Saturday, April 27, 2013

A Not All That Hilarious Heart Attack, Part 2: The Cardiologist Strikes Back

So, when we last left our hero, the seriousness of the situation was finally - belatedly - registering (because even I can't have a discussion with a cardiologist about the risk of death associated with a medical procedure versus the risk of death associated with doing nothing, without it sinking in that something important might be happening), and I was being taken upstairs on a stretcher.

While I was being prepped for the procedure, the cardiologist explained a few more things, including that I wouldn't be able to drive for some time afterwards. 

"That's not an issue for me," I said, "I don't drive."

"Oh," he replied, "You got here in an ambulance?"

"No," I said, "I took the bus."

A look of pure incredulity flashed across his face. "You took the bus? Why wouldn't you take the ambulance?"

"It seemed excessive," I told him.

He laughed out loud. "It seemed excessive," he said, shaking his head. 

So yes, everyone: Point taken. The Head of Cardiology at Sunnybrook Health Sciences Centre agrees with you. The bus was not one of my better ideas. Sheesh! Can we move on to the procedure? 

This was the procedure: I would get a local anaesthetic on my right wrist, and a sedative - but not a general anaesthetic. Then a camera would be inserted via my wrist and snaked up to my heart. They'd have a look around and take further action as needed.

The further action, I learned afterwards, was the insertion of a stent. One of my arteries was totally - one hundred percent - blocked. They were able to clear out the blockage and re-open the artery with the stent. So there's a tiny plastic tube in my artery. It releases medication, too, over time, to ensure that my body doesn't try to heal it over.

Yeah, how amazing is medical science? Based on information obtained via a tiny camera that went to my heart via my wrist, I had a stent inserted - again, it went in via my wrist - into one of my heart's arteries. All of this without being cut open (the tiny incision in my wrist healed within days) and without needing anaesthetic. This all  took an hour. I was conscious throughout the whole process.

It didn't even hurt.

My one regret is that I couldn't see the monitor myself from the position I was lying in. Although with the sedative, I'm not sure I would have been able to make much sense of it. I was flying pretty high, except for the time I fell asleep.

Fun as it was, the sedative wore off quickly and I was able to talk to the cardiologist and debrief as soon as the procedure was finished, which is when I found out about the stent, and the extent of the blockage in my arteries (in addition to the total blockage of the right anterior artery, two others had partial blockage - one was forty percent blocked, one fifty. These didn't require intervention as they're considered treatable via medication and lifestyle change.

So, the procedure was done and I was ushered into my post-heart attack era by being taken down to the Cardiac ICU. There I was moved into a bed - the nurses who got me settled in told me that the bed cost more than both their cars, put together - and hooked up to a bunch of machines that go ping: An ECG, a blood pressure monitor, oxygen, an IV feeding me blood thinners, and a blood oxygenation monitor (which, in another "Sweet FSM modern medicine is freaking astounding!" moment, is a little clip that goes on your finger, shines a laser at it, and via that process determines how oxygen-saturated your blood is).

That's when they let Sarah in to see me.

I probably looked a bit hellish by that point, even if she hadn’t already been scared half out of her mind. We were both pretty emotional. She hugged me - gently - and sat with me, and held my hand. We talked a bit - not a lot, we were both exhausted. The kids had school in the morning, or later that morning, really, since it was after 3:00 am by then, so after a little bit of just being together, she went home to take care of things, and I went to sleep in a bed that cost more than two nurses' cars. 

Exhausted, weak, with a tube in the artery next to my heart. And alive. 

Next: The first day of the rest of my life (in a post-heart attack world)

Sunday, April 07, 2013

A Not All That Hilarious Heart Attack

Alice Sheldon, who wrote some absolutely brilliant science fiction, mostly under the pen name and guise of James Tiptree Jr., once wrote an account of her experience having a heart attack while on vacation in Mexico. She called it 'How To Have An Absolutely Hilarious Heart Attack' and it's well worth reading, if only to note the deft writing that went into a very frank account of a medical emergency that still managed to keep her gender implicit and therefore, her identity secret.

My own experience was perhaps not as hilarious, and my description of it will be a lot less well-crafted. On the other hand, I promise that "Stephen" is my real name.

And last week, I had a heart attack. Oh, and if that wasn't hilarious enough? I'm 41.

I had been feeling not very well for a couple of weeks. Simple activities, that wouldn't had even rated as effort before, seemed to get me winded, to get my heart pounding.

I wasn't sure what to make of it, but I figured, meh. I'd put on some weight since the holidays and it was slowing me down. I was getting over a cold. It was a long, cold, winter. Nothing that starting to eat better and exercise regularly again wouldn't fix.

Besides, after talking to some people and researching my symptoms online, I was pretty sure I had acid reflux.

But last Sunday, March 31st, some time after 10:30 in the morning, that theory got a lot less tenable. My father-in-law had taken the kids for an outing and Sarah, my lovely partner, was getting some well deserved sleep, so I was the only one both home and up.

And I suddenly felt like a giant was leaning on my chest. My heart was pounding, again - and this time, I hadn't been doing anything at all. It hurt to move. It hurt to breathe. It just plain hurt, and no matter what I did, it felt like that giant was pushing me, putting all his weight into pushing me right in the chest.

My first thought was that this acid reflux thing? A lot worse than I'd expected.

I looked up some home remedies (apple cider vinegar, that sort of thing) and tried a couple. They caused a lot of burping, but brought no relief. They also seemed to bring on a bout of nausea, and it was the sound of me trying to throw up that woke up Sarah. Since I'm rarely sick, she was surprised and concerned. "Are you okay?" she asked me.

"No," I said, "I think I need to go to the hospital."

As I said, I'm rarely sick - until this recent misadventure, I hadn't used a sick day in about two and a half years. We talked about it, and agreed that the best thing for me would be to get some rest instead.

So I went to bed and slept for about five hours.

When I woke up, the pain had subsided, but it was still there. I still felt awful, and I'm used to a decent nap being a cure-all, so I was even more concerned, even though I didn't actually hurt as much. I decided to call Telehealth and get some advice.

(For non-Ontarians, Telehealth is a toll-free phone line the provincial government operates - you call and talk to a Registered Nurse, who can advise you how best to proceed based on the symptoms you describe. The idea is that it keeps people from rushing to the emergency room when they don't need to go, and makes sure that people who need to go to the ER do).

The nurse at Telehealth was... a lot more concerned than I expected, and encouraged me to go to the ER as soon as possible. "I can transfer you to 911 right now," she said. I said that was okay, I needed to talk to my partner about making sure she and the kids were okay, et cetera. "If you don't take this advice, you could be putting yourself at risk," she said. I thought that was hitting the disclaimer boilerplate pretty hard, but I said I understood, thank you and so on, and hung up.

I told Sarah the nurse had said that I should call an ambulance, but that I didn't think that was necessary. A bus stops right in front of our building that goes right past the nearest hospital - it was minutes away, probably just as fast as an ambulance would be.

So I showered, put on clean clothes, got some things together and went out to hop on the bus. It had been a mild day but was starting to get cold. Happily, I didn't have to wait long. The bus arrived in a few minutes and I was en route to the hospital.

I arrived a bit before 8:00 pm, and sat down to wait for triage. I saw a nurse, told her my symptoms. She gave me a couple of baby aspirin, which I chewed up and swallowed. She didn't seem unduly alarmed. I may have understated my pain then, or the seriousness of my pain earlier. I may have been a bit too committed to my acid reflux theory. In any case, after triage, there was more waiting.

Over this time, my heart rate seemed to speed up, and sometimes it felt like my heart was doing some particularly awkward acrobatics in there. I chalked it up to stress and psychosomatic symptoms brought on by my imagination.

Eventually, I was assessed, and got an ECG.

More waiting.

Finally, after midnight, I was seen by a doctor. She looked at my chart and immediately told the staff to give me another ECG, since it had been so long since the last one. When that was completed...

The doctor looked at the ECG. "Did you feel that, just now?" she asked.

"Feel what?" I said.

She nodded, as if to herself, "Yeah," she said, "We're going to get the cardiologist down here to talk to you."

Would you believe that it wasn't until then that my internal "Oh shit!" alarm started to go off?

The cardiologist was there shortly. He looked at my ECG results, did a quick examination and assessment.

"You had a heart attack," he said.

"Really?" I replied.

He told me, yes, I really had. We discussed the risks and benefits of an angiogram and angioplasty, and I agreed that the procedure sounded like a good idea - and signed the appropriate paperwork.

I might, he said, want to call someone.

I said that I didn't think that would be necessary. I didn't want to bother my wife.

He looked a bit incredulous, and tried to explain to me that a heart attack was not a minor thing. I should probably, you know, tell my family.

I called Sarah, and let her know the news. She started to cry. I told her that I was going to be okay, but that she should probably come to the hospital. Within a few minutes, she had made arrangements for a friend (the kind and generous Melanie - thank you so much!) to come over and stay with the kids, and told me she'd be there as soon as she could.

After the waiting, waiting, waiting, I was a little surprised by the speed at which events moved forward. I was only waiting for about half an hour while the CATH lab team was assembled (they're called is as needed, rather than kept waiting around) and that was just as well - it gave me time to talk to Sarah.

Then I was taken upstairs on a stretcher - for the procedure.

Next time: The procedure and afterwards.

(Spoiler warning: I didn't die!)