2016 Nov 20th
True story from “A Double Dozen and Six” on the occasion
of my needing a break from politics.
Emergency
It is still
pitch dark but I am suddenly fully awake.
My left shoulder and left chest feel stiff, a little like muscle strain,
but not exactly. I assume that I have
been sleeping on my left side with my left arm in an awkward position. I get up and turn on the light. It is 2:30 AM
I sit on the bed and move my shoulder around. That does not help. The discomfort is turning into pain and is
localizing in my chest. I think about
indigestion and then I think about how often heart attacks are assumed to be
indigestion, and I think about the importance of time. Even so, I wait. Finally, preferring embarrassment to death, I
decide to call a hospital emergency room, describe my symptoms, and see what
they suggest. Give someone else the
responsibility.
The
voice in the ER is male and businesslike.
I tell it that I have awakened with chest pain, which by now is
considerable worse. No the pain is not
radiating down my arm; no, I am not sweating; yes, I am having trouble
breathing. When the voice hears that I
am 61 years old, it suggests that I come right in. Smart voice!
I
live alone and I do not much feel like driving.
The voice suggests that I call the local fire department and have them
send their ambulance-rescue team. That
sounds somewhat extreme, but my choices are limited. I call their dispatcher; give my symptoms and
my address, and say that I will wait downstairs to save some time. No dice; the dispatcher wants me to stay by
the phone.
I
wait. The pain increases. I wait a bit longer. My phone rings. It is the dispatcher checking the
address. The ambulance is having trouble
finding my apartment building. The
buzzer rings at last, and I get up to press the button releasing the outside
door, open the apartment door, then retreat to the couch. By now, I feel awful generally, and the chest
pain restricts my breathing. Strangely,
I am more curious than frightened.
An
EMT and a driver come in. A police
officer hovers in the background. They
are friendly, almost casual, but they waste no time. I get the same questions. Where is the
pain? Is my left arm involved? Is it a shooting pain? Was I sweating? The answers haven’t changed. Then pain is localized to the left of my
sternum and feels like a vice. Breathing
is uncomfortable to say the least; my left arm is not involved. I am not sweating. No, I have no history of heart trouble; I jog
for God’s sake. (I had thus assumed myself
immune from heart problems.) I have had
several exercise EKG’s. No
problems. My relatives do not die of
heart attacks. I see myself as
indestructible. The Greeks are right;
hubris has a price.
The
team gets to work. Out of a large case
comes a blood pressure cuff. My
frighteningly high 190/100 is radioed to the hospital ER. Oxygen tubes go around my neck, one
terminating in each nostril. Electrodes
are attached to my chest and the results are sent to the hospital by
telemetry. A needle goes into a vein in
my arm, and a plastic bag begins dripping something into by blood stream. They tell me it is simply a precautionary
measure should I need intravenous medication quickly. I am given a nitroglycerine pill. “Dissolve this under your tongue. Don’t swallow it.” They still think I am having a heart attack.
If I am not, it is a great imitation.
Through all of these ministrations, the emergency people are cheerful,
apparently clam, and certainly unhurried. They express no sense of desperate
urgency, which might lead me to believe I am at death’s door.
This
calm, deliberate behavior, I begin to see as overdone. Impatient by nature and hurting considerably
I want to get to the hospital. A
collapsible-wheeled stretcher appears. I am helped aboard, strapped down, and
the journey downstairs to the ambulance begins.
The wheeled stretcher is jockeyed around the corner of my living room
toward the apartment hall, and then down the stairs. It is a very tight fit. They keep me right side up and get me
downstairs, but only with considerable effort.
I weigh 150 pounds. Had I weighed
200 we might well have needed two more stretchers and a new EMT team. They radio the hospital to expect us in five
minutes.
The
trip to the hospital is quick. No sirens. I am wheeled into the hospital ER and
a casually dressed, cheerful male physician about 45 meets me there. He tells me his name and I promptly forget
it. There are two nurses, both young,
both attractive, one with a ponytail. I
am not too sick to notice things of importance.
I
am hooked up to a larger, more impressive, heart monitor with many more
leads. A substantial blood sample is
drawn, filling many vials. The physician
begins to take a quick history by asking the same questions I have heard twice
before. I give him the same answers. A portable x-ray machine appears. I am given morphine for the pain, but it helps
very little. They ask the whereabouts of
my closest relatives. My 27-year-old
son, Henry, is in law school, and lives in a rooming house about three miles
away; I mention him. Suddenly, he is
there, trying to stay out of the way and not look too worried. We agree that we will not call his mother
just yet. We are divorced, but good
friends. She lives 50 miles away and can
do nothing except worry. She is a nurse;
she does not handle this sort of worry very well.
I
finally have time to notice my surroundings.
I am the only ER patient. The
room is large, white, and almost barren.
The physician tells me that with some effort they have persuaded the
admitting office to give me a room in Coronary Intensive Care. He insists that I am too sick to move elsewhere. Fine, I prefer to stay right here.
I
begin to feel light-headed which is strange considering that I am almost flat
on my back. I am obviously on the point
of passing out, perhaps irretrievably. I
tell the doctor. He is already doing
something, moving quickly. Atropine is
administered through one of the tubes feeding into a vein, and I feel warm and
very awake. Sober faces are suddenly
smiling. A nurse said my heart rate
dropped below 40. An EKG device on the
wall behind my head has a continuous pulse monitor. I am very thirsty. I am told that this is the result of the
atropine. The team decides that my
little scare could have been caused partly by the heart’s response to
pain. They increase the morphine, asking
me to tell them when the pain is all gone.
It takes several doses through the I.V. tubing, but eventually there is
only a twinge when I breathe deeply. I
decide that I like these people.
In
addition to watching the EKG, the physician and the nurses spend a good deal of
time listening to my heart, their stethoscopes probing about for what I assume
is a good location. One says, “I can’t
hear it at all now.” If I weren’t
feeling a good deal better, I’d have found that profoundly disturbing. I looked at them quizzically, “Oh?” The nurse smiles self-consciously, suddenly
aware of the remark’s impact. They
explain that I have, possibly among other things, pericarditis. This, I am told, is an inflammation of the
pericardium, the sac that contains the heart.
When inflamed, this container swells, and the beating heart rubs against
it. The physician can hear this “rub”
and the patient feels it as chest
pain. In my case, the rub is loud enough
to obscure the sound of the heartbeat.
All my attendants hear is “swish-swish, swish-swish;” no “flub-dub,
flub-dub.” They let me listen.
While I have pericarditis, I may also be having a heart attack, a
myocardial infarction. In the early
stages, the EKG patterns are similar.
Later, if there is heart damage, the EKG will change, as will certain
blood enzyme components. At this point, it appears to be “just” pericarditis.
They decide I am stable enough to leave the emergency room and go up to
Coronary Intensive Care. They trundle me
off on my wheeled table, IV’s, oxygen tubes, etc., accompanying me. The ICU is impressive. The new nurse is friendly and cheerful. It is a double room, but I am the only person
in it and with one RN per room, I get generous and expert attention. They give me Indocin, an anti-inflammatory
drug. I say goodbye to Henry who has
class in three hours. He will be back at
noon. They fit me into a blood-pressure
cuff that inflates automatically every few minutes and prints my blood pressure,
systolic and diastolic, on a continuous tape.
I watch it perform. An amazing
gadget! The EKG and pulse monitor are
mounted on the wall just behind my bed, so I can see them when I turn my
head. Things are settling down. I notice that my pulse hovers around 60 with
blood pressure 110/70. Great. The young nurse is impressed. Perhaps I will live after all.
I decide that I have been taking life much too seriously. I had thought earlier this summer about
buying a red Alfa Romeo convertible, but after some soul and wallet searching,
had concluded that it was just not a sensible choice. Now I promise myself that I will get it as
soon as I recover enough to drive it.
That settled, I fall deeply asleep; morphine is well named.
A nurse awakens me very early
with my anti-inflammatory drug followed five minutes later by a lab tech that
needs some more of my blood. Blood
enzymes are monitored periodically to determine the extent of heart
damage. Breakfast arrives. I am starving.
I am anxious to get out of Intensive Care where only relatives may
visit. I speak to the nurse and I am
told I will be moved soon. The grim
reaper has moved off a few steps.
By 3:00 PM, I am on my way to a stepdown unit.
Now I am allowed to walk around.
My EKG leads go to a small, portable, telemetry box that broadcasts my
condition to a screen at the nurse’s station.
I can stroll about carrying my transmitter so long as I stay within
range of receivers protruding every twenty feet or so from the corridor
ceiling. If I stray out of range of
these receivers, my EKG at the nurses' station will show a straight line and
there will be all manner of unpleasant consequences.
That afternoon I am again visited by all my physician friends who again
go into my medical history. It seems I
have only pericarditis, but they cannot find its cause. I have no bacterial infection, nor any of a
variety of other diseases that can precipitate pericarditis. They assume the cause is viral, but they
cannot tell which virus until well after I have recovered, if then. To determine which virus I had, they will
take new blood samples in about a month and compare the antibody level then
with the present level. Increased
antibodies will indicate which family of viruses has attacked. Since there isn’t much they can do about
viral infection anyway, the matter seems academic. There is no evidence, either
from the EKG or from the blood chemistry, of heart damage. They tell me that I can probably go home the
next day.
Later that afternoon I have a visitor, a friend about my age who smokes
two packs of cigarettes a day, eats eggs whenever he wishes, which is
frequently, and exercises several times a day by standing up. He doesn’t say so, but after seeing his
expression when he looks at me, I can tell he is thinking, “So much for health
nuts.” I carefully explain that this was
not a heart attack, but pericarditis, and that a man my age (and his) in lesser
physical condition probably wouldn’t have survived. He smirks.
They discharge me at 2:00 PM the next afternoon. I have been in the hospital barely 60
hours. Someone pushes me in a wheelchair
to my son’s antique Volkswagen. Fifteen
minutes later, I am climbing the stairs to my second floor apartment to
retrieve my car keys so I can get some groceries.
*
* *
It is now several
months later. The convalescent viral blood studies reveal nothing. The cause of the attack remains unknown and,
presumably, could recur anytime. I am
told that no precautions can be taken, just “stay healthy.” Life is a crapshoot. Even so, I have not bought the Alfa. Promises made in extremis, even to yourself,
are easily broken.
