The Heart of the Matter

This adventure started on New Year’s Day, 2011.

It was a pretty quiet day for me, with just a few social visits. At one stop, a friend’s house, I noticed part of her sidewalk needed some tidying up, so I grabbed a shovel that was handy and cleared away some snow.

And I felt a little ... twinge. In the middle of my chest.

“Hmm,” I said to myself. “Odd.” And gave it not one more thought ...

... at least until later, when I was visiting some other friends and had to climb over a bit of a snowbank to get around a car that was carelessly parked.

Another twinge. Not “pain”. Just a little tightening. Like something in my chest was saying, “Hello. I’m in here. Pay some attention.”

But I didn’t. Not just then.

I got home around suppertime and came in to find a note from my wife. She’d gone out to dinner with our older daughter. The house was cool - it had been a while since anyone had thrown wood on the fire. So I went out into the wood shed, got an armload of logs, carried them into the house ...

Twinge.

Well, that was three strikes. Now I was a tiny bit concerned.

See, about three years ago, my brother keeled over one day and died on the spot from a massive heart attack. In the time since, I have often wondered if he’d had warnings. Twinges. Pain. Tightenings. Anything that would have hinted to him that he should go visit his local Emergency Room.

I know my brother well enough to know he probably did have some warning signs. But he was a typical “guy”. He would have shrugged it off. He was too busy to go to an ER. It was just a twinge. It was probably nothing. The people in ER have their hands full with folks who are really sick; they don’t need me wandering in and whining about a little chest pain. All the things guys say.

Well, all the things dead guys say. Or would. Except they’re not saying much of anything, because of the whole “being dead” thing, and all.

I want to be clear, I’m not blaming my brother, or any of the other formerly living guys who decided they shouldn’t pester the poor busy folks at the ER just because they had a little chest pain and shortness of breath. We are brought up to think that way.

I’m not entirely sure I understand it.: “I don’t want to bother the folks at the ER with something like this.” Isn’t that a little like: “Yes, I have a flat tire, but I don’t want to bother the folks at the tire store about it.”?

“Sure, my kids need an education, but I hardly see why we need to trouble all those hard-working folks down at the school.”

Here’s the thing I have learned about people who work in Emergency Rooms: very few of them do it as a hobby. These are not dabblers. They are in this full time, and are paid to be there. So thinking you are “bothering them” when you come in with chest pains is like apologizing to the pilot for taking up a seat on his airplane.

I saw what happened when my brother shuffled so suddenly off this mortal coil. I saw the devastation he left behind - the grieving sons, the heartbroken wife, unfinished business, grandchildren he would never see. Life goes on, of course. But it is in so many ways diminished when it goes on without a treasured friend, a father, grandfather, brother, husband.

Sometimes, all that can’t be helped. People die every day. But often something can be done about it. And if something could, I figured I had a responsibility to pretty much everybody to explore that possibility.

So I drove myself into the Emergency Room.

(I caught a lot of flak for that later, by the way. But I figured I had been driving around all day. Another few kilometers wasn’t going to tip the balance one way or another. And I was still pretty sure this was just an annoyance. To me, I was just going in to have them peek under the hood.)

When I got to the ER, there were probably 20 or more people hanging around, waiting. It was New Year’s Day. People are always hanging around the ER, but holidays are especially busy.

I went to the triage nurse and she smiled up at me. “What seems to be the problem?” she asked.

I said, “Well, I’m kind of having these chest pains ...”

Her smile froze, and things started happening very quickly.

The thing is, if you go into an Emergency Room and complain about a sore wrist, they will probably be very sympathetic and tell you to “... have a seat and we will call you.” I would recommend having a book handy. Perhaps, say, “War and Peace”. Or the entire Harry Potter series.

But if you go in with chest pains? Baby, that is the Golden Ticket to Willie Wonka’s World o’ Heart Monitors and Intravenous Fun! Nils Ling ... COME ON DOWN!

Within seconds I was on a stretcher in a trauma room, stripped to the waist and having electrodes stuck to various and sundry places on my body, including but not limited to my ankles. Now, the two nurses who were attending me were working quickly to get a reading as soon as possible. So they didn’t spend a lot of time on niceties such as, say, shaving body hair from the places they would be applying very sticky electrodes. Put that in the category of Things That Don’t Seem Like An Issue At The Time.

A very nice doctor came in and began looking over the information that had been collected. He asked questions about my history - family, medical, life-style. He was trying to get as clear a picture as possible of the patient in front of him in order to treat me more effectively and perhaps even save my life. I knew that.

So of course I had to fight the urge to lie.

“Are you a smoker?” he asked.

I hate that question. It reduces a complex issue down to a black and white, yes or no answer, which is really unfair. Because while on the one hand, I was, technically, a smoker, in the sense that I smoked ... on the other hand I really would have rather not been, so that I didn’t have to say “yes” when he asked me if I was a smoker.

So I sugar coated it. I said, “Sort of. Yeah, I guess you could say that in a way I am. But I’m trying to quit. Or at least, that was my plan. Eventually.” As impressive as my commitment was, I could tell it did not provoke admiration in their eyes.

“How many cigarettes in a typical day?”

See, now that is an entirely unfair question because it assumes all days are equal, that we’re awake for the same amount of time and really, is any day “typical”? So I started to explain all this and he just rolled his eyes and shot me a look so I made my best guess. And because he has met people like me before, he rounded up. Way up. I wonder if the machine they hook you up to doubles as a lie detector?

You understand, I was not trying to be difficult or evasive. It’s just that, like the vast majority of smokers, I was mortally ashamed of my addiction.

Here’s the honest truth about smoking, and don’t let anyone tell you differently: I do not know a single smoker who wants to smoke. I know smokers who bristle and insist that it is their right to smoke, that they want to have a cigarette, that they have the right to choose. But it’s sort of sad, because really? They can’t choose. They aren’t strong enough, and on some level they know it. So rather than admit that they are unable to choose to not smoke, they defiantly insist they have made the choice to continue smoking.

If you ever want evidence of how addictive nicotine is, all you have to do is look at how it makes otherwise decent human beings lie to their friends, their loved ones, and themselves. That is one powerful drug. People who have never smoked just don’t quite get that.

There were other questions, but by now the first readings were coming in from the blood lab and the computers and, for all I know, Mission Control in Houston. The doctor looked over the sheets.

“Okay,” he said. “We’re going to call in a cardiologist. And we’re going to admit you. Now, is there somebody we should be calling for you ...?”

I thought for a second.

Oh, right. My wife. Yes. This is exactly the kind of thing she would want to be told about ...

I was resting quite comfortably in the ER, in a special area set aside for patients who come in complaining of chest pain. It’s like a V.I.P. section, except instead of getting finger food and champagne, the main benefit of getting past these ropes is that you are far less likely to perish.

They pride themselves on that in any ER I’ve been to: having their patients not expire. These are trained professionals with years of experience, and on a daily basis all their considerable skills and education are thrown into the task of keeping people like you and me alive, sometimes in spite of our best efforts to kill ourselves.

They have a lot of good days in any ER. A good day is when you and your colleagues are able to beat back the wave after wave of injury, pain, and suffering that crashes up against the counter and spills out into the waiting room. On many - even most - days, they get everybody fixed, bandaged, stitched, splinted, medicated, and sent back out the doors.

But they also have bad days. And unlike the rest of us, who count it as a bad day at work when the cash receipts don’t balance or the copier gets a paper jam or Darlene goes on a rampage because somebody put their coffee cup in the sink without washing it, in the ER a bad day is measured by the number of people who won’t be shopping at Eaton’s tomorrow.

(That was my mother’s utterly charming euphemism for Death. I would go over to her house and she would be reading the obits, and would say “Well, I guess Beryl MacLean won’t be shopping at Eaton’s tomorrow.”

The concept of shuffling off this mortal coil was not considered polite dinnertime conversation, so Mom would never address it directly. People did not die. They simply would not be shopping at Eaton’s tomorrow. )

(And by the way, it amused me greatly when Eaton's went into receivership and I was able to go over one day with the business section of the newspaper and say, “Well, Mom, I guess Eaton’s won’t be shopping at Eaton’s tomorrow.”)

My point is, the people in the ER - the doctors, nurses, and technicians - are in it to win it when you come waltzing through the door. These people are not dabblers and hobbyists. They are working. They have nothing more pressing to do than take care of people just like us. In fact, taking care of people just like us is what they do. For a living.

The test results came in from the first round of blood work, and the ER doctor said he wanted to bring in a cardiologist. He also asked if there was anyone else I thought should be here. Like, perhaps, say, my wife?

“Right. Yes. If you’re saying you’re going to admit me to hospital for a few days, that is just the kind of thing she might appreciate knowing about.”

Because I was not allowed to use my cell phone, I got the ER doctor to make the phone call to my wife. Also, I really wanted to see how he was going to pull this off. Because frankly, if I get a phone call and the first words I hear are, “Hello, this is Doctor ...”, I am not going to hear much more than that.

It’s a common human reaction, shutting down like that. One time I was away on a business trip and both our daughters were out with friends. It was 11 o’clock at night, and my wife answered a knock at the door. She opened it to find a couple of RCMP officers. They were investigating a break-in down the road, but it took them a long time to get my wife’s full attention to what they were saying.    She was certain they were actually there to tell her one of us had been fatally injured and refused to believe their cover story about a break-in.  “Really, Ma’am, we wouldn’t tease you about this, you have to believe us ...”

So the doc called her. He was able to calm her after an initial explosion of concern and convince her to get right down to the hospital because I was in immediate, urgent need of a lecture about all my bad lifestyle choices over the past forty years  the support of a loving wife.

So she arrived and launched in, but then the cardiologist showed up. He looked over all my charts, checked me out, asked a few questions, and said, “You won’t be going home for a few days. And you’re not smoking any more. Ever. Any questions?”

So, I resigned myself to settling in to the hospital, because the doc said he wanted to keep me in for "a couple of days" to run “... a few tests.”

Over the next 96 hours, I would begin to quibble with his definition of the term “a few tests”.

And over the hospital’s definition of “... a couple of days”. Oh, and “food”.  

The thing is, I hadn't been expecting some long involved exposure to the medical community.

(Here is proof that I am a guy: when I was deciding whether or not to go into the ER, I got out my television remote and checked out the programming for the night. When everything I looked at was crap, I decided to go in. One could argue that I am here today because I have a TV that gets some 100-odd channels and I could not find a single thing worth watching. So here’s a big tip of the chapeau to all you television industry executives. Well done!)

So I drove myself into the hospital. Later, I was roundly scolded for this; evidently, it is considered bad form to drive yourself anywhere if you are experiencing chest pains. Something about having a heart attack behind the wheel, swerving into the oncoming lane, and colliding with a school bus full of nuns carrying kittens. Frankly, I find such arguments less than persuasive, focussed as they are on nuns and kittens rather than on me. Let’s get our priorities straight, people.

And our definitions.  The cardiologist on duty decided to admit me to the hospital for what he described as “a couple” of days. This should have been a dead giveaway. In any situation where we don’t want to be completely honest about numbers because a higher amount might not sit well with the listener, we use the term “a couple”. As in:

“Honey, I’m fine to drive. I’ve just had a couple.”

“Drinking? Not really, officer. Maybe a couple.”

“I’m just going to check my email. I will be up in a couple of minutes ...”

“We hope to get our troops out in a couple of years.”

So I should have known that a couple of days might stretch to more, and it did. Four days of pretty much unrelenting boredom, broken up with occasional visits from a nurse (“You will feel a little pinch.”) and some trays of very bad food.

Now, a word here about hospital food - and this may surprise you. I know I am sometimes given to being somewhat curmudgeonly. But I think hospitals really do the best they can with food. Providing a party for your taste buds isn’t their primary mission. Hospitals are there to save and preserve lives. To be honest, I am just as happy to let them focus on the reason we show up there, which is not to sample the fine cuisine.

The food is bland and boring - essentially, a delivery system for nutrients, as opposed to a “dining experience”. It is what it is. So when people whine and complain about hospital food, I often feel tempted to send them to Pizza Hut and have Katie and Jared back in the kitchen perform their appendectomy. Yes, you might die. But mmmm, the Chipotle Chicken Pizza is delicious!

Finally, it was time for my Stress Test. That’s where they put you on a treadmill all wired up and get you to move. How you do on the Stress Test determines the next step in your treatment, and really, isn’t that stress enough?

So I get on the treadmill and it’s moving slowly and I’m walking and I can feel a tightening in my chest. And the Idiot Male rises within me and says, “Oh, come on ... really? You’re that much of a baby you’re going to mention a little tightening? What kind of man are you, anyway? Suck it up!”

I swear, he wants to kill me. Instead of listening to the Idiot Male I reported what I was feeling, as honestly and truthfully as I could. And the nurses all laughed at me and called me a girlie man  respected my good judgement and willingness to give them the accurate information they needed.  


Once the results were in, the doctor sat me down. “We need to look at what’s going on in there,” he said. “We have scheduled a dye test for next Wednesday. That is where we inject a contrast solution into ..” and he kept on going. I didn’t hear a lot.

All I was thinking was “Next Wednesday. This can all be fixed by next Wednesday. But I have to make it till then.”

(Spoiler alert: I would. But I didn't know that for sure.)

My cardiologist (and hey, only weeks ago I did not even own a cardiologist!) sent me to a hospital that specializes in what is called cardiac catheter testing. This is where they run a tube up through your artery and inject a contrast solution into your heart so they can look at your heart through an x-ray and determine the condition of your various coronary arteries. Basically, it’s a peek under the hood. If there’s a problem, often they can fix it on the spot.

I arrived at the hospital just before 7AM and the nurse showed up to prep me for the procedure. I won’t go into detail about what this involved except to say there was an inordinate amount of shaving. She shaved the hair off my wrist, which I understood, because that was where they expected to insert the tube. And then she shaved my, um, groinal area. I was told this was “Just in case.”.  (It was not a very convincing explanation, but as any new mother will tell you, when you go into a hospital you essentially check your dignity at the door.)

An hour or so later they wheeled me into the operating room. They gave me a shot to relax me, which was really quite pleasant. Then the doctor froze the area around the artery on the inside of my right wrist. I closed my eyes while he made a small incision, then watched as he began to feed the tube up my arm.

I know it sounds gross to a lot of people, but that’s not something you think about when it’s happening. You can feel the tube going up your arm, which is a bit uncomfortable. But as much as anything, I was fascinated. They had computer screens above me that showed various views of my heart, thumping away in there like nothing was at all amiss.

“OK, now, I’m going to inject the contrast solution,” said the doc. “It’s going to feel like you’re being warmed from the inside.”

“What do you mean, like I’m being war- .... Ohhhh. That’s just ... beautiful.”  And it was ... the most incredibly warm, wonderful feeling I have ever experienced, and that includes a lot of things we tend to associate with physical pleasure, if you get my drift.

Once he could see where the problem was, the doc set to work. They found the blockage in my right coronary artery. It was 99% blocked. That’s not good. At all. That’s about one heavy shovelful of snow away from dead, is what that is.

So the doc narrated as he fed a balloon up through my artery, pumped it up to open the blockage, and left behind a wire mesh stent to keep things clear. It took two stents to open things up, and then after a couple of fairly routine maintenance tweaks to other arteries, he was done.

OK, really. Only ten years ago I would still be on the waiting list to have open heart surgery. If I lived through the wait, I would have gone through a gruelling operation where they would cut my chest open, saw through various ribs, graft piece of artery from my groin to replace or bypass the diseased arteries in my heart, closed me up, and send me home for several months of recovery.

On January 12, I went through an hour of day surgery and was sent home by 5PM.

And now, I’m fixed. From unknowingly being in danger of keeling over dead from lifting my grandson, my heart is in pretty good shape for a guy my age. If I’m smart, I can basically get another 20 or 30 years out of my ticker, maybe even more.

My brother died January 30th, 2008 of a massive heart attack. Because of that, I was alert to what was going on and didn’t dismiss what I was feeling when the chest pains hit. I went to see people who knew a lot more than me about it. And today, I can pick up any one of my five grandchildren - three of them born in the time since I went into ER -  without worrying it will be the last thing I do.

So, I was feeling pretty smart when the kids came over for brunch a few months after it happened. My daughter picked up something off the counter. “What’s this?”

“Oh, it’s a Medic Alert bracelet. They want me to wear it in case I run into a medical emergency. Tells them I’ve had this heart thing and that I’m using blood thinners.”

“And you’re not wearing it because ...?”

“Well ... if just looks kinda ... I don’t know ... uncool.”

“But being dead? Because you’re stupid and vain? That’s ... what, cool?”

So, I have the heart. Now, all I need is the brain.