peterography

At 4 AM on Thursday a few weeks week ago I awoke with chest pains. I thought it was a bad case of indigestion and tried the usual home nostrums but after 20 minutes none of them helped. Recently one of my co-workers had a heart attack and delayed going to the hospital because he thought the same thing and guys our age die that way all the time so my wife drove me to the ER.

The first words out of my mouth to the triage nurse were that “it feels like someone is squeezing my esophagus”. But let’s get real: if a middle-aged guy with a history of hypertension shows up in the ER at 4:30 AM with chest pains, unless he’s got a gaping bullet wound in his sternum they’re going to think MI (Myocardial Infarction = heart attack), as well they should.

They plopped me on a gurney, parked me in a service bay and got to work, hooking me up to all kinds of hospital gear. My ECG was normal; my other vital signs were OK, but they pointed out that my blood pressure was a bit high (well, duh …)

As a test they popped a tab of nitroglycerin under my tongue. Nitro widens your arteries so the theory was that if it widened an obstructed coronary artery the pain would subside and we would have a clue that this was a heart attack. But some people have overachieving vagus nerves and I guess I won that lottery because I passed out.

When I came-to everyone was all excited and they showed me why on the ECG: My heart had stopped. No P wave, no T wave, no QRS complex, nothing complex about it - simple, really - I had flatlined. Luckily, while I was blissfully dead, everyone there knew exactly what to do and they got me rebooted quickly. The doctor explained that these things happen sometimes with nitro.

But I had no time to ponder the meaning of death or why I didn’t rate a tunnel of light or an out-of-body experience (maybe you have to go to a prestigious hospital like MGH or the Mayo Clinic if you want that stuff) because the rest of the ECG told a scarier story - I now had an elevated S-T segment, which even I recognized as a sign of an MI. So they pumped me up with heparin, made me swallow a handful of Plavix and told me they thought I was having a heart attack. I asked if the ECG could be due to the the fact that my heart had stopped, or from the atropine they had given me while restarting it. Maybe, they said, but we can’t take that chance. An elevated S-T segment is classic, they explained. I knew that already. The problem with doing what I do for a living is that you already know some of the answers before asking the questions.

They handed me and my wife documents describing stents, and sheets to sign authorizing them to put one in.  I was rolled into the cath lab.

The plan was to run a tube from a blood vessel in my groin up into my heart, find a blocked coronary artery and insert a stent in it. I’ve always wanted to visit a cath lab as a clinical site visit for my job, but I never got to go. Doing it this way wasn’t quite as good, but it was still interesting because I was awake for the whole procedure. I’m not sure if they put a sedative in me - they commonly do for a cardiac cath, and I did feel spacey but I attributed that to my little vacation from the land of the living a few minutes earlier along with the atropine.

I was placed on an operating table. The room was filled with gear which in other circumstances I would have loved to geek out on. Everyone was dressed in greens and I could no longer recognize the cardiologist. Above me was a huge image intensifier suspended on a C-arm, aimed at my chest like the eye of God. They shaved my pubic hair, painted on a cold antiseptic, and numbed up my groin with a local anesthetic.

I felt a warm stream of blood flowing down my thigh and pooling at the bottom - they were in my femoral artery. As they wended the tube through my blood vessels toward my heart I desperately wanted to watch. I poked my head up and everyone in the room shouted for me to stay still - any movement could be dangerous. I tried to lay quietly and meditate on curiosity and cats.

I felt a flutter of arrhythmias and when I announced this the doctor explained that he was inside my heart having a look around. In my prior 54 years having someone in my heart had always been a strictly metaphorical concept. They began pumping dye into my coronary arteries to light them up and I felt waves of warmth as the dye passed through my body.

A few moments and a few waves of warmth later the doctor announced that I had the heart of a much younger man. He didn’t say who it was or what the guy was using now to pump his blood, but one thing was clear - this was not a heart attack! They aimed a computer monitor at me so I could see. Yup - even I could tell that those arteries were looking good and doing swell.

I lay quietly and thought happy thoughts while they unwound everything and plugged me up. They wheeled me into the ICU, which I kept referring to as the “Expensive Care Unit” and they kept pretending they had never heard that one before. I didn’t really need to be there but they had been so sure I was having an MI that they had booked it in advance.

For awhile people came and went drawing blood and doing other tests. I was attached to an ECG, a cuff, an O2 monitor, a saline drip, an oxygen supply, and lots of different colored ports connected to needles and tubes in my arms. I had my journal with me and I wrote everything down. Some of the equipment was made by my company’s competitors, and some was made by us. I observed carefully and quizzed the technicians about what they liked and didn’t like about those systems versus ours. Finally my wife went home and the staff went outside. I was left alone with all my tubes and wires and careful notes (and antiquated notions?), and I lay there marvelling at how my day was going so far. It was only 9AM.