Women and Heart Disease: The Heart of a Woman

More of the saga... I guess you know that they post from most to least current, so read backwards, please!


All of these central figures in my life were essential. If you happen not to have the good fortune to have available to you a similar support network, seek out a willing nurse, colleague or friend to advocate for you and to help you feel safe. The difference it will make in your recovery is enormous, even if you have some misgivings, discomfort or shyness about it. Through the support you will receive, you will notice a decrease in fear and anxiety and an increase in relaxation and, most imperatively, hope.
When I was finally wheeled into the procedure room, nearly twelve interminable hours later, anxiety had turned to sheer terror. All the denial, all the thoughts of not belonging in the hospital had disappeared. Taking their place were immense worry, mixed with hope, tinged with only a modicum of belief in the power to meet this challenge and emerge victorious - even with my assemblage of comrades just outside the door.
The room was so large, foreboding, cold and the narrow operating table so hard and uncomfortable. The lab team was involved in casual conversation while bustling around the room, preparing trays of instruments, which I found inappropriate, implying aloofness. They seemed to have no idea that I was shivering with cold, uncomfortable, totally terrified and not particularly confident; they were busy chatting. I realized that for them this was routine, just another "angio". It amazed me that they were completely uninvolved with me, as though I was neither awake nor aware. I announced my state of being quite clearly and I guess they took my anxiety seriously, because my husband was allowed to come in to help me exercise calm and encourage trust, but to little avail. None of these feelings were unusual, just new to me.
What I did not know was that when my husband left the lab, he rejoined my daughter, mother and stepfather in an adjacent room where they watched an "instant replay" of my angiogram on a screen. They then had the ominous task of participating in making a decision about what course to take. Next, the interventionalist appeared with an announcement: "We have a problem". Since the blockage in the LAD was 100%, there was some question as to whether or not I could be helped by balloon angioplasty. He was not certain that he could open the artery and not confident that he could then properly place the little metal stent, a metal-like "gate" meant to keep the newly-unclogged vessel patent, or open. There was a distinct possibility that I ultimately would have to be taken on an emergency basis directly to the operating room for open heart surgery. I don't know that I could have rallied if called upon to assist in making such a monumental decision, but I was surely not available for consultation so he had to have the family reach consensus.
It was my daughter who was in the unenviable position of calling literally around the country to every doctor she respected, asking them to seek the opinions of their trusted colleagues in cardiology. This complete stranger who held my life in his hands agreed to attempt angioplasty coupled with stent placement, although he had expressed qualms about its likelihood of success. Stents are still relatively new in the field, having been introduced in 1995. No long-term studies were yet available, but this technical wizard's willingness to attempt the procedure could save me from bypass surgery, a rather unappealing alternative. There were no promises, but the decision had been made. I could have awakened in the “cabbage patch”, my affectionate (?) nickname for the unit bypass patients are taken to after coronary artery bypass grafts (CABG).
He succeeded, or so it seemed, and when I emerged from the lab, I remember receiving diligent care from the staff of after-care nurses. I was not particularly coherent, which frankly was my preference, and everyone was teasing me unmercifully when, after the procedure was complete, I was still asking for more medication, in a voice already slurred by narcotics! Once again, but totally out of character, I wanted not to be present; I who had spent my life trying to crawl ever-closer to the television set to witness any medically or surgically-related show, opted out of my own case. I have since spoken to many people who actually watched the monitor as first-hand witnesses to their own procedure. I needed to avoid that level of lucidity no matter how much medication it would take! Oddly, it was months before I was able to watch similar topics on television. Not only would I immediately change the channel, but my heart rate would climb and I would be on the verge of tears. My experience at the time felt so unique, but I know now that all of my thoughts and actions bore great similarity to those of us who have endured similar physical happenings.
When my family and friend were permitted to come around the curtain to see me, I remember most vividly their vociferous complaints. My somewhat relieved cheering squad had been basically sequestered in a room that was Antarctic, even compared to the post-op ante room in which I was shivering! Naturally, I would rather have been turning blue in the waiting room or boiling at the Equator than continuing to lie on the gurney, but I tried to express my condolences, quipping about my own "comfort" level, particularly to my frozen, exhausted, overwhelmed daughter. My humor intact, at least to the degree my consciousness allowed, I promised sweaters all around and was ready for the next phase. I would have gone anywhere to achieve an exit from the lab. I could not have known then one of the many things I now know: they were searching for a way out, too.
So, I was returned to the CCU, still not fully in command of my faculties, but presumably out of danger.
There followed about two days on the unit, involving a strange and unfamiliar level of incapacitation coupled with a feeling of being trapped, literally tethered to equipment, unable to venture even to the doorway. I had convinced myself that I did not feel sick enough to warrant intensive care, but admittedly and inescapably, I was not completely stable. The blood thinners were not working well enough and my heart rate was uneven. Since the weekend had arrived, my physician care was almost non-existent. If you have ever been in this disquieting situation, you know that there are many possible reactions, all of which are natural. The one that surfaces keeps hidden from view all the scenarios we elect not to expose. For example, in one of my more obnoxious moments, I instructed an uninformed on-call cardiologist to go back and read my chart before he re-entered my room! Although insulted and somehow seemingly anxious for my approval, he had no knowledge of my condition and no ability to answer any of the questions that were beginning to plague me. By this point, my daughter was furious and talking about the possibility of transferring me to another hospital. Patience was wearing thin, concerns were rising, tempers flaring, and I was not exactly making friends with the frustrated staff. My complaints were neither baseless nor sugar-coated, but they belied my desire to gain some degree of mastery or at least minimal control over what I was just barely beginning to comprhend was my condition.
I am actually not sure at what point my brother and sister (in-law, in life) were notified, but I do remember feeling so happy to see them and so beautifully close. There was a blur of visitors during those first several days, but most outstanding in my memory was my sweet, frightened brother, for whom this would engender, not surprisingly, a wake-up call. He would lose a little weight, exercise more diligently, adjust his lifestyle to protect himself. This actually did not come easily, since he at first announced that he was not the recipient of our father's genetic flaws. I remember telling him that as far as I knew there was no sperm and egg discussion regarding transfer of specific genes. He seemed to have inherited many positive features from our mother's side, but was not magically immune to the rest. His wife, my wonderful friend/ sister, was totally supportive and avidly in favor of his wise decision to change some of his potentially dangerous habits. They were both endearing, tearful, genuinely loving and concerned and we were to become closer to one another than ever. My mother felt a tinge of guilt from the first visit, but was easily forgiven!
Once I returned to telemetry, I had more freedom and there were visits, cards, flowers, gifts and phone calls from people who were important to me and some from those who were more peripheral. The common thread was that each person had concluded that they had better take this seriously in their own lives. What had happened to me seemed so unlikely that the general thinking was "if it could happen to Sue"… There was some solace in hoping that I could help transmit such an important, potentially life-saving message to as large a circle of people as possible.
Once back on the floor and able to begin to wash myself and even venture out into the hallway, I began to feel more human, even daring! It's funny how definitions twist: I dared to pull the IV pole without assistance and walked a few steps beyond the permitted parameters! Now that was me: a rule-breaker, downright mischievous!
I had survived and now would concentrate all my efforts on getting stronger. No one knew how dauntingly slow the process seemed to me already. Assembling the patience for a long journey was not my natural bent and wreaked havoc on my do-it-now personality. I also knew that I would have to summon up the courage to educate myself on a topic I did not want to utter in any sentence containing or referring to my name.
That education was foist upon me unexpectedly when I was brought to the X-ray department by wheelchair for chest films ("small complication" of fluid in my lungs and potential pneumonia). I was left alone in a hallway, waiting for my turn, my complete chart on my lap. It was my only reading material! Never one to do nothing, I began the perusal. My review: heavy, melodramatic, polysyllabic and unbearable. But there it was: “worsening of pulmonary vascular redistribution”; “diagnosis: CAD” (Coronary Artery Disease); “left ventricular wall function severely impaired”; “ejection fraction 30%” (60-80% is the norm, and is a determinant of the heart's ability to pump out blood returned to it by the venous system); “30% scarring” (necrotic, or dead, heart muscle). On and on I read, plunging myself into an abyss, really wondering if there was enough of a medical armament to pull me through.
On one particular hallway hike, I encountered the aforementioned insensitive clod who viewed me through his gender-myopic, emotionally lacking lens. I might not have bothered to pursue the closure I desired, but when he spotted me he eyed me with contempt, mighty far from the repentance I thought appropriate, so I made my move. It was calculated to be therapeutic, my natural style, but clear and no-nonsense in delivery. I ended up lambasting the poor creature because he had the gall to come back at me when I began my contributory little sermon. Initially, I let him know that I felt his manner left me feeling upset and peeved and was not constructive. I added that his training needed to include compassion, not condescension and that I did not think he was intentionally negative. When he came back at me with a fierceness belying his immaturity, I told him that he had been medically incorrect, as he well knew by then, but that his approach to me as a human being was even more reckless than his poor medical assessment. He remained belligerent, unwilling and/or unable to listen, so I suggested that his chief resident should be told the details of both this and our first encounter. He announced that he had an unblemished record and I should feel free to do whatever I wanted, never admitting even the slightest guilt. He continued to provoke me to the point of my allowing him to make my heart beat faster and my blood pressure soar, so I retreated to my room. By then, an audience of nurses and ancillary staff were sprouting antennae and making high signs. He was next victimized by my mother, who bounded toward him, intent on lambasting him further for the harm he caused her cub when he blurted "I saved her life!" Responding to his absurd level of arrogance, and never at a loss for words, she read him chapter and verse, standing too close to him to provide for the escape he would undoubtably like to have made. The crux of her message was that he may think he is wonderful, but she believed him to be an incompetent moron and an insensitive boob. She received the equivalent of a standing ovation, mimed applause included, from his co-workers who had been enduring his nonsense for months. It was a healthy release for her and a deserved bruising for him.
By day four, I was more interested in the activities of daily living (ADL, in the vernacular): brushing my teeth, using lipstick, eating, if minimally, but the level of fatigue was dismaying. I was definitely in a state of basic denial and was disturbingly ignorant about my disease. A life-long fascination with medicine, natural curiosity and the drive toward acquisition of knowledge were non-existent. I was asking almost no questions and absorbing little information. I had no interest in becoming a "heart patient" to the point that when the cardiology team would come to examine me and use terms like "coronary artery disease", I would feign looking around the room to see to whom they were referring. My baseline acceptance was about .1 on a scale of 1- 10. I never again dared to look at my chart, didn't ask what my blood pressure readings were, made funny comments as a defense, doing a great ostrich imitation, even without the sand.
I was not particularly trusting of the hospital or the doctors, none of whom were known to any of us or recommended by professionals we knew. I had acquired enough information to comprehend that I not been "repaired" through conventional bypass, so I dreaded the possibility that the stent would fail. I cried often, but was urged to quell these natural reactions so that I would not strain my heart. What a concept! How is that even possible? Talk about a "broken" heart; I was racked with fear, loaded with potentially dangerous medications that were not yet accomplishing their purpose and felt little control over my situation. My husband was trying to be present and positive but was obviously tired of the whole scene. Everyone was on overload from the ever-growing list of small disasters that had taken place - like the light bulb that broke overhead and landed on my bed, which was never properly attended to until my mother's intervention. Of course, these minor episodes provide our dismayed visitors with a safe venue for their feelings of fear and helplessness: it is a relief to react to a broken bulb rather than cope with a clogged artery!
My transfer back to telemetry just days before had been welcome, but I needed to go home, another expected reaction, familiar to all of us who have tolerated hospital stays.