Another close brush with death

Contrast view of coronary arteries before and after stents
At left: my Left Anterior Descending coronary artery, before stents. Vessel is shown by contrast material; multiple occlusions as high as 90 percent are visible. At right: same artery with 3 stents, (indicated by marker lines alongside artery) restoring blood flow

To be honest, my doctor wasn’t that helpful. I had a bad experience with a statin drug; he couldn’t suggest any alternative. But for one checkup he was not available so I got his assistant. She listened carefully, outlined different kinds of statins and got me on one that doesn’t seem to have awful side effects. Based on my symptoms, she also suggested a calcium scan for my heart.

The heart is a muscle; it isn’t supposed to have deposits of calcium in it. But arterial plaque has calcium in it, making for a simple and cheap test using an ordinary CAT scanner. It was only a hundred bucks, not covered by insurance. I went in.

A calcium score above 400 indicates “extensive plaque burden”. My score of 1,325 for the Left Anterior Descending artery was… concerning. I met with the PA again. She called for a coronary perfusion scan coupled with a stress test. The results of that test confirmed the calcium scan.

Bridge Out SignCould it wait until the end of the semester to address? Well, no. Actually, the choice was between meeting the cardiologist this week for a procedure next week, and just doing the procedure this week. The cardiologist’s nurse advised just going ahead with the procedure. There was no “snooze” button.

The procedure itself was fascinating, and carefully-chosen drugs allowed me to recall every detail, only with a sense of detachment, as if it had happened to someone else whom I’d read about in a magazine article. I could see the flow stopped by occlusions. I could see it improve in real time, as the stents were inserted.

Some takeaways: My exercise habit is probably responsible for the fact that I saw a cardiologist and not a coroner. Even though the intensity of exercise had declined sharply, I had kept doing it every day. This kept blood flowing.

I have tendinitis in my left elbow. Often, the entire arm hurt, quite severely.  Coupled with lack of energy, shortness of breath, and sudden dizzyness, was the signal that prompted me to ask the sympathetic PA for a deeper investigation. Now, only my elbow hurts. Not my whole arm.

Because I’m on Plavix now, I can’t take ibuprofen, which is the only medication that really helped with my chronic pain. That’s a trade-off. After 25 years however, I have many strategies for dealing with pain. This is familiar territory, don’t worry.

I’m gonna have to find a new doctor. Unless I can just keep seeing his assistant. She’s a better ‘doctor’ than he’ll ever be.

I do not yet have a dramatic improvement in energy, but it’s only been two days. In earlier times, this would have been a bypass operation with six months of recovery.  I’m going back to work on Monday. Once the semester is over, I’m gonna take an actual two weeks off. Spend some time at the senior activity center.

What did I mean by “Another” brush with death? Well this post is already getting long, but it’s been an eventful couple of decades, and I’ve got to go for a walk.

 

Stress Test

Medical treadmill and testing control equipment

OK so here’s how it went down. You remember that scene in “The 40-Year Old Virgin” where they tear off all his chest hair with tape? Pretty much me as they tore off about a dozen ECG contact pads. They had me wired up like some kind of cyborg. Only not a cool cyborg. More like a bald, overweight cyborg. Like, you’d design your cyborg that way if you wanted no one to ever guess…

After they got an IV set up, the technician brought in a tiny, battered metal case and opened the lid, which was lined with an inch of lead. She lifted out a hypo with a lead shield around it and lit me up. Then I had to go sit in the waiting room and irradiate other people while it perfused through my circulatory system.

Then they packed me into some kind of scanner I’d never seen before (with no room to move) and took 5 minutes of radioactive heart video. OK, it’s stress test time now!

Cardiologist: (watching, giving orders)
Me: (walking along like a normal person on a white GE treadmill hooked up to their system) It’s cool, I feel fine.
Nurse-tech: “OK, now we’re going to turn up the elevation and speed. You sure you’re OK?”
[Repeat several times]

Cardiologist: “More, more! I’m still not satisfieeed!”
Nurse-tech: “Are you OK? Any chest pains? Any pain in your arm?”
Me: (at full ‘running-from-wild-boars’ level of exertion, have my undersized lungs near bursting, sweat building up)
Nurse-tech: “Are you OK? You can’t just step off, we have to ramp it down, any chest pains?”
Tech: Injects something into the IV that burns like hell
Me: (between breaths) “Pile it on, I’m good”
Treadmill: (doubles)
Cardiologist: “Almost got it… 30 more seconds”
Me: (feet pounding, hallucinating the hyper-drive scene from 2001, a Space Odyssey)
Nurse-tech: “Can you make it 15 more seconds?”
Me: “I’mgoodgetthedata”
Nurse-tech: “5 more seconds”
Time: (slows down tremendously at light speed)
Nurse-tech: “That’s it! We’re slowing down now.”
Me: (walking slowly, lungs on overtime for another full minute)
Me: “Did you get the data? Did we get it?”
Cardiologist and nurse-tech: “We got it. We got good data.”

Then there was some other stuff about studying the readings and the radiologist’s report and my doctor and something…

Another scan, this time lying on my stomach, a position in which I am not comfortable.

OK all done! So we went home.

NOTES:

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  • Test machine is running Windows XP
  • *(I never saw that movie, but I saw that clip. Since it was in the trailer I figured most people would remember it. If I do this again I’m giving my chest a buzz-cut first.)

Sliding on the ice

LaughAtDeathFarSide
Some of you may remember I did a joke post a couple weeks ago, where my doctor called me and said “We need to talk” and I said that was never a good sign. I posted a Star Wars reference where Han Solo says; “Never tell me the odds!
Well they told me the odds anyway. My left anterior descending artery is badly clogged. Cardiologists playfully refer to this artery as “The Widow Maker” because the human heart goes haywire when that artery doesn’t make its delivery schedules. I have a big test this coming Friday to help determine the best treatment. (Oh man, will it be multiple choice? Essay? Will there be math involved?)
Dear friends, several things. This condition is well-understood in medicine, and of course I have already read extensively about it. While it is true a whole lot of people die every year from this condition, it is also true that a whole lot of people get treatment and _don’t_ die. I hope to be in the latter group. Thanks to the diagnosis my odds are now better than even. At the moment I am still very much alive.
While everybody has their own approach to danger, I prefer silliness. I would rather receive reassurances in the form of inappropriate jokes and movie references. When the guy in the dark robe and the scythe finally shows up, there is no more defiant response than laughter.
It’s the weekend. Go outside and enjoy the weather, even if it’s bad weather. Read a good book. Watch a movie YOU like even if someone told you it was too silly or sentimental or whatever. Clean something or mess something up. In the words of Sidney Freedman; “Ladies and gentlemen, take my advice. Pull down your pants, and slide on the ice!”
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  • Extra points if you read that last quote in the voice of Sidney Freedman, the psychiatrist on M*A*S*H

Story time about caves

Remember the Thai soccer team that got stranded in a cave with rising water, and a global effort was required to rescue them? That story felt a little personal to me. I had a cave experience once that clued me to how fast and unexpectedly you can get in trouble, in a cave.

Back in, maybe, 1977 or ’78, I was caving with a friend in Tennessee. We went down a long, twisting incline, walked around the perimeter of a subterranean lake, and crawled through a low horizontal passage. Its ceiling was so low we had to take our packs off and pull them behind us.

The horizontal passage opened into a chamber with a vertical wall. Which we scaled, and found a labyrinth of delightful new passages we’d never found before. These we explored for a couple hours (seeing only a small part of them), and returned to climb back down the vertical wall.

Which we did, and setting a foot down onto the level of the horizontal passage, felt… water.

The passage, maybe fifty feet long, had about four inches of water in it.

Outside, it had begun to rain. We could hear water pouring down the incline leading to the lake. Shining a light down the horizontal passage, we could see small waves coming toward us. The water was rising.

We could have climbed the wall and stayed in the high part of the cave for an undetermined period of time. Days? Longer?

How fast can you crawl? My answer to that right now would be “not very fast and not very far”. But when I was twenty? A lot faster, and a lot farther.

We race-crawled through the water in the passage to the lake. The walkway we had taken around the lake was now submerged. The incline had become a creek, feeding the lake.

Fortunately the water was very clear, so we could shine our lights through it and see the walkway. Then we climbed the incline back to the surface. When we emerged the rain was tapering off. It had been a brief event.

I have another story to tell of that cave, sometime. And others near it.

NOTES:

  • By the way, what a moving, amazing story the Thai cave rescue was. When I look at the hate and fear in a world bristling with pointless weapons, I wish we could all grasp the common fate of humanity and pull together for each other and the future like this.
  • In the excellent NOVA documentary, Elon Musk’s goofy plan to deliver an aluminum submarine for rescue got exactly the amount of attention it deserved.

REFUSING TO PLAY THAT GAME

It took forever to walk that road, icy feet torn and bruised in the dark
Dismantling fear with little hope of comfort or safety
Scraping at prejudice etched into my child brain and always felt to be the pattern of truth
And now, you want me to retrace those bloody steps for your benefit?
To go back on every discovery, to visit again the humiliation of finding out I was wrong?
To share with you this treasure, the spoils of battle against my worst self
So you can mock me? So you can throw talking points at me?
I finally won some understanding of human value
I can finally see humanity and beauty where before I could not
At last I am beginning to understand that the history I learned has been sanitized
You are not interested, not really
You are not seeking
You could say; “Please recommend a book that helped you understand”
You could ask me to suggest a movie title, or an experience, but all you want is an argument
Well, no.
My friends are not up for discussion. That issue is closed now.
I am not going back just to carry you kicking and screaming
And I have much farther to go to as it is.
Go on your own damn journey.

NOTES:

A human truth about John McCain

John McCain in senate
McCain’s Senate portrait

Oh, that’s right; I was going to write about John McCain!

Right after he died, I said I never doubted he loved his country, and that I would wait a couple weeks to say anything else. Now it’s been 22 days and the news cycle (which is on ultra-spin these days) has moved on. So here we are. And this post is about him, but it isn’t only about him.

See, I want to honor the heroic things he did. I don’t care if he was a great pilot or not, he stood for his country and went to war while cadet bone-spurs was dodging STIs in Manhattan (look it up). He co-authored an important piece of campaign finance legislation. He spoke against the lies about Obama. And I am delighted that he stood up to Trump right at the end. But.

But he also gave us Sarah Palin, and there’s a straight line from Caribou Barbie to Donald Trump. Let’s be honest about that.

His voting record, for the most part served the interests of the rich. Which is not surprising, because he married into a rich family and lived as a rich person ever after. Let’s be honest about that. And have done with the myth that rich people built this country. It was the sweat and blood of working people and enslaved people. And the blood of indiginous people. And people in other countries who suffered and died so our extractive industries could exploit their resources. Let’s be honest about that, too.

Why bring this up? Because as someone once said, the truth will set us free.

When I die, don’t sugar-coat my legacy. (For example, I have never been great at anything, and have come very late in life to some realizations I should have had much earlier. And in spite of that, I still have hurt people who are important to me; sometimes by lack of understanding, sometimes by being unable to reconcile the directions of our respective lights.)

Why does this matter? Because we the living, need to stop living in the shadow of perfect dead people. We are trapped in the expectations of one sanitized legacy after another. If you want to honor me when I am gone, don’t pretend I was great. Let my shortcomings give living people space to breathe. To make mistakes and admit them, and walk on a journey instead of pretending to live at a destination.

And that’s the same for John McCain. He sometimes rose to greatness, and he was sometimes just awful. There are damn few people who were mostly great or mostly awful. This is where most of us live.

Let’s be honest about that.

NOTES:

  • Wikipedia, John McCain, is a pretty complete history and lacking in partisan rancor