Stress Test

Stress Test
A test that turned out to be more stressful than planned.
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Ninety-three seconds into the stress test, the cardiologist, my new guardian angel, sternly instructs me to stop walking and get off the treadmill.

“But it doesn’t hurt. Usually it starts by now,” I inform him.

For two weeks or so, I had been experiencing discomfort that had become predictable during exertion. I had been scheduled for the test when my previous, initial diagnosis of acid reflex did not seem to pan out. I had also become convinced that I was harboring a hiatal hernia, a common risk factor for reflux, based predominately on my smiling recall of my mother’s repetition of the term when I was younger. Her doctor had mentioned its possibility to her, and from then on for decades she often referred to it, frequently prefacing the malady with a definite article when anything stomach-related was discussed.  (“Well, the doctor said I might have the hiatal hernia.”)

And of course there was the ever-more-common refrain, suggesting a stress test was due anyway.  “Well, as you are over fifty now...” which had recently become standard in my exchanges with physicians, along with, “Fifty, huh? Time to get a colonoscopy.” Over twenty years ago my primary physician had coyly warned me that the “real fun,” vis-à-vis physicals, would begin when I turned that mystical age—and it did. Who says life doesn’t begin at fifty?

I had confidently predicted to the new young sentinel of my heart and any nurse, tech, et al who appeared in the room that I had a pattern, and a few minutes or so into exercise my pain would occur. I had described it as accurately as I could as the sensation of a piece of apple caught in my esophagus, mid-chest level. I had even begun timing its duration, closet scientist that I am and have been since I used to dissect frogs donated by my then pre-med older brother.

My present research was to determine for myself analytically if the symptoms were worsening, either in intensity or duration. Of course my innate wisdom did not suggest, nor did it occur to me, to get the hell off the exercise bike, which I had begun using again after the holidays, when the substantial stab in my chest would start. A childhood of playing ball and “rubbing it in the dirt” after an injury, and quickly returning to the game, had trained and conditioned me to “work through it.” Maybe a little macho mixed in too.

Back at the stress test. “Take this.” (This being an aspirin.) “Chew it. And put this under your tongue.”

“What is it?” I innocently asked the cardiologist.

“A nitroglycerin tablet.” 

I knew enough to deduce that that could not be good.

“But I really feel okay. It doesn’t hurt at all.”

“Please, just take it--for me.”

“Doc, you’re freakin’ me out here!” I believe I repeated that line a number of times. Oddly, it is not a phrase I would normally utter, but I do recall feeling as if things would be okay if I were still able to insert a little humor. On considering it long afterwards, I realized that I was probably just trying to maintain some control of a situation I had quickly lost control of and needed the prophylaxis of denial.

Sometime very soon after my aborted treadmill trot and therefore the test itself, and following my gracious cooperation in taking the aspirin and nitro, even though I felt fine, much of the conversation was directed to and turned, quite literally, to my wife, whom I had called and invited to join me in the doctor’s office.

“He needs to go to the hospital today. He can go to Westchester Medical Center or Danbury, but he has to go tonight for an angioplasty.”

“You’re really freakin’ me out here!”

“Hopefully it’s just one artery and they can do a stent. If it’s more than one we’re looking at bypass.”    

We quickly settle on Danbury Hospital, which is closer and did not have any bad experiences associated with it for me as did the Medical Center.

I was soon wheeled in a chair to the emergency room, which was just down the hall from the cardiologist’s office. (Timing is everything, and as we all know, location, location, location.)  They were waiting and fully prepared by the doctor’s phoned instructions moments before. I felt foolish as my wheelchair stroller was pushed, making its way through the hall and into the ER. I wanted to get up and say, and tried to with my eyes, that I was really fine and this was just an overly cautious instruction from my doctor. Within a minute I had multiple IVs in me. My wife asked what each line was for, and when she heard one of the meds mentioned she asked why.

“To prevent any further damage from the heart attack.”

Heart attack. WTF! This, to both our repeated recollections and subsequent myriad retellings, was the first time we heard that dreaded term that day. 

Somehow we both stayed relatively calm, other than my wife’s inability to locate her bag for over five minutes. It was on the bed with me, and apparently also invisible to my own fiddle-footed vision during the incident. It was only when her good friend and co-worker in the Birthing Center arrived that the missing bag was located. Her calm but take charge manner was truly a comfort when the shock of the situation began to manifest itself. How can I leave work now?  Who will drive the car if I go in the ambulance with him? Where is that bag? Her handling of the practical details made the situation far less stressful. She found the bag, went to inform my wife’s supervisor of the situation, drove our car to Danbury, and basically put things in perspective and assured us both that everything would be okay. And as she left the ER, she turned and flashed her unambiguous Irish smile as she gave me a much-needed thumbs up. 

I managed to ask my wife to call my brothers and my boss, to tell her I would not be in the

next day. This way, should things get dicey later that night, or into the morning, there’d be no

reason to make that call at least. And somehow I, who was really not much of a cell phone person, found myself chatting away with my boss, who only the day before joked with me to “man up” when I described that piece-of-apple-caught-in-my-chest feeling to her over coffee in her office. The details of the scene, that I was lying in a bed in the ER, being treated for a cardiac infarction, and small-talking away with my boss didn’t yet seem as ridiculous as they would in future retellings, especially hers, once I returned to work in two weeks.

Sometime not long after I was “stabilized,” the ambulance guys who were to drive my wife and me the seventeen miles or so to Danbury Hospital arrived and began the transfer of lines and tubes through which I was being pumped with drugs and oxygen to a portable version of everything for the ride. Each transfer was explained to me by one of the two EMTs in a thoughtful attempt to keep me well informed of what was happening. Of course, I couldn’t comprehend anything, or get my mind around the fact that I was actually the patient in this medical drama, but I did manage to nod a lot and say, “Oh, okay, I see. I get what you mean.”

On the way, the same guy who had been offering the explanations at my bedside in the ER stayed in the back of the ambulance with us and continued his friendly tutorial, likening my heart and its arteries to a car, something about which I at least knew a little more. Again, however, my comprehension was basically nil. I knew enough about myself to realize that the explanations of the serious medical stuff happening to me would pass from one ear, through the stress-induced void in my head, and out the other.

Repeatedly I nodded to his kind automobile analogies of what was malfunctioning with my cardiac arterial system, and managed an “uh-huh” whenever possible. But the longer it went on and the more diluted the explanation became, the closer I got to one of those cinematic experiences when the words echo and bend, and become nearly unintelligible as the scene distorts. The terror of the whole thing was starting to sink in a bit more.

I surmised from the exchanges between the two EMTs that we were perhaps lost. “Well not really lost. It’s just this isn’t the entrance.” Luckily, I wasn’t “coding,” or heading toward the light, or in any pain, and it was possible to appreciate the humor of the situation—sort of. And given my inherited, complete lack of any sense of direction, the irony and strange poetic justice of our indirect route to the facility was not lost on this reclining passenger.

One is awake during the angioplasty and as had been just explained to me, other than the prick of a small cut through which a catheter is inserted into the thigh, there really isn’t any pain as the arteries don’t have nerve endings. All I felt was occasionally being moved into a more advantageous position for the doctors to manipulate the catheter in order to get the best view. I did, however, as I lay there on my back, waiting to hear if I had more than one artery blocked and/or it was beyond stent repair and my chest would have to be cracked open, look hard at the huge cath lab light above and wonder if it soon would morph into that other white light, and if I’d shortly be reunited with my father, grandfathers, grandmothers, et al who had proceeded me toward its assumed warm glow.

I was lucky, and two stents carefully inserted and strategically placed did the trick. Six weeks later an echocardiogram showed that there was no permanent damage detectable in the small area that had initially taken the brunt of the attack. Having a heart attack in a doctor’s office, in a hospital, allowed for the immediate intervention that most are not fortunate enough to receive.

The area affected looked fine; my heart was apparently just temporarily stunned. 

Seven years later I return to Danbury Hospital three times a week, completely by choice and usually without getting lost, to continue my heart healthy habits in the excellent Marcus Cardiac Rehabilitation Center there. It is staffed by a devoted, kind, and caring group of men and women never too busy to listen or help and encourage all the participants. Each time I see a newbie, recently traumatized by his or her heart’s transgression, show up for the first time, looking every bit the deer caught in the headlights, I am reminded how understanding all the staff was during my first sessions. I recall the fear of exercising and really exerting that mythic muscle for the first time following the scary and life changing experience I had.

I know that just as I did, some of these individuals newly informed of their draft into the ranks of heart disease patients would soon find themselves addressing the same inquiries, along with making more of their own, with the welcoming veterans of rehab. “So how did you wind up here?” “What were your symptoms?”  “They end up doing a stent? Bypass?” All these questions were asked with ample time allowed after each for the one to whom they were directed to answer as fully (or minimally) as he or she desired. And a new bond often forms with others several months, years, or even decades out from their own procedures. 

Perhaps for those of us engaged in this designed and targeted physical exertion, our thrice weekly catharsis is achieved through the literal sweat (and sometimes agony) needed to continue our stories, our paths which were briefly and abruptly interrupted by the very real frailties of our own compromised but resilient hearts.

 

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