Pages of interest

Tuesday, November 13, 2012

To Mend a Broken Heart

By George:

While the events chronicled here are absolutely factual, the names of the doctors have been redacted for obvious reasons

The cold gloomy February day was mirroring my mood as I sat by the window trying to examine my innermost emotions. I was 44 years old and in top physical condition. I worked out at a gym regularly, and my doctor had just given me a clean bill of health. Yet I KNEW that there was something drastically wrong with me. I was positive of it, but I just couldn't convince either my wife or my physician.

I even tried to persuade myself that perhaps it was just my overactive imagination, but the more I tried to rationalize it away, the more my body kept compelling me to do something about it.

It all started the previous summer.

I have never considered myself as being out shape, but since the Jazzercise bug has bitten my wife and daughters, I decided to join a gym too and try to recapture my youthful physique. I had a comprehensive physical checkup prior to committing to my exercise regimen, and with my doctor's blessing I took to the task of rebuilding my body. My wife also did her part by putting me on the latest "Low-Fat" diet, expunging the consumption of my usual “heavy on the grease” Hungarian cuisine.

It wasn't too long before the results of my workouts became evident. My muscles started taking shape, I was filled with renewed energy, and I felt great. As the weather turned warmer, I even abandoned the car as the form of commute, and decided to ride my bicycle to work. This was very convenient for me because I worked less than three miles from my home, and had a wife and two teenage daughters at home who NEEDED my car more than I did. I was happy to be able to take the healthy route to work.

I have been commuting by bike for about four weeks before I had my first indication of something amiss. The ride that morning was uneventful, as no drivers tried to cut me off or push me off the road. My stamina had improved to the point where I no longer needed to shift the bike into low gear to get to the top of the slight hill as I approached my workplace. I started my sprint up the hill, but this time before I reached the crest, a wave of nausea swept over me, accompanied by a slight burning sensation in my lungs. I got off the bike and walked the last couple of hundred feet to work, but the nausea went unabated.

At work I sat down at my desk, put my feet up and tried to relax, but by now the nausea was joined by a feeling of impending doom. I picked up the phone and called my doctor, only to hear a recording saying that he was away for the day and referred me to a doctor covering. My boss, who was worried by this time because I probably looked the way that I felt, suggested that I call a nearby doctor that he used. I called his doctor and tried to explain to the nurse what I was feeling. She very efficiently informed me that I have an 11:30 appointment with the doctor. Since it was about 9:30 when I called, I snapped that it would probably be too late by then, and hung up. I sat at my desk trying to breathe deeply to relax, while debating with my co-workers and myself the merit of calling an ambulance. Eventually the feeling subsided and I realized that I just might live through the day after all.

Next day I went to my doctor for a complete physical. With great apprehension I awaited the results of the examination and the EKG, and was relieved to hear that there was nothing wrong with me. As to the previous day’s episode, he couldn’t explain it, but he told me that since I had no family history of heart problems, didn’t smoke, exercised regularly, and had low cholesterol, it was probably nothing and I shouldn’t worry about it.

Easier said than done. Worry I did, because the burning sensation I had felt in my lungs kept cropping up from time to time. At the gym while I was “pumping iron” I was fine, but when I hit the treadmill or the bike, the burning started. So I did the only logical thing… I stopped using the treadmill and the bike.

At home the burning feeling would sometimes recur when I exerted myself, but not always. I mentioned the burning to my wife as we were strolling one evening, and she immediately diagnosed me as having a hiatal hernia. I told her that I didn’t think so, but by then I had already decided that I just had to find out what was the cause of my discomfort.

My doctor had told me that my heart was okay, so since I felt the burning in my lungs, maybe something was wrong with them. I decided to find out for myself. I made an appointment with a local radiologist friend for a chest x-ray. When the results showed that my lungs were perfect, I accepted the diagnosis with mixed emotions. I was happy that my lungs were fine, but more and more that would point to a conclusion that I was trying to avoid. It had to be my heart.

In the weeks that followed, the burning in my lungs got worse to the point where I couldn’t walk up a slight grade without stopping every 50 feet or so. It was at this time that I got my final impetus to resolve my situation. I was a few minutes late for Mincha (afternoon prayer service), so in haste I sprinted the last 30 or so feet. It was then that I first felt the proverbial elephant standing on my chest. The feeling didn’t last long, but the crushing chest pain that lingered in my memory convinced me that my suspicions were correct, and my pain was cardiac related.

So on that dismal February day, I resolved to get to the root of my apprehension. I made an immediate appointment with a cardiologist friend to get a stress test. He examined me, took my blood pressure, did a resting EKG and told me that I was in perfect health, but to humor me he would give me a stress test. He hooked me up the EKG and I started pedaling the stationary bike. He kept his eyes on the EKG strip, and after pedaling about two minutes he asked me if I felt anything. I smiled and said that as a matter of fact, the burning sensation has started. He let me pedal for about another minute and then told me to stop.

My cardiologist tried to comfort me by saying that while the stress test showed a problem, it was not serious because the EKG showed a "distal" (away from the heart) blockage. But to put my mind at ease, he suggested an Angiogram to assess the extent of the problem. To his wide mouthed amazement, the Angiogram film (there were no videos back then) showed a 95% blockage at the bifurcation of the LAD (Left Anterior Descending artery). He tried to explain to me that the reason that it showed to be "distal", is because I was working out, which created more arterial paths. Since I didn't understand it, I took his word for it.

My cardiologist friend recommended that I undergo an Angioplasty procedure to clear the obstruction, and over my wife's objections, I agreed to have it done. It was MY heart, I felt the problem escalating, and I didn't want to go shopping around and take a chance of having a heart attack. My friend set me up for the procedure to be done at St. Luke's Medical Center in Manhattan, and the doctor doing the procedure would be Dr. K., whom he called "The Father of Angioplasty". He explained to me that I will be having the best doctor, and it will be done in a non-teaching hospital to make sure the doctor himself will be doing the procedure. St. Luke's also has a heart surgery center, which is necessary as a standby whenever an Angioplasty is done, just in case there are any complications. I happily agreed.

On Monday, March 9th, 1992, I checked into the hospital for the short procedure, after acing my pre-surgical tests. As I was sitting in the room trying to stay calm, a tall gentleman walked in flanked by a young intern in green scrubs. He introduced himself as Dr. K, and told me that he will be my doctor for the procedure. I apprehensively glanced at the young man in green, and announced "I want YOU to be doing the procedure, and not him". He assured me that the "resident" will be there only to observe, and they left to get ready.

I was sedated instead of anesthetized because I was told that I needed to be awake to be able to follow instructions to reposition my body during the procedure. As the catheter was introduced through my femoral artery and snaked through my body to the blockage at my heart, I tried to listen to and follow the conversation around me. I was quite surprised to hear Dr. K. saying "... now move the catheter a little more, and inflate it for 2 minutes... that didn't work, so inflate it for 5 minutes...". In my sedated condition I was confused, because it sounded to me like the resident was doing the procedure and Dr. K. was "directing" him. He kept trying to clear the blockage, eventually telling the resident to inflate the catheter for 20 minutes, when suddenly I sensed that something was wrong. The conversation around me changed in timbre and pace, and I couldn't follow what was going on. I remember Dr. K. leaning over me to tell me that there was a problem and I have to be taken immediately to surgery. My sedated mind said "O.K.", and I was whisked off to the operating room.

As I was being wheeled down the corridor, my wife appeared, and in a tremulous voice inquired about what was happening. I couldn't follow the conversation, but I did manage to get one sentence out. "Doctor, could you please give my wife some Valium?" Then quickly I was under the bright spotlight of the operating room, frantic activity around me, someone leaning over me saying something, and then...

I awoke slowly and I found myself gagging. I have never been on a ventilator before, and it took me about a minute before I relented and let the machine stuff air into my lungs at its own pace. By then the nurse had noticed my stirrings, and a short time later freed me from the tyrannical mechanism. I was very weak, but I tried to assess what my situation was. I was aware that my chest has been "cracked", but I still didn't know exactly what was done to me.

Finally they allowed my frantically worried wife in to see me, and I started to get some answers. I was in surgery for over 8 hours and I had a double bypass. The angioplasty procedure had torn my artery apart, and if not for the doctor using the catheter as a quick emergency shunt, I would have died right there. The surgeon had to spend an inordinate amount of time just cleaning up the "mess" left by my blown-out artery. My cousin from California who is a physician, told my wife to check my legs for signs of surgery. When she found none, he told her that the surgeon did the bypass using the mammary artery instead of using veins from the legs, which was a more permanent and better way. Somewhat relieved, I surrendered to the blissful prodding of the Sandman.

That week I worked hard to get back on my feet, and by the following Monday I was ready to leave the hospital. When Dr. K. gave me my release instructions, he made the following statement. "We don't know why you had that blockage. You were low risk, no family history, you exercise and don't smoke, have low cholesterol and the surgeon found your arteries to be squeaky clean. You don't need to be on medications, and I can't even tell you to be on a diet". I took those instructions very seriously, and made sure that my wife no longer tried to deprive me of my natural Hungarian sustenance. You see, while trying to figure out what caused my problems, I humorously concluded that since my arteries were previously well "lubricated" by the Hungarian cuisine, putting me on a low-fat diet removed the lubrication thus resulting in a blockage. Little did I realize that 15 years later a study would actually prove that low-fat and no-fat diets are actually detrimental to the heart.

Leaving the hospital that Monday, my wife insisted on driving due to my infirmity. We did, however, stop on the way home to attend the funeral services of my wife's cousin. I also insisted on stopping off at my workplace to inform them that I'll be back in a few weeks. Three weeks after the surgery I returned to work, followed two weeks later by our visit to Israel for Passover, which included some ice skating recreation. I was back to my normal functioning.

But wait, that's not the end of this story. When I returned to my cardiologist friend for a checkup, he seemed reluctant to chat with me. Whether talking to him or his partner (I never knew he had a partner), it was all business with every word carefully parsed. I was confused, but I figured that they felt uncomfortable about my botched procedure. So I shopped around for a different cardiologist which proved to be a chore, since they all wanted to put me on medications that I knew I didn't need.

Seven years later I was attending a function where I happened to sit next to a local cardiologist. During our conversation I related to him my Angioplasty debacle. He sympathized with me, and he wanted to know who did the procedure. When I told him it was Dr. K., he got this incredulous look on his face and said. "Dr. K.? Everybody knew that he was an alcoholic. And it was about that time when he disappeared off the face of the earth". I was speechless (which is a rarity for me), but that explained the reluctance of my cardiologist friend to speak to me. I guess he was afraid I would sue. I never did see my friend since then, but I heard that he had a heart attack a few years back.

As for me, I finally found a cardiologist who agreed not to push drugs on me, and I have managed to keep my diet quite edible for the past 20 years. Can't say that my story since my Angioplasty has been uneventful, but that's for another narrative at another time.

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