2016 Nov 20^th

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.