Heart Bridge (eBook)

1:
The Gold Standard

First symptoms, first hospital stay ~ Angiogram ~ Manchester terror attack ~ “My cardiologist”

“I think you have a problem with your heart.”

So she said and the heart in question sank. I had just described to my doctor the various symptoms that I had recently experienced while riding my bike: chest discomfort and a heartburn feeling. This had been going on for about a month during morning cycle rides to work and was easily dismissed as a consequence of my increasingly bad habit of having heavy cream on my morning ‘Special K’.

Some weeks earlier, I had gone on a regular fitness ride from my home in Mill Valley to the Golden Gate Bridge via Sausalito. On the start of the climb out of the town there it was again: the heavy chest and heartburn but this time also something new. My energy level dropped and I had to pull over and hang my head on the handlebars as if I had just drained myself completing a stage of the Tour de France. I was exhausted but strangely not out of breath. Another cyclist passed me, detected my distress, and yelled out: “Are you ok?” I wanted to say “Not really – this is very wrong” but instead I shamefully replied: “I’ll be fine – thanks”. Apart from the blatant lie, I knew that this hill was never so challenging. I also hate to be overtaken by other cyclists on a climb. Still, after a few minutes by the road, my energy level – and pride – were restored. I cautiously cycled up the rest of the hill and completed the ride without further incident.

About a week later at the family dinner table, my 10-year-old daughter told of a curious occurrence at her school that day. During a PE session, a whole bunch of kids had simultaneously exhibited asthma symptoms. It was May and pollen levels were reportedly very high. I wondered how unusual mass outbreaks were.

With this still in mind, I set out the next morning for my commute cycle to work. I had decided to catch the ferry to San Francisco from the terminal in Larkspur. This meant the start of the ride from Mill Valley would be over Camino Alto grade – a steady 300-foot climb of around one mile – a vigorous, five-minute-long cardio exercise. As I started the climb, not unusually, I saw two other riders about 100 meters ahead chatting side by side. I was slowly catching them. Target in sight! But as the hill steepened, my legs turned to jelly, and shifting down gears was of little help. The other cyclists pulled away and disappeared around a switchback bend. Yet I persisted – I know how this hill should feel whether I am fit or unfit. Something unusual and new was happening, but I could not or would not yield until, nearing the summit, I was most definitely compelled to stop and pull over. I was now not only lacking in energy and feeling strong chest discomfort but was also nauseous and salivating. I remembered my daughter’s tale about her classmates the previous day and thought: Wow, did I just have an asthma attack?

I recovered quickly as I freewheeled down the other side of the hill and, eventually, made it to work albeit with an abnormally low energy level. While grabbing a coffee, I confided in a colleague about my ride and my asthma speculation. She was unsure but was unequivocal that I should not delay contacting a doctor. I made an appointment as soon as I got back to my desk. There was a slot the next day – Friday, 19th May 2017.

So here I was, face-to-face with my doctor. She quickly dismissed my asthma suggestion but she must have noticed my shocked expression at her suggestion that the symptoms were heart-related – I had no reason to doubt her tentative conclusion – so she then tempered it by pointing out that there could still be other explanations. After all, I did not have the usual risk factors for cardiovascular disease. I was 48 years old, in otherwise good health, kept myself moderately fit with regular exercise, ate the right things – mostly, had never smoked, and was not overweight. However, my reported symptoms were typical of a coronary artery blockage of some kind so she was estimating that it was 70/30 likely to be heart-related. She sent me for an electrocardiogram (ECG) stress test that same afternoon and I hung my hope on that 30%. After all, Donald Trump had just won the presidency from much shorter odds.

The test involved exercising on a treadmill while wired up to an ECG monitor. I fully expected to show this machine who was boss. Whatever I was experiencing could not be my heart, could it? Let’s rule that out right now. And so the test began – the treadmill put me into an increasingly brisk walk for two minutes. I felt fine, good even, and was about to ask the technician to feel free to step it up a notch when she abruptly stopped the test. She eyed me with a steely, grave expression.

“You did the right thing by seeking medical help.”

In other words, although I felt fine, her charts showed something of concern. She handed me a brochure and gave me a warning:

“Under no circumstances should you do anything this weekend except relax. On Monday, a cardiologist will be in touch about the next steps.”

I returned home and flipped through her glossy brochure which was titled ‘Living with Angina’. Living with? There is no cure? There were photos of smiling, graying, elderly folks supposedly coping well with their condition while gardening or sharing a joke over coffee with friends. This was depressing. I sat on my bed flipping through the superficially positive pages and felt genuinely middle-aged for the first time in my life.

My only experience with the word ‘angina’ was the knowledge that my father’s mother had this complaint before she died, suddenly, in her sleep when I was an infant. I googled ‘angina’ – the full medical term is angina pectoris, meaning literally “chest strangulation” – and read that, before modern times, the condition was considered a harbinger of death. OK, this is now more scary than depressing. The doctor had prescribed a cocktail of meds which I now started unenthusiastically. An anxious sleep followed where I was not able to shake the plight of my hapless grandmother, now seemingly connected to her in a way that I never was in life.

The next morning, Saturday, while out driving for an errand, I felt an indistinct anxiety start to develop. Is this what the technician was worried about? Was it a side effect of the meds? As I felt my heart racing, I decided that I simply had to go to an ER despite my instinct to ignore the anxious feeling and not be silly. Given what I have learned in the last 24 hours, how can I do otherwise?

I drove myself – I would be chastised for doing so later – to the local Kaiser-Permanente hospital in Terra Linda, just north of San Rafael. I was duly checked in, and presently, the on-duty medics hooked me up to an ECG monitor and inserted an IV line as a precaution. They soon determined that I was in no immediate danger.

Hours passed and eventually, I was advised that they needed to perform a coronary catheterization procedure. These were carried out at the cardiology unit of Kaiser’s Medical Campus on Geary Boulevard in San Francisco, henceforth “Kaiser-Geary”. A doctor impressed upon me that it was the center for all of Northern California and that the procedure was “the gold standard” for determining the state of the arteries around my heart. 

“The team there is very good; you will be in good hands.”

They booked me for the next Monday and so, given it was Saturday morning and, out of an abundance of caution, I was committed to spending the rest of the weekend lying in a hospital bed watching cable TV, enjoying free hospital food, and getting used to wearing a hospital gown.

This was my first overnight hospitalization since I was a child. In between, I had enjoyed a life of great health punctuated only with a bad cold or flu every three years or so. Since moving to the United States in 2002, I had regular annual health checks where it was often remarked upon that I had a very low resting heart rate and that I must, therefore, be super-fit. This made me feel great, obviously, but I knew deep down that I was no triathlete and as the years passed, I came to regard my heart rate as just abnormally low.

As I attempted to sleep that first night, an alarm sounded just at the moment I was dozing off, waking me up. The alarm stopped. I thought nothing of it and closed my eyes. Again, I started to doze off and again the alarm sounded just at the crucial falling-asleep moment. This cycle was repeated a few more times before I guessed that the alarm was being triggered by a too-low heart rate. The alert level was set at 50, low relative to the human average of 72 but, evidently, not low enough for me. A nurse reset it to 45 and I was soon enough in the land of nod despite the lights and other intermittent activities on the ward.

The weekend passed quickly – there was always something going on. On Sunday morning, I had an echocardiogram – an ultrasound of the heart. Fascinatingly, I watched my own heart beating in real time, noting especially the strong flow out of the aorta, without any squeamishness as I chatted with the friendly technician. Later that afternoon, my wife Ann and 10-year-old daughter came for a visit (my 13-year-old son was away at a Boy Scout camp). All three of us were sure the situation was overdone and purely precautionary. The only evidence justifying me being...