It’s a Bummer

This is the story of my heart attack, and all the worrying, thinking, wondering, and fear that accompanied it. Enjoy!

I couldn’t believe it: I had a heart attack! Well, I had heart damage, and a leaky heart valve to boot. Suddenly, life was moment-to-moment, with yesterday’s indifference becoming a vanishing Eden. I wouldn’t live to my anticipated 85 anymore, instead hoping for 70 with the constant guidance of a cardiologist incubus on my back.

To tell you the truth, life had already become a bore, stuck, redundant. I would even go so far as to say I wished this illness upon myself. I’m a physician, so I know that if you don’t croak right out the minions of cardiology have an ever-proliferating number of drugs, angioplasties, surgeries, diet and exercise mantras to keep the sanguine flow pulsating through your coronary arteries and preserve what’s left of your ticker. Sure you become their patsies, subject to daily assaults by yummies of all shapes, colors, and coatings. You have to be on the lookout for side effects, hair color changes, diarrhea, swelling of the end of your nose. It’s all a royal pain in the ass, a strike against manhood, freedom and wilderness adventure. I felt my life contracting like a prune out to dry. On the other hand, my contracting horizons made my life take on value. I had a sudden desire to grovel, to cling to whatever false bone was thrown before me that might push death’s bite back a bit. Even the thought of being filleted open, having my coronary arteries rerouted, a feared adventure in basic plumbing, seemed desirable. The pain, suffering, the zippered chest scar and possible pump head complications was a price that suddenly seemed worth paying.

My mind reeled forward, reconstructing the new me, the cardiac, with my shrunken life horizon. Yes, I was a 60-year-old, too young to quit my job, though who would want to hire a cardiac cripple? I wouldn’t be able to get a new health insurance policy. Forget life insurance. The angiogram was somewhere in my future and I dreaded it, though both my mother and father went through the procedure without complaining and I had sent innumerable patients to the cath lab without a wink.

As for my colleagues, I was a bit older than most – I would become an incubus they might have to ‘carry.’ Of course, my condition might invoke empathy and human kindness. Maybe I could milk that one. I figured as long as I could stand up they’d have to put up with me. The thought made me feel surprisingly safe.

My girlfriend seemed sympathetic, caring, but I suspected she had some hesitations about how to deal with damaged goods. Was I no longer her corporeal hero? She was a winnowy 5’8”, size 4, with a great ass and long, undulating legs that made men sweat when she wore tight jeans or short skirts. Vigorous sexiness was her dial, regularly giving men the glad eye so they would sweat. Would she be repulsed, see me as a cardiac sex invalid (no rough stuff)? Would my money (and her lack of it) help sustain her climaxes or would fear, disgust, or – worse yet – contagion invert her, dry her womb, zero out her lust and chuck us both into impending greyhood? I always told her marriage would be important to me when I had to bow to the necessity of having someone push my wheelchair. Would I marry her now, not out of desire, but out of desperation? Would she marry me and willingly push my wheelchair? I worried that if she left me I would have to seek out that class of women who are devoted to caring for wounded men, men who are safe bets to stay home, faithful and civil.

Once a patient of mine, an old kraut, broke every bone in his body due to a clumsy arthritic fall from a trellis he was repairing. I asked him if this was a clumsy suicide attempt or a way to prove he was omnipotent. He all but died, and when he didn’t he was treated to two months of rehabilitation in a nursing home. His wife wailed to me, saying that his verbal abuse was worse than ever; he blamed her for his prolonged detention in the land of the living dead. With tears streaming she stated, “All my life he has never let me talk. I have no friends. He wouldn’t let me even go to my parents’ funeral because they hated him.” She felt she couldn’t bear to have him come home if his verbal violence remained at the same intensity. I felt she never wanted him back under any circumstances.

We met, the three of us, in my medically sterile cubicle of an office, and went about changing a 50-year marriage in 15 brisk, brutally direct minutes. I liked the old boy’s stiffness, which made slicing him in half all the more of a thrill. The kraut was emasculated. “You either kiss your wife’s ass or stay locked up in the shitter until damnation rings,” I spouted. He kissed the flesh. Perverse as it was, this event registered as an epiphany, an awakening, in the couple’s journey through their married life. Was I to be the next to do some kissing?

Dr. L, my cardiologist, was a good man: he balanced the business of my heart attack with humor, and a ‘life will go on’ sense of encouragement. He bent wisely to my ‘in denial,’ Cleopatra-like needs. He pushed my diagnoses forward, always supplying me with both the facts and the ambiguities we would likely encounter, and the odds involved in taking action versus sitting on one’s hands. He gave me his home telephone number, which I liked, and didn’t get angry when in a panic I called him at 2 AM, waking and worrying his wife. He was good. Still, as newer diagnostic results revealed or confused my cardiac state, my mind searched for a firm grip and transferred my care to a new bosom friend, a prominent cardiologist who loved me. Years ago I had lived with the Trukese tribesmen who had taught me the magic in the uniting of love and death. I always try to teach this to my patients, and now I was the patient.

But how to share my crisis with my close ones? I’d had a heart attack, but I wasn’t sure where it fell on the scale of seriousness. Was I facing eminent death or was this a minor cardiac event, with me living for many years to come? My girlfriend knew of my evolving concerns. My colleagues were vaguely informed. They all expressed mixed curiosity and apprehension. My work schedule did not change. My compulsive roommate, ten years my junior, was the one who got it right. He demanded all the details. With the ceiling lighting bouncing off his bald head, I felt the heat of his interrogation. He then exclaimed how upset he was. When I asked him why, he blurted out, “I could be next.”

Indeed, three weeks later he landed in the Fairview Southdale Hospital Coronary Care Unit, complaining of chest pain. In the middle of the night he drove himself groggily to the ER, chest pain accelerating with each mile, occupied with impending doom. He only called his soon-to-be frightened out of her wits wife on admission to the coronary care unit.

How vividly I remember the ancient, revered Yiddish cardiologist, Dr. Dressler, admonishing his residents when he was stricken by a heart attack in the far past. At the time I still bore the ignominy of being a medical student at SUNY Downstate Medical Center in Brooklyn. Dr. Dressler’s name was forever attached to the post myocardial infarction syndrome, a cardiac condition he was the first to describe. When told he would be admitted to the newly conceived coronary care unit, of which he was the medical director no less, he declared, “Never! That’s only for the patients.” He croaked two days later, in the wards of Maimonides Hospital, a survivor of Hitler’s attempt to annihilate his people, surrounded by those who had similarly not been annihilated, presumably content with his choice.

Echocardiography is elegant simplicity – sound waves bounce off the heart and are reported as a cinema of cardiac motion. Good hearts move rhythmically and with courageous strokes. Damaged hearts hesitate, flap about, move discordantly. As I watched my heart’s performance in real time, with narration provided by the eager seasoned tech, I was treated to the viewing of a small area of ‘hypokinesia,’ at the inferior margin of my heart. There was also a jet of red, in a sea of blue. “Back flow through a leaky mitral valve,” the tech told me. His matter of fact detailing of my echocardiogram, portraying damage, was not encouraging. I was now truly the patient, the damaged, the sufferer. The tech attempted to sooth me. “I have seen it before,” he said. But no words would make it better. I was the health care deliverer, now on the other side of the fence. As much as I tried to climb back over the fence, the faulty performance of my heart on that video haunted me.

How would my kids deal with a wounded dad, no longer their fearless, faultless defender? The thought crushed me. I needed a good work out. I went home that day, grey with information. I had had a heart attack, a small one, which in itself could be a minor event. The echocardiogram strongly suggested my other heart vessels were okay but my mitral valve structures may have been damaged causing the valve to leak, possibly enough to complicate life for years to come.

The next night, my daughter Gabrielle and I had our usual two week dinner hour at her favorite Sushi Restaurant. She was 28-years-old, her tall, stately body molded more by the menarche suppressing effects of her childhood ballerina training than by parental genetics. She’d had many relations over the years, but she’d avoided marriage, avoided an occupation. Gaby had never avoided life experiences though, and I loved her dearly.

That night, I told her of my heart attack. I cried, she cried. She relieved me of my burden. She wasn’t crushed; my daughter was already sufficiently rooted in herself. The evening went well, and I started to realize that my mortality, my death was okay.

My new cardiologist was a prince of his profession – a philosopher, scientist and discoverer. I brought him the ‘echo,’ the most damaging evidence of heart damage so that he could evaluate for himself its message. Echo interpretation is in the eye of the beholder, art and opinion. In the university expert’s opinion, the video’s quality was suspect, my heart’s performance was even more suspect than previously thought to be. I was chilled. I never hesitated (half ignorance was hell), but the issue now was to directly visualize my coronary arterial system and to end the anxiety ridden ambiguity. ECG’s, echo’s and blood tests are all safe but never definitive – only the invading coronary angiogram settles the issue. It was scheduled for four days hence.

I blocked out the date, tried to stop time, closed my eyes, and let it happen to me. Once again, I had a front row, real-time seat to the main event. Fifteen years before, I had shared the fluoroscopy screen with Dr. Sewell Gordon as he squeezed barium gingerly about my small bowel looking for the devil that had caused me so much pain. We both observed the sentinel marker of incurable cancer at the same moment – in a rush I felt disbelief and belief at the same time. I saw my death and simultaneously exiled my mind from the bedeviled image in the fluoroscope. In the end I survived. But now another moment of fluoroscopic truth awaited me, soon to be self-evident in three to five second segments of a video. This time I was emotionally seasoned and forewarned. One moment I was preparing for a filet job, coronary bypass surgery, the next a much more benign assault on my status quo – angioplasty, weight loss, medications. The angiogram would tell me which life would soon be the real one. I had both scenarios ready to be rolled out, and I found myself shifting between the two, like an uprooted plant waiting to be put back into the ground.

But first came the awkward hospital gown, the shaved right groin accomplished by amateur barbers, a cold slab table, gowned and masked performers, cameras and meters everywhere and three needle pricks in my bared-groin, ready for launch. The placement of the catheter in my femoral artery was accomplished with only a sense of pressure. My view of the 18-inch fluoroscopic screen, eight feet away and up to the left, was unobstructed. A clear view of my destiny.

How many wounds has my mind, my body incorporated into me? Jacob became Israel in his night-long tussle with the angel and limped ever after. Virginhood, the Garden of Eden, both unacceptable to human kin­­d, were only starting points. I could feel the universe, gravity pulling me forward into the light, and fully embracing revelation (or perhaps it was all the sedative?).

The black catheter slipped rapidly through the gray space of my body. Suddenly its tip began to beat rhythmically, then a gush of squid-like ink discovered the mouth of a mighty river. The catheter snaked into the river, the left coronary artery, the major arterial system bringing oxygen and sugar to my ever hungry beating heart. The next second a large gush of black shot out of the catheter and outlined the major river, lighting up all its myriad tributaries. I was enthralled by the river’s marvelously smooth branching esthetics – a clear left coronary! The big one down, one still to go. The catheter snaked into the right coronary artery. Again, a rapid black gush revealed a pulsating river, again what a wonderful branching, pulsating vessel. The chief of the masked men pointed out a blocked distal channel, the culprit revealed. The decision was to open this clogged channel so that in the future it might succor other nearby vessels, if they ever became clogged. The balloon catheter entered the involved area and opened the blocked channel. It caused an aching pain in my chest while it did its duty, and then black ink swarmed freely through the previously blocked channel – a stent was placed and all was back to normal. The ventriculogram – accompanied by a swarm of tasty dye induced heat that traversed through my whole body – confirmed a near normal ventricle. The only blemish was a small limp area caused by the occluded vessel. Forever the limp, but life goes on. My cardiologist said it all: “Now at least you know you are normal.”

In the past, there were times I was deemed insane, depressed, inconsiderate, isolated, insensitive, loved, unloved, cursed, willing to die, fearless, fearful, incapable of controlling my bowels, etc. Now, I welcomed them and all other descriptions I would be called in years to come.

Bring on the rest of my life, I am ready.