A View From the Other Side

My own experience started easily enough. I first started noticing small changes sometime in early May of this year. I would leave the hospital and walk up two flights of steps into the parking garage. After getting to my car, I would find myself winded and sweating. I kept telling myself that I was really getting out of shape and that I also needed to change my breathing patterns, because I was obviously holding my breath while climbing the stairs. This went on for a half a week with my beginning to dread the walk to the car. The weekend found me on-call and seeing numerous emergencies. I was now beginning to have upper chest discomfort that only seemed to be able to be relieved by a large burp (anyway, that’s what I kept telling myself). Unfortunately, there never seemed to be any burps large enough to resolve the discomfort. I told a co-worker about my chest discomfort and desire for a burp and we both laughed. Except I was beginning to have my worries. Tuesday I took my kids to the mall, and while shopping, developed crushing upper chest discomfort by the time I’d returned to the car. I got home and put the kids to bed and still had chest pressure. I quickly rummaged for a nitro spray that had belonged to my mother-in-law. It was dated use by 1997, but I didn’t care, and tried it. I smelled the familiar nitro odor but felt no tingle under my tongue. It didn’t matter because it didn’t ease my chest discomfort. I felt relief, thinking that it was probably not my heart (just really bad gas). The next morning, I went and removed a balloon pump as my first job of the day. I returned to the department with that now-familiar chest pressure. I went to my assigned lab and out of curiosity, felt my radial pulse. This was the first time that I felt some missing beats. Now I was worried. I went to a monitor, hooked myself up to it and saw bigeminal PVCs. I told the monitoring nurse in the control room about my observations. She laughed and said it was probably nothing and I laughingly agreed. I left the lab and went into another, where I grabbed a bottle of nitro. I then went into the coffee room, made sure that no one was watching, and sprayed myself. Again, I smelled the familiar odor and this time, felt the tingle under my tongue, but still had no immediate relief. I again felt relieved because the pain was obviously coming from some other source, such as pulmonary or abdominal. I went back to my control room and suddenly realized that the pressure and PVCs were gone. Now I had to come to terms with the fact that something was drastically wrong, in an area that I thought I would never experience. I really didn’t want to go there. The rest of the morning was a blur. At lunch, I talked to Shannon, an old experienced nurse (old being my age), and told her of my worries. She asked me who I wanted to have work on me. This was a big dilemma, as I’d worked with some of these guys for over twenty years. I pondered over who to pick and how not to hurt everyone else’s feelings. We talked it over for a while and I decided on a physician who was on vacation. She left the room and was gone for a few minutes, then came back and asked me to come out in the hallway. Another "old" nurse (Gaylia) was waiting for me. Gaylia told me everything was all set and to expect a call within the hour. Meanwhile, I was having chest pressure and thinking, Man, I never thought I’d be lying on that table. OH SH*T! I realized that my lunch break was over, and went and scrubbed into a pacemaker. I was just in the process of finishing the sewing up of the pocket when the phone rang and it was the call. A colleague came into the room to relieve me while telling me that I had a call in the front office. He looked at my taking the last stitch and started complaining about having to relieve me when all that was left was the clean-up. He didn’t know what was going on and I told him, Okay, I’ll help with the clean-up. However, Shannon was right behind me, saying, Leave, Gerry! Just leave, now! I went to another lab and grabbed a shaver while the circulating nurse (Gaylia) told me to hurry. I went into the bathroom and shaved just one groin and only enough to get the job done. I walked out of the bathroom to see Alan holding a gown, Rhonda, and an IV set up, with a cart directly behind them. Before my head hit the pillow, I had an IV in my arm and was on my way into dreamland. During the procedure, I woke up to feel the arterial access, woke again with the panning of the table, and realized that the procedure was on its way. I remember waking and looking to my left, seeing my RCA and realizing that I was in trouble. I awoke to preparations being made for an LV gram. I always had been curious as to the sensations associated with the hot flash. My final memory was of interventional supplies being placed on the sterile field. When I came back into consciousness, I discovered that I was extremely lucky. Sirolimus stents had arrived only the week before. I’d received three stents. If I’d come in two weeks earlier, I would have had open-heart surgery. If I’d waited for the weekend, then I might not have made it. Sometime in the 1990’s, I remember reading that there were 50,000 Americans that died annually due to sudden cardiac death. I used to wonder how so many could suddenly die without previous symptoms. I thought, some of these people must have known something was wrong, so why didn’t they see someone about it? Well, we as cardiac specialists know all the signs and symptoms, so how in the world could I have missed my own?! Sometime after my own experience, the chief of cardiology, Dr. William Campbell, came by my room to visit. We discussed my delay in getting help. Dr. Campbell talked of a recognized problem among medical staff. He stated that it was a well-known fact that medical personnel were poor self-diagnosticians. He recounted that he once was called to the emergency room because the ER doc was having problems. He arrived, looked at the monitor and told the man that he was having a heart attack. The ER doctor refused to believe this fact, while also looking at the cardiac monitor. Then the monitor suddenly showed asystole and his face quickly registered acceptance and shock. Dr Campbell and the ER staff were able to successfully recover him. He is now doing well post by-pass. I also have heard of a cardiologist being found and recovered in the cath lab recovery area. I’ve seen cardiologists seeing patients in the morning and on the cath table in the afternoon. How could knowledgeable and trained cardiologists possibly have missed their own symptoms? I had my procedure on a Wednesday and then spent several days as a houseguest of my doctor and his wonderful family. I was back at work on Monday. Two of the staff wished me well on my return as they were going outside for a cigarette break. One of those individuals is my age, smokes constantly, doesn’t exercise, eats all the good things you’re not supposed to have, has a family history and carries his personal 20-ounce cup of coffee from room to room. What’s wrong with him why aren’t there red flashing lights going off? We, as cardiac cath lab professional staff, have seen all the different manifestations of cardiac symptoms. The reason that my co-worker, the cardiologists, and I, didn’t or don’t get it, is because we see cardiac problems as other peoples’ problems, not ours. We know the symptoms, but until we personally experience these symptoms, we have no clue as to what they truly feel like. We can’t seem to associate the discomfort to cardiac signs. The 50,000 cardiac deaths a year were not because these people didn’t know the symptoms. For the most part, I suspect that it was simply because they didn’t associate the symptoms to the disease. Let’s give everybody a break and stop patronizing, poo-pooing, talking down to and otherwise giving the post-cardiac patient a hard time. They weren’t planning on messing up your schedule, they didn’t wait to the last minute before coming to the hospital and they aren’t idiots who can’t understand the warning signs. They were just people like us who didn’t believe it could happen to them. We think that we’ll have some kind of forewarning, that we’ll get some kind of four-alarm signal going off in our skulls, saying, Proceed immediately to your friendly neighborhood cardiologist. Yet it doesn’t happen that way. The symptoms are different for everyone, and until you yourself experience them for the first time, you have no clue as to how to interpret the signs. When I came into the cath lab in 1976, the average age of the staff was in the mid-twenties. Today, the average age in my lab is mid-forties and I suspect that is more the norm than the exception nationwide. We have an aging staff, who will, as I did, suddenly start to experience similar difficulties. Let’s not laugh off our own or each other’s symptoms they may very well be real. We are not made of steel and we can have heart disease just like your average Joe. Two months post procedure, I remain still alive and pain-free (with the new sirolimus stent). I’ve been going to rehab and seeing the other post cardiac patients that are there. There are rehab patients that with exercise are discovering a newfound well being, while others are now discovering new physical limitations. I've seen patients now becoming attuned to their own unique heart pain and learning to slow down when these new limitations present themselves. I've mouthed to patients for years that they were lucky to have survived their cardiac event. I’ve told patients that chest pain can be experienced in many different places. I've seen patients come in with chest pain that manifested itself as left arm pain, lower back pain, a jaw ache, tooth ache, chest pressure and chest pain, shortness of breath and no pain whatsoever. I’ve told them to remember that pain, because it was their own unique heart alarm. I now know my own heart’s unique heart alarm and I've come to realize that even a cardiac cath lab professional is not immune from the very thing we treat: heart disease. So, fellow cath lab professionals, while you’re out there helping to save lives, please pay attention to your own. As someone once said, The life you save may be your own.

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