Passing the ham, part 2. So I mentioned to my boss that I needed to take off a bit early, what with the incipient heart attack and all, and he nicely dropped everything and drove me to the hospital. I ran through my list of symptoms for the woman behind the admissions desk, and quickly got wheeled to an exam room where they hooked me up to a variety of beeping and blinking gadgets. (By this time, I had called Moira and said, Don't freak out, but could you come to the emergency room right now? I'll explain later.)

I recited the symptoms again to the emergency room nurses while they were rigging me up, and then again when the ER doctor appeared. Then Moira and Ranting Spawn arrived, and we sat in the windowless room, and waited, and waited some more... eventually the ER doc. reappeared; my ECG was normal, indicating no obvious damage to the heart, and my blood tests were clean - there were none of the enzymes released by stressed or dying heart muscle present. So there was nothing obviously wrong -- but given the chest pain, the risk factors, etc., he wanted to run me through a cardiac stress test. But it was too late in the day. I would have to wait. Overnight. In the hospital. I tried to argue that we only lived 10 minutes away, I could be back in the morning in a jiffy - but he wasn't buying it, the cardiologist had a full night's worth of periodic poking, jabbing, and prodding planned for me already.

So M. & R.S. left to pack me an overnight bag. My shirt and sweater were replaced by the usual dignity-sucking hospital robe. A nurse looped an oxygen line over my ears and up my nose. I had ECG leads stuck all over my torso, and I could just see the monitoring equipment if I turned my head a little. A nurse stuck an IV into the back of my hand, not for anything in particular, but just in case. Every fifteen minutes a blood pressure cuff would automatically inflate and take my blood pressure.

After a while, the cardiologist came in, and I gave him the Litany of Symptoms again, and then the he asked the usual chain of questions, which I answered as I had before.

Moira returned with my bag, and then they wheeled me upstairs to my room. Not bad – private, (fake) wood-paneled floor, LCD TV in the corner, "room service" on demand... "Hey, can you take this thing out of my nose?" The nurse checked my oxygen saturation and shrugged. "Okay." Ahhhhhhh. Then she hooked up all the ECG electrodes that were still stuck all over my torso to a small wireless unit that attached to the gown - they could track the ECG's of all the cardiac patients on the floor from the nurses' station.

In the morning I was all ready to get tested and get it over with, but my schedule was not the hostpital's schedule. From what I could see, the hospital moved at a languid pace, with at least an hour between any sort of major event, such as me being moved to the stress lab, or being moved back to the room, or having person pop in and give me an update as to what was going on. I ate breakfast (egglike substance, bagel, low-fat "cream cheese", orange juice). I finished Flashman. I picked up Thucydides. Those Athenians sure were full of themselves, weren't they? Pericles was all, "Hey, face it, we're tyrants. Let's be the best damn tyrants we can be!"*

My regular physician came by, and I repeated the Litany of Symptoms again. A nurse came in with a Russian accent an a metal-shielded syringe. "I have to give you the tracer now," she said. She attached the syringe to the IV line sticking out of my hand and depressed the plunger. "There. Now you are radioactive." (Now you are radioactif.) More waiting. More endlessly quarrelsome Greeks. About 2 hours later, they wheeled me down to the nuclear medicine lab, and I lay very still on the gamma camera, a small table with big moving detectors clustered closely around it. I had to lie there for about 20 minutes. It was quiet, dimly-lit and not unpleasant; Paul Simon's Negotiations and Love Songs played in the background. Some of the lyrics were a bit jarring: "Now I would not give you false hope/ on this strange and awful day..." but not a bad patient experience, overall.

I watched the monitor, scintillating points of light outlining bits and pieces of my insides. My gall bladder was intensely lit up; a sign my liver was dilgently trying to scrub this strange foreign substance out of my body. The intestinal circulation was a diffuse halo, and my heart was a dim oval near the top of the image. After round one with the gamma camera, they wired me up to another ECG** and made me stress out on a treadmill, followed by another dose of tracer in the IV, followed by more waiting, followed by another session with the gamma camera (still with the Paul Simon), followed by a return to my room. Then the wait. Surely it can't take this long to interpret results, I thought. How much is all this costing, anyway? I briefly entertained a few visitors. Finally, the nurse on duty came in: My stress test results were abnormal. The cardiologist would be in with details. When?? Sometime.

I called M. and told her what I could – it didn't look like I was getting out anytime soon. Pace, pace, pace. As I was pacing, the cardiologist, a small, dapper man, fell in with me. We returned to my room. "So, what do you do for a living?"

"I'm a software programmer." (Incomplete, but the simplest answer.) He looked me over for a second, and said, "Here's the situation." He started writing on the whiteboard in my room. "There's a patient with chest pain." He wrote CP +. "Cardiac perfusion at rest is good, and exercise capacity is good." He wrote Ex. Cap -. "Blood enzymes look good." He wrote Blood en. - "But under stress, the muscle at the apex of the left ventricle showed less of a signal than the surrounding muscle, possibly implying a blockage." He drew a very credible little heart diagram, showing how the tracer didn't distribute itself as expected. Then he wrote Card. perf. + "Given this, and adding in the patient's history of hypertension –" hypert. + "– high cholesterol –" hyperch. + "– and family history –" fam. hist. +; what would you do?"

"I'd assume that there was a problem."

"Yes. The most likely explanation for you episode is that there is a partial blockage in this region of the ventricle –" he circled the apex – "and that something -- a clot, a broken-off bit of plaque -- got stuck at the blockage momentarily, resulting in the angina. It will happen again, and it will probably get worse. An angiogram will tell us definitively what the state of the arteries is in your heart; it is the gold standard. Depending on the degree of blockage, we can either prescribe medication, or perform an angioplasty, insert a stent, or (in the worst case) perform bypass surgery."***

Oh yeah, I'm lovin' this. "When would you perform the angiogram?" Can I please please please go home now?

"As soon as possible. Tomorrow."

"And could I go home, before....?"

"No. I wouldn't advise it. You need to be prepared." Oh, great. I'm never getting out of here.

---

* A paraphrase.

** I was still finding and removing ECG electrodes from my body the morning after I finally got back home.

*** Another paraphrase.

Posted by David Fleck at 28 January 2008 06:43 PM