Heart Attack!

Heart Attack!

Cumberland WI, August 22, 2018

It’s gonna be a bright, bright, bright, sunshiny day.

Cumberland Memorial Hospital

Johnny Nash’s song reverberated in my mind as I pedaled my bike furiously around Beaver Dam Lake in Cumberland, Wisconsin. It was Wednesday afternoon, August 22, 2018. I was accompanied by my longtime friend Mike, a fellow retiree and Cumberland resident. From his house, situated on the south side of the lake just west of downtown, the ride up and around the lake was just 13 miles. A short distance, but not an easy ride. The initial hill after, pedaling up from the lake front, was succeeded by a steep, three-quarter-mile climb that would leave me short of breath even in the lowest gear on my thick-tired, fat-saddled tourist bike, not the thin-wheeled lightweight crossover I was accustomed to at home. 

A fine ride. A fine afternoon.

This was not my first ride around Beaver Dam Lake. Without straining either my memory or penchant to squeeze the truth into a more heroic vision of myself, I’d say I’d circled that lake 40 times or more. I owned it. The hills, the valleys and the lovely lakefront properties along the way afforded “life-is-good” views of the lake below, where pontoon boats meandered with no particular destination and jet skiers raised a watery tail.

A fine ride. A fine afternoon. Mike has the annoying habit of beating me in most of our competitive activities over many years, including tennis, ping pong, and biking. As we hit the final mile of the turn around the lake, he was but half a hill ahead of me. It was mostly downhill on the final stretch. I kicked into a higher gear and pedaled fast and hard, determined to overtake him. Then, pedaling even faster and harder, I felt a tightening in my chest and a sharp pain, as though caught in a vise, slowly tightening. I did not ease up. Instead, I pushed harder, sensing that if I crashed before arriving home Mike might have assumed I was simply taking my own sweet time, while I was lying by the side of the road gasping for my final breath.

I took the last turn, heading downhill at breakneck speed and into Mike’s driveway. He was rolling his bike into the garage. I screeched to a halt, short of breath, and uncertain of what might be happening to me. “I’ve got to lie down,” I said, and disappeared through the back door of the house into my bedroom, first door on the right. I laid down on my bed, trying to regain my breath, but the vise tightened. Whatever was happening to me, I was clear that it had never happened before. That forever little voice in the back of my head was saying, “It’s probably nothing; don’t make a scene.” But what if I’m dying? I replied. What if I am dying?

“Turn on the siren!” I instructed Mike, hoping to get in a final joke.

Staggering from my room, I found Mike in the kitchen. “We’re going to the hospital,” I said. He looked at me quizzically. “NOW!” I said. “WE’RE GOING NOW!” I was out the door. Moments later we were in his Honda Odyssey headed up from the lake towards town and the Cumberland Hospital just 11 blocks away. “Turn on the siren!” I instructed Mike, hoping to get in a final joke. Lucky for me the hospital was close. Lucky for me I did not stop my bike when the Grim Reaper grabbed at my heart. Lucky for me I grabbed back. In fact, since ditching the bike I had been clutching the skin above my breastbone, alternating between my right and left hands, and squeezing as hard as I dared, creating a counter force to the iron hand that was squeezing back from inside. It was an arm-wrestling duel: If I let go I would die.

“Don’t park, just drop me off,” I ordered. He did. In front of the emergency entrance. I walked quickly and fearfully (fearful I might fall) to the entrance doorway. I pulled down on the red emergency handle, recalling all the airplane flights where I’d sat in the emergency seat next to the exit window, secretly wanting to pull the handle, step with it onto the wing, and heave it into the sea.

Moments later a nurse arrived followed by two men with a gurney. “I need help,” I said, still clutching my chest and unable to think of anything else to say. My next memory is being in a large room with people surrounding me on all sides, Mike included, needles in both arms. The lights seemed bright. I felt I was in a movie, playing the lead role and watching it at the same time. The pain had subsided.  Morphine, I was told. “Aah,” I replied.

“Our concern,” he said, “is that you have a burst aorta.”

A commanding but genial figure with a hearty Midwestern girth (fueled I imagined by ample amounts of Wisconsin cheese, brats and beer) strode into the room and stood at the foot of my roll-around bed. My doctor. Not exactly a heart-healthy specimen himself, I mused to myself. He introduced himself. How do you do, I might have said, but I do not recall. “Bob,” he said, “I’ve got some good news and some bad news.” (Do they teach this in medical school? Does telling the good news first provide a safe landing spot for the bad? Might leading with the bad news cause you to go into apoplectic shock, never hearing the good news that might strengthen your will to live and pique your curiosity to find out if you are going to live or die?)

The good news appeared to be little more than a pat on the head from the pleasantly rotund Doctor Feelgood. “The good news,” he said, is that you are in good place with highly skilled people and we are going to do our absolute best to take care of you.” He paused. The room went silent. My fate seemed balanced on the tip of his tongue like the Sword of Damocles.

“Our concern,” he said, “is that you have a burst aorta. If you do, we have a very serious situation.”

Despite a bit of med-speak, I admired his candor. What I heard was more to the point: “Unless my initial diagnosis is wrong, you have a burst aorta. If you do, there is nothing we can do for you.”

I responded with my own measured pause.

“What’s next?” I asked.

“We’re going to do a CT scan,” he replied. “That will tell us everything we need to know.”

Well, isn’t that dandy, I thought. “Let’s do it,” I said instead, feeling like the captain of the Titanic looking at the oncoming iceberg and shouting, “Full steam ahead!”

A CT scanner is a million-dollar machine that appears to predate what sex might look like once the robots take over. It “allows the doctor to look at the inside of the body just as one would look at the inside of a loaf of bread by slicing it.”1 The experience resembles going back into the womb, and (in my case) wondering if I might not return. All these thoughts were going through my mind as I slid slowly, head first, into the abyss. I may have passed out while in there, as the next thing I remember was being back in the big room and the smiling Dr. FG telling me, “Bob, I am happy to report that your aorta is fine. Just fine.” I heard clapping. Perhaps angels stomping their feet. Glory be to God! I was going to live.

Yes, I was going to live. I started to cry.

“We have ordered a helicopter,” he continued. “We’ll be sending you to Minneapolis, to Abbot Northwestern Hospital. You’ll get the finest care in the world.” Music from the spheres. Dancing in my ears. I was smiling, head to heart to toe.

The whirlybird was there in a flash. It was tiny and bright blue. I was expecting a robin; this was a hummingbird with a round glass head. Two med-techs, Gary and Joe, all-American boys, squeezed me into one side and climbed in the other. The tail lifted, the cab dipped forward, and we ascended into the bright, sky-blue sky. Flying to, through, and from the heartland. I looked up at the sky and smiled. I looked down to see woven fields of green and plenty in the Wisconsin farmlands flying by below me, as if I were standing still. The same drive from Minneapolis to Cumberland two days before was a two-hour crawl. The copter ride was just 33 minutes flying at 1500 feet and 150 miles per hour. Flying high and fast, I was aloft in that oh-so-American illusion that life has boundless possibilities, and that good old American grit, determination and love, yes love, can overcome all. Yes, I was going to live. I started to cry.

Soon, too soon, we dipped earthward and moments later alighted on the helipad atop the Minneapolis Heart Institute. I was whisked away, down an elevator and into an operating room where a surgeon and his attendants awaited my arrival. To my amazement I had only a local anesthesia. I watched with fascination as they removed the skin from my right wrist and opened the artery that would lead them to my heart. Two stents were placed in one artery, a balloon inserted in a second. The only evidence of my surgery was a deep purple stain covering the inside of my right forearm. It faded away over the coming two weeks. I was sad to see it go.

After a heart attack, you pay attention.

I was released two days later. Mike picked me up at the hospital and drove me back to Cumberland, where I had left my car. Two days later I drove to St. Paul and picked up my Denver friend Bill who had flown in to accompany my on the drive home.

Life is a learning experience. A heart attack, if you survive it, is no exception. What you learn after a heart attack are many of the things you may have heard before – and paid no attention.

Let me assure you. After a heart attack, you pay attention.

I am now enrolled in a cardio rehab program at Presbyterian/St. Luke’s hospital in Denver. Everything is measured here. Forty-six minutes of measured, progressive movement two times a week. Three-minute warm-up. Three-minute cool-down. Forty minutes in-between on your choice of the rowing machine, the elliptical, the arm turner, the treadmill, and three more I haven’t tried yet. It doesn’t matter which one you choose. You just need to keep moving, keep your heart rate up. Not too much. Not too little. “What are your METS?” Kris the nurse calls out to me. METS are the metabolic equivalent of oxygen consumption while resting. If you are at two METS, you are consuming twice the amount of oxygen as you are at rest. The higher the better, unless of course you overdue it. Kris tells me that if a person who has had a heart attack can get to a METS of seven and maintain it for the 40-minute session, his likelihood of having another is exceedingly low. I’m at five. aiming for eight.

Pills! I used to wear it as a badge of honor that I took no pills. Take the pills! They are regulating your blood pressure, preventing blood clots, reducing “bad” cholesterol and increasing “good” cholesterol.

Diet is also on your new life menu. Yes, obesity kills. Yes, vegetables and fruits are good for you. Lots of what you love to eat – not so good. Sugar? Only on your birthday. Easy on the salt. The information is all out there. Find it. Do it.

Smoking! People who smoke are two to four times more likely to get heart disease. Women who smoke and who take birth control pills are at even greater risk. Secondhand smoke? Save it for your enemies!

Why does smoking lead to heart disease? Because nicotine:

  • Reduces how much oxygen your heart gets
  • Raises your blood pressure
  • Speeds up your heart rate
  • Makes blood clots more likely, which can lead to heart attacks or strokes
  • Harms the insides of your blood vessels, including those in your heart 2

See your doctor! Ask! Listen! Prevention is better than a cure. (Actually, if you are lucky enough to survive a heart attack and you successfully alter your lifestyle, you may be in better shape than you were before the dastardly event occurred.)

Why am I telling you all this? I was lucky. Damn lucky. You may not be.

I can see clearly now the rain is gone
All of the bad feelings have disappeared
Here is the rainbow I’ve been praying for
It’s gonna to be a bright, bright, bright, sunshiny day
                                                                                      – Johnny Nash, 1991

1 What is a CT Scan? >> https://www.emedicinehealth.com/ct_scan/article_em.htm

2 How does smoking cause heart disease? >> https://www.webmd.com/smoking-cessation/quit-smoking-heart#1

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