How do I prepare for a diagnostic test, procedure, or surgery that I will be anesthetized?
I go to the bathroom. Too many stories about messed up underwear.
I memorize my surroundings. I know once I am out, it is time that has never existed.
“Play dead” like in the cartoons with the bears. If I lay motionless, maybe they will move past me.
I tell my wife and daughters that I love them.
I have had this job for nearly ten years. I have seen hundreds of people come through the doors of our office. Patients have undergone cardiac stress tests performed by me for reasons such as physical shape, conditioning, cholesterol, age, and heredity. One day does not necessarily stand out from another.
This morning started out no differently than most others in my career as a cardiac technician. My first patient is a 42 year-old male who has been sent to our office for a nuclear stress test by his general practitioner. This is odd, and clearly a waste of time, money, and benefits. There is no reason for him to be undergoing a test of this level. In any case, I call him to the implementation room to install his IV line so that the radioactive dye can be injected for the x-rays to be taken prior to, and after the treadmill exercise.
What a baby he is! He is a cancer survivor and so intimidated and squeamish as I try to put in his line. Yes, patients have a fear of needles, but this patient is so over the top. With the IV now inserted, the dye is injected and the first set of x-rays are taken. Nothing unusual is noticed. I have him follow me to the exam room, where the next set of technicians are waiting to hook up his EKG lines and then he gets on the treadmill.
I move on to my next patient, not thinking anymore about Paul.
Within ten minutes, Paul is led back to the x-ray room. That is odd. At least a half an hour should have gone by before he returned to my care. In any case, the second set of x-rays needs to be done which will now show the blood flow to his heart under stress. Once the pictures are done, I will escort him back to the waiting room until the results are read, and then I will release him to go home.
There is a definite age that you need to be in order to vote. You have to be so old to get into an rated R movie. There is a minimum drinking age. These ages are so long ago, so young. Cancer does not discriminate based on age. Undiagnosed health conditions lead to shocking and sudden obituaries with high school student athletes. So young.
I am not the doctor. But I do have basic knowledge of what these photos mean. The colors on the film are either orange or purple. In the beginning, his heart shows that blood flow is just as it should be and this is confirmed with the orange color, the blood. But as stress is introduced, the treadmill, the orange changes to purple. He has a blockage. It looks fairly serious to me, and I am just a nurse.
The waiting room is now mostly empty except for the first patient of the day. This will be the last time that I see him. He will be referred to one of our cardiologists and the staff that will be needed to save his life. Mr. Edelman? Oh my God, he is so young. My children are his age. This could be my child. He is so young. I want to cry.
“I am going to take you back to Dr. S’s office. Dr. S would like to talk with you.” He is getting bad news, and he knows it. You can see it. But he still gets out, “Thank you, you have been so nice to me.”
I do not know what exactly his diagnosis or prognosis will be. I do believe in our doctors to save this man’s life. It is just that he is so damned young. It is just not fair.
I have never been a vegetable eater. I will eat carrots and corn, but when it comes to anything green, not a chance. So, ears of those who know me, perk up when they hear me proclaim how grateful I am for having “cabbage”. As I don’t normally wear v-neck collars, just to look at me, one would never suspect that I am a survivor of heart bypass surgery, Coronary Artery Bypass Graft, or simply, CABG.
Twenty years earlier, my body and soul had already been through a life-threatening battle with cancer, Hodgkin’s Disease. It may be arrogance to have assumed that I should never be put through something traumatic again. I had done my time. I had already proven that “it can happen to me”. I should have been safe being able to say “it will never happen to me – again”. In true déjà vu fashion, from start to finish, I now faced another challenge. But the difference this time, time was not on my side. Time was clearly against me.
There I was, 42 years old and trying to stay, rather, get into shape. I was slightly overweight (translation – really overweight), and not very active. But for four months, I had been spending close to two hours a day, five days a week at the gym, and making great progress. But for those four months, I also had developed a symptom that I had ignored, not just at the gym, but everywhere else that I was exerting physical stress on my body. It was a tightness across my chest which lasted only several seconds into my workout. I was not worried as it was not excruciating pain as described by people who have had heart attacks.
I spoke to my family doctor of twenty years. She made comments of my cancer history, and current physical being, but made the suggestion to undergo a nuclear stress test with a cardiologist just for giggles. Of course, just as in my Hodgkin’s past, I was not putting two and two together. Though I knew what a cardiologist was, I did not realize that was the direction she was sending me in. At age 22, I had no idea what an oncologist was either.
I arrived at the cardiologist’s office, naïve, dressed in shorts, sneakers and having all kinds of wires attached to me. A dye was injected into me, and the tech took the first set of pictures. No big deal. No bells and whistles went off. Then the tech showed me to the treadmill. While I did not anticipate a marathon on the mechanical track, I did expect to go longer than three minutes. The test had been stopped as something appeared on the EKG. But still, I did not suspect anything. One more set of pictures, then it was back to the waiting room.
Then I watched people leave who came in after me. I had done that drill twenty years before when I was diagnosed with my Hodgkin’s so I now knew something was going to be wrong. I met the cardiologist who drew the short straw getting me for a patient. He was young and had a nice bedside manner, and confidence. He was certain that I had a blockage, and he wanted me to check in next door to the hospital for catheterization the next day. I would be good as new with a stint and back to my grind within a week.
For the second time in my life, I would face Elsabeth Kubler-Ross’s stages of grief (denial, anger, bargaining, depression, and acceptance). Unlike with my cancer diagnosis, I skipped right past the denial and anger. “Doc, look, I’ve got some things I need to take care contractually with some clients. I’ll get back to you in a few weeks when things slow down. I’m disc jockeying a wedding this weekend and have two gigs the following weekend.” His response? “Mr. Edelman, perhaps you don’t understand, I don’t want you even going home.” The bargaining kicked into high gear. “Look, I need to go home, and explain this stuff to my wife and make sure that she knows everything she is going to have to take care of with the kids and the house, and everything else.” Dr. S. said, “Okay, fine. But I don’t want you to do anything other than go home and rest.” Then I backstepped into the denial. “So I can’t even mow my lawn which needs to be done? Mowing is relaxing to me.” You can finish that conversation with what you think he might have said after that. Let’s just say in kind words, my intelligence had been questioned.
The next morning, my wife drove me to the hospital. As I came out of the anesthesia, there was Dr. S along with my wife, and a co-worker who stopped by just to visit. “Our attempt to stint was unsuccessful. It seems that some of the therapies that were used to treat your husband’s Hodgkin’s, over time have caused some severe damage to his cardiac system. Your husband has been set up for emergency bypass surgery first thing in the morning. He has three blockages but of the most concern is the left anterior descending artery which is 90% blocked.” I do not recall my wife’s reaction but she told me of her knees buckling under her while I lay coming out of the anesthesia babbling “bypass… okay… bye bye… bypass… see ya in the morning…cool… bye bye bypass.” But I will never forget my co-worker’s words. As an EMT, she immediately knew what was happening and commented, “Oh my God, it’s a widowmaker.” To which Dr. S responded, “simply put, yes.” Blood was being restricted to my heart 90%. It was not a question of “if” I would drop dead from a fatal heart attack, but “when.” Dr. S. called me an “extremely lucky man” that I actually prevented my heart attack from occurring. Okay Doc, you got my attention. On to acceptance. The easy part about that, was that I had less than twelve hours to worry and be frightened. However I was still coming out of the anesthesia, and then for the next many hours, underwent many pre-surgical tests. I did not have a lot of time to think about what was happening to me.
And so, the next morning, I would have my first experience with “cabbage”, CABG. There are a lot more details to this event. But the long story short, I now owe my life to something that sounds so similar to something that I have avoided my whole life, cabbage. And no, I still do not eat it.
Paul's Heart 