(Buffalo Spree January 2001)

Heartburn
by Bruce Jackson
 
Getting There
Late one Thursday night–maybe two or three in the morning--I woke with a very slight sensation behind my breastbone. I wouldn’t give it the status of pain; it was more an awareness, a slight pressure. When it was clear that the sensation wasn’t going to let me go back to sleep, I got up and went to my desk. I answered email, did some mindless deep-in-the-night web-surfing, then downloaded and nearly completed Friday’s Times crossword. I was annoyed rather than worried: I’d done some freeweight exercises on Wednesday, exercises I hadn’t done for months, and I assumed it was just my body telling me that if I was going to do that sort of stuff I should be more regular about it. The whole episode lasted about an hour.

The following Wednesday, during a screening of Midnight Cowboy at the Market Arcade, the same feeling came and went again. Not so much pain as a pressure present enough that it distracted me from the movie. Diane and I were sitting in the back row. I had some Bufferin, drank some water, walked around, got back into the movie, and after a while the sensation was gone.

Friday morning it came again. That happened to be the day I had a long-scheduled appointment with Dr. Robert Gatewood, the cardiologist who monitors my high blood pressure. Bob asked me how I was feeling and I said fine, except for this one thing. He said “What thing?” I told him about the three episodes. “Are you feeling it now?” he asked. Not really I said. “When did you last feel it?” he said. Just before I came there, I said, and also while I was waiting to see him. “Are you feeling any of it now?”

I looked for the pressure and sort of felt it. You know how sometimes you have an itch and it goes away and you look to see if it really went away and then you start feeling it again? Was the itch was really there all along only you got distracted or did you, with your fine thinking, bring it back? It was like that. I told him that I couldn’t tell if I sort of felt it because it was there or because I was thinking about it. He said, in his usual pleasant voice, “We’ll do a cardiogram, just to be sure.”

Cardiograms are faster than they used to be. I remember them putting gooey stuff on me and turning dials while the machine cranked out long slips of narrow paper.  Now it’s a few seconds with no goo or knob-twirling and they get a immediate printout on 8 ½ x 11 paper, like a fax, only instead of the fax coming to you from some distant correspondent it’s coming to your doctor from your heart.

Bob pondered it a while, paged through my file, paused at what I could see was an earlier EKG, and then said, “There’s a slight difference between this one and the last one. I think we’ll put you in the hospital, just in case.”

“Am I having a heart attack?”

“I really don’t think so. But it’s my job to be cautious, conservative. We’ll just do a few enzyme tests and if they’re normal we’ll send you home.”

Impossible! I was due at a univeUB film committee meeting in less than an hour. A friend just back from Tuscany had brought us three black truffles and a huge bag of fresh porcinis, so we’d invited eight people to dinner that night and I was going to make wild rice with fennel and porcini, and, from a recipe by the great Pellegrini Artusi, La Cotoletta alla Bolognese—breaded veal with truffles. Before I’d left the house for this appointment with Bob I’d mixed the dough for the French bread we would have with that dinner; that dough had to be punched down right after that university committee meeting, and I would shape it into loaves in the late afternoon and then bake it about six so it would be ready just before the guests arrived.

I didn’t tell him all that. I just told him that I simply couldn’t afford the time to go down to the hospital for tests that Friday. “How about we do this Monday?” I said.

“Um,” he said, pretending he was thinking about it, “I don’t think it’s a good idea. We’ll just call an ambulance now and take you on down there. Is there anybody you want to call?”

“Ambulance??!! Are you thinking things you’re not telling me?”

“I promise you: I’m just being cautious. You go down in the ambulance and have these enzyme tests and when they’re done tomorrow we’ll see where we are.”

Something just like this had happened three years earlier. I’d been at a faculty meeting and everyone had been grumpy and (from my point of view) irrational and I was being very polite and not yelling out what I thought and after a while I had a pain in my chest. A week later, the night after Thanksgiving, I had a similar pain, only it didn’t go away, and I finally woke Diane at 3 a.m. and asked her to take me over to Millard Fillmore to have it checked out. That time I was in the emergency room for five or six hours, then in the cardiac ICU for two or three days while they did the enzyme tests and an angiogram and after all of it they decided my heart and arteries were in great shape, that it had been acid reflux or an esophageal spasm. They also said that I had high blood pressure, that I should try to avoid anxiety-producing situations where I couldn’t express myself and that I should lose weight and exercise more. That was where Bob Gatewood and I had established our continuing relationship.

I really like Bob Gatewood and everyone I know tells me he’s a first-rate doctor, but there’s this occupational problem: cardiologists no more care about your schedule than a hound dog cares about who promised what to whom before the election. You tell a cardiologist that you’ve got appointments to keep, promises to fulfill, and they assume a look that is sublimely and perfectly disinterested, as if you just had said that one of your feet is slightly larger than the other.

“Maybe this is the same as last time, maybe it’s nothing” I said.

“Probably. The tests will tell us,” Bob said. He went off to get the paperwork ready for the ambulance and I called Diane to tell her what had happened to my day.

Poked, Prodded and Stuck
The ambulance driver didn’t use the siren or run any red lights on the trip from Williamsville to Gates Circle, which was reassuring. They couldn’t be too concerned, I told myself, else they’d be making that horrible noise. I called Diane on my cell phone and told her that Gatewood’s office was right now on the phone with Millard, setting things up so I’d go straight to a room and wouldn’t have to be parked for hours in the ER like last time.

Diane was waiting at the ER ramp. I told her I was feeling fine, that this was surely nothing but medical overprotectiveness.

“You said on the phone that this was the third episode in a little over a week,” she said.

“I guess.”

“And you didn’t tell me? How could you not tell me?” I shrugged. “You really should let me know things like this,” she said.

“I figured if I told you, then it would be real.”

“I’d probably have done the same thing,” she said.

“Don’t you dare,” I said.

She went to do the paperwork while the EMTs from the ambulance wheeled me inside the ER.

“What’s that?” a nurse said, pointing at me.

“Check for M.I.,” another said.

“What?” I said.

“They’re checking on your room availability,” one of the EMTs said.

They took me to a two-bed room in the Cardiac Monitoring Unit and put me in the bed by the window. The EMTs went away and a nurse came over, looked down at me, took my hand, smiled nicely, and said, “Hi. My name is Sue.”

“My name is Bruce.”

“I know that,” she said. Then she asked a question no one had ever asked me before: “Are you a hard stick?” When I didn’t respond she said, “I mean, easy or hard finding the vein?” I told her it depended who was doing it. “Let’s give it a try, then,” she said.

Sue took blood she needed for the first enzyme test and left what they called a “hep tap” in a vein on the back of my hand so they could later acquire more blood or inject me with drugs without having to worry whether I was at that moment a good or bad stick.  “I’ll do the next one at ten p.m.,” she said, “and Veronica, who you will like, will do the third at six. We’ll have reports on all three by the time Dr. Gatewood makes his rounds in the morning. You just take it easy and let us know if you need anything.”

“How about a get-out-of-jail-free card?”

“Not that,” she said.

When you’re in the hospital and they don’t know what, if anything, is wrong with you,  people you don’t know put their hands all over you and they look at parts of you even your best friends never get to put their hands on or look at. They stick thermometers in your mouth and needles in your veins. They wrap cuffs around your arm, they poke here, prod there, listen to your lungs fore and aft and to your bowels left and right. They tell you how important it is that you rest and relax, then they wake you up for a sleeping pill, wake you up for the thermometers, wake you up for the needles and cuffs and pokes and prods. They tell you to sit up, lie down, breathe in, breathe out, don’t breathe at all, don’t move, don’t talk, swallow this, eat that, and wait. Mostly wait. Wait for the tests to get done and to come back, wait for the doctor to make his rounds, wait for them to be ready for you downstairs, wait for them to come and get you.

 My numbers were slightly high on two key indicators in the first test, and perfectly normal across the board on the second and third. By the time Bob Gatewood turned up in my room on Saturday I was dressed in street clothes and had my bag packed.

“Are you a visitor or a patient?” he said.

I held up the report on the three enzyme tests and said, “Perfectly normal.”

“The first was high,” he said.

“Not the second and third. First could have been high because I was freaking about being here.”

“That’s not what’s interesting me now,” he said. He showed me the cardiogram they’d done that morning, then the one they’d done in his office the day before. He pointed to one small descending loop. “That’s different from yesterday and because of that I’m more concerned than I was yesterday. Yesterday I was just being very cautious. Today I think we ought to look at this more closely.” I asked him again if there was anything he wasn’t telling me. “Nothing, I promise you. It may very well be nothing, but we can only be sure with an angiogram.”

I told him that I’d heard that sometimes they did angiograms through the wrist now. He said that the doctor who did them Monday and Tuesday went in through the femoral artery in the leg and the doctor who did them on Thursday and Friday liked going through the wrist. “So it depends when they do you.”

“Who does them Saturday and Sunday—today and tomorrow?”

“Nobody. They don’t do them weekends.”

“I can’t possibly stay here all week waiting for a test.  How about letting me go home and giving me a call when they have time for me?”

He smiled pleasantly, the same smile he had when I’d told him in his office about my busy day on Friday, just before he packed me off in the ambulance. “I’ll do what I can to get you in Monday or Tuesday,” he said.

Daughters
I was in a semi-private room. My first roommate, who had already been there a full week, had been sent home Friday afternoon because the hospital couldn’t fit him in for a angioplasty until five days later and his medical plan wouldn’t pay for him to there all that time waiting for it. “Now if the problems start up,” a doctor told him just before he left, “you just come right back here. Don’t wait. If someone’s there, have them drive you, don’t even wait for the ambulance. If a taxi can get you here quicker than the ambulance, take a taxi.”

My second roommate was a really sweet guy who was probably going to have bypass surgery. His daughter arrived from out-of-town Saturday afternoon and immediately chastised him because she’d been able to find only four of his five credit cards. He asked why she was taking his credit cards and she said, in the kind of voice you use for a three-year-old if you’re a lousy parent, “You’ll find out when the time comes.” Then she chastised him because he’d left dishes in the sink and hadn’t she told him never to leave dishes in the sink, that it was a sign of sloppiness? He said, in a weak voice,“I wasn’t feeling very well yesterday” and she said, “I told you: don’t leave dishes in the sink. You never see dishes in my sink.”

Diane and I had been talking when she started in on him. The daughter’s voice was so loud and insistent we fell silent. We could both see her from where we sat and she could see us. She had to have known that she’d shut us up, which meant not only was she not embarrassed at the patronizing and bullying way she was carrying on but she was probably proud of it. She was a take-charge person, she was.

Our daughter Rachel arrived about then, joined us, started to speak and then fell into silence as my roomie’s daughter started in on him again.

She gave her father some papers and told him to sign them. He asked what they were. “The power of attorney,” she said, sighing in exasperation. It was like he shouldn’t have asked the question, like the three-year-old asking why he was being made to go potty. He signed all the copies where she told him to sign. Then she told him about some changes in his will she thought he ought to make immediately and said he just couldn’t keep letting things go like this. Finally she left, saying she would be back the next day with her brother.

The woman never once said “Dad, how are you?” or “Dad, I love you.” It was perfectly horrible. I wanted to say to him, “Well, we hope you’re feeling better and we love you,” but I didn’t. Diane, Rachel and I–and no doubt that poor guy the other side of the half-closed curtain—all sat there, silent and depressed.

Rachel saw Sue out in the hall and the two of them talked briefly. Both looked at me, looked at each other, and nodded. Rachel stuck her head in the door and said, “I’m going downstairs for a few minutes.” When she came back she said, “I got you a private room.” Within an hour I was in it.

A Room of One’s Own
Ward, double room, private room: so little space or time is really yours in a hospital, even when you’re just hanging around waiting for them to fit you into the schedule, so your space and time become ever more precious. It’s like in the army where you don’t sit on someone else’s bunk and in prison where you don’t wander into someone’s cell–not without invitations, not without permission. The more public the living condition, the more vulnerable the resident, the more stringent the rules of access. Having a private room in a hospital doesn’t mean you own any more of the time or space; it means only that the intrusions all belong to you.

A man I hardly knew walked into my hospital room at 6:30 Monday evening. He hadn’t called Diane at the house or me in the room to find out if I wanted or was in shape to receive a visitor. He said he was surprised to find me wearing jeans and a black t-shirt. “You expected a hospital gown?” I said. He said he had. He said there was only one doctor he’d let do an angiogram on him and if I wasn’t having that doctor, well, I should rethink this whole thing. I told him that was the doctor I had. He seemed disappointed. He said he’d wondered why, if I wasn’t in dire straits, had I’d been in the hospital so long. I told him it difficult getting a slot in the angiogram unit because of all the patients backed up over the weekend from Millard and several other hospitals that unit serviced. That, he said, was only one of the real reasons. The more important reason was they had to have an operating room ready to go when they did these procedures. “Sometimes they poke through an artery or the heart itself, you know?” I said I hadn’t known. “Well, that’s why,” he said. Then he told me that when he’d had his angiogram they’d yanked the urinary catheter out and it had been very painful and it had bled. I told him that they hadn’t used a urinary catheter when I’d had an angiogram three years earlier. “They use them now,” he said. “Why are you telling me this?” I asked. “So you’ll be ready,” he said, and smiled pleasantly.
 I got to feeling slightly dizzy and I had a tightness in my chest. I thought about buzzing for the nurse—Bob Gatewood had told me to call them if I had any symptoms at all. In a situation like that, you don’t want to be hypochondriacal, but you don’t want to slip into denial either. If I’d been alone with those symptoms I’d have buzzed. As it was, I just breathed deeply and slowly. I wanted him to leave but I wouldn’t tell him why because I’d be damned if I’d have him going out into the world and telling everyone he knew that he’d been there when Jackson got hit by the Big One.

Rachel arrived and he left. I told her what he’d said. As I recited his bits of information the tightness and dizziness evaporated. “He’s the visitor from hell,” Rachel said.

 “Exactly,” I said.
 
They scheduled me for the angiogram at five p.m. on Tuesday. An hour after I finished lunch, Mary Cooper, the nurse who was Sue Brown’s counterpart at this end of the CMU, came into the room and said, “They just called up and said they’d take you now if you like.”

“I just had lunch less than an hour ago. I thought you couldn’t go down within six hours of food.”

“I’ve seen them go down still chewing.”

I got out of my jeans and t-shirt and put on one of the hospital gowns. As they took me down to the fourth floor I kept thinking about later, when they’d yank out that urinary catheter and it would hurt and I’d bleed.

They wheeled me into a brightly-lighted room with a big table on one side about which several people in greens sat talking, drinking coffee. On the other side were several bays separated by curtains. They wheeled me into one of the curtained bays. Almost immediately a nurse said, “Are you ready to go over for the angiogram?”

“No, of course not” I said. “ I’ll never be ready to go over for the angiogram.”

“Shall we go now, then?”

“Sure.”

It was delightful in three regards. The first was the intravenous Valium they gave me shortly after they wheeled me across the hall. They hit me with that IV and in seconds I felt perfectly fine. Perfectly fine. Valium dissolves dull care. They went to work and within minutes the arteries of my heart filled up with dye put there by the catheter they’d snaked up my femoral artery and we all watched my big and small coronary arteries go black on the monitors. It was like watching a video game.

The second reason it was delightful was I learned that if death is going to come my way in the near future, it will almost certainly be through some agency other than my heart attacking me. The angiogram showed my heart had no blockages and that its ejection function was 68%. The ejection function is a measure of  how well the left ventricle pumps oxygenated blood into the aorta. Normal is 60% and doctors are happy with anything over that. (When Dick Chaney had his heart attack during the Florida recount just before Thanksgiving, his ejection function was 40%.)

The third reason was there had been no catheter. After they were finished and I was back in my room I told Mary what my uninvited Monday evening visitor had told me about his bloody painful catheter that he said they used on everyone having this procedure now. “I’ve never heard of anything like that,” she said.

I got an email from that guy Wednesday. The subject line was “Angio-Beach.” Anzio was the site of one of the bloodiest Allied landings in World War II. Cute, huh? The message, in its entirety, went:

“How did it go yesterday?  Single, double, stand-up triple ... or a home run?”

I showed it to Diane and Rachel. “Doesn’t he mean ‘home free’?” Diane said.

“No,” Rachel said, “he’s not interested in that. He just wants to know if they’re doing a single, double, triple or quadruple bypass.”

What I Learned
I was thinking that this was a bunch of expensive huff and puff and wasted time for nothing, until I got this letter from someone I know only slightly:

I'm writing as a Yiddishe mama.  My husband died of a heart attack at the age of 55.  He'd had two episodes of heart-attack symptoms, went to the hospital, an EKG showed no changes and he was sent home each time.  The third episode proved fatal.  An autopsy showed scar tissue on his heart. What I'm saying is that I hope that your were checked thoroughly.  There's a blood test to indicate enzymes that show up during an attack, and also the possibility of an angiogram.  Please make sure that your physician exhausted all possibilities of ruling out an MI.

Best of luck!

She was of course right. There’s no way to differentiate the symptoms of acid reflux and a heart attack and even though I’d had a similar symptom three years earlier and it had been nothing and even though these symptoms were mild and there were none of the associated symptoms of an MI, my doctor had refused to take a chance. My plans for the day and the weekend and the beginning of the following week were of no moment to him because if this time it was the real thing, then there wouldn’t have been any rest of the day or weekend or beginning of next week, or anything else.

I realized that health insurance buys you something more than maybe getting fixed when something isn’t working right: it also buys you peace of mind when you don’t know whether anything is wrong at all. It lets the doctor toss you in the hospital and do thousands of dollars worth of tests that you might very well not be able to afford, and you can go home knowing exactly where you are in this life.

Without the insurance you don’t find out, and you don’t go into the hospital until things are really bad, when it is maybe too late. I was lucky that it wasn’t a heart attack, and I was also lucky that I had a health plan that let me know that if I lost some weight and exercised more I probably wouldn’t have one in the foreseeable future.

I’m happy to know my heart is okay, but what I keep thinking is this: how great it would be if we lived in a country where every one of us could have that peace of mind for ourselves, our children, our parents. How great a thing that would be.
 
 



copyright 2001 Bruce Jackson