A Heartfelt Post, Part 1: Between the Dup & the Lub

February 2, 2018


Here's a view you never want to see


This is a different kind of blog post. It's a heartfelt attempt to share a recent experience that changed my life. On Wednesday January 7th I had a heart attack. I'm doing much better now, but in the weeks since my 'cardiac event' I've been forced, because of fatigue and drug-induced lethargy, to really reflect on my priorities and practices. This won't exactly be a Saul on the road to Damascus blog post, but it might resemble one. Fair warning: Parts of it may be a bit airey-fairey, loosy goosey for some readers. No apologies are forthcoming. When I was lying on my back in the ER in Medellin Colombia, looking up at the big overhead light, its glow was more than metaphor. It offered a kind of peace and insight that only dire and truly life-threatening situations can provide. Despite the pain, the anxiety, and the awful inconvenience my heart attack produced, I felt gratitude along with it: At being alive, certainly, as it was a near thing there for a while that I would succumb, or not. I was mindful of being at the right place at the right time, surrounded by the right people to receive the correct treatment. And for having my dear spouse next to me with her expertise, her calm assurance, and her unfailing support. And finally, I was aware of the opportunity the situation presented to look into the abyss, and then climb back out again to report what I saw, and what fragments of wisdom there were to be had. This is part 1. Here I'll relate the physical episode, the health scare itself, and the logistics of dealing with it. In part 2 I'll write about the metaphysical aspects of looking at my potential demise, and the changes that engendered. 


 The smell of my morning pancakes gets the waterworks started


If you've not had a heart attack, or any sort of life threatening event, this may not resonate with you. If you have experienced something like I did, you'll recognize my words and emotions here, and even have a few of your own.

Indeed, one of the biggest takeaways from my harrowing ordeal were the powerful emotions it generated, immediately and ongoing. I've always considered myself a pretty sensitive guy. I pay attention when others are speaking. I notice homeless folks, the halt and the lame, and people needing assistance. I watch those baby duck and dog rescue videos on Facebook and get weepy at their successful termination. But since my heart attack I really do cry at card tricks. A kid's lost balloon makes me whimper. The smell of my morning pancakes starts the waterworks. Watching the slightest display of outward humanity I'm a mess.


Let me take you through my cardiac adventure, then on to the postscript. You may want to grab a hankie. I just did.


 The ambulance that transported me to the hospital in Medellin

That big overhead light showed me a lot of things I need to pay more attention to: The exquisite love and care of the woman I'm privileged to be married to who stood beside my hospital cot; the needs and wants of family and friends; even the aroma of fresh pancakes in the morning.


And something I never expected. As I stared at that light, I realized I was waiting for every single heartbeat. It struck me that each and every one of those beats was a gift. Lub-dup, lub-dup, lub-dup. I began tracking the time between the lub and the dup. Then I started tracking the pause, the time between between the dup and the lub. It's a remarkable feeling to be that focused, that aware. One thing it told me was that being mindful of such small things erases any fear that may have crept in. I wasn't the least bit afraid, or anxious, or fretful. I remember feeling curious that each moment may be my last. It was odd to me, yet strangely fascinating, even a bit funny that my pending death was to be so anticlimactic. So this is it? This is the big friggin' fear people worry about all their lives? I actually smiled at the insignificance of it all, the banal nature of my passing and how little impact it would have. So we think we're a big deal? Not so. I could tell that the world in all its indifference would just keep on spinning, with little or no recollection that I'd ever existed. And that was a strangely comforting feeling.


Another deeply comforting thing was that, had I died on the cot that night, I'd have done so with the woman I love right there with me, finished with the major goals I'd set for myself, and secure in the knowledge that I'd achieved my stated purpose, that is, to leave the campsite a bit better than I found it. In other words, I was prepared to die fulfilled and happy. Not a bad way to go, and one I can recommend.


Nonetheless I kept tracking the dup and the lub. Between the dup and the lub lie a multitude of emotions and sensations that as long as we're alive ought to rivet our attention. Between those two life granting intervals is the proverbial flashing screen of our history, our good deeds and our bad, our saintliness and sinning. Between the dup and the lub was my first memory of childhood, first day of school, the fishing trip with dad when I was six. There was the Good Friday baseball game I got in trouble with my mother for, the violin lessons at eight. Between the dup and the lub I saw my mother's face at the door when I came home bloodied after wrecking my bicycle. I saw the nuns wave goodbye when I graduated from St. Andrew school. I saw that helicopter plunge to the jungle knowing my friends were about to die. Between the dup and the lub I saw much more than the time allowed me to see, but there it was anyway.


 My forever thanks to Pablo Tobón Uribe hospital & staff. Muchas gracias!


Here's how it all started. Mariah and I were just walking in our neighborhood. I had to stop when a rather large dog sat on my chest, and the son of a bitch wouldn't get off. There wasn't much pain per se, just a tremendous pressure, and a bit of sudden indigestion. I spent a big part of my career in pre-hospital medicine, so I knew right away what kind of dog it was, and why the bastard wouldn't budge. For 20 years as an emergency rescue helicopter pilot I flew heart patients all the time, so one of my first thoughts was how strange it seemed to be on that side of the situation. 


I arrived at the hospital, and started receiving the kind of cardiac care I used to watch as a casual observer. But there was nothing casual about my interest this time; I paid very close attention. The medical staff in my ER cubicle hovered around adjusting IVs, checking my monitor, watching me like a hawk.


Good that they were, because at one point I slipped into V-tach, a rhythm no healthy heart should be in, and often a precursor to V-fib, and cardiac arrest. My blood pressure spiked to 166/93, and my heart rate shot up to 190. The episode lasted two minutes. At that moment, no hyperbole involved, I was as close to death as I could be, and staring into the abyss. I was, as folks way back in the hills say, 'on the drop edge of yonder.' A quick dosage of Amiodarone to stabilize my heart, and my vitals returned to somewhat normal levels.


When I slipped into V-tach, and stared into the abyss, I was 'on the drop edge of yonder.'


Fortunately, the excellent ER staff at the hospital, ever mindful of my retired RN wife close by, jumped in and pulled me back from the deepest hole we're aware of, the bottomless pit from which no one has yet returned. The coda to this part of the story is this: The V-tach episode bought me an express ticket to the cath lab, and within minutes I was there. 


 On to the cath lab for my angioplasty. Once again I was on the other side.


Years ago, in my hospital flying days on the other side of the emergency health care drama, I witnessed the race through the corridor scene many times. Now it was me watching the florescent lights zip by overhead, yet more lights that illuminated my past and present. How many hospital corridors had I raced through with patients on the way to the helicopter? How many times had I sped alongside heart patients, as their families reassured them prior to their flight with me? And how many times had I carried the equipment for the medical staff so they could tend to their clients? Now it was me on that cot, my life in the hands of people I'd never met, professionals charged with taking me on a journey toward better health. In an odd way it seemed like some kind of reward for all my diligence and expertise in the air, all my attention to weather and wind and the wiles of emergency medical aviation. If that's what it was, some kind of weird karma paying me back for those efforts on someone else's behalf years ago, I'm okay with it. 


1- My LAD showing 95% blockage. 2- Here comes the stent. 3- Stent inflated. 4- Vessel reopened. 


The pictures above show why I was having difficulty with chest pain, why I ended up in the emergency room and cath lab, and the almost magical treatment that restored my blood flow and likely saved my life. Number 1 picture is the floroscopic shot of my Left Anterior Descending coronary artery. Even as a layman, unfamiliar with the heart and its vasculature, from my vantage point on the table in the cath lab I could see the obstructions in that vessel, like someone had clamped rubber bands around it in two places. In number 2 the stent wends its way into that vessel, as my doc fiddles with his magic wand to navigate around. Number 3 shows the stent fully inflated. Number 4 shows the notable increase in blood flow, and the restoration of the vessel to its role in supplying oxygen to my heart muscle. It was fascinating to watch this process. The relief I felt was immediate, not just to have the problem identified and addressed, but to know I'd been in such capable hands. Plus, for those who've considered me a heartless bastard, I now have proof otherwise.


Here's the lobby of Pablo Tobón Uribe hospital in Medellin. My only issue with this institution was the meals. I think hospitals and airlines were in competition for worst food, and the airlines lost. My meal ticket shows my mother's name. Colombians are extremely family oriented, and they typically use their mother's name to identify themselves. 


 My kitchen counter now resembles a CVS pharmacy. A BP cuff now sits where the deep fat fryer and the All American diet cookbook used to be.


I once lived in Colombia. Now I live in the land of Ace Inhibitors, Beta Blockers, Plavix & Lipitor. One of the toughest parts of this brand new world is the realization that it actually happened, and coming to terms with it. Especially since I was not a candidate for an MI. I'm a reasonably happy guy. I sleep well, exercise regularly, have a BMI of 22, very low LDL cholesterol, high HDL numbers, and I eat pretty well, too. I haven't had a cigarette in 40 years, and the only family I can discern with cardiac issues was my paternal grandmother who had a heart attack at age 64. So I find myself wondering WT..? Maybe I should have kept smoking? 


I'll behave myself, take my meds, eat around a Mediterranean diet, and get through the prescribed rehab, which is going well as I write this. On a happy note, my cardiologist said red wine is a very good thing. I intend to test his theory. Chocolate can also be therapeutic, I'm told.


But the psychological aspect of this event has been difficult. I'm now officially a heart attack victim. I have a 'cardiac history.' This reality will follow me forever. One of the toughest things is this: almost overnight, I feel old. I aged much more than one night that first night, and it will be this understanding that will focus my attention, along with the wondrous possibilities that lie between the dup and the lub. In part 2 I'll go into more detail about those things. 




















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