Anatomy of a heart attack – a love letter to all of you

by Bruce A. Smith 

Part 1, in a series.

One phone call is all it took to save my life.

 “911,” said the calm, even, female voice on the other end.

 “I’m having chest pains,” I replied.  “I’m 62 years old and I weigh 225 pounds.

 “Please stay on the line,” she said.  “I’m going to bring on a medical technician.”

 Instantaneously a male voice entered the conversation.

 “You’re having chest pains?

 “Yes.”

 “What kind of pain?  What does it feel like?”

 “It feels like a hand-grenade just went off in my chest.  I have sharp radiating pains all over my chest.”

 “Do they go all the way into your arms?”

 “Yes.”

 “Where else?  Into your neck?”

 “Yes, the pain is up in my neck and jaw, and it’s even in my teeth – the cavities in my teeth are ringing.” 

 He paused, then the woman spoke again.  “Medical units have been alerted and they are on their way.”

 I took a breath and listened for the sirens of the South Pierce Fire Department ambulance coming down from the 340th St Station, about two miles away.  I didn’t hear them.  I guess they’re just getting dispatched, I thought.  Give ‘em a few minutes…I hope they don’t have to come in from Roy.

 “Any trouble breathing?” asked the guy.  “Shortness of breath?”

 “No, I can breathe.”

 “Okay.  The medical unit should be there shortly.  Is there anyone with you?”

 “No, I’m alone, but I can call a neighbor to come help me.  He’s just on the other side of the driveway.”

 “Is there anything else we need to know right now, do you think?”

 “No, I’ll think I’ll be okay.  I’ll just wait.  The gate’s locked though.”

 “Would it be okay if we cut it?” said the female voice, jumping back into the conversation.

 “Sure, but I can get my neighbor to open it.”

 “Okay,” said the woman.  “Medical units have confirmed they are on their way.  Good luck, sir.”

 “Thanks,” I replied.

 “Yeah, good luck,” said the male voice.

 They hung up, and I waited.  Then I heard the first siren coming down Mountain Highway as I called my neighbor Dave and told him what was happening.  Without hysterics he confirmed that he would unlock the gate and direct the paramedics when they arrived. 

 “Hear those sirens, Dave?” I asked.  “That’s my ambulance.”

 I hung up and sat still.  The quiet drama of life and death flowed around me, but I went into a Zen-like calm.

 Then I realized I had to pee.  I stood up and walked outside to the garden to urinate as I usually do.  My chest ached.  I leaned against a post supporting my car-port-like roof over my little home, and as I relieved myself I heard the sirens getting closer – they sounded insistent like they were screaming past a red light.

 They’re coming for me.  Wow.  I’ve never had an ambulance come for me, before. 

 It all felt so new, so incredibly original and vital.

 I went back inside and sat again.  I listened to the sirens and I tried to follow their approach.  Are they coming down the Eatonville Cut-Off Rd or coming the back way down 352nd?  I couldn’t tell.

 I heard them get a little louder.  Must be the Cut-Off Rd.   Then nothing.  Silence.  I waited for another round of siren wailing.  Nope; it never came.  Where are they?

 I waited quietly for several moments, maybe minutes.  Who can tell time when you’re waiting for an ambulance?

 Then quietly, out of the corner of my eye I saw movement.  I turned to my left and looked out the window.  I saw blue uniforms.  Thank God.

 Dave was leading them and brought them through my garden gate and around to my little trailer’s door.  Three strange faces crowded around the entrance and peered in at me.  Well, two strange faces and one very familiar one – South Pierce Fire Department paramedic Cindy Worter, a woman I had interviewed two weeks prior for the Mountain News in a piece on the health impacts of wood smoke.

 “Hi, Cindy, it sure is good to see a familiar face, right now.”

 “I bet it is,” she said with a smile. 

 She began directing traffic.  She sent in one of her colleagues, a firefighter toting a blood pressure monitor and an EKG machine.

 Must be the portable rig they were telling me about that costs $50,000.

 The firefighter told me his name but I can’t recall it, as much of what was happening became wrapped in a blur of emergency, anxiety and drama.  He and Cindy began placing about ten EKG pads on my chest and legs, then Cindy attached monitoring wires.

 Then the firefighter put the blood pressure cuff on my right arm and pumped it up.  As he released the air he looked frustrated, and tried again.

 “It’s 169-something, but I can’t get the low number,” he called out.

 He tried again.

 “Still can’t get it.”

 Cindy traded places with him and re-positioned the pressure cuff.  She pumped up the bladder until I screamed.

 “Christ, Cindy, you’re killing me!”  I shouted. 

 “Sorry, Bruce – I’ve got to pump it up to get the reading.  It’ll only be for a second or two.”

 “Gawd, Cindy, it feels like you’re amputating my arm,” I said weakly, trying to complain and make a joke at the same time.

 Cindy pumped the blood pressure cuff up a second time and called out:  “169 IS the low number.  I’m having trouble getting the systolic!”

 She pumped past the original pain and kept going.  Then, she backed it off again, and then re-pumped even tighter.

 “It’s at least 219 – I can’t get it exactly.  It’s in the 230s, probably 238.”  She quickly unwrapped the cuff and grabbed my shoulder.

 “Bruce,” she said, “we’re taking you to the hospital.  Good Sam okay?”

 “Sure, Cindy.  Good Sam’s fine with me.”

 Cindy then barked out some more orders, and while one firefighter turned the ambulance around, another readied the gurney and then brought a “stair chair” in close to my door.

 “Do you think you can walk down your steps to the chair and we’ll wheel you out from there?” Cindy asked.

 “Sure.”

 She held my arm and steadied me as I descend two steps to the outside.  There, I plopped down in a skinny, metal-framed chair with small, hard wheels – almost like casters.

 They haven’t changed in forty years since I was an ambulance orderlie at the Meadowbrook Hospital in New York, I thought.

 I rolled through my garden, agonizing for the firefighter panting to pull me over the dirt and blue stones that lined my pathway.

 “I could have walked all the way to the bus,” I thought out loud, using the medic slang for an ambulance.  Why take a chance, I thought.  Besides, these guys are strong.

 At the “bus,” I was unstrapped from the chair and transferred to the gurney.  Then I was re-secured with a fancy harness that contained my shoulders, waist and legs.  Then they popped me into the back of the bus just like I had done for hundreds of patients back in my day.

 Cindy joined me, and re-connected me to the monitors.  She also gave me a shot of nitroglycerine in aerosol form.

 “Let me squirt it under your tongue,” she commanded.  “It’ll dilate your arteries and help bring down your blood pressure.”

 She also started an IV, and even though she assured me that she could do it while we swayed on the road, I insisted that she stick me before we started moving.

 “Thanks for doing it my way, Cindy,” I said as she got the IV flowing.

 I also asked that we not roll with lights and sirens, and that the driver move slowly and carefully, flowing normally with traffic.

 “When I was an ambulance orderlie,” I told Cindy, “I often thought that the use of lights and sirens was over-used.  I think it’s contra-indicated, medically.  I really don’t want to bang around back here as we accelerate and weave our way up Meridian.”

 The driver complied.

 As we crept down the driveway and began our journey through rural Eatonville, Cindy and I debated the finer points of medical transport.

 “If you stop breathing, Bruce, or your heart stops, we’re going with lights and sirens,” she announced.

 “I agree, Cindy.  No – when someone’s not breathing – or they’re bleeding – anything that is absolutely life-threatening – ya gotta run.”

 She smiled and nodded.  As we motored up Merdian, she gave me a couple more hits of nitro, and we watched my BP come down to 185 over 110.  She took notes and got all my vital information, including next of kin and explained Do Not Resuscitate.

 This is getting serious.

 I hesitated on the DNR, and we agreed that I could postpone life and death document signing until later, with a doc around to explain the finer details.

 She also assured me that since the voters of the South Pierce Fire District had approved the latest EMT Levy, my ride was paid for by the bond if I didn’t have insurance.

 “I don’t have money or insurance, Cindy,” I announced.

 “Then, don’t worry.”

 It was the first of many wonderful gifts from taxpayers and medical staff that I was to receive in this heart attack experience.

 She also called Good Sam’s Emergency Room and gave them the details of my condition.

 Fifteen minutes later, Cindy and the boys were wheeling me through the ER doors, past a monitor board indicating what room was reserved for me, and whisked me directly into a private ER chamber.  It was unlike so many ERs I have been in – with interminable waits, gurneys parked in the hallways awaiting a triage nurse, and a half-hour later – if the patient was lucky – a doctor.

 However, in my room an ER nurse arrived within seconds and I was transferred to the hospital bed.  More monitors and wires, a new IV in my other arm, and after a blood draw Cindy and her gang bid adieu.

 Thanks, I mouthed as they left the room.  I was sorry to see them go.

 My Good Sam team took over, and as they gave me some meds my mental acuity began to fade.  Pain killers, anxiety medications and vascular dilators began to work ever so gently.

 Fortunately, my body was helping, too.  I was soon to learn that my heart had experienced a 95% blockage in the rear circumflex coronary artery, and that the heart muscle tissue that was being deprived of oxygenated blood was sending out distress enzymes, which the blood tests quickly showed.

 With that discovery I was zoomed down to cardiac surgery, a large room called the Cardiac Catheter Laboratory, or Cath Lab, for short. 

 This is getting very serious.   

 But it all felt surreal since I had no pain unless I tried to move.  How could I be so ill and not have any symptoms?  Whenever I had been in a hospital before, I knew I belonged there.  I summoned my journalistic courage to ask a tech for a straight answer on my medical condition.

 “Say, would it be fair to say that I’ve had a heart attack?  No one has actually said that out loud to me yet today, the words ‘heart attack.’”

 “Dude, it could have been fatal,” the tech replied.

 Wow.

 I was prepped for an angioplasty to determine the size of the blockage and probable stent placement.  That meant more drugs, shaving off the hair on my legs, and signing releases.  My last coherent statement that I remember was my announcement to the three or four technicians buzzing around me, “I can still understand English!”  I felt very proud that I could still comprehend what was being said even though my ability to reply was quickly evaporating into a pharmaceutical haze.

 Nevertheless, here is what I understand happened next.

 Over the course of several hours, two physicians and the technicians opened up my right leg to access my right femoral artery.  Then they built a kind-of “work-station” there so that several tiny instruments could be inserted into the femoral artery and eventually snaked into my heart.  This portal included a four-inch plastic liner that was placed inside the femoral artery, and connected to a kind of gelatinous man-hole cover temporarily placed in my leg.

 Here is a list of what was placed inside this set-up and wiggled upstream into my heart: a camera or some kind of sonogram device to see where they were going, a balloon, and a small metal stent, which is a kind of flex-pipe for the heart.

 The balloon got inflated at the site of the blockage, which was caused by plaque, a hardened residue that takes years to build up.  When the balloon was inflated, the arterial tissue expanded and cracked loose the plaque.  Then the balloon was retracted and the stent positioned in the artery to secure the re-formed blood vessel.

 The stent is about the size of the spring found inside old-fashioned ball-point pens.  This ballooning procedure is called angioplasty and many heart patients get at least one stent.

 The docs also told me that I had a 30% blockage in another coronary artery, but the chamber that it served – one of four, two ventricles and two atriums – was still “ejecting” about 60% of the blood volume of a normal heart beat.  Since a 65% ejection rate is the sign of a wholly healthy heart, 60% is in the 90th percentile of perfection and they decided to leave it alone.  I concurred, and figured that I could clean up the rest with diet, exercise, and my work in consciousness.

 They woke me in the middle of the procedure to view the blockage on an overhead monitor; afterwards, I don’t remember a thing until I woke up in a cardiac recovery unit that evening.

 “Hi, my name is Catherine and I’ll be your nurse for the next twelve hours or so,” said a slim woman standing by the side of my bed.  “I just came on at 7.”

 I lay back on my pillow and said, “Okay.”  I was out of it.

 Catherine explained all of the procedures that would follow in my immediate recovery – blood pressure checks every fifteen minutes, hourly inspections of my leg to check for swelling or bleeding in the portal area, and monitoring of my heart’s EKG.  Plus, they were going to pull the portal device in a special bedside procedure at 4 am.

 I nodded.

 An aide came in and asked if I wanted any dinner.

 “Sure.”

 A turkey platter soon arrived.

 Catherine swirled about, taking care of me and three other patients in their adjoining single rooms.  She was one of the busiest nurses I have ever seen in my sixteen years of hospital work. 

 I had a large, spacious private room.  Monitors on stands straddled both sides of my bed.  It looked like the kind of place a really sick guy could be found.  But I didn’t feel sick – actually I felt pretty good – just a little woozy.

 After dinner I was more alert.  Then I got tired and dozed as Catherine came in regularly to do her latest medical chore.

 Besides being sleepy, on some level it hadn’t sunk in that I had a heart attack.  It was too foreign a concept.  I guess you could call it shock.

 About 11 pm Catherine also began working on my psycho-social history, and it felt like she was asking me about somebody I knew really well, a fellow who used my name and birthdate, but wasn’t me.

 But as she plowed through the paper work and kept testing my blood pressure and vitals, it began to dawn that I was recovering from a heart attack.  I began to ponder what that meant.

 Two things happened instantaneously.  I didn’t want to eat any fatty foods – it was an immediate revulsion of anything that would harm me and plug my arteries – no ice cream, butter, salt, or beef.  None.

 The other was a realization that I would need to change my life.  I had to fix the love in my life besides healing the blockages in my heart.  Love and my heart – the two go together like wind and rain, peanut butter and jelly, or hand-in-glove.

 Okay, cool, I thought.  I’ve been working on those issues for a long time.  Now, I’ve really got to make some changes for the better.  It felt like good news to my soul.

 So, when Catherine began asking me about how I lived, whether I was married, did I have a significant other or live alone, and who would be my next of kin, my initial resistance crumbled.

 “Okay, Catherine!” I called out.  “I admit it; I’m a lonely guy and I don’t have anyone in my life.  Yes, I live alone – it makes me a good investigative reporter – but I don’t really have any friends – not anyone that I can really talk to about how I really feel down deep.  I admit I’ve got to change that.  I need to create better connections with people, build stronger relationships – be less judgmental, be more open and loving – and being open to receiving love.  Love in all its forms, not just romantic or sexual stuff – but friendships and social connections – especially the love of life.”

 I went on for a bit, and Catherine let me rant.

 “I really am a ‘stop and smell the roses’ kind of guy,” I said.  “I’ve just got to do a better job of it – really appreciate the beauty of life.  I’ve got to learn how to really love my life, and I haven’t up to now.”

 Over the next several nursing shifts, I deepened my awareness of how I got my heart attack – too many fatty foods, not enough exercise, and not enough love expressed or felt. 

Katie came on at 7 am, and after my deep sleep until noon  she preached the virtues of salmon and veggies.  I told her that I already ate as much salmon as my food-stamp budget would allow.

 “What else besides salmon is good for the heart – how about whole grains?” I asked.

 Katie stumbled searching her guide book for an answer.  I resolved to call Ray Cool, a guy from Graham who has lost 140 pounds in the past year eating the way I now needed to feed myself.

 Catherine returned in the evening and we continued our conversation.  The next day, Colleen saw me through my discharge day at Good Sam, ushering me out the door late in the afternoon on Tuesday, February 28.

 It had been a wild 48 hours of heart attack – from mid-day Sunday, Feb 26 when it hit until Tuesday afternoon when I rolled out in the proverbial wheelchair.  With my new insights and resolve I launched the first baby steps of change:

 First, I called everyone I could think of.  I wasn’t going to be a stoic suffering in silence or isolation, which has been my tendency and was often punctuated with sharp bursts of whining.  No, this time I wanted something in-between.

 I called Dave and gave him the news.  I also called my writing friend Judy Spiers for a ride home upon discharge.  As stalwart a friend as Dave has been – watching my back and making sure I have a roof over my head – I decided that I didn’t want to ride home in his pick-up truck with a bad door and iffy heat.  Instead, I opted for some self-love and asked Judy for a ride in her Lexus.

I called Carol Wright, perhaps my truest kindred spirit in Graham, and she came to visit.

 I called New York and spoke with mom, sis and my ex.  I savored the scene as I watched the energies of love back home swirl around and seek to gather me to its bosom.  I shaped it as it grew, and offered caution when it grew testy, such as when my ex began chastising me for being “cavalier” with my health.  What she was really saying (I think) was, “Don’t you dare die on me, you sonovabitch.”  Ah, love comes in so many forms.

 I also received more love from the folks at Good Sam.  I got a social worker, and I signed all the paper work for charity care to cover the stent operation and for Medicaid to provide continuing aftercare.  She also set me up for cheap meds at Walmart.

 So, I survived the crisis, and all it took was one phone call – to a 911 dispatch operator who picked up on the first ring.  Say what you will about national health care, we have certainly figured out a system to take care of people when they have a heart attack – even guys who are broke.  I am very grateful, and I thank each and every one of you.  There was nary a delay anywhere in the system, and I received Cadillac care every step of the way.

 So, I thank you for voting for the common good, paying your taxes, praying for me, sending me your healing thoughts, and doing everything that needs to be done to make sure that guys like me stay alive when their heart can’t pump.

 I’m now in full recovery mode, and from time-to-time I’ll be sharing additional updates as I explore my new world of cardiac repair and love.

Me and Sis at Paradise, October, 2010.  If you'd like to be part of my "strolling" club, give me a call.

Above picture:  Sis and me at Paradise, October, 2010.  If you would like to join me in my daily strolls, give me a call. 

©  2012  Bruce A. Smith

 First in a series on health care, heart attack recovery, and building a joyful, loving life.

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26 Responses to Anatomy of a heart attack – a love letter to all of you

  1. Nancy Mays says:

    Oh,my gosh, Bruce!!! So glad you are okay….and you are the guy who was going to WALK home from the Graham FD the day we saw Cindy!!!! Get better, be strong, and keep up asking for and graciously accepting help! I’ll be in touch. This is a wonderful piece you wrote…thank you for that!
    Nancy Mays

  2. Jeff London, The Sovereign Scribe says:

    Wonderfully engaging story Bruce, about a day not easily forgotten. Thanks for documenting it so well and for being here to tell it. I especially liked how ‘original and vital’ you felt while waiting for your ambulance. Well done.

  3. Dick Thurston says:

    Hang in there, Bruce. I can identify with you all the way. I had a triple bypass in 2001 and had a bit of a scare back in December when I got some atrial fibrillation. Graham Fire & Rescue was there for me, did a great job and kept me informed the whole way to Madigan. The people at Madigan were great, too. After 24 hours, i walked out with stablized heartbeat and a bunch of new pills. So take your pills, do your rehab and be glad we have a good fire/rescue system.

  4. Paula Morris says:

    Bruce,
    I’m glad you have reached the point of writing about your experience. Usually, going over the whole thing, rehashing it, mulling over it…whatever, helps to get it out of “shock mode” from deep in your psyche and out into the frontal lobe area where you can understand it in the here and now and slowly let that scary stuff evaporate away. You did an exceptional job clarifying and defining the whole process….using it as a real teaching episode!

    Yep…that part about giving and receiving love is vital to a healthy heart–and life. Out of great adversity can come great healing and growth.

    This is from the nurse in me: A small amount of cabernet and dark chocolate are “heart healthy!” :o) Also, use lemon juice instead of salt, grated low fat parmesan instead of yellow cheese, and olive oil instead of butter. You can even have a few real whole eggs per week. So, eating healthy doesn’t have to be boring.

    Take care and continue healing.

  5. Karen Shearer says:

    I’m glad to hear that you got through this and are improving. Blessings.

  6. Thank God you are alive to tell the story. It makes me glad to see my tax dollars are going to help people like you who need it.

  7. Peachy says:

    Dear former cavalier,

    Great piece. Looking forward to more good writing based on less scary personal material.

    With love — your existing

  8. Matt Hamilton says:

    Wow , I learned so much about the heart and stents and what to look for Bruce . Great first hand account . Once I started reading Bruce it was great to read the details and what happens . That story needs to be sent on for larger distribution… Please take care Bruce …. Matt

  9. Kare says:

    Glad you are doing better and that you are working thru all of the feelings physically and emotionally. Hang in there. Blessings,

  10. David J Johnson says:

    Dear Bruce,

    What a shock.

    Please take things steady for a while and conserve your strength. Both Susie and I wish you a complete recovery.

    With very best wishes from Portland, UK.

    As ever,

    David

  11. John Marshall says:

    This one brought tears! A week after we spend almost a whole day together, with breakfast at Micky D’s and then that fine lunch at the Hanger Inn, you are in full cardiac arrest! Bruce, you are remarkable! I wish you all the best.
    Your friend,
    John Marshall

    • brucesmith49 says:

      John, I had my last hamburger with you – remember it well, PLEASE! I may need you to remind me how it once tasted…

      …but I can do without those sausage breakfast burritos at Micky D’s.

  12. Carol Goldstein says:

    A second chance, SWEET! So many can’t claim that! You’re meant to write many more articles! I look forward to them all, including the wellness ones! See you in Orting at the Daffodil Parade!!

    “Let food be thy medicine and medicine be thy food”

    • brucesmith49 says:

      And if I may Carol, I strongly advise that dark chocolate be recommended next year for the vendors at the “Chocolate Stroll.” Perhaps I can be a consultant (hint, hint…)

      Smile.

      Yes, see you at the Daffodil Parade. Last year, I had a blast. Lots of down-home fun.

  13. Charlyne says:

    GREAT WRITING!!! I was hanging on to every word. I’m thrilled that #1 – you called 911 right away, and #2 – that all is well with you once again and your headed down the path of health and love. Nothing like “a wake up call” to right the wrongs of our day-to-day journey and set the frontal lobe to focus. As I’ve told you in the past, you are such a wonderful story teller and writer. As I was reading it, I could actually hear your voice as if you were here telling me all about your experience. I’m so glad I’ll have the opportunity to read more from you in the future and listen to your wisdom. Love your beautiful being!!

  14. gkcclc says:

    Today the lesson was how we can see more clearly after the “dark” events in our lives! (-:

  15. Melanie H says:

    Glad to hear you’re doing well after a scare like you had. Sounds like you should’ve stuck with Zumba way back in 08. LOL Kangoo Jumps might be more your style. 🙂 I wish you all the best and a happy healthy life for many more years! Melanie H.

  16. JM says:

    Good article. Enjoy the path back to health.

  17. Rory Sagner says:

    Ohmigawd Bruce, that is one of the best things you have ever written…straight from your heart if you’ll pardon the pun! I know that this is indeed a blessing for you and the opportunity for you to heal and address what your soul really wants.
    I cried reading your account and was so moved by your perceptions and your openness!
    And judging from all the comments here…..there is a lot of love for you readily available! Thank you so much for sharing your story and I’d love to know more about your change in diet and come take a walk with you soon!
    Love,
    Rory

  18. Judi Flanders says:

    This story needs to get to others who had a similar experience. You worded it beautifully and I know now how you must cherish life. My father and grandfather died at 60 of heart problems. The heart means joy. I don’t know if you take coq10 but it is excellent for the heart. I visit the area of Yelm often and know your experience is your wisdom and will help others.

    • brucesmith49 says:

      Thank you for your kind words, Judy. Yes, I do take Co-Q 10, upon the enthusiastic encouragement of my chiropractor step-daughter! I agree with you about sharing this story with a wider audience. I sent it to a buddy at NPR and another at This American Life, along with lots of local distributors, such as the TNT. One web site, for the Good Sam Health Care System, is doing a feature story on “the story” and it will be out in May, so that’s a start.

      I’m also in a national health study examining how quickly guys like me get to a hospital – what are all the socially conditioned fears and impediments to getting help. 40% of guys like me, and you father and grandfather perhaps, don’t make it in time. The average American takes four hours to get to a hospital, and by the time I decided to call 911 a much longer period of time had elapsed. I’ll be writing about that in the near future.

  19. Pingback: Anatomy of a Heart Attack – The Recovery | The Mountain News – WA

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