them as a meal, assuming I want to max out however long I have before another cath or — shudder — full-blown chest-cracking bypass; or death.
But those restrictions don’t bother me. Thanks to things like patches and Chantix to ease the craving, it turns out quitting smoking has been a lot easier than I would have ever believed possible. Folks this cannot be emphasized enough: it was so much easier to quit that I feel damn stupid for not just doing it in the first place. Even with those restrictions I’m obviously incredibly lucky. In cardiac rehab are people half my age on the transplant list, teenagers and kids with congenital heart defects, older patents who have lost significant cardiac function for life along with years of life expectancy as a result.
I’m lucky I had a great PCP, I’m lucky I had a history of working out, I’m lucky I have enough brains and willpower or whatever it is that makes quitting bad habits seem like no big deal. I’m lucky I have a new lease on life and friends and family who love me, who will ride my ass like a stubborn bronco should I ever fall off the many wagons I’m now condemned to ride. But most importantly, I’m lucky I had good health insurance and the medical science that comes with it.
Without that insurance I might shrugged off the initial signs out of fear it was a bad case of indigestion and the anxiety of being in debt for life if I were admitted. In that dismal scenario I would have either progressively lost more and more cardiac function until it was impossible to ignore and probably irreversible to some degree, until it required bypass or a heart transplant, or more likely, I would have just suddenly keeled over dead like my buddy. These things would have happened soon, probably within months and maybe within weeks.
Fifty million Americans do not share my good fortune, they are uninsured, millions other have junk insurance policies. Many of them will die preventable deaths because of it. Some from heart disease like me and others from the 60 zillion completely treatable conditions that humans are heir too. That is simply unacceptable, and at the risk of touching on politics, 2014, when all Americans can go to the ER without fear of being turned away or indebted for life can’t come fast enough for me. But for those of you have comprehensive insurance, for crying out loud, if you feel the slightest twinge in your back or chest, if you’re getting into your forties and think a fried cheese sandwich with a side of Marlboro’s is a tasty meal, for crying out loud, don’t be a freaking idiot: use your damn insurance, use the living shit out of it. That’s what it’s for and it might just save your life.