Cardiac Catheterization
2006.12.15
These medical satire things are getting harder to write about as they become more serious, but I guess I owe it to others to relate my experience with cardiac catheterization, angioplasty and stent placement.
With all the work I've done in the past few years to lose weight and maintain a fitness schedule (see Bicycling in Brownsville), you would think some of the Gods would smile on me. I'm here to tell you it's not what you did in the past couple of years to maintain fitness, it's what you didn't do for 20-30 years prior to that. Like every other human being that hasn't faced a life-threatening illness, I was immortal. So, when I started having chest pains, especially during my morning bike rides, I ignored it. Finally it got the better of me and I succumbed to a visit to one of the fine Methodist Hospital facilities in Memphis.
I didn't go to the nearest facility. I live fairly close to the Midtown branch, but I've been to that ER with my wife before and we spent the better part of our lives there one day. So my wife and I trekked down to Methodist South and got in fairly quickly. First you get to see a receptionist who asks the minimal number of questions possible to determine who you are and what's wrong with you. After you're labeled with chest pain, she hollers to the nurse standing 8 feet away, "I've got a CHEST PAIN here!" I look around and notice that most of the people waiting are asleep, so I don't have to feel too embarrassed. Then I'm instructed to have a seat and someone will call me.
So we wait for about 20 minutes and they call me in to see the triage nurse. She takes my blood pressure, temperature, puts sticky things all over me, takes an EKG, a brief history, starts an IV line, draws a blood sample and we go back out to wait some more.
This time, when we're called, we're lead deeper into the bowels of the ER to room #1. I must be pretty important to rank such a room number. Here, over the course of an hour or so, I am visited by about 5 different people each of whom must never talk to one another or read what has already been entered into the computer because every one of them takes my history all over again. A nurse practitioner explains that I'm on track 2 for cardiac evaluation which means 3 blood samples are to be taken over the course of a few hours. She also tells me that my myoglobin and troponin are elevated despite a normal CK-MB. I know what this means because I'm a Clinical Chemist and have studied this stuff for years. It means that there may be heart damage or there may just be a shortage of blood getting to the heart muscle. This starts to worry me. Then a cardiologist and his cohort explain that I'm going to be in the cath lab within an hour or so. Now this really rings a bell with me. The words "cath lab" hit home.
The hour or so stretches into about 3 hours and then I'm visited by a nurse who needs to give me a shot of benadryl in the hip and 5 mg of valium just before they take me to the prep room outside the cath lab. I never have understood what the benadryl is for, other than it is one of the more painful shots you can receive. No trip to the hospital is complete without iatrogenic pain.
I am still waiting for the valium to kick in when they start wheeling me back to the cath lab. I explain to the nurse that I am nervous and that the valium is not working. She comforts me with "Oh, we'll give you something to make you sleep. You won't even know you have nerves in a little bit." She then shaves both sides of my groin and removes the excess hair with broad swaths of surgical tape.
So, they transfer me to an ice cold table, tape a towel across my genitals and paint both sides of my groin with disinfectant. Then a nurse injects the shot into my IV that I've been waiting for -- the nervectomy. A few shivering minutes pass and in walks the cardiologist. I can feel a little bit of the nerve remover work, but not nearly enough in my book. The cardiologist inserts a needle into my femoral artery and starts the procedure. They inject a dye which I am warned will cause a hot flash. This is probably the understatement of the year. What a total body hot rush! But, I was so cold, it actually felt good, so I dozed off. From time to time I am awakened by some chatter and I grab occasional glances of pictures of my heart arteries on the video screen.
When it's all over, Dr. McGee tells me that I really did well and plays the video of my heart for me showing me the before and after pictures. Jesus Christ! The before picture shows this half inch segment of right coronary artery that is just a thread! How the hell had I been operating with this thing? The after picture shows a completely patent artery with stent in place. "I've got to have a copy of this video," I tell Arnie the tech. He tells me it's no problem.
Now I am supposed to be transferred to some kind of step down room, but they don't have any available so they put me in ICU. This is an acronym for "place where you cannot possibly sleep." Every ten seconds some type of alarm, bell or whistle is going off. Every 15 minutes a blood pressure cuff is squeezing the hell out of your arm. Every hour someone comes in to take your temperature and ask you how you are doing. You can't get up because you're tethered down by a mass of tubes and wires resembling the aftermath of Katrina in Southern Mississippi. My back had begun to ache from lying in bed all day and all the night nurse could tell me was to keep my right leg straight until 2 am. "Would you like something for pain?" "Yeah, I'd like about 3 fingers of a nice single malt scotch!"
Oh wait, let me tell you about the wonderful food. I swear to God, this was the cardiac special the first night -- chicken fried steak. Can you believe it? Chicken fried steak! Breakfast was better with stuff I'm accustomed to like oatmeal, egg-beaters and pancakes with no butter. The entree for lunch was a hamburger patty swimming in grease. Now I'm starting to get a little pissed off. Are they trying to put me back on the table already?
The second day in ICU was absolute hell because I was actually feeling pretty good but held captive. The cardiologist had told me the night before that I would be getting up and moving about. I tried it, but had to disconnect myself from the monitor before I could partially move some muscles that were not bound by the IV tubing. My day nurse was pretty cool, because she knew I was feeling OK, so she'd let me break some of the Gestapo ICU rules. She showed me how to disconnect the monitor so I could go the bathroom, but when I did, some of the informer nurses would tattle on me. "You're cath patient in 15 is not hooked up," they'd say. Nurses take pride in referring to you by room number and case type -- not by name. Pearl would maintain her cool and assure them I was still in there.
The main purpose of the second day was to wait interminably for a 24 hour IV dose of a special anticoagulant called Integrilin (eptifibatide). The drip rate was 13.3 mL/min calculated based on my 82.7 kg mass. The little bottles take forever to empty. As soon as one was done, and the alarm started to sound, I was immediately on my nurse call button to get the next one going. Pearl must have loved me. She called me her problem child.
By the time Dr. McGee rolled around that night, I was a basket case. He talked to my wife and I for a few minutes about how well I did, etc., and I stopped him and asked if I could go home. "Sure, if you feel like it." I was up like a rocket disconnecting all the stuff Pearl had shown me while the head nurse was telling me "Hold on! We need to disconnect you."
I guess I was pretty lucky with this whole thing -- that is, that I didn't sustain any measureable heart damage from farting around for 2 weeks and that I came through the procedure with flying colors. All in all, it wasn't that bad, but I think I'll start seeing physicians more frequently now and I'll also be taking 4 medications for the rest of my life.
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