The Wonders of Modern Medicine

Stock photo; not my actual shaved and herniated belly.

So it turns out I ruptured myself a few weeks ago (I don't really know when; I noticed the hernia while I was wallowing in the tub) and I need to go have the surgeon repair it. It's relatively minor surgery and, if it goes well, I'll be sent home the same day. Back to work in a week or so. (Probably best not to putt any shots for a few weeks, though.)

So since they'll have to put me under for the surgery, I had to have a screening EKG before hand. So Thursday I walked from my office down to the hospital to have the EKG done. I didn't even bother to take a book since it should take maybe five minutes.

So the technician takes me back into the room where they keep the EKG and starts wiring me up. She comments that all the chest hair makes it a bit tough to attach some of the leads. (<--Ominous foreshadowing.)

So the machine goes klick-klick-klick and spits out an EKG strip. The technician looks at it, boggles, and asks me how I'm feeling. "Er, fine, why?" "Because this says you're in the middle of having a heart attack."

Well, okay, then. My chest obediently starts aching, I'm suddenly short of breath, and I feel like I might faint. Who wouldn't feel that way?

She steps out to show the ER doctor, to get his opinion, and closes the door behind her. About ten seconds later the alarm comes on: "Code Blue, Dr. Salazar's office, Code Blue, Doctor Salazar's office, Code Blue, Doctor Salazar's office." I hear the thundering herd headed down the hallway outside, lots of running feet and heavy equipment being rolled, and so help me I almost passed away right then.

The nurse comes back in about ten minutes. "Sorry, we just had a bit of excitement. A patient was taking a stress test and his heart stopped in the middle of the test. Let's run your strip again."

Klick-klick-klick. "Okay, it doesn't say you're having a heart attack this time, but it's saying you had one an unknown time ago." I guess I missed that one. "I really recommend you check yourself into the emergency room so we can do some more tests and be sure you're okay." I really couldn't say no to that, could I?

So they put me on a gurney, wire me up like a motherboard, put the little clip on my finger to measure my pulse and oxygen saturation, put a blood pressure cuff on my arm, put a needle in my other arm to get a blood sample and in case they decide to start running an IV, have me chew four baby aspirins, and stick an oxygen tube in my nose. That oxygen is great stuff; I'm still scared stiff but I feel my mellow coming on. All of this takes about ten minutes.

So now they run yet a third EKG strip: Klick klick klick. "Gee, this one says you're normal." Okay, nervous stress and all: I bust out laughing. Nurse goes out. Comes back about five minutes later and tells me, in essence, that if you squint at the strip just right you can see something that's not quite right...

Then I sit on the gurney for three hours while they tend to other things. I am not kidding. Three hours. My work day is wasted, I'm scared stiff, and there's not a book or television anywhere. About all I can do is lie back and try to get some sleep. Which, thanks to being on a surprisingly comfortable gurney and huffing pure oxygen, I'm actually feeling like I might be able to do. So I start to drift off, and ... Honk honk honk. The patient monitor is flashing its "If I may have your attention, I believe this patient is croaking" alarm.

Now, understand, I habitually walk about an hour a day, briskly. My normal blood pressure is about 90/60 (and, in fact, that's what the monitor is showing, thanks to the oxygen compensating for me being scared out of my gourd.) My normal resting pulse is in the 60s, and, thanks to the oxygen, it's gone even lower. To be precise, it dipped below 50 and set off the alarm. So no sleep: Every time I try to doze off, the Honk honk honk snaps me out of it.

So after three hours the emergency room doctor comes in, scratching his head. "Gee, everything looks good, except for those first couple of EKGs. We're going to let you leave, but go make an appointment with the cardiologist for a followup screening and stress test before you have your surgery." So the blood test didn't show any heart tissue dying just at this moment, good.

I walk over to the cardiologist: We can get you in Thursday; when's your surgery? Wednesday? You're going to have to reschedule. You are not having surgery until we run this down. Well, I wouldn't, anyway. (Great.)

So I walk back to my office (cough cough a half mile away cough cough) and call the surgeon's anaesthesia nurse to reschedule. I tell her the whole story (as it has transpired thus far) to the accompanyment of much sympathetic blasphemy on her part. "Well, I'll bet I can get you in to see a cardiologist at the Heart Institute; we use them a lot. Maybe we won't have to postpone." I'm not adverse to a more rapid diagnosis of what in profane metaphor is going on, so I agree to that, and she gets me an appointment the next day (Friday) in Espanola where the Heart Institute will be running a clinic.

Being a stubborn cuss, I go ahead and do my walking exercise Thursday night. If I'm dying, I'd just as soon get it over with now, y'know? I feel all kinds of twinges and aches in my chest ... but then I always do. I've got arthritis in my back and a touch of gastric reflux and the minor pains these cause me kind of radiate wherever in my torso they feel like. And there's something about being told your heart is maybe failing that lowers your pain threshold by about a factor of ten, y'know?

So after thirty hours of white knuckled fear, I show up at the clinic for my screening. There are two technicians waiting for me. I tell them the whole story (as it has transpired thus far) and so help me, they smile. The one tech allows as how the electrodes for an EKG really need to be placed right, or you can get false readings that look like a heart attack. Do you mind being shaved? Heck, no, do whatever it takes to get an accurate EKG. I want this done right. I get strategic patches shaved in my chest hair, the electrodes are all carefully put in place, the tech hits the button on the machine ... and their computer promptly crashes.

I'm thinking about something I once read, about an unfortunate convict with his neck in the guillotine looking down into the head basket for about thirty seconds while his executioners tried to get the blade unstuck.

Finally the computer boots up. Didn't take long but it sure felt like it. Klick-klick-klick. "All right, Mr. Budge, we're done. You can sit up now." I sit up; the tech is looking over the strip. "Okay, the doctor will be in in just a few minutes to discuss this with you." As she heads out the door, I see that she is trying real hard to hide a smirk.

I know then that I am in the clear.

Cardio comes in. "Well, Mr. Budge, your EKG is perfectly normal." AAAAHHHHhhhhhhh...

He goes on and mentions that I do have a perfectly benign idiosyncrasy in my EKG that is not uncommon in "younger men like yourself." Heh. I like that "younger men" thing. We talk about how I feel when I'm exercising: Yes, I get pains in my chest, and just about everywhere else. From the arthritis, I thought. No, they don't get worse with time or with harder exercise. No, I don't particularly get out of breath. "Well, good, Mr. Budge. Relax: You are NOT having a heart attack. However, you're still going to have to postpone your surgery."


He gives me a quick lesson on heart attacks. He's got this groovy model of an artery with various thicknesses of plaque in it. "As a diabetic, you're going to have plaque in your arteries. It's just how it is, especially with a family history of heart disease. Since you can sustain a brisk walk for forty minutes without any particular difficulty, we know your plaque is still thin and not obstructing blood flow significantly. That's good. But it's not the thickness of the plaque, it's the area, that determines risk of a heart attack. Thin plaque is almost as likely to rupture and trigger a blood clot as thick plaque."

I did not know this.

"So we have to consider you to be at risk of a heart attack. The risk is reduced by regular exercise; you're already doing that, good. You should also be taking a statin, which helps prevent plaque from rupturing easily; you're already doing that, good. You should start taking a baby aspirin every day, but not just now since you're planning surgery. And you should be taking a beta blocker, and should be on it for at least seven days before surgery. Your surgery is sooner than that so you'll have to reschedule."

He explains that the beta blocker reduces blood pressure and heart rate. "So we'll adjust your dose to get your pulse where we like without lowering your blood pressure too much. Looking at your chart ..." Long pause. "Hmm. Your blood pressure is already 90/60." The tech chimes in that my pulse was down to 50 the previous day in the hospital.

Long pause.

"No point to a beta blocker, we can't safely take your blood pressure any lower. Have a nice surgery, Mr. Budge. No, I don't think we'll do the stress test; with your walking routine, you've essentially already passed the stress test."

Copyright 2012 Kent G. Budge. All rights reserved.