Post #683225 by khan_tiki_mon on Sat, Jun 22, 2013 5:03 PM

From the NBCNews.com coverage of the death of James Gandolfini. “If a 50-something man dies, heart disease is the No. 1 suspect…’A quarter million Americans experience sudden cardiac death each year,’ says Dr. Michael Miller, director of the University of Maryland Medical Center’s Center for Preventive Cardiology. ‘Half of them experience sudden death as the initial symptom.’ In other words – there were no symptoms, no warning. ‘In many patients who have a heart attack, the first symptom is sudden death and they don’t even make it to a hospital,’ [Dr. John]Harold says…[There is the] artery known as the “widow maker”, Harold says: the left anterior descending coronary artery.”

I wrote the following almost seven years ago.

2006/08/19 04:30 I am writing this at 4:30 AM on the second floor of St. Joseph's Hospital cardiac wing. To tell this story properly I need to go back a year and a half or two years ago. At that time I had two friends, about my age that had died from heart attacks. I was particularly sensitive to the fact that it was very important to report any symptoms of heart disease as early as possible. Waiting, or toughing it out, I knew could be fatal. So, about two years ago I had some chest pains at work. It was more a discomfort than pains but it was a feeling I didn't recognize so I went to my primary care physician. He referred me to a cardiologist and I went and had an echocardiogram stress test done. I ran on the treadmill and then a sonogram of my heart was done. At this point I was given a clean bill of health as far as my heart went. I next went to a gastroenterologist and was diagnosed with an ulcer. Recently it has been determined that a majority of ulcers are caused by a bacteria. Of course I had the stress induced variety. I was prescribed HCTZ for borderline high blood pressure, a statin for high cholesterol, and Prevacid for the ulcer. I also had an endoscopy done to fix a stricture in my esophagus and a colonoscopy. I was good to go.

Over the next year and a half the stress in my life just kept increasing. It came on two fronts; both from work and at home from my oldest son Robert. This brings me up to Thursday morning August 17th at 6:30 AM. I woke up and was feeling fine. I was feeling a bit anxious about work perhaps but I was feeling fine. I started moving around, getting ready for work, when I felt a pain in the center of my chest. It lasted about ten minutes and then went away. I decided it was my ulcer acting up. About ten minutes later the pain came back. My wife Karen gave me four Tums antacid chewables and the pain went away. I told Karen I was fine and told her to go to work. She left for work and I got ready to take a shower. Before I could get in the shower the chest pains came back and this time I was having a hard time breathing. Also, I now had a pain in my left hand. This bothered me because I knew that one of the symptoms of a heart attack is a pain that radiates down your left arm. I called Karen, got her voicemeail, and left a message for her to come home and take me to the emergency room. As soon as I was done leaving the message the pain went away. I decided it was the ulcer but took an aspirin just in case. I figured it couldn't hurt. I got in the shower and felt fine. I figured when I got out of the shower I would call Karen and tell her to disregard the voicemail I had left. I got out of the shower and that's when the pain came back with a vengeance. Now, in addition to the chest pain, the pain in my hand, and the shortness of breath, I felt like I was going to throw up.

I called Karen again and this time she answered the phone. I told her to come home and take me to the emergency room. I was waiting for Karen and now for the first time I started to think that I might die. The pain wasn't subsiding. I tried sitting. I tried lying down. I couldn't find any position that brought any kind of relief. For some reason that I don't recall I decided to start walking. I walked out to the end of our street and that's where Karen picked me up. She said, "Where do you want to go?" I was thinking St. Joe's, but at this point I wasn't sure I'd make it there. Karen suggested urgent care at the Dewitt North Medical Center and I said okay. So, that's where we went.

Karen dropped me at the emergency room door and then went to park the car. Right from the start the nurses and the doctor at urgent care seemed the most concerned by how much I was sweating. I told the nurse I had just gotten out of the shower and that's probably why I was damp. "Oh honey," she said, " you don't look good." They laid me on a bed there and the pains went away. The chest pains I had then have never come back. I felt fine. They insisted I be transported to St. Joseph's Hospital and an ambulance was called. They did an EKG while we were waiting for the ambulance and everything looked fine. At this point I thought it was a false alarm. The doctor said better safe than sorry. He told me that a higher percentage of heart attacks are fatal at my age, late forties, because your body hasn't had time to develop "work arounds". When you are in your 70s or 80s and you've had blockages build up your body has had time to compensate with other vessels. When you are 49 you just die.

They tried to start an IV but were having a lot of trouble. After sticking me 4 times with no luck the ambulance had arrived. They decided to let the EMT start the IV in the ambulance. The two people from the Fayetteville Fire Department ambulance put me in the back of the ambulance. They started the IV, first time, and put me on oxygen. I felt really stupid riding in the ambulance because at this point I felt completely fine. There was nothing wrong with me and I was wasting everybody’s time. That's what I thought. At the St. Joseph's emergency room they did another EKG and they wanted to start a second IV. The nurse had a terrible time trying to start the second IV and after sticking me another three times she called an IV specialist. The specialist was able to get the second IV site established. The cardiologist came in to see me. He said I was not presenting as a heart attack. My EKG looked fine. The first blood test had come back fine. He said it was probably my ulcer but that they were going to keep me overnight for observation. He said on Friday they would give me a stress test and then depending on how that looked they might take me in for a heart catheterization. I told Karen to go back to work. She was missing lunch at Red Lobster with her co-workers. Karen decided to hang around a little longer.

The doctor came back in and at that point everything changed. I guess something was now showing in my latest blood work. It was definite that I had had a heart attack. We were skipping the stress test and going directly to the heart catheterization and it was to be ASAP. Dr. Alfaro-Franco, who was going to do the the heart catheterization, came in to give me the odds and to get the consent forms signed. I didn't have much time to think about any of it. One in a thousand dies during the procedure. Three of every thousand lose a limb. I signed a consent form that said if they couldn't fix things with the heart catheterization they could crack me open and go to open heart surgery. On two occasions I've had lunch at Trappers Pizza Pub, played quick draw, and won enough to cover lunch and then some. The odds for that are more than a thousand to one.

As I lie in the emergency room waiting for the procedure what kept popping into my mind was a scene from Taladega Nights. I had just recently seen the movie. The character Ricky Bobby, played by Will Farrell, is in the hospital after a car crash. He's lying in the bed and his wife and the doctor are standing at the foot of the bed. His wife says, "I know it's a hard decision to make but I've decided I want to pull the plug." The doctor says, "He's sleeping." The wife insists, "I want to pull the plug." "No," says the doctor, "He's just sleeping. He's not in a coma. There is no plug" I had to tell that to all the nurses. They wheeled me up to the catheterization lab. There were at least 7 people working on me and that's before the doctors got there. They were going into the femoral artery through the groin. A couple of the nurses were arguing over who was going to shave me. Apparently shaving my groin was one of the good jobs?? That's about the last thing I really remember from the cath lab. I wasn't under general anesthesia but I wasn't feeling too much.

Afterwards the doctor explained that I had definitely had a heart attack. There was damage to my heart. I had a 99% blockage in my front artery. She said the blockage I had is called the "widow maker." They were able to insert a stent and open up the blocked artery. The hardest part of the whole thing was the next six hours. For the heart catheterization they had gone in through my groin and the femoral artery. They plugged the site with collagen and a suture. You have to lie still, flat on your back, for six hours or risk popping open the wound site. Karen fed me that night like a little bird while I lay flat on my back. It must still be true love.

Friday morning two undertakers came to my room. You could tell just by looking at them and the way they were dressed that they were morticians. I thought, "Gee, maybe the doctor didn't tell me everything." But, they were there to visit my roommate and not to measure me for a new wooden wardrobe. Apparently my roommate was buying a vintage car from these guys and they were up to make sure the deal was going to close. After they left my roommate called his wife and started screaming at her, "What the "F" is the matter with you sending "F'in" undertakers to the "F'in" cardiac wing." His wife had called 911 when he had chest pains against his will. It had turned out that he didn't have a heart attack or heart problems but had separated one of his ribs from his sternum while shoveling. His wife had spent ten hours sobbing hysterically and had called every possible person she could think of to tell them her husband had had a heart attack. Well, she and this motley crew came to visit him. Officially it wasn't visiting hours, this was around noon, and there were four of them. They were drinking, and they had brought beer, wine, and liquor to the hospital. They were getting pretty rowdy. It was entertaining listening to them discuss the various felonies they had committed including dressing up a 15 year old girl to look like her mother, feeding her valiums, and then sending her into the bank to forge her mother’s signature and clean out her bank account. Part of a divorce settlement I assumed. His big concern was getting out of the hospital in time to make the bank in order to get the vintage car from the undertakers. Once they were gone several people from the hospital, of increasing rank, came to my room to apologize for the boorish behavior of my roommate. Apparently the hospital frowns on drinking and partying in the cardiac wing. I figured them to be some real lowlifes and so I was amused when one of the nurses told me that my roommate was the chief of police for a local municipality.

The nurses told me once the IV was out I could get up and move around. They pulled the IV and so I decided to get up. I had electronic leads attached to my chest because I was on constant heart monitoring. I expected to be tethered to something but found out I was wireless. I could walk anywhere on the floor and I was still being monitored by a wireless connection. I bet they didn't have that a few years ago. That brings me up to early in the morning on Saturday the 19th. I couldn't sleep and I've walked down to the lounge where I am writing this. The moral of this tale is that there are really some marvels of modern medicine out there. But all of the wonderful medical technology we have is of no use if you don't go to the doctor. I am extremely lucky. Looking back on this I should have called 911 right from the start. I feel like I have a second lease on life and I plan to take full advantage of it. Everyone at St. Josephs has been absolutely wonderful. The nursing staff here is top notch.

[edited in an attempt to prevent googly eyes]

[ Edited by: khan_tiki_mon 2013-06-23 11:08 ]