My Heart Attack 4 — Closer to the Heart
June 7, 2017 I sought medical treatment for chest pains. I was having a heart attack. I’m writing about the experience to help others avoid the mistakes I made, know what to expect if it happens to them, and to reflect on the experience. I didn’t talk about it to anyone but my immediate family and some close friends that happened to be in the right place at the right time.
I was never scared that I was going to die, not really. It occurred to me several times when the chest pains were getting bad after work on Wednesday, but the fact that I could relax and let the pain recede completely reassured me that I was not critical. This was a mistaken assumption, it turned out, but fortunately, I didn’t pay for it. I had even taken time to find accommodations for my dog before going to a clinic instead of directly to the ER as I should have done. What was happening was that 4 arteries feeding blood to my heart were critically congested with plaque and the circulation was so insufficient, it caused spasms. I may not have had “the big one,” but the gradual worsening of the pain and lengthening of the attack duration was rapidly reducing my prognosis.
Still, the only point that made me worry about dying was when they were about to operate. That moment, I didn’t feel scared, I felt angry. Angry that after surviving a cardiac trauma, a random chance could end everything. Everything.
I wasn’t anesthetized unconscious. I was awake for the whole procedure. I believe they gave me a sedative and some local anesthesia for my arm, but I was alert and award of every step. It was unnerving, but I’ve had worse trips to the dentist.
“I can see the cheeseburgers stuck in there!”
After waiting around, being repeatedly poked, prodded, and tested by nurses, a mobile electrocardiogram cart from around the year 2000 rolled into my room. After pulling off the electrodes AGAIN, they lubed up the wand and proceeded to view a shadowy sonogram view of my beating heart. It was pretty cool the way I could see it like a moving shadow on a shadowed background. It was beating strong around 60 beats per minute, I’m told that was a pretty healthy resting clip. The electrocardiogram displayed various shadows of soft tissues almost in negative space: streaks of tougher, more dense tissue were grey and visible in the muscles of the heart, the rib cage was a solid grey-white, and the soft tissue was a darkness in relief to the denser white tissue.
It didn’t take a specialist, or even a doctor to see the problem. Bounding the edges of the beating heart were solid streaks of bright white. The congested arteries stood out bright and clear as solid objects that trailed off into the background. This illustrated the most congested sections of the arteries feeding blood to my heart. More than anything, this was the most sobering, disturbing proof that I had reached the day of reckoning that my genetics and lifestyle had made inevitable. I wonder if my grandfather, grandmother, uncles, or aunts that died from heart attacks ever actually got a look at their failing circulatory system. I knew that everything I had ever eaten had influenced this moment.
“Heart Catheterization”
I talked to cardiac specialists, the surgeon, and received more information on the procedure until after lunch time. (I was suprisingly spry considering I hadn’t been able to eat since midnight.) After lunch, they came to take me down to prep. I was told to strip and put on a different gown, and I did, then I waited an hour or so in a room I shared with an older man who had also had chest pains this morning. (He was already planning to have gravy and sausage when he got out.)
I was getting anxious, therefore, in the face of all the chipper, cheery medical professionals, I was talking a bit short and clipped, joking less than is my normal. They shaved both my wrists and my groin on either side of my junk explaining that the doctor generally would go in through my right wrist, but they needed the other possible locations prepped in case that plan didn’t work out.
They wheeled me into a specialized operating room that had a surgical platform with a bank of 3 large monitors on a track that allowed the doctor to raise and lower them around the operating table. There was also a big imaging device with a keyhole symbol in the center. It reminded me of the radiation machine that Dr. Bruce Banner used in the intro to The Incredible Hulk TV show, but then, most things like that do.
They took my gown and left me naked on the operating table, then they covered me with blankets and a plastic “splatter guard.” Okay, it wasn’t a splatter guard, it was to keep things outside the procedure site sterile and to help keep me warm in the chilly operating theater. My groin was prepped as a precaution, but then I was completely covered and my right wrist was restrained to a board with my hand taped across my palm to force my wrist up.
I don’t remember much about what we talked about. The doctors were professional and nice, they asked some questions and made some jokes. I think I got some zingers off, because I seem to remember them laughing. Finally, the surgeon entered the room and things got more serious.
My co-worker Bill had told me about how his mother had died during a routine procedure exactly like this. They went in through her groin, but something went wrong and she died from a clot. Tragic. That story haunted me the entire time. When they told me that they would use my wrist, I felt a bit better knowing that they could probably manage a smaller blood vessel more easily. Shortly after that, I would always remind myself I had no idea what I’m talking about.
The doctors had offered to walk me through the procedure, but in my nervousness, I dismissed it. Even though it was kind of obvious what was happening, I kind of wish they had in retrospect.
The surgeon explained that the first part of the procedure would be without anesthetic. Once the incision was complete, they would numb me. I nodded, took a deep breath and waited for him to start. It didn’t take long.
“You’re going to feel a pinch.”
Just as I thought that it’s never JUST a pinch, just as I followed that thought up with, “that shit ALWAYS hurt when they say that!” He cut my wrist and, as expected, it hurt. It wasn’t a terrible pain and it didn’t last very long. He seemed satisfied and I felt my thumb go numb.
I couldn’t seen the monitors very well, but I could see my heart and generally the arteries on one. It was an awkward angle for me, and I believe I was a bit sedated. To sum up, he opened the artery in my wrist and put a kind of airlock on it that would allow him to insert a surgical wire with a small balloon and stent payload. He would run the wire down my arm, through the arteries of my heart, and, when he arrived at one of the blockages, he would inflate a tiny balloon to force the blood vessel open, and then he would leave behind a medicated wire mesh cage attached to the artery wall. Once the baloon opens it, the stent acts as a structural reinforcement treated with a chemical that prevents fat from accumulating in that location again.
They would later tell me that it was surprising to require 4 stents in someone my age. They generally see that in someone much older. They also congratulated me on how lucky I was because older people with this kind of coronary artery disease have the benefit of more time for the circulatory system to create new paths to deliver the blood flow to the heart, kind of using blood backroads instead of the blood interstate. In someone younger, the heart attack is more often fatal because their bodies have not had a chance to develop this redundancy!
He got 3 of the arteries unclogged before I heard him ask his assistant for the “largest wire” they had.
During the procedure, I had no idea there was a wire travelling through my arteries other than the motion of the doctor at my wrist, however, once they inflated the balloon payload, I could feel it! It was a brief bloom of the chest pain, but they quickly passed. Once he used the big wire, I had a brief sensation of vibration and a tightness in one area of my chest before it quickly ended.
Following the procedure, he explained that three of my arteries had been 80% blocked, and the fourth was 100%. It was so clogged, in fact, that he couldn’t get the balloon in to accomplish the angioplasty. Instead, he did the best he could to open it with the wire and that he would have to try again in a month or so.
I remember that one of the assistants told me I could move my restrained arm, but my elbow had been hyper extended so long that it ached and I couldn’t move it. She helped flex it and the join kicked right back in, a bit stiff, but unharmed. They lashed my right wrist to a board and I realized that my wrist had been bound with a clear pressure bandage. A pressure bandage was filled with air to keep consistent pressure on a wound that’s very likely to bleed. They told me that I had to spend at least 2 hours in recovery and then I could go back to my room. It was 3+ hours, but after a long, tedious time in recovery, they gradually reduced the pressure in the bandage, extracting the air with a syringe, then, my wrist painfully lashed to a board, they wheeled me back up to my room around 9pm.
I still had the IV in my right arm, various electrodes for the vitals display off to my left, and a board pressing painfully against the boney protrusion on the back of my wrist. I was feeling pretty good, all things considered, I managed to drag my IV into the bathroom to take a quick sponge bath and use the bathroom. It was amazing the freedom I felt by being able to move around a little and drink some diet sprite soda! Eventually, a late dinner arrived and I inhaled it, starving. It was almost 24 hours since I had last eaten.
The nurses had me on a torturous 15 minute blood pressure routine. The auto pressure cuff inflated every 15 minutes, and, along with the bed randomly inflating and deflating, I was kind of irritated. After a couple hours, it was removed and I finally had a little peace. (Other than the bed rolling me around to prevent bed sores.)
With only a square of gauze and some tape around my wrist, I was surprisingly none the worse for wear, and out of immediate danger. I was exhaused, and had one more learning session with the head nurse before I curled up in my shifting, deflating bed, and fell dead asleep.
I slept for 2 hours at a time, that is, because they kept waking me until around 4am, then they seemed satisfied I wasn’t going to bleed out and just took the essentials. I slept a lot that morning. It was great.
The worst was over, but now living with it began!