“You are one, lucky guy…” said the doctor as he sat down to examine me, emphasizing each word as he said it. He was right, of course, but I was only beginning to accept both just how right he was as well as the seriousness of what had happened.
I’m 47 years old. My cholesterol levels aren’t bad. My blood pressure is fine. To be sure, I can stand to lose a few kilos, but I’m below the weight where metabolic disease and its side effects really multiply the risk factors. Genetics and stress, however, and more than a bit of chance had combined in a bad way.
Two days before that description of my good fortune, my family and I had just arrived in Frankfurt from San Francisco. I got off the plane, weak, dizzy, and throwing up. The airline called the medics to take a look at me. It seemed to them that I was extremely dehydrated. Out of caution, they ran an EKG, but didn’t see anything out of the ordinary. Still, they wanted me to go to the airport clinic and get checked out before flying again.
At first, the clinic agreed with the dehydration diagnosis, going so far as to speculate the bit of pain I now had behind my sternum was my esophagus reacting to puking and dry heaving. Katerina, however, wasn’t convinced. As she watched me struggle, she asked them to check further. They hooked me back up to an EKG and this time it looked far from normal. Within minutes, the doctor had me in an ambulance on the Autobahn heading into Frankfurt proper, lights and siren on.
It didn’t take long to get to the hospital and after a quick escalation of personnel and checks, I was on a table being prepped for a heart catheterization. Everybody in the room was moving with calm but quick precision and I was reminded of Atul Gawa’s TED talk on building systems for surgery. I found myself wondering if they were using checklists and, if not, that was certainly a discussion I wanted to have with them.
After a bit of local anesthetic and some pressure from the initial incision, Doctor Teupe — the chief doctor of the clinic who was leading my intervention — said, “I’m at your heart” and nodded to the screens projecting a motion view of my heart from an open frame MRI. Seeing my heart pumping away on a screen while still being secure in my chest was nothing short of amazing. For a few moments, I was lost in the surrealism of it all, the doctor’s narration of what he was doing pulled me along.
My right coronary artery was clear. My left artery — considerably smaller than my right — wasn’t. It was totally blocked. Each injection of dye that could be tracked by the MRI showed that no blood flow was getting through. Seeing the problem, the doctor went to work using a variety of tools to open the blockage. Interestingly, as blood flow resumed through the artery, the pain picked up and I really had to work at breathing through it, even with the help of a bit of extra morphine that the staff gave me.
I don’t know how long that part lasted. Five minutes, maybe ten. It felt like forever. I heard the catheter wire zip back and forth as the doctor placed two stents, but just focused on trying to control my breathing and just hang in there while the doctor finished what he was doing.
And then, like flipping a switch, it was done. The pain faded. I felt instantly better. Dr. Teupe finished up, closed the incision point in my leg, and then came around the table and walked me through the MRI imagery explaining what he did. Then I went to the ICU for recovery and to slowly start figuring out exactly what happened.
My first approximation of understanding it all was blasé: “Oh, I’ve had a minor heart issue but nothing that a quick little operation couldn’t sort out.” I held onto that thought for more than a few hours and that’s pretty much what the email I sent to my colleagues at work telling them that I’d be out for a bit of time said.
As the immediate shock of the experience wore off, I talked more with the nurses and doctors. It became clear that it was anything but a minor issue. For older people that have had some heart issues, the body builds enough collateral vessels around the main artery to handle some load, which gives some headroom for treatment. Also, many small heart attacks have their source in those smaller vessels. For somebody my age, there’s not much in the way of alternative paths. A heart attack with complete blockage of a primary artery requires fast, decisive action or the consequences are devastating and deadly.
Luckily, the initial symptoms getting off the aircraft were just precursors and the heart attack seems to have only started in earnest when I was at the airport clinic. That meant that I was positioned perfectly to get the kind of care that was science fiction not long ago, and to get that treatment immediately. And that made all the difference.
Whether you chalk that up to luck, deity, or a miracle — I can’t even begin to fathom how fortunate I am. The expression “dodging a bullet” comes close, but it assigns credit to the person doing the dodging. It’s more like a bullet was heading towards me from behind, Katerina saw it, and the doctor/guardian angel that just happened to be suddenly standing right next to us was able to gently nudge me out of the way with just the right amount of judo, making it look easy in the process.
So, why did this happen now? How did I get on an airplane in San Francisco with a ticking time bomb in my chest which had been there for who knows how long? And why did it manifest like it did, instead of somewhat later in route to Berlin or somewhat earlier over the Atlantic? Why didn’t I catch this earlier? What symptoms did I miss? What could I have done differently?
There’s probably no easily determined answer to any of these questions, although I will be tracking as many of them down as I can because I’m a geek that way. In general, however, the staff at the clinic have educated me that my case falls into the category of: “It happens.”
There’s a history of heart disease in my family, but I’d done a lot already to take counter measures. It’s unclear if I could have done much more. Maybe if I was in marathon shape, I’d have gotten some more time. Maybe not, however. I’d even recently done a physical with an eye to picking up on any signs and the doctors involved in that didn’t see a thing, nor did they see a reason to go to the next level of investigation. Maybe we’d have caught something then. Maybe not.
It’s possible, although probably not very likely, that it’s a side effect of all the flying I’ve done in my life. Maybe there’s a chance it has something to do with the size differences of my coronary arteries, but my doctors seem dismissive of that. Maybe fate had just written 17,294 days on my timeline and I’d simply reached the last one.
One thing I’m pretty sure of now that I’m on this side: this didn’t happen overnight. It took some time. I did have a few symptoms that are clearer now with hindsight. For example, I hadn’t noticed a tightness in my chest building up, but I now have a sense of relaxation there I haven’t felt in a long time. The best way I can describe it is that it’s like noticing how good you feel after a quality massage, and how much you didn’t realize you needed it.
A more productive question is: What comes next? A very real possibility is that this has been dogging me for a long time and now that it’s fixed, it’ll stay fixed for a good long time. The doctors here certainly seem hopeful of that. They’ve seen many examples of people who got as lucky as I did go forward seemingly better than ever.
Even if that’s the case, however, I’ll have to do my part to approaching the factors I can control. Those last few kilos have to come off. I’ll have to monitor the best practices in the treatment regimes for people like me. And, I’ll have to modify my work stress levels. The last few years haven’t been kind on that front and I’ve already been taking steps to adjust my life there. I have an additional sense of urgency to make those steps happen now.
But mostly, I’ll be living life, enjoying my family, trying to do work that matters, and making sure that every moment of what now feels like bonus time on the clock is well used.