HIS HEART ATTACK

He awoke around 2:15 AM with that burning pain in his chest again. He'd had it before earlier in the week. Thought it was heartburn. At least it seemed like heartburn. Milk and an antacids had taken care of the pain before. Even so, the previous morning he had to go back to sleep sitting up in bed. Lying down would bring the pain back.

This morning it was different. The milk didn't work. The pain was down both arms and into his little fingers. It felt like he'd tried to swallow a grapefruit and it was stuck in the center of his chest.

Sitting down in the dining room, he called for his wife. She didn't hear him the first time. A second call, then a third. Sleepily, she answered from the bedroom.

"I need help" he told her. The pain made it difficult for him to talk loudly enough for her to hear.

Sleepy-eyed, she appeared in the hallway.

"What's the matter?" she asked.

He told her "The pain's back, it's bad, I've got to do something about it."

After some rationalization, a 911 call is made.

The proverbial a few minutes seem like hours passes before the first EMT arrives. She ran out of gas literally as she entered the driveway.

"The ambulance is on the way, what seems to be the problem?"

"Chest pains."

He's fitted with an oxygen mask and his vital signs are taken.

"Do you have any shortness of breath?" "Any sweating?" "Any history of heart disease?"

No to all.

"The antacids always helped before." he explains.

"Maybe it's a hiatal hernia." one of the EMT's is heard to say.

The ambulance arrives and a paramedic is now on the scene.

"No, I think it's a heart attack."

There are now five or six people milling around his dining room. Two-way radios. Med kits.

He tells them he can't lay down, so a transport chair is provided. He's strapped in and the transport begins.

"On a scale of one to ten, what is the level of the pain?" someone asks. This question would be repeated many times over the next few days.

He starts thinking about the question. "Pain is relative, how do I quantify it on a scale of one to ten?"

He gets stuck in a loop, and his wife answers for him. "He's in a lot of pain". She knows him too well.

It's cold out. There's a full flight of steep stairs to the driveway where the ambulance is waiting with it's lights flashing. He'd meant to fix the stairs. He wonders if he'll be back to do the job.

At this point, he begins to realize the gravity of the situation.

He's taken from the chair and placed on a stretcher. Sliding into the ambulance, he notices that it's really cold inside. He still can't lay down, so the stretcher is set in a sit-up position.

"We'll have the heat on in a minute."

The one to ten question is repeated.

"Nine, I guess."

A IV of lidocaine is started. The EMT inserts the IV deftly. Not bad for 70 miles per hour. A spurt of blood appears on the back of his hand.

The paramedic hooks up the portable EKG machine.

"He's thrown a few PVC's (Premature Ventricular Contraction)."

"Mr. B****, it looks like you're having a heart attack."

He notices a syringe being prepared.

"What's that?"

"It's morphine, it's for the pain."

"No, that's OK".

"Mr. B****, it will actually take some of the stress off your heart". He concedes, but it really doesn't help much with the pain.

The paramedic produces a small aerosol can that looks like a breath freshener. "This is nitro-glycerin, I'm want to spray some of this under your tongue for the pain."

The paramedic is now on the radio calling ahead. He catches only part of the conversation. It does not sound good.

The ambulance slows and seems to be taking a sharp turn. He looks out the window and realizes he's only in Milford center. We've only gone seven miles. We've got thirteen more.

The one to ten question is repeated.

More nitro.

The oxygen mask is too much. The paramedic replaces it with a canula type. one of those with the two tubes that are inserted in the nose.

"I hope Lin is OK to drive down by herself" he thinks.

Occasional glances outside through the smoked glass windows of the ambulance. Although the route is very familiar, it's difficult to determine where they are. After all, he is riding backwards laying down.

"Where are we?" he asks as the ambulance comes to a stop.

"We're outside the hospital."

He's been there many times (for visits). The morphine and the pain cause some confusion. The hospital entrance looks unfamiliar.

It's now nearly 4:00 AM. The passage through the emergency room is a blur. Faces looking down at him. Idle conversation interrupted by his passage.

At this point, he becomes a little hazy on the details and the sequence of events.

He glances toward the door. Lin and Shannon are standing there. He hopes he doesn't look as bad as they look. Ashen. It then comes to a conscious level that they look that way because they're looking at him.

"Who let them in here?" "Get them out of here".

It's like he always maintained about things like this. "It's like a motorcycle accident". "Don't know which is worse, having one or watching someone you know have one".

The one to ten question again.

A chest x-ray. Blood tests. An electro-cardiogram.

"Is that the machine that goes 'PING'". He reaches for an obscure reference to a Monty Python movie. Only the nurse Mike gets the reference.

Calmly he asks "Am I dying?" All sorts of emotions, but strangely, fear isn't one of them.

"We're trying to see that you don't." is the response.

At one point, the crew that brought him in come in to pick up their gear. He tries to say thanks but the room is too noisy and the don't hear him. After all, he did get them up in the middle of the night.

Eventually, the pain subsides and he's to be transferred to the ICU. It's now just a little before 6:00 AM.

The remainder of the day consists of short nap periods punctuated by visits from doctors, hospital personnel, and those concerned about him. His wife brings him a small stuffed teddy bear angel holding a rose. He hangs it on one of the infusion pumps near the head of the bed.

"My guardian angel." he tells her.

At one point, someone wearing a lab coat is standing at the foot of his bed asking questions one of which was the one to ten one.

"Who are you?" he asks.

"I'm the doctor." is the incredulous response.

He didn't recognize him. The last time he'd seen him he was in street clothes and was a lot closer. Without his glasses on, he can't see that far.

The pain is all but gone completely by 1:00 in the afternoon. He's resting well. The looks on the faces of his visitors is troubling. They transcend the looks of concern.

"If they're looking at me and this is what I see, what do I look like?"

More tests during the day. An EKG, and a sonogram.

A sonogram is basically the same as the ultrasound given to pregnant women. A ultrasonic transducer is passed over the chest over the heart and the results are observed on a scope and are recorded on a VCR. Took about one half hour to complete.

The doctor tells him that it looks like 30% of his heart is involved.

Around 4:00 PM, the pain seems to be returning. He tells the doctor.

He hears the doctor on the phone. It seems that some sort of arrangements are being made.

A quick 20 minute trip down the highway through rush hour traffic.

"Now, no fair doing a code 3 back North with no one inside" he tells the driver as they're taking him out of the ambulance.

"Nah, we're going off duty now." "We may even stop for dinner and wait for the traffic to die down."

They enter through the emergency room. The emergency room is different here. It's very large and crowded. Lots of faces looking down at him as he passes through.

Another ICU.

Within an hour after arrival, he was made ready for the cardiac catheterization. The cath team is also prepared to do a balloon angioplasty in the event that the blockage is still present.

He's brought to the cath lab. At some point, the nurse adds Dilaudid and a tranquilizer to his IV. The drugs have the wondrous effect of making him not care about what is done. The sensations are still there, he just doesn't care.

"Stick a tube in my groin, no problem." "Cut my legs off, no problem."

Once the catheter is in place, the rest of the procedure is painless. The catheter is maneuvered into a position in the blood vessels as they enter the heart. A contrast medium is injected into the vessels. The medium makes the vessels x-ray opaque allowing them to be seen and video taped.

The whole procedure takes about 45 minutes. He's wheeled back to his room.

Shortly after being brought back to the ICU, a husky man with a beard enters his room.

"Hi, my name is D***, I'm the vascular nurse." "I'm going to remove your catheter."

The catheter sheath is removed and shown to him. It's about 8 or 9 inches long and about the diameter of one of those little straws you get in one of those rum and anything drinks at a Chinese restaurant. It has a clamp/seal sort of thing on one end. D*** applies direct pressure to the wound to ensure that it closes. Takes a half hour.

"Oh, good Startrek is on" D*** notes.

They watch Startrek together as D*** keeps him from bleeding to death.

He's told not to move his right leg. A hyper-extension brace is placed on his leg to help keep him from bending his leg. He has to remain relatively still for about six hours.

"Let's see, it's 7:30 now..."

After his visitors leave he's alone with his thoughts again.

He tell his night nurse to make sure to check on him at 2:00 AM. That's when the attacks come. This done, he gets some real sleep.

It's Friday morning. It's seems like longer, but it's been only a little over 24 hours since the attack. He has his first real meal. After breakfast, he's transferred to a regular room. They need the bed in ICU.

He tries to make sure that his visitors see something different every time they come in.

He's sitting up in bed. He's sitting on the edge of the bed to eat. He's walking to the toilet by himself. He's got his dungaree shorts on. He's up and sitting in a chair watching TV. The heart monitor is gone. The IV pole is gone. He's actually dressed, no more johnny.

Monday morning. He awakes with excitement. He's going to take a echo-stress test to determine how much damage has been done. Then maybe he can go home.

The test is supposed to happen in the morning. The computers that do the scheduling are down. The test is manually scheduled for 1:00. The morning drags on.

He's told not to eat a lot for lunch. Don't want all the blood trying to digest food instead of supporting the heart.

The echo-stress test is another sonogram type test. Ultrasound pictures of his heart are taken at rest. Then comes the tread mill. He makes it to level three and can't go any further. His heart is doing OK, it's his legs that give out. More pictures.

The cardiologist comes in to review the results and to dictate his comments into a hand-held recorder. Lot's of unfamiliar terms.

He hears 35%.

Well, that's about it. He went home later that day. Picked up his medicine on the way home. Gets to take a little bottle of nitro with him wherever he goes.

Lots of doctor appointments were made afterward by men who were shocked by his attack. He just wasn't the type. No apparent stress. Slim, eats well and watches his diet. He did smoke though.

He has a cardiologist now. Never remembered asking for one.

The cardiologist tells him he should expect to have a normal active life despite the fact that his heart is now operating at a level 30 percent below normal.

WHAT HAPPENED

The following describes what happened in terms we can all understand.

First, a little refresher course on human anatomy. Something we all knew at one time, but have probably forgotten.

The heart is muscle that forms a four chambered pumping mechanism. Two of the chambers (atria) take blood in from the body and two of the chambers (ventricles) pump blood out to the body. The heart is divided literally and functionally into two halves (vertically). The right side pumps blood in from the body and out to the lungs where the blood is replenished with oxygen. The left side pumps the oxygenated blood in from the lungs and out to the body.

When a blood vessel in the body becomes injured, the body repairs the injury by forming a patch, or blood clot, at the site of the injury to prevent further loss of blood. The body's clotting mechanism has two main components: BLOOD PLATELETS and FIBRIN. The platelets are analogous to the bricks in a brick wall and the fibrin is analogous to the mortar.

Now, what happened to me.

Due to genetic factors, age, and some bad habits, cholesterol and calcium deposits (known as PLAQUE) have built up on the inside of some of the blood vessels that supply my heart. The cardiac catheterization has since shown that I have two blockages of approximately 50 percent.

When a plaque deposit forms in a blood vessel, the body's clotting mechanism sees the deposit as something that needs to be repaired. The mechanism "repairs" this perceived injury by sort of wall-papering the plaque with fibrin.

All remains apparently well until what is known as a PLAQUE RUPTURE occurs. The deposit sort of bursts through the fibrin wallpaper and exposes itself to the blood stream within the vessel. It is not fully understood what causes these ruptures to occur. The body's clotting mechanism perceives this newly exposed plaque as a hole in the blood vessel and proceeds to attempt a repair of the injury. A blot clot is formed at the site of the plaque rupture. Due to the fact that the vessel is already partially blocked at this point, it becomes a simple matter for the clot to complete the blockage. As the vessel closes down, the blood cannot reach the heart muscle that is downstream, so to speak, of the blockage. The lack of blood means lack of oxygen and the affected portion of the heart muscle dies.

As the muscle is dying, the pain comes. The pain is called Angina.

My heart attack occurred because what is known as the Left Anterior (front) Descending Coronary Artery became blocked. Because it is on the left side of my heart , it affects the blood flow out to my body from the lungs.

The average human heart is approximately 60 percent effective relative to the amount of blood it pumps out. That is to say for every 100cc of blood that the heart takes in, about 60cc is pumped out. Due to the fact that I've lost approximately 30 percent of the pumping capacity, for every 100cc of intake, about 40cc is pumped out.

I am now taking medication. The first (Lopressor) is what is known as a Beta Blocker. It's purpose is to make my heart work slower and thereby more efficient. I am also taking a medication (Zocor) that will help reduce my cholesterol level. My cholesterol level (total) was in fact below the recommended high point of 200, but now it's a case of the lower the better. I take some vitamins and one aspirin a day to thin my blood.

I carry the proverbial little bottle of nitro around with me wherever I go. If the pain comes back I place a nitro tablet under my tongue. The nitro acts as a vasodilator, that is to say, it expands the blood vessels and improves the blood flow to the heart.

I was a smoker, but no more. Smoking is a heart poison especially to someone like me. The nicotine affects the blood vessels directly and the carbon monoxide bonds readily to the hemoglobin in the blood blocking out the oxygen.

The little teddy bear angel now hangs from a maptack over the head of my bed.

Update April 16, 1998

Well, it's been almost a year and a half since my heart attack. Things are pretty much normal here now. That's as normal as they can be following a heart attack.

A month after my attack, I enrolled in a cardiac rehabilitation program at a local hospital. For a little over six months, I went there 3 times per week. The staff (nurses and exercise therapists) starts you out slowly on the exercise equipment and monitors your pulse and blood pressure as you exercise. You work on various pieces of exercise equipment like stationary bicycles, treadmills and rowing machines. Gradually, you work up in intensity. Although you hope you won't need it, there's a crash cart there just in case you do. It sort of ends up being a safe haven to get back on the road to recovery.

The program also includes some dietary psychological counseling as well.

In January following my attack, I began seeing a psychologist and began drug therapy for depression. It wasn't that the attack made me depressed, it was that the depression was part of the reason that I had the attack in the first place. I continued the psychological portion for about six months and I am still in drug therapy.

I had to make some serious modifications in my life style. As I said, I quit smoking right off. I am still without cigarettes although the cravings are still there. I figure they will never go away completely, just get further apart. When I want a cigarette, I WANT A CIGARETTE. Oddly enough, the antidepressant that I take is now prescribed for smoking cessation.

Modifying my diet was a different matter. I had always watched what I ate, at least I thought I did. At first, I would literally leave the grocery store in tears over the frustration of finding things I could eat. It took a while, but I have finally gotten to the point where I am able to do the shopping and maintain my low fat diet.

At my six month checkup, I took a stress test and did really well in it. My cardiologist was really pleased with my progress. My blood tests also showed a reduction in my cholesterol levels indicating that my change of diet and my medications were doing what they needed to.

I left the program in June of the year following my heart attack. I enrolled in a cardio-vascular exercise program at a local physical therapy center. The center is sort of like a gym except that most of the people there are either at risk for a heart or pulmonary problem or have actually had a problem already.

I have been slacking off just a bit recently, but up until January of this year, I had been going there three times per week. I work out on bikes, rowers, and treadmills.

Right after my attack, I was limited to the amount of weight I could lift (50 pounds). Unfortunately, no one told me that at the time. I went back to pretty much normal activity which included loading 65 pound blocks of concrete into my pickup truck for weight in the winter. I was also carrying heavy loads of groceries into the house. Guess I was lucky to get through that first few months.

When I found out about the weight limitation, I got even more depressed. How was I to carry on a normal life when I couldn't even lift my six year old granddaughter up to give her a hug? I felt at that time that I would rather die than live like that. I wanted to ride my motorcycle but what would happen if it fell over? Would I have to ask someone to lift it up for me? Two cinder blocks weigh 70 pounds. The pails of sand that I fetch to sand my drive in the winter weigh 65 pounds each. I used to carry them one in each hand.

At my one year checkup, the cardiologist removed my weight limitation and I will soon begin weight training. I figure if I am spending as much time as I do at this exercise thing, I may as well have a body that looks like it.

All in all, I feel pretty good and I am in better condition than I have been in many years. I just hope I can keep it up. This IS a LIFE sentence, you know.

Update October 1, 1998

I am a freelance product designer and one of my clients is a company by the name of Millipore. The company is one of the world's leaders in the manufacture of ultrafiltration equipment.

The project I am currently working on is the development of some molds to be used in the production of ultrafiltration cassettes, that is the expendable portion at the heart of the filtration apparatus: the part that actually does the filtration.

In the course of putting the finishing touches on the design of the mold, I was sitting in a meeting with my associates at Millipore when one of my associate's secretary came in with a frantic look on her face and a postit message in her hand. Handing it to her suprevisor, she announced that a customer by the name of Genentech was having a problem with piece of equipment.

Given that Genentech is very important customer of Millipore, my associate excused himself and hurried off to investigate the problem. In fact, Genentec is a major user of the very filtration cassettes I was designing the molds for.