(This is very long, and includes a lot of detail. I wrote it because so many people over the last year – women my age, especially – have asked me to tell them, exactly, step by step, what happened. And how. And why. And when. And what it felt like. And what the symptoms were. And so on and so on. Here is what I know: I spent a lot of time convincing myself that I was fine. And apologizing for wasting other people’s time. And not wanting to impact anyone else in any way. And had I carried on in that manner for much longer, this might have turned out very differently. If there’s a moral to the story, it’s to not ignore strange things. So, all that to say: here’s the full story of my funny, strange heart.)
A year ago (a year ago, yesterday, if I’m being precise), I casually jogged down the hallway at Las Vegas airport to pick up a bottle of water and a magazine at a shop near our departure gate. I noticed my lungs felt weird – heavy and uncomfortable.
I chalked it up to all the smoke in Sin City (not to mention the partying) and figured it would go away after a few days home. But it didn’t.
Every time I’d go to the gym, or go out walking or jogging, my lungs felt uncomfortable. Eventually I decided it wasn’t my lungs at all, but clearly side effects from silent reflux … maybe all those pina coladas in Vegas had messed up my tummy? So I ate extra carefully – no sugar, no high acid foods – and I took Tums and over-the-counter acid medication, and drank gallons of water.
But it still didn’t go away. In fact, it got worse. It was giving me back pain through my shoulders – also a side effect of silent reflux, I learned on google.
It made working out particularly challenging. One day, I dropped the kids off at school and drove myself over to Barnet Marine Park in Burnaby. I walked for about 10 minutes, then started to jog … after maybe just a minute at the faster speed, I had to stop. My lungs hurt. My shoulders hurt. My arms hurt, right down to the fingers. My neck and jaw hurt. No sharp pain, just aching, the way I imagine arthritis might ache.
Every time I started to jog again, it would return. So I kept stopping. And it would go away. And then I’d start again. Over and over. But I didn’t tell myself I was stopping. I told myself I was “pausing to enjoy the scenery.”
I’m not kidding when I say I “paused to enjoy the scenery” about six times that day. It’s a pretty beautiful place, but let’s be honest, no one pauses six times in a 45 minute walk/jog to look at the mountains over and over.
The conscious part of my brain was calm as could be, but some little part of my subconscious was shouting at me: why are you out here ALONE. This is not normal. This is NOT normal. But by the time I got home, nothing was amiss.
I mentioned it to my hubby. Go to the doctor, please, he said. I mentioned it to my friend and workout buddy. Go to the doctor NOW, please, she said. I mostly didn’t mention it to anyone else. Because it was JUST acid reflux. I needed more Tums. It’d be fine.
By my 40th birthday, the first week in March, it didn’t require a minute of jogging to get uncomfortable. A brisk walk from the car to the door with a load of groceries required a “pause to enjoy the scenery.”
I ached. My entire upper body would start aching. But: my heart was not racing. My blood pressure was not elevated. I wasn’t dizzy. I had no sharp pain. No headache.
I was just uncomfortable. So uncomfortable. My friend, Kathy, kept asking if it was better. I’d sort of answer in circles, implying I’d chatted with the doc (I had, sort of, at the tail end of a conversation about one of the kids, but I made it sound more thorough than that.)
Then, a week after my birthday, in the gym on a Saturday morning with Kathy, I “paused to enjoy the scenery” several times. I’d get off the treadmill, go out into the hall, and a minute later, feeling fine, I’d get back on. I’d lift a few weights, then go get a drink at the fountain, and stand there waiting for it to ease – then I’d go back in and lift more weights. Kathy just watched. Frowning.
By the time we were done, SHE was done. After weeks of quietly prodding and bugging me, she wasn’t messing around anymore: you need to get this checked out. TODAY.
Then she told me a scary story about a young woman who had a heart attack. She laid it on thick. The story involved young children. I don’t want to scare you, she said. But she did want to. And it worked.
I was spooked.
By the time I’d driven home, I felt fine again. When I felt fine, it was so easy to forget how bad it had been just a moment before. I came in, mentioned to my hubby that I was going to call in to the weekend drop-in clinic at my doctor’s office. He said please, yes, do that. Or find another clinic. Today. Don’t leave it.
I said, well, I can’t find another clinic, it’s Saturday and the middle of the day and nowhere else will be still taking patients.
Anyway, the kiddo had a Scout event to go to, and I was leaving in a few minutes to get him there. So if my doctor’s clinic wasn’t open, I’d just be out of luck till Monday, I said with a shrug.
Or you go to the ER, said my hubby.
I rolled my eyes. I didn’t need the ER.
I got lucky when I called my family doctor’s office – yes, their Saturday clinic was open, no my doctor wasn’t there but another doctor was … but they were very quiet, no patients, and only open for a short time longer, maybe an hour or two. Maybe less, even.
I said: I’m coming right now.
But first, I rounded up my son, and drove him to his Scouts event. It was important to him. He’d been looking forward to it, and I wasn’t going to cancel out on getting him there.
The whole time I was driving, I kept thinking: this is silly. I’m fine. I don’t feel a thing!
By the time I got there, I had mostly convinced myself it was foolish to go to the drop-in after. But then I walked him from the parking lot to where the group was meeting. Maybe 300 yards.
I was aching. Everywhere. Right away. At a strolling pace.
By the time I got back to the car, I was starting to get a little scared. I got to the clinic, was ushered right in, and rambled out the whole story to a doctor I’d never met before.
I made sure to pepper my tale with lots of warnings: I’m sorry I’m wasting medical time. I know it’s probably nothing. I don’t want to be that ‘hysterical lady’ but it does seem to be getting worse. I know lots of people go to the ER thinking they’re having a heart attack and it’s just acid indigestion so that’s probably all it is.
I listed my family history, my own health history, my previous weight gain, my recent weight loss, how often I walked or swam, the years I had smoked.
He looked at me, took my vitals, scanned my recent test results (high normal but still “normal range” cholesterol, good blood sugars, slightly low iron as a result of previous post-childbirth anemia.) My blood pressure was fine. My heart rate was fine.
What’s your level of pain right now? he asked.
Well, I’m just sitting here, so … zero.
I think, he said, that this is not your heart. Your blood work is good. Your vitals are good. You’re 40 … no, I think this is your lungs. Pleurisy. Your lungs are inflamed, and when you breathe harder, like when you jog or workout, they’re rubbing against your chest wall. That’s what’s causing the ache.
(And let’s just pause here and say thank you god for doctors who say “but”…)
BUT he said, I can’t rule it out. I don’t have the equipment here to rule out that it ISN’T your heart. And you’ve got some wicked family history.
He turned to his computer, wrote some stuff onto a digital prescription pad, and printed it out. He folded it up and held it out to me.
Do not go home, he said. You’re going to go right to the closest hospital. You’re going to give them this at registration. I’ve made a note for them on it.
I took the paper, and drove to the hospital. When I parked the car, I didn’t realize that sometime the next day, our friend Dan would be driving it home for me, and it would be weeks before I drove again. Blissfully ignorant, I just parked it, and sauntered in.
I went to the counter with my CareCard and explained the basics. Again, I apologized. For wasting ER time. For being silly. It’s probably nothing.
She asked: does your chest hurt?
Yes, it does (I had just walked from parking lot to waiting room, after all.)
How far down?
To my fingertips. Like arthritis. It aches.
Your jaw? Face?
Yes, all through my jaw. Aching.
Are you out of breath? No.
Are you dizzy? No.
Are you nauseous? No.
Are you having sharp pain? No. It aches. It just ACHES so much. But it’s easing now, while I sit here. Actually it’s almost gone.
Then I handed her the paper from my doctor.
Five minutes later, I was on a bed, with EKG running, IV already in, blood pressure cuff running on three-minute repeats, and multiple vials of blood already taken and off to the lab.
My curtain-walled “room” was FULL. At least three staff at any given moment were circling the bed, and at times as many six.
They asked me a million questions. If you smoke, and don’t need me to make you feel worse, you might want to skip this part, but the thing they were most interested in wasn’t what I weighed, or how early my dad died but: when did you start smoking, how long did you smoke, how much did you smoke a day, did you always smoke that much in a day or did it change over time, when was the last time you smoked. Every person who came, asked me about smoking. I’d started smoking when I was 14. I’d smoked till I was 21, quit a few years, and started again. At 27, I quit for “good” .. and didn’t have another smoke again for more than a decade. I hadn’t thought I’d ever smoke again … but then in my late 30s, I had one while camping. Then a few weeks later, while I was out with friends. One or two here and there had turned into “social smoking” … and I did it way more than I should have. Now I had to confess it all, this awful history of smoking.
I’m sorry. That was all I wanted to say: I’m sorry.
I wanted to tell them I was sorry. Sorry for knowing better, and doing it anyway. Sorry for not being more careful. Sorry for losing weight but not having lost enough. Sorry for not being more scared before now. Something was wrong, maybe, and maybe it was my heart and maybe, probably, it was my fault. I felt so foolish.
What’s your pain level? they kept asking.
Well, I’m just lying here, it’s zero. I have no pain. I feel totally fine. I’m sorry, maybe it’s nothing.
And for a while, as we checked and tested everything, it seemed like maybe it WAS nothing:
The chest x-ray was fine (no pleurisy or pneumonia or bronchitis.)
The EKG was fine.
The blood pressure was fine.
Resting heart rate was fine, better than fine, actually – it was great.
Except for my descriptions of how I FELT, everything was fine. So we waited on blood work. The blood work will show us if there’s a problem, they said.
I surfed on my phone. I messaged friends. I called my husband and explained that the doctor was pretty sure it was nothing but he’d sent me over to ER to get a few tests. I made it sound like it was nothing. I laughed, and chatted. He had tickets to take the kiddo to his first ever Canucks game. I knew he’d be too anxious to go, if he knew what was happening. I said “yeah, it’s a long wait here, so I’ll get my mom to come over and she can stay with Emily so you guys can go ahead.”
Ok, he said, sounds good. I’m glad you’re getting things double-checked, hopefully they’ll be fast, he added. I’m sure it’s nothing but better safe than sorry.
Yes. I’m sure, too.
I heard the doctor, a young woman around my age, discussing my file with the nurse.
Blood work back?
It just came back, said the nurse. It’s pristine.
(Pristine, I thought. That’s good then, right?)
Let’s do it again, the doctor said.
I would learn later that this second draw came back clear too.
The doctor, who knew only that my EGK, BP, heart rate, etc were all FINE and that I was describing my symptoms as “fine NOW but previously really not fine,” had the blood drawn and tested a third time. To be sure. It was clear two times already … but …
(Again, can we pause here to say thank you again for doctors who say “but” … )
She came back an hour later:
You have triponin in your blood. It means your heart is in distress. If you were having a heart attack the number might be 40 or 50. Yours is about 0.27 … but it’s there. There is no reason for it to be there EXCEPT if your heart is in distress. You’re going to be transferred to the coronary ward at Royal Columbian Hospital. The ambulance is coming now. They will probably do an angiogram.
I called my husband. “No biggie but they need to run another test. Delta Hospital is too small, so they want me to go over to New West.”
Notice “they want me to go over” – as though I was driving myself … as though it wasn’t a big deal. Later, wishing him a fun night at the game, I said well, they need to keep me overnight, it’s the weekend and I can’t get the angio yet … but everything looks fine. I was such a good actress, he had no idea I was in a ward with people having open heart surgeries, on IV, with nurses hovering. It wasn’t until the next morning that I properly explained. Why make a fuss, right?
I spent the next couple days at RCH waiting for an angiogram. The ward there receives emergency cases from all over the province, people who are in urgent, critical need. I wasn’t critical. I wasn’t even in pain. I wasn’t even, frankly, uncomfortable, unless you count the unpleasantness of hospital gowns and lumpy beds. So I waited, and waited, and waited. I texted with friends and people came to visit and I read a trashy romance novel. I joked about how it was like having a spa holiday and someone else was at my house doing laundry in my absence. Anything to not let on that maybe this was terrifying.
Finally, a couple days later, my turn came. I lay in the pre-op area for ages, chatting with the nurse, making fun of the weird operating socks I had to put on (they only offer ONE colour!! Beige!) Then it was go time, and I was wheeled in to a dark room with a lot of equipment. The staff were all in gowns, plastic masks in front of their faces.
The anesthetist asked if I wanted to be awake, in “twilight” – mostly asleep, to help with nerves – or all the way out. My blood pressure increases in medical settings, and it was amping up, so there was no “zero anasthetic” option.
I said: please, the lightest you can give me, just enough to keep the BP down if you MUST but I want to see everything. I need to know what’s happening.
They prepped my wrist, and explained the process. A catheter would go in just below the bend at my wrist, up my artery, around my shoulder, and into my heart. It would push a special dye into the valves. That part would feel funny, they explained. Don’t panic when it happens.
I asked questions. I’m good at asking questions, especially if the questions distance me from the reality of something unpleasant I’m about to do. I asked a lot of questions during my c-sections, too, and every time my children have been in the hospital. I ask and ask. And they explained everything step by step, while they sterilized my arm, and got everything ready.
When I was done asking questions, I made small talk. The staff kept working as we chatted about this and that. I made a joke. Somebody laughed at it, loudly, and cursed … then gasped and apologized profusely for cursing. Someone else cracked a joke about the patient (me) suing for unprofessional behaviour. I said: hey, guys, don’t worry … the OB played Nickelback during my last c-section, and I didn’t sue THAT guy, so I think we’re safe.
It was fun, if a “your life is probably about to change forever moment” can be fun.
And then, it was time. They pierced my wrist (I can see the dark spot still today), I could feel it (a little, only) up my arm, around my shoulder, and when they said ‘ok, you’ll feel this now’ I had the strange sensation of warm water being poured over my chest, and for a few seconds I couldn’t quite breathe, like all the air had been pushed out of my lungs.
It was the dye, filling up my heart, forcing my blood out of the way. I panicked for a moment. But they’d told me not to, so I kept it inside, and waited for it to pass.
The cardiologist looked straight ahead, at a screen, while my arm – pinned down, sterile, still wired up – lay next to him.
Ok, he said. We’re in. Let’s see. Right side, looks totally clear.
Well, I thought to myself, that’s a relief. But if it’s not my heart, then what’s wrong. I thought this would tell us what was wrong, and we could fix it. What if there’s nothing wrong, and it’s just a mystery and I just can’t do anything for the rest of my life without being uncomfortable …
Going into the left now, he said …
And then, a chorus, from the room:
And from the doctor: There it is.
All at the same time, everyone in the room saw it on the screen. From my angle, it was just fuzz.
There WHAT is? I don’t know if I asked out loud or just in my head.
Blockage. Left circumflex artery. Low. It’s 99 per cent blocked. Everything else is great. You have the heart of a 25-year-old. Except this.
Why? Why in one spot? I asked.
He answered: If I knew that, I’d be a very rich man laying on a beach somewhere. We don’t know. A blockage can start building up on a spot of damage. You could have had a virus when you were 16 that left some damage and it’s been slowly building ever since. It could have happened during your pregnancies. Once the arterial wall is damaged, the plaque catches on to the damage, rather than passing by.
I started to cry.
I was told, later by the nurse, that the interventional cardiologist performing the angiogram is normally a quiet fellow, doesn’t say much. An expert at what he does, but not really the chatty type. He was, in my memory, Indo-Canadian, with a beard, maybe 40. He had very kind eyes.
He put his hand on my side and squeezed a little, to get my attention. When I looked at him, his eyes were piercing.
Listen to me, he said.
I’m going to fix this. I’m going to fix it right now. It’s going to take me less than a minute. And then it will be done. And your job is to make sure it doesn’t have a chance to come back. Ok?
I nod again. I stop crying. I swallow everything I’m afraid of, every apology I might make for wasting everyone’s time. I nod.
Yes please, I said.
And then he fixed it. My eyes were too blurry with tears to really see what was happening, but everyone was very, very quiet then. No one moved. He ran his hands over the equipment, his eyes on the screen, and the wire that was running up inside my arm, around my shoulder, into my heart, slowly moved into position – though I couldn’t feel it.
He put the stent (which looks like the spring in a ball point pen but much much smaller) into place, and then put a balloon inside of that, to push it outward. It pushed the blockage aside, and opened the artery. The stent stayed where it was, widened to the width of the artery, clinging to the walls.
Won’t a blockage build up on the stent? No, it’s called a drug-eluting stent, it’s covered in a drug like chemo, to kill any cells that attach to it.
What about the plaque that the stent has pushed aside? It’s still THERE, isn’t it? It is for now, but over a few weeks or months it’ll be reabsorbed by the body, as waste, and it’ll be gone.
So this metal thing will be inside my heart forever? Yes, more or less, but after a while it will mesh with you, it’ll just be part of your body really.
They pulled the wire out. They cuffed my wrist in a high-pressure band, to keep my artery from going geyser-city. Every hour for the rest of the day, they ease the pressure on it but for most of the day it was so tight, my fingers were numb.
And then, like magic, I was better. The final diagnosis, from my primary cardiologist: the blockage had caused progressively worsening angina, hence the ache in my chest, back, arms and jaw. But I was lucky: no heart attack, no permanent damage.
I went home a few days later. Spa time at the hospital was over, and there was laundry to do, and lunches to make, and walks (without pauses to enjoy the scenery) to go on.
I feel like the luckiest person who ever lived: I have the heart of a 25-year-old, adorned with a piece of shiny jewelry in the shape of a very small spring. My heart (and I) bounced back after all.