A Matter of Personal Significance

“Your EKG is abnormal. It indicates that there are problems with your heart and we need to find out what they are right away. I don’t want to alarm you, but this is something that needs immediate attention. This is not something that can wait. I’d like to call your wife in to let her know that we need you to go to the emergency room right away. I don’t want to alarm her, either, but she needs to understand this is serious, too. “

The comments caught me completely off guard. The difficulty breathing after yardwork…the way my lungs ached…it made me think my smoking was catching up with me. I thought I might have emphysema, certainly not a good thing, but problems with my heart...that scared me. It couldn't be my heart...heart problems can kill you quickly, without warning. Emphysema, I thought, was slow and painful.

But I had been wondering about the pain, wondering why I felt this odd and uncomfortable sensation. When I had difficulty breathing, I also felt a very strange sensation in my lower arms. They felt heavy and tingled. I had heard that tingling in the upper arm might be a warning sign for heart problems, but the lower arm? Frankly, I had been wondering whether I was being a bit of a hypochondriac…my “pain” wasn’t too bad, but it had drained my energy. Maybe it was nothing...maybe I was just over-reacting to an artifact of the aging process.

The weekend before I made the trip to my doctor, I had been visiting my brother and his wife in Portland, Oregon. During the trip, I was almost incapacitated by what I normally would have considered a relatively low energy walk about town. That’s really what made me decide to call the doctor. I felt something was really wrong when I buckled onto the couch after walking just a few blocks from a bus stop. My wife and I had cut the trip to downtown Portland short because I was out of breath as we wandered about town…and then, I walked eight or ten blocks from the bus stop and felt ready to collapse.

When I called the doctor the following Wednesday, I expected to be told I could not be seen for several days…and, sure enough, that’s what I was told. But the receptionist asked why I needed to see the doctor, so I explained. She explained that the doctor was on vacation and asked whether I wanted to see someone else. I told her it didn’t really matter to me, but I thought my regular family doctor would probably be the best one for me to see. She put me on hold and shortly a nurse came on the line, asking the same questions. I explained again. “I’ve been getting easily winded doing simple things like yardwork and just walking. I have a pain in my chest…kind of a burning pain in my lungs. My lower arms feel heavy and they tingle.”

She asked me a series of questions about my symptoms. Finally, she said, “I don’t want to alarm you, but your symptoms could be indications of something very serious. I want you to go to a hospital emergency room. You should not drive yourself. You need to go right away so they can rule out that you are having a heart attack.” I remember so many comments about not meaning to alarm me. Hers was the first...she didn’t mean to alarm me, but she did. I told her I was not presently experiencing pain…I just wanted to get checked out to be sure it was nothing or, if it were a real problem, to have it addressed. She persisted that I needed to go to the ER. I protested and said I would wait until my doctor was back from vacation to make an appointment. After what seemed like a long period of banter, she put me on hold again; when she came back on the line, she said she had made an appointment for me to see another doctor in the practice at 1:00 pm, just over an hour from the time I was talking to her. "I want you to have someone else drive you," she said, "don't drive yourself. With the symptoms you described, you could be having a heart attack. You should not drive. If you can't get someone else to drive you, you need to call 911 and have an ambulance take you to the hospital." I promised I would not drive myself.

By the time I got off the phone with her, I was feeling a sense of panic. My wife, who works with me, was out of the office for some reason, but I knew she would be back soon. But that day was the last day of work for a staff member who was leaving to get married, and my wife was planning on having a little celebration after lunch to send the staff member on her way. I wasn't sure whether my wife would be able to drive me to the doctor. I mentioned the conversation with my doctor's office to another staff member, trying to make light of it, but she seemed to take it a bit more seriously than I pretended to and offered to drive me to the doctor. I declined, saying I was sure my wife would be back soon.

When my wife got back to the office, it was getting close to the time of my appointment, so I asked her to drive me to the doctor. I guess I didn't mention that the nurse told me not to drive, because my wife seemed a bit miffed at my insistence that she change her afternoon plans to drive me. I'm sure I was being rather cranky with her as I talked about going to the doctor.

The nurse called me in almost immediately after we checked in with the receptionist. There were few of the usual pleasantries I associate with visits to the doctor; this time, it was all business: take off my shirt, lie back on the table, lean forward so the wire leads can be properly placed on my chest. While she was preparing me to have the EKG done, the nurse asked me to explain to her about the pain, how often it hurt, whether it was hurting at that moment. In no time, the EKG was underway. It took the nurse only a short time to print the EKG results and the nurse took them out to show to the doctor. He came in shortly thereafter and introduced himself; his nurse was with him. He asked the same questions the nurse had already asked, peering intently at the EKG record as I answered. Then he explained the EKG was abnormal. The doctor asked the nurse to have my wife come in; she joined us almost immediately.

"Your husband's EKG is abnormal, indicating a problem with his heart. The abnormalities are significant and they concern me enough to make me want him to see a cardiologist right away. It will be easiest for him to get to see the cardiologist quickly if we send him to the hospital emergency room. I'll call Dr. Pettyjohn and he'll expect to see your husband there. I don’t want to alarm you, but this is something that merits extra precautions to be sure that we are able to solve the problems before they get worse. The EKG indicates there are some problems that could result in a heart attack. He has not had a heart attack, but he could have one, so it's important that, when you leave here, you drive directly to the emergency room."

The doctor's demeanor didn't demonstrate any sense that this was a life or death situation...in fact, I remember that he tried to make light of it, at the same time he made clear he was really concerned as he spoke to my wife: "I want you to understand that you need to go directly to the ER. Do not go home to get a new pair of socks or underwear. Do not stop to buy a toothbrush. Do not pass go! Go directly to the ER. Based on the EKG, I probably should have your husband sent by an ambulance, but I really don't think it's quite that serious...but I'll be in trouble if you stop on the way to get a candy bar and something happens. So please heed my instructions so I'll stay out of trouble."

I wasn't quite sure what to think as we left the doctor's office. I was concerned, but I had a sense of disbelief. I started wondering whether I had exaggerated my descriptions of the pain, the breathing difficulties, and the feelings of exhaustion. Was I going to the ER and getting ready to spend a small fortune because I was a hypochondriac? I should have known better, of course, because the doctor had just told me my EKG was abnormal, but I wasn't thinking clearly.

The moment we got outside into the open air, I lit a cigarette and smoked it as we started toward the car. In retrospect, I think that says volumes about my state of mind. I had just been told I was having serious heart problems, yet I lit a cigarette the moment I got outdoors. I smoked less than half of it as we walked toward the car, dropping it to the ground and crushing it as we approached the car. Normally, I would have picked up the butt and found a trash can to drop it into, but not that time. Now, well over a year later, I remember that as the last cigarette I ever smoked.


The Hallowed Halls of Hospitals


My wife drove to the emergency room entrance and let me off near the door. A security guard had stopped us as we neared the ER; his job was to prevent people from getting in the way of ambulances bringing in seriously ill or injured patients. When my wife explained that my doctor had told her to drive me to the ER, he waved us through. She stopped at the door and I got out and went inside while she went to park.

I explained to the admitting desk clerk that my doctor had sent me to the ER and that I was supposed to meet the cardiologist there. She gave me some papers to fill out and asked me to sit in the waiting area until I was called. My wife came in and shortly thereafter I was called back to an examining room.

It wasn't long before an ER physician came in and started asking questions. He did not seem to know anything about teh cardiologist expecting me, but said he would check into it. I was connected to another EKG machine and the ER doctor, like the family physician shortly before, peered intently at the paper record flowing from the machine. After what seemed like an eternity, with the ER doctor going in and out of the examining room, along with various other medical personnel, the doctor said they were going to admit me to the hospital and said the cardiologist would see me after I was situated in my room.

For some reason, my recollections of what happened from the time I went into the ER until the time I was released from the hospital are, in many respects, very, very muddy. I was not on any painkillers, etc. until well into my second day in the hospital, but my memories are vague and disjointed. My wife's recollections are equally fuzzy...I think perhaps the hospital staff used memory-limiting drugs on us. I will recount what I remember and I will add comments my wife made to me later...I cannot vouch for the accuracy of my account of my experience, but the important thing here, after all, is my perception of my experience.

I was admitted into a private room (the hospital is in a high-income area...it has no semi-private rooms, as such accommodations are not befitting people of such economic stature...) late in the afternoon, after the ER determined my EKG warranted admittance as an in-patient. The process of admission to the hospital is a bureaucratic one, with enormous volumes of paperwork, tests on top of tests, measurements of heart rate, blood pressure, weight, height, color, smell, size, attitude, and god knows what else. It seemed like it took several hours to finish the tests and give me some peace. The cardiologist finally showed up after I had been admitted to the hospital. He said he had seen the EKG. It showed that there was a clear problem with my heart; there was blockage in my arteries. He said I needed to have an angiogram to see where the blockage was and, once the location was known, he would perform an angioplasty, in which a balloon-like device would be inserted through the angiogram tube to expand the artery and a stent would then be inserted to ensure adequate blood flow. He said I should be able to go home the day after the procedure, which he recommended be done the following day. He stressed that the procedure was very common and that there were rarely any significant complications...but he did say he was obligated to let me know that complications do occasionally occur, including permanent brain damage, death, and other nasty-sounding stuff. He also said I needed to have the procedure done as soon as possible because my condition was serious. "You're at very serious risk for a heart attack, which could be fatal," he said. "Until we correct the problem, the risk that you could suffer a fatal heart attack at any moment is very real. We need to fix this right away."

I don't recall being shown a video about angiograms and angioplasty, but my wife says they had us watch a video that afternoon, after the cardiologist talked to us, that explained the procedures and also discussed heart bypass surgery. I have no doubt they showed us the videos...but I have absolutely no recollection of seeing anything like it.

Once I was left alone in my room, my wife went home. It wasn't long thereafter that I decided I needed to explore the hospital, so I went out for a walk. As I was returning to my room from a circle around the floor I was on, a man in a nurse's uniform, a guy about my age, approached me and asked my name. I told him and he explained that he would be my nurse. He told me I should not be out walking around; I should be relaxing in my room. He explained that the medical team was concerned that I could have a heart attack if I exerted myself, so I should just sit quietly in my room. The nurse assumed I was nervous about the procedure and he assured me there was nothing to it...but he then explained all sorts of things that could happen in connection with it. He stressed, though, that Presbyterian Hospital was the best place I could be to have the procedure done. And he assured me that it would be over and done before I knew it and I'd be back home.

I had assumed...perhaps we had been told...the procedure would be done early the next morning. That was not to be. It was late in the day before I was prepped for the procedure. I recall being told that, after the angiogram, I would need to lie perfectly still for several hours to ensure that the artery in my groin where the angiogram tube was inserted had time to heal. A heavy weight would be placed over the incision, they said, to help stem the flow of blood after the procedure. I remember almost nothing of the procedure, nor the time afterward that I had to lie perfectly still. My wife told me that I was complaining bitterly about my back hurting very badly during that time; my back does hurt quite alot when I lay flat on my back, so I can well imagine that. She told me the staff had a bit of a tough time keeping me still. The cardiologist told my wife before he told me that the blockage was too extensive and in the wrong place for angioplasty to work. He showed her an image of the arteries at my heart, showing 95% blockage in one and 75% blockage in another. He told her I needed to have double bypass surgery right away.

I had no sense of time when all of this was happening. I remember the cardiologist saying that my angiogram revealed more blockage than he had expected and that I needed to have a bypass...but I do not recall whether he was talking to me or to my wife. The anesthesia must have been clouding my thinking and my ability to understand what he was saying. I recall agreeing to have the surgery done immediately, but I don't know if I was agreeing with him, with my wife, or someone else. I know, now, that the bypass was done the following day, but I don't recall anything of the preparation for surgery.

What I do recall is the surgeon, someone I don't remember having met before, standing over me after the surgery, laughing and saying something to the effect that "If you're feeling good and aren't in any pain, then I'm the surgeon who performed your bypass operation...if it hurts, then my colleague here is the one who did it!" I must have been in the recovery room at the time. The next thing I remember is my wife holding my hand and talking to me, but I don't remember what she was saying. I felt like I was in a deep fog. I don't think I realized at the time that I had a breathing tube in my mouth and that I could not talk. I don't remember feeling any pain, but my wife says I complained afterward about being in pain.

Legalized Torture

I think I was in the cardiac intensive care unit for at least two days, maybe three. I remember much of that time vividly, though some of what I remember may not be memory, but hallucinations. You'll understand when I explain a bit more. During the night, a very attractive young nurse was the person who looked after me. She was very talkative and friendly and very quick to be upset with me when I tried to get out of bed to go to the bathroom by myself. She said her job was to take care of me and that I should let her do it.

The breathing tube came out about a day after the surgery, before I was lucid enough to be able to communicate well with the medical staff. When it was taken out, something happened that I still don't understand; it was very scary. Two nurses (I assume both were nurses) appeared; one of them spoke to me, telling me the breathing tube was going to come out. She told me she was going to pull the tube out and that I should exhale as she was doing it. I felt the tube move through my throat as she pulled it out and I felt it scratch across my throat. When the tube came out, the nurse said, "OK, breathe!" Something was wrong...I could not take any air in, nor could I exhale. It was as if my lungs weren't connected to the air...like something was blocking my trachea. I really started to panic and started shaking my head and motioning with my hands that I could't breathe. One of the nurses said to the other, "What's wrong?" The other responded, "I don't know, he says he can't breathe." Then I heard her say "Oh, I always forget to do that." And I could feel air rush into my lungs. It felt so good to feel my lungs fill with air. I have no idea what she did, what prevented me from breathing, but it must have been related to the breathing tube...how she took it out...who knows. I wish I had been coherent enough to ask, to complain to someone. That episode was among the most frightening things that happened to me during my hospital stay...but there were other times I would feel very frightened.

It was either the first or the second night in cardiac ICU that I may have drifted into hallucination. Late at night, probably three or four in the morning, I awoke after hearing the alarms on my heart monitor go off. That had happened several times before when I had moved or turned on my side, disconnecting the wires that were attached to leads on my chest. When that happened the first time or two, the nurse had come in rather quickly to reattach them. But the second or third time, it seemed to me that it was taking quite awhile, so I tried to reattach them myself...it was almost impossible to do while I was lying down, so I sat up on the side of my bed and tried to reattach them. When the nurse came in and saw that I was sitting up, she scolded me and told me that I should just wait for her to come in to fix things. For some inexplicable reason, I felt that I was annoying her by disconnecting the leads, so I felt I should fix the problem and not depend on her to do it. She made it clear that wasn't the case and said I should just wait for someone to come fix the leads if it happened again.

The last time that night I remember the leads causing the alarm to sound, it seemed like it took a very long time for her to get to the room. When she came in, it seemed to me that she was disheveled...her hair looked like it had not been combed and I would have sworn she was tucking in her shirt as she came through the door. Right behind her came the respiratory therapist who had, earlier in the evening, tortured me by forcing me to blow long and hard into a tube...measuring my lung capacity. He replaced the leads with an entirely new set. I began to think that my heart monitor alarm had jolted them out of a sexual encounter somewhere far away from my room...that was why it took her so long to respond. And I started thinking, "What is this respiratory therapist doing here in the middle of the night?" After they got my leads reattached properly, turned out the lights, and left, my mind continued on its make-believe odyssey.

"Obviously," I thought to myself, "they know that I know about them. And they know that, if I chose to, I could get them in serious trouble, possibly even get them fired. They're not going to let that happen. I've heard about nurses killing their patients. If she were to come in to give me an injection or add something to the bag that's connected to my IV, how would I know whether it is legitimate?" My mind raced and I began to wonder how I could get out of there without her seeing me. I tried to think of how I could get out of bed, stay connected to my monitor, and get to another area of the hospital before she was able to kill me. As I write this, I am laughing. I was not laughing at the time; I believed I was targeted for murder by a nurse about whom I had inadvertently seen evidence that she was engaging in illicit sex while on duty.

I must have drifted off to sleep, despite my fear of imminent murder, because the next thing I remember was hearing the door opening. My eyes popped open immediately, but it was obvious to me that the door was still closed. The ICU room...I guess it was a private area, not really a room,...was very small. The bed was in the middle and various types of machinery were off to the right and left of me. The door to the area was near the foot of my bed, at the center of the ICU area. On both sides of the door, the walls were solid at the bottom, but the tops of the walls were large, fixed-pane glass panels. Curtains could be closed on the doors to make the area private. I think the curtains had been closed earlier. But when my eyes popped open, I saw that the curtain to the right of the door was open several inches. Standing outside, peering in through the window, were a little girl and a little boy, probably eight and ten years old, respectively. Immediately, I knew that they belonged to the ICU nurse. It was clear to me that they lived with her in the ICU at night when she worked. And it was clear to me that she had enlisted them to kill me.