Facing the Firing Squad

Walter Mitty lighted a cigarette. It began to rain, rain with sleet in it. He stood up against the wall of the drugstore, smoking… He put his shoulders back and his heels together. “To hell with the handkerchief,” said Walter Mitty scornfully. He took one last drag on his cigarette and snapped it away. Then, with that faint, fleeting smile playing about his lips, he faced the firing squad; erect and motionless, proud and disdainful, Walter Mitty the Undefeated, inscrutable to the last.
The Secret Life of Walter Mitty
James Thurber

That was me the other day. I was the one facing the firing squad. Over the years, a clot silently developed in one of the arteries that feed my heart, threatening the flow of oxygen to this vital muscle, and threatening the flow of my daily life.

This past Saturday, I learned about its existence. This is a recount of what happened. I will post more on this topic, shorter posts covering smaller aspects of my experience, and what it’s like to be a heart patient so soon in life, in a new category, “Heart Attack.”

It’s still hard for me to imagine that at the tender, young age of 51, I am writing here about me, about my experience with heart disease.

The Event

I woke up early on Saturday morning, about 7:30, a bit uncomfortable. I went to the bathroom, drained myself of the previous night’s beer, and returned to bed.

I couldn’t get comfortable, and couldn’t sleep. I rose, even more uncomfortable, about an hour later. I felt an internal pressure, in my body, and figured that I had eaten something the night before that didn’t agree with me. That explained the clammy sweat and the tension.

It didn’t explain the increase of pressure over the next 20 minutes.

I told my wife that something was wrong, that I felt funny. She asked me if I was having a heart attack. I seriously didn’t think so, but since my symptoms were close, I decided I wouldn’t rule it out.

I decided to take a shower, to see if I could get the “clammies” off my skin. Just getting my clothes together was a trip: the tension in my chest was slowly increasing, and the acts of sitting or lying down made things worse. I found myself kneeling on all fours in front of my closet as I looked for a shirt and jeans.

Something was definitely not right. As fear started creeping in, I realized that I was into this far too deeply to panic now, so it would be best to see what I *could* do…

The shower failed to do what I wanted. Again, my bride asked me if I was having a heart attack, and if I wanted to go to the Emergency Room. I told her that I was unsure, and to go ahead and take a shower; I’d let her know later.

As she showered, I knew I had to go. She was quick, and once she was ready, we left. It was 9:20 a.m. During the ride I can remember only thinking, “Oh, shit. This is not good.”

In short, here were my symptoms: I felt pressure throughout my chest, making my breathing difficult, and this pressure radiated down my arms to my wrists; it radiated upward through my neck to my jaw, all tingly-like, feeling similar to when you go outside on a cold day and your glands swell and drop just a little too far. I had the clammy sweats. I felt rubbery, yet tense. Attempts at relaxation only made it worse; I paced the living room to release the stress. I can’t remember any other aches or pains, or if my vision was affected at all; these I list are the only ones I can — or need to — recall.

Meridia Euclid Cleveland Clinic

The fastest way to get people to move quickly, as a middle-aged man, is to walk into your local ER and tell them your chest “feels tight.”

They took my insurance card, I told them my wife was following me in, and they led me back into the ER. They hooked my right arm to an IV stump for later use, took my blood, blood pressure, temperature, and started asking me a ton of questions. They did not give my nitro-glycerin or aspirin. The attack faded, on its own, about 11:00 a.m.

ER heart attack protocol sets a number of tests in motion, among which are numerous blood tests, an electrocardiogram (EKG), and a couple of chest X-rays. The blood tests were the only thing marginally conclusive, at first: my Troponin level was initially 0.02, which indicates something happening. A reading of 0.10 indicates heart attack-level heart damage. The ER staff decided at this point that I would be staying overnight for observation.

Subsequent blood tests that day revealed that my Troponin level had increased to 0.05, then 0.07. On Sunday morning, they tested my blood again, and the Troponin level reached 0.17. Within an hour or so, I was hooked up on the blood thinner Heparin, (which required that I have a blood test every 4 hours).

I knew something was up on Sunday morning when I got up to take a walk — and was ushered straight back to bed.

Because there were no cardiologists available at Meridia Euclid that weekend, they had to transfer me to either the main campus of the Cleveland Clinic, or to Hillcrest in Mayfield.

We chose Hillcrest due to proximity. It turned out later that Hillcrest has a better reputation for heart than the main campus, which is better with infectious diseases and cancer. Excellent for heart (let’s face it, if you’re in my position, you can’t do better than any Cleveland Clinic campus!), but better elsewhere.

So, later on Sunday, I took my first ride in an ambulance. No, I didn’t ask for them to turn on the siren or the lights. And I didn’t exactly feel like a 7-year-old right then either — well, at least beyond the idea that I was in the middle of something I couldn’t control.

Cleveland Clinic Hillcrest

It’s hard to say for sure because of everything that was going on at the time, but I believe I arrived at Hillcrest Coronary Care Unit on Sunday afternoon about 2:30-ish. I was hoisted and moved from bed to bed by three very skilled (female, not that it matters) paramedics. From their conversation, I gathered that their impression of the record-keeping at Euclid was not good.

At Euclid, I was hooked up to a telemetry heart monitor. At Hillcrest, it was wired. Sunday night, my right arm was connected to the heparin, my left arm tethered the monitor and a blood pressure cuff checking my BP every 15 minutes or so; my lower legs were attached to a pair of inflatable cuffs attached to an air pump, alternately inflating and deflating, massaging my calves and preventing clots.

They continued to take my blood every 4 hours, even through the night. I didn’t sleep well at all: there was noise outside in the ward, I could only lay on my back (I usually sleep on my stomach), and I as in a strange place (and in more ways than one!).

On Monday morning, I met the cardiologist. He stressed that I needed a cardiac catheterization, and he wanted to do it that day — in about an hour from then. That hour turned out to be three hours later, as two heart attacks came into the theater as I was waiting to get in. The live heart attacks took precedence of my “dead” one.

So they wheeled me into the operating room at about 1:30. It was freezing. To make matters worse, I was naked. They shaved me — yes, there. I tried to ignore the indignity, as they were only doing what was necessary to help me out. Then they washed my thighs and lower torso with a blue soap that still marks my body today. I don’t remember falling asleep. I could have stayed awake and watched, but I get a little queasy with this stuff, so…

I woke in my room about 3:00, incredibly hungry because they would not let me have anything to eat or drink (even water) before the surgery. They found a 99% blockage in one artery, and they performed angioplasty (inflating the artery with a balloon), and left in place a stent (a spring-loaded sleeve that keeps the artery expanded).

The Scary Part

At 4:30, two nurses entered my room, explaining that for legal reasons, two people had to be present for what they were about to do — remove the catheterization guide that they use to enter the femoral artery. It was a dangerous job.

As I said, I am queasy with this stuff. As that sucker came out of my leg (actually, the crease between my torso and my leg), I jumped. Both women yelled and tried to hold me down, but what caught my attention, and forced me to stay still and take my medicine, was the feel of a shot — and the resounding splat — of warm liquid down my leg.

That was blood. I was in trouble. Oh, shit!

I froze. I let the nurses do their work, which was to hold pressure on my femoral artery for the next 30 minutes, blood pressure cuff going work every 5 minutes. Oh, God, just don’t let anything happen right now. Please.

The Pain in the Butt Part

After 30 minutes, they could let go, but I was not allowed to move anything more than my arms or my head for the next 3 hours. At 8:00, I was allowed to move my left leg, but not my hips. To pass the time, I watched TV and noted the function of the cuff, which was firing every 30 minutes now.

Finally, at 11:00 p.m., they finally let me move. I could roll and flex, but I had to take it easy. They would now check my wound hourly for the next several hours, throughout the night, making sure there was no bleeding. That would mean Big Trouble.

Meanwhile, the “vampires,” as I called them, continued to take my blood. I felt like a pincushion. By now, they were having trouble finding usable places on my arms. I showed them a couple of new, choice veins to poke and draw my blood.

The biggest problem I had, by this point, was the pain produced by my 8-hour immobility. My arthritis came back big-time. For a while there, I couldn’t tell if my hip or my femoral artery area hurt worse, and I walked (Tuesday) with a decided limp.

Other Issues

Meridia Euclid may have been a little lax in their attitude and their record-keeping. As I said before, they did not give me aspirin or nitroglycerin. That should have been the first thing to happen. The aspirin came on Sunday, after the diagnosis was in. It’s more of an orthopedic hospital now, so this, in some ways, does not surprise me.

Hillcrest CCU was a different story: everything is documented; everything is counted; every little detail is noted and considered; every procedure is followed to the letter.

Just don’t try to sleep there: the housekeeping staff kept me up talking loudly outside my room after midnight: earlier in the day, a man was convicted in a Cleveland court, and as he was escorted out of the courtroom, he told the judge that he could “kiss my black ass!” repeatedly. These housekeeping people were talking loudly about that and laughing. When they wake you up every four hours to take your blood, temperature and pulse oxygen, and the BP cuff is firing every hour on the hour, stuff like their conversation gets a little troublesome.

Sorry, I just lied: it pissed me off. Hillcrest CCU, please take notice!

Also, I seriously need to locate my phone’s wall charger, and get a wall charger for my iPod Touch. I kept having problems keeping them charged so that I could keep you folks informed on Twitter and Facebook. Yes, I tweeted the entire thing. Well, on Facebook, at least. Add to that my bride’s attention to certain games on those devices, and there was even more drain on the batteries than I would have liked. That’s why there were virtually no updates after Monday night.

The Bullet Dodged

Tuesday found me decidedly improved. This was the day I would be visited by my attending physician (a representative of my regular doctor) and the cardiologist. The cardiologist showed up around lunch time, and he gave me the poop:

The catheterization revealed a congenital heart defect — a corkscrew twist in my circumflex artery (the artery that curls around the left side of the heart to carry blood to the rear of the heart) — and this twist has a ridge inside that eventually caused a 99% blockage of the artery. Imagine twisting a hose until it kinks. So I now have a 15mm x 3mm stent holding my artery open — perfectly correcting the defect.

The heart attack was very minor, and will leave no permanent damage. With proper care, it is quite possible — and quite probable — that I may never hear from my heart again. My heart defect has been successfully repaired.

By this point, I am quite relieved.

STOP.

According to the doctor, had I not paid attention to this episode, or had this episode not happened, I probably would not survive the next event. He used the term, “widowmaker.” THAT got my attention, believe me!

By going to the hospital when the event was happening, I saved my own life. A couple of days out of my life to take care of something seemingly trivial ended up paying big dividends.

What I Learned

First off, I eat fairly well: whole foods, little processed junk, fairly low-fat, low cholesterol, low(er) sodium. I stay away from fried foods, and almost anything that comes in a box.

When it all came down to choosing what I wanted, in a time of trouble, I didn’t waffle. I quietly and definitively spoke my mind. No excitement or drama there.

I made the right choices.

The best thing I ever did for myself was quit smoking. Upped my survival chances by 50% or more.

Uninterrupted sleep is under-rated.

No matter how dire the circumstances, it’s not a good thing to lose your sense of humor.

Skilled nurses are a Godsend when they’re looking for places to draw blood or enter intravenous appliances.

Confident, almost cocky cardiologists are a Good Thing.

Confident, almost cocky cardiologists who find — and correct — defects in your heart are a Good Thing as well.

Don’t bitch about the food: it’s better than it used to be, and will never be like home. Besides, no one will listen, anyway.

I am human.

For this first part of my life, if you had asked me if I believed in God, I would have said no: I know of God’s existence, so no one needs to prove that to me; what I struggle with is the idea of benevolence.

Many years ago, in a fit of depression, I asked for it all to end. You know what I mean. Obviously, you need to be careful what you ask for, because you just might get it. And, the answers to prayers do not always come back in our time.

Perhaps my initial wish was being granted. If so, this event may have been presented to me as the question, “Are you really sure you want this? In case you may have reconsidered, here’s the OFF switch.” A possibility I must consider.

Of course, I may have had far too much time to think. And when you consider the emotional nature of my experience, I could have easily over-thought this entire mess.

After all, even Sigmund Freud said, “sometimes, a cigar is just a cigar.”

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8 Comments

  • by Jim Kukral 20 May 2010 at 12:27 pm

    Wil! What a scary story, but I’m glad you are better. You did the right thing, obviously. Continue to get better and let’s go golfing!

    I’m 38 now. I’ve been trying to get healthy, working out, eating better, etc… It’s stories like that that keep me going to the gym and trying to stay on this path.

    Get better buddy!

  • by Donna 20 May 2010 at 12:32 pm

    Will:

    This all sounds very scary, especially the part about the femoral artery….I would have made them put me out if they said something like they said. Oh, geeze.

    When I had my pulmonary embolism a couple of years ago, I couldn’t believe that happened to me at age 47. But the medical professionals told me that “disease knows no age.”

    It’s hard to hear the word disease associated with yourself, though. I know it…

    I was on Heparin for almost a week, so I can relate to the pincushion business.

    I’m sure you will take your whole experience as I did….A wake up call, albeit a mighty scary one.

  • by Heidi Cool 20 May 2010 at 12:38 pm

    Will,
    Thanks for sharing this with us. My dad spent plenty of time in the CCU at UH years back, but I never really knew what he was thinking–as he was typically keeping up a good front–even after a triple bypass, which I am happy to know you don’t need. This offered great insight into the experience. I’m also impressed with how cool and calm you remained on Facebook. You kept us informed, but used your humor to keep us at ease. While you were the one in pain, waiting to know how it all would turn out, you made sure we would remain calm. I think it takes a good sense of empathy to make that so. Well done and welcome back. Take care Teddy Bear!

  • by Will 20 May 2010 at 12:47 pm

    As I just told an old friend of mine on Facebook: I have a lot to process from this, emotionally. Physically, I have never felt better. Spiritually, I have more clarity, which is a Good Thing. But I have a ton to process, emotionally. Good thing I now have all the time in the world!

    Thanks!

  • by Stacy 20 May 2010 at 12:50 pm

    I’m so glad to hear you are on the road to recovery. My dad had a heart attack several years back, and had no indicators either. Normal cholesterol, eats right, due to Mom… normal BP. You never know.

  • by Susan Nowoslawski 20 May 2010 at 1:43 pm

    I’m so happy you came out of this OK! Scary thing with the artery. Two things, I breached the same artery years ago (freak accident, I won’t describe it) The dull but almost overwhelming pain in my leg lasted for days. My dad spent a good bit of time in hospitals with his heart and one of his pet peeves was the late night gaffawing in the hallways – he would go into rants about it and I know it wasn’t doing the man’s blood pressure a bit of good! He just couldn’t understand how anyone could be so inconsiderate.

  • by JDO 04 Jun 2010 at 1:14 pm

    Dude, it’s not time for a long time! Take it easy and hang in there bud. Pick up that old Ovation, and take some time for yourself every so often!

    ~ JDO

  • by Will 04 Jun 2010 at 1:29 pm

    Dude, I’m hanging, believe me, but it ain’t easy.

    It’d be nice if I was working: I’m getting bored, and they’ll only allow me to spend so much time per day/week at the rehab facility (90 minutes/day, 3 days/week)!

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