What I’ve Been Up To, August 2017

I’ve been feeling angina for a few weeks now, and also feeling very tired. You probably know that angina is discomfort in the chest, normally attributed to blood flow that is insufficient to the needs of the body’s muscles; the heart is straining. I’d also been experiencing some dizzy spells. So I made an appointment to see my cardiologist in early August.

On the very next day I had two fainting spells: I just keeled over with no warning. Fortunately, I didn’t hit my head hard or break any teeth out or anything like that. I was lucky in that. 911 was called and I was taken by ambulance to the emergency room at local Summit hospital, to be checked out for what was going on with me. It speaks to my childishness that I felt embarrassed for inconveniencing the ambulance crew in this way.

Speaking of angina, by the way, you should know that there is no truth to the story that when a staffer told then-president George Bush that Dick Cheney had “acute angina”, he said that that was silly: men don’t have anginas.

In any event, to make a long story short, I spent five days in the hospital. I just got out a few days ago. I had a bunch of tests and procedures done on me while I was there. Fainting can be brought on by a number of things, but one of the things they worry about most is heart problems… which I have; you may already know that I had heart bypass surgery in 2004.

It turns out that the heart can have three main kinds of possible problems: (1) something wrong mechanically (with the heart muscle and valves), or (2) something wrong with the plumbing – that is, obstructions to blood flow — or (3) something wrong with the electrical impulses that regulate the heart’s beating. Remarkably, the heart has a different system that’s in charge of each of these different functions; knowing this makes me understand a bit better what a miraculous piece of engineering the heart is. Not only that, it is the only muscle in the body that never, ever rests. It can go on beating for a hundred years. That’s pretty impressive, really.

Parenthetically, I am impressed with how complicated it is to run a hospital. When someone like me comes in with an immediate problem the doctors have to scramble to diagnose and deal with what’s going on. They have to book access to various rooms and equipment, consult with various specialists, and to assemble the teams that will run the equipment and do the procedures – and interpret the results. Not least, someone has to schedule and coordinate all this in the face of the fact that the needed facility or equipment will likely already have been booked to deal with someone else’s not-so-urgent problems that will no doubt have been scheduled weeks previously. So between this and that and the other thing, it took three days before they were in a position to take a close diagnostic look at just what was going on with me. Until then they drew blood, took X-rays and gave me a CT scan, looked at my vitals, took bets on how long I’d last, etc.

Before I could be given either of the catheterization procedures they had planned for me, however, my heart stopped spontaneously… for 4.2 seconds. The nursing staff noted this because I was hooked up to all kinds of telemetry. I must say that doctors were grateful to me for having been helpful enough to provide them with such a major diagnostic clue; the electronic telemetry of the event solved a lot of the mystery for them. I think I heard champagne corks popping down the hall.

They rushed to bring in an E.I. specialist (that’s cardiac-electrical stuff) and gave me an electrocatheterization procedure (it’s called something else in hospitalese, but never mind that). This is when they open up a vein in the groin and insert a loooong thin wire that they snake into the heart. That wire is used to test various electrical nodes in the heart. They were able to induce another heart stoppage in a bundle of cells called the Bundle of His (named after Swiss doctor Wilhelm His who first identified it and its functions; it acts sort of like a spark plug). The reason for my fainting, it seems, was that I was experiencing episodes of my heartbeat stopping. The official medical term for this is syncope; it’s not exactly the same as a heart attack, but it’s a bad thing anyway. With no blood pumping, and the brain receiving no oxygen, one begins to function like our current president.

There are, I learned, specific “bundles” of specialized cells in the heart, that have different functions. There’s one that’s called the Widowmaker, because if it misfunctions then it’s game over; the others, they can do something about them if caught in time. They checked out my own Widowmaker and it seems to be doing well. With a name like that I expect it to hit men more than it hits women, but I’m sure it’s equally a Widowermaker. For more information on any of this, I refer you to Wikipedia.

I now have a pacemaker installed. Its function is to jump-start the heart in case it wants to take another coffee break during working hours. It is installed under my left clavicle, and that part of my body is a bit sore. The pacemaker is not large; it’s about the size of two fifty-cent pieces; and some wires go from it into both of my heart’s atria (the upper chambers). They had a representative from the company that produces these show up the next day to check that the placement, circuitry, and wiring were correctly done and that the wires were working as they should. These things can be programmed to function in various ways, to work at different speeds and settings, depending on just what kind of spark might be called for. It’s interesting to know this. And I’m instructed to not move my left arm very much, or lift it above shoulder height, for six weeks in order for the newly installed wires can… uh… blend into the flesh they’ve been inserted into. I’m not much motivated to move my arm: the incision site is quite sore. So, anyway: no more weightlifting or tennis or calisthenics for a while. I also have two newly made incisions in my groin to recover from… which is also sore.

Interestingly, I’m told that the pacemaker’s job is actually to just step in when it senses any irregularity in my heart’s electrical impulses; otherwise, if the electrical impulses are working, the pacemaker backs off and stays quiet. So, according to what they told me, the average pacemaker is inactive most of the time.

I was also given an angiogram the day after I got the catheterization; this is where they insert another catheter into the heart — once again starting at the groin — to take a look at whether there are any blockages to blood flow in the heart. If any blockages are found then a stent is introduced, to open them up (that is, if the blockages are not impossible to reach without risk of damaging something). Mainly, the doctors needed to determine whether I also had a problem (besides the electrical one) because of narrowed or blocked cardiac arteries. These can cause the electrical problems that I’d been having.

Apparently, and happily, I have no arterial blockages in my heart. That’s good news. And, according to the arcane medical taxonomy that is brought to these matters, I did not have a heart attack. I had Syncope. I think the difference is that with the latter the heart simply stops; with the former there is trauma and damage to the heart muscle. At least, potentially… depending on how quickly an intervention might occur. But there are so many other words for heart problems: ischemia, angina, fibrillation, infarct, stenosis, romantic breakups, etc. Will Shortz could probably come up with a crossword puzzle made up of only these kinds of words. But, well… none of them are exactly good news.

I might mention that my doctor was quite pleased to report that my bypass grafts, installed in 2004, were clear and unobstructed. He said that half of these things clog up again within ten or fifteen years! Wow; no one had told me that before. Well, it’s been 13 years for me and I seem to be all clear in that regard. Now, I’m simply going to be setting off airport security alarms. I hope my heart can stand the excitement.

I got home last Saturday and I’m very tired as I write this. I’ll recuperate and be back to normal, more or less, in four to six weeks. But I also am amazed at the luck that was with me in how this all came down. As I said, I fainted twice at home… and didn’t hit my head on cement; I hit it on carpeted wood flooring instead. The fainting came on without warning and without time to react. I simply collapsed. It was most fortunate that I wasn’t driving. Or crossing the street. Or up on a stepstool or ladder. Or leaning over my table saw. I could easily have killed myself and/or someone else. Things could have been so much worse.

I have to also say that I am grateful for the way the hospital nursing staff took care of me. They were kind, competent, professional, hard working, and without exception pleasant and friendly. On a chatting level, almost all the ones I met are multicultural and multilingual, and bring with them a wi i i i i i ide range of interesting life experiences. One of them, I found out by just talking with him, speaks seven languages! What an amazing bunch! If I were running the hospital I’d be giving them stock options.

Finally, having a pacemaker will add $300 to the cost of any future cremation that I might be subject to; it costs that much to remove it. If it is not removed then the oven blows up. Perhaps a burial at sea (you know; a sack and some rocks?) would be the way to go?

In any event, I intend to take it easy and recuperate for a while now. I am tired.