On Wednesday, 9 January 2013, around 5:30 pm, I started feeling a pain in my chest. Within a few minutes, I found myself sweating like I was on a Vegas rooftop in July. It didn’t take long for the paramedics to arrive. By the time I got out of the operating room an hour later, the pain was gone. This is the story of my heart attack at age 36.
When the 911 operator asked me on a scale of one to ten, how bad my pain was, I put it around seven. The truth is that it wasn’t really all that bad. I’ve had migraines that were much more painful than what I felt in my chest that night. It wasn’t so much that it hurt — it was just tight, feeling like a dense ball in the center of my chest.
My knowledge of heart attacks is largely informed by two sources: media portrayals (everything from TV dramas, to the movies to Looney Tunes, and a book I read in middle school called Hatchet) and the experiences of my grandfather. A heart attack is supposed to be just about the most painful thing in the world, and it starts with a pain in your left arm. But I knew from my grandfather’s experiences that sometimes it wasn’t like that. Laboratory tests showed that at one point he suffered a massive heart attack that effectively killed half of his heart — yet he had felt nothing. (It was his second or third, I believe he had at least four before he died.)
What About the Kids?
My wife was heading to a meeting when I called her. If I had called just a few minutes later, she wouldn’t have gotten the call. I was home alone with our three kids, and the nearest relative/babysitter was over 90 minutes away. (Seriously, what happens in that situation? Would the kids have been taken into protective custody?)
When the paramedics arrived, they immediately told the kids to go into the other room. My wife arrived shortly after they did (luckily) and she was also sequestered away. She was told that due to my vital signs, it was best if she and the kids were not in the same room. My heart rate and blood pressure were both in the mid–50s — I was crashing. Because of how much I was sweating, they were having a hard time getting accurate numbers.
The ride to the hospital was uneventful, save for the fact that the gurney was positioned to keep my legs elevated, and since they forgot to lock the wheels, every time we slowed down I rolled forward. It was the back and forth communications between the hospital and the paramedics that informed me that I was suspected of suffering a very serious heart attack.
Safe Surgery Checklist
At the hospital, I didn’t go to the normal Emergency Room, but instead I was taken to a special section. At least nine people worked on me within a short time: removing my clothes (I have no dignity left, I assure you), poking me, shaving me (not my face), forcing me to chew medicine that caused me to vomit gloriously, threatening to give me a suppository, etc., etc.
One nice man introduced himself as the Cardiologist. He said he’d see me in a moment. Around this time, after being on an I.V. drip of some sort of anti-coagulant, my chest pain subsided completely. I was wheeled into something known as the Cath. Lab and placed on a metal table with my lower body completely exposed. By now, I knew what was about to happen, because 20 years ago my grandfather had undergone the same procedure: Angiogram or Angiography. In this procedure, a cut is made in the femoral artery in one’s groin. A tube is slid into the femoral artery and travels up into the heart. Radioactive iodine is injected for contrast, and X-Ray imaging is performed to evaluate blood flow, looking for possible obstructions.
There was something else that I recalled from my grandfather’s procedure that sent chills up my spine (despite the morphine). My suspicion was quickly confirmed: A surgical team was prepared for immediate open heart surgery if complications arose during the angiogram. Then I heard it:
Is the site marked?
Yes, right femoral artery at groin.
During a pause I asked, “Is that the Safe Surgery Checklist?” “Yeah, we always use it. How do you know about it?” “I work in construction defect litigation and we’ve been looking at ways to improve the quality of construction projects. Atul Gawande’s book, Checklist Manifesto, which chronicles the development of the Safe Surgery Checklist, has been a huge inspiration to me.”
I realized only a few days ago, that I must have been in complete shock during the entire experience.
More Questions Than Answers
I spent the next several nights in the hospital in a ward where the average patient was a good 30 years older than me. The good news: I had no evidence of coronary artery disease (no plaque), no evidence of serious damage from the heart attack, still had low blood pressure and low cholesterol. Sure, I could stand to lose a few pounds, exercise more, and eat less fast food. But why did I have an alleged heart attack in the first place?!
Currently, the three leading theories are:
- Relatively fresh clot caused an obstruction in a coronary artery and was cleared by the anti-coagulant.
- Focal Myocarditis – Immediately prior to my heart attack, I was suffering from a horrible case of Strep Throat. Sometimes the immune system produces anti-bodies to fight infections like Strep that can cause damage to the heart muscle.
- Coronary Artery Spasm – In this scenario, for whatever reason, the smooth muscles in one or more coronary arteries constrict to the point of preventing adequate blood flow, resulting in a heart attack.
Unfortunately, absent an autopsy, the only way to find out what happened is to try different medicines and see what works. Since the original event, I’ve had four other times where I experienced chest pain — twice in the hospital, once last week causing me to go to the Emergency Room, and another time that wasn’t that bad. My medications have been adjusted a couple times, and my cardiologist is keeping a close eye on things.
Life Is Short
Besides eating better and exercising more, I also need to address the most significant risk factor in my life: Stress.
I’m not sure how exactly that’s going to pan out, but I assure you, it is something I’m working on.
What I can say, is that since my heart attack, I’ve been sleeping better than I have in almost 30 years. I haven’t had a single migraine, either.
So if you’re wondering why I haven’t written much lately, now you know. I plan to be writing a lot more going forward, because I think that it is good for me.
No more procrastinating. Life is for living. And I’m not done yet.