Paul's Heart

The “Oh Sh*t!” Moment

Continuing on from yesterday’s “anniversary” post, as promised, I arrived at the Cardiac Cath Lab at six in the morning for what the cardiologist had described as an “in and out” procedure, “a stent or two and would be good as new.”

Without getting too lost in the weeds, a catheterization process involves a thin tube being inserted through an arm or leg, in my case a leg, fed through a blood vessel to the heart with a small camera to look for issues such as blockages or irregular heartbeats. During this process, if the doctor sees something that needs correction, which was already assumed in my case, he fixes it, again, expecting to place a stent to open up what is expected to be a blocked artery. Textbook procedure.

My nurse Heather had prepared me for the procedure. I do not remember why, but a conversation about my surviving Hodgkin’s Lymphoma came up. It might have been, because I was only forty-two years old, way too young for heart surgery, and I had explained that I had already been through a major event, so, age really had nothing to do with it.

My biggest concern, was that I had no spleen, removed as part of the diagnostic and staging procedures for my Hodgkin’s. So, I urged Heather to make sure all involved, knew that I was at an increased risk of infection and to take all necessary precautions. I wanted this to go as simple as possible.

When I came to, in my room, I saw my cardiologist, and a friend/co-worker who had stopped by to see how I was doing. The looks on their faces were serious. Though I remember the conversation, at that moment, it was not sinking in.

These are the actual images from my heart, and a drawing to make sure I could clearly see and understand the moment. A moment that was so extreme, and because of coming out of the anesthesia, I could not grasp how dire the situation was. Perhaps that was a good thing.

It was explained that I had three blockages that were of concern, one to the degree that even as a cancer patient I had not given the prognosis a possibility. The most serious of the blockages was the main artery, blocked between 80-90%. My friend, who also happened to be a paramedic, blurted out, “oh my God, it’s a ‘widow maker.'”

This simplified exclamation from my friend, though accurate, caught my cardiologist by surprise. “Yes, though we don’t like to call it that.” As I mentioned, I was fortunate to still be groggy from the anesthesia. I had no idea, that I could die at any moment, a fact that my cardiologist would tell me at my first follow up appointment a month later.

A blockage like this, nicknamed “a widow maker,” is referred that way, because the result is a major and fatal heart attack and unless it is able to be responded to immediately, the likelihood of survival is zero. The fact that I had symptoms for as long as I did, and did nothing about the situation, even more astounding as to my luck of survival. As my cardiologist phrased it, “it was not a question of ‘if’ you were going to die, but ‘when.'”

Oh shit! But as I was not understanding fully what was going on, my cardiologist was also confronted with his own “oh shit!” moment, clearly not expecting to have run into what he did.

I was scheduled for an emergency triple bypass the next morning, April 18, 2008, which was Friday, as in the anniversary of that day is tomorrow.

I thought the worst I would have ever had to deal with in my life, was going through cancer. My heart said…

As the anesthesia wore of, I discovered I had a busy twelve hours ahead of me in preparation for this surgery. The doctor had to find a vein to be used for the bypass, likely from either of my legs. Chest x-rays would be done, and tons of blood work. All of this had to be done quickly, as I was scheduled for surgery first thing in the morning. But there was one thing that I could not do before then.

See my daughters one more time. Hug my daughters one more time. It was an awful feeling. I could not even tell them I loved them one more time. And as long as the surgery was successful, it would still be days before I could see them.

A Heartbeat Away

This machine almost killed me, literally. To this day, it still haunts me when I see it. Yet, repeatedly, I have had to face this demon, as part of the recovery from not one, but three heart surgeries. For at least four months that I can recall, I would climb up on the eliptical, begin, and moments later, develop such a tightness in the left side of my chest. The heartrate on the telemetry of the machine, had climbed from 83 to 152 beats per minute in less than a minute. And then, the tightness was gone. I continued with my exercise for a full hour on the piece of equipment, then proceed for an hour’s worth of strengthening and weight training.

But I was annoyed by the way my trip to the gym always began. Only in hindsight, did I discover, this issue developed anytime I was putting a physical stress on my body, such as snow shoveling, mowing the lawn, or certain tasks at work. And just as with the gym, the tightness would disappear soon after it began.

I reached out to my doctor, who, on a hunch, and I do mean a hunch, especially for a forty-two year old man, felt that given my past history with Hodgkin’s Lymphoma, and the treatments of radiation and chemotherapy, that a stress test on my heart was warranted. It made no sense to me, as I had no heart problems (spoiler alert, there is a reason they call cardiac disease the silent killer) that I was aware of.

Though the date was April 16th in 2008, today, it is actually today, Wednesday marks fourteen years since that stress test was given, and would change my life forever. Cancer survivorship took on a whole new meaning for me.

The following sentences and phrases were written on my report:

“Exercise stopped due to EKG changes with chest tightness, indicating some sort of ischemic response.”

“There is a large in size, moderate in intensity defect involving the entire anterior wall (of the heart), anterior apex, and anterior septum on stress images. This is consistent with significant left anterior descending artery territory ischemia. Ejection fraction is 38%.”

I was told I needed to speak to a cardiologist about what all this meant, because just as my first visit with an oncologist (aka cancer doctor), I knew what a cardiologist was. I just did not expect to need one.

The doctor did not mince words with me, completely confident that I was dealing with a blockage. It was not known how bad but he was certain I had at least one. Confident and casual about the situation, he assured me, “I want you checking into the cath lab right now. We will pop a couple of stents into you first thing in the morning, and you will be good to go in about a week.”

For the full conversation, check out the page “CABG, Not Just A Green Leafy Vegetable” here on “Paul’s Heart.”

I had an appointment to keep in the morning.