5:30 am: I feel like shit. Mainly because this is my third night with less than 6 hours sleep, and because it’s cold. Pretty darn cold. My watch says 3C, but the frost outside belies that.
Still, I have a weekly commitment to exercise with Amanzi, and as I keep reminding myself, once I’m there I’ll enjoy it. Well maybe not when I’m there exactly. Maybe afterwards. Definitely afterwards.
6:00 am: It’s cold. Kaz our trainer has 6 layers on. I only have 2, shorts, t-shirt, tracksuit pants and hoodie. Jeff amazingly has only shorts and t-shirt. Insane. We set off on our warm-up walk.
Kaz leads a hard class, and I can see from Apple’s Health App later that my max pulse hits 171. That’s not exactly healthy at 48. Max is something like 172, but I should be operating at about 80% of max. Shoulda, Coulda, Woulda. The Shoulder Press Burpees after the cardio/resistance circuit are a killer. I hate them. And I know I’m going to hurt tomorrow.
Little do I know.
Usually I’m the comic side-relief in the class. It’s easy getting a laugh when you’re the fat, old guy in a group of marathon running fitness freaks.
Today I’m subdued though. TBH there’s not much opportunity for breathing, let alone speaking between exercises.
7:01 am: Heading home and I don’t feel great. My windpipe burns and I feel slightly nauseous. I attribute this to over doing the exercise, and the cold air. That’s exactly what it feels like.
Lu has sent a WhatsApp to myself and Amanzi that the milk is on the turn, so Amanzi offers to pick up a bottle at the BP en route home. I joke with Kaz that heart attacks usually happen much later in the day, and the surprising number of over-40 triathletes that fall over and die because they have such little body fat.
7:14 am: I arrive home, and try to catch my breath in the car. I’m feeling really shit. Much worse than usual after exercise. Later I see from my watch that my pulse went from 60bpm post-exercise to 98. I suspect this was the beginning of the Heart Attack.
I drag myself out of the car, and I’m overwhelmed with cold. My wind pipe is burning, and my skin is clammy. Not good. But then I have been sweating for an hour and the air is freezing.
Instead of hitting the shower, I decide to lie down for a while. I don’t have to get to the office today, at least not early. Nothing on the calendar apart from distributing my recent presentation on IoT. And expenses. Always expenses.
Shit it hurts. I hear myself crying out in pain as if I’m an observer. I still don’t think it’s a heart attack, but I’m clearly unwell. Seriously unwell. I haul myself up into a half-reclined sit and pull the doona up over my shoulders. Damn I’m cold.
I think about calling ‘911’, remember in Australia it’s ‘000’ then consider the global GSM ‘112.’ But I still don’t. All I want is for the pain to cease, and I still think that I just overdid exercise in extreme temps. A high pain threshold turns out to be a pretty poor capability in diagnosis.
HTSAHA #1: Call for help early, even if you don’t think you need it
7:23 am: Lu comes in after hearing me cry out. Impressive considering how much noise the radio and the girls are making in the kitchen. She asks what’s wrong and I’m hard pressed to describe the pain and the cold. “My lungs are burning.” She asks whether she should call our doctor or an ambulance. I respond with ambulance, which was the right choice. This is the first time in 48 years, and four continents, that someone will call an ambulance for me. First #1.
HTSAHA #2: Don’t waste time calling a GP. Call an Ambulance
Sitting up helps. On a scale of 1 – ‘Kidney Stones’ it takes the pain from 11/10 to about 10/10. I begin to meditate. Focus on my breathing. Very shallow to minimize the pain, centre myself to this moment. This breath. Later I see my watch measured my pulse back below 60. In. Out. In. Scan from hair to toes. Out. Just focus on the present.
Outside the rising sun is dazzling through the bare branches of the trees. Lucy closes one of the curtains. In. Out. Shit, where is that Ambulance? Maybe I should ask Lucy to phone again, but I know that the highest priority ambulance call is ‘chest pains’ I just have to trust that they are coming as quickly as possible.
In. Out. Where is the Ambulance? I’m not scared. In fact quite the opposite. I’m upset because it’s likely I won’t be able to ride my bike to work, and I haven’t ridden since Sunday. I’m not worried or concerned or anxious. I really don’t think I’m about to die. All I do is focus on my breathing, remain as calm and still as possible. As a Dive Instructor I learned early on calm is always good in a catastrophe. I just wish for the ambulance to arrive so they can take the pain away.
HTSAHA #3: Meditate and calm yourself. Focus on core functions like breathing
The pain. A burning through my chest down my windpipe into both lungs. I review what I’ve learned about heart attacks in the 34 years since first learning First Aid in St Johns Ambulance:
- Crushing pain? No. My pain is intense, but burning.
- Left arm and up to the jaw? No. Just in my windpipe and lungs. Across my chest sure.
- Unchanging intensity? Not exactly. My pain increases with depth of breath, and although it’s bloody sore, I can ease it slightly by sitting up and breathing shallowly.
I can’t be having a Heart Attack. For one thing I have, and always had, a healthy heart. My average resting pulse is 53-57 measured over the last 3 years. I don’t know of a single person my age with such a healthy pulse. For another, the symptoms just don’t stack up. The paramedics are going to chuckle and tell me not to overdo it with a 20 year old in circuit training.
Shit I’m so cold. Hypothermic. I pull the doona closer around me. And breathe. It’s only later I recognise the cold is from shock. Cold and shivering are only intellectual symptoms for me, a checklist. This is real.
A faint siren blip assures me they’re almost here.
7:49 am: I’m not aware of the time, only how long it’s taken for the ambulance to arrive. But two paramedics enter the bedroom. Justine is blonde with short hair, and Bronwyn a 5’8″ brunette with a wicked sense of humour. I memorise their names and answer their questions. They give me a tablet to swallow and half a one to stick under my tongue.
HTSAHA #4: Get to know your rescuers by name.
“How are you?”
“On the one hand, pretty shit actually. On the other, above ground, you’re here and the sun is shining.” The pain reminds me I’m still alive. And going to live. Of this there is no doubt.
Justine takes off my watch, and Bronwyn my FitBit. Looking for an arm to stick a needle in.
I mention to Justine that Emily, my daughter, is a registered nurse and has just completed her midwife training. She smiles: “That’s great. I’m a RN and a midwife too.” Wow.
Pity I’m not having a baby.
Bronwen stethoscopes me. Breathing hurts more and removing the doona is freezing. Then she prods my chest. She pokes around in my right arm to set up an IV. “Jukkels, stukkels, FUCK! Me. Sideways! That hurts.” I apologise for my language. They laugh.
Justine: “That’s not the worst we’ll hear today.”
Bronwen: “It’s not like you’re swearing at us.” I can’t imagine why anyone would swear at these life savers.
Bronwen makes another attempt to stick a canula in my radial artery on the right wrist. But the vein won’t play ball and keeps sliding out of the way. I reckon my BP has plummetted. My language is a little tamer this time: “Faaaaaaaaaaaar out.”
Then they wire me up to an ECG.
Bronwen: “You’re not well mate, but the good news is the symptoms don’t match a heart attack.”
She takes a print from the ECG. “Actually the ECG has just made a liar of me.”
To Justine “I’m going to transmit it to Westmead.” A nod.
Justine: “Are you allergic to anything? Would you like some morphine?”
Would I ever?! “Just azathioprine, and yes, morphine is awesome.”
She looks at Bronwen and holds out the vial. “Confirm 10/2018, 5mg?” Bronwen, however, is busy. Head down working on the ECG.
She looks up. “Confirm 2018.” They stick it in the canula in my arm.
“Holy Crap!” My arm goes colder, icy, then begins to burn, an insane itch all the way up my forearm. This must be what it’s like becoming a night walker.
“You’re really calm Roger. That’s good, keep it up.”
I nod, “No point in panicking really.” I think of (the cover of the) ‘Hitchhikers Guide To The Galaxy.’ Douglas Adams remarkably prescient.
Bronwen’s phone rings, and I’m struck by the idiosyncracy of a 90’s Nokia ring tone. “Straight in,” she responds, “we’ll be there in about 15 mins.”
Justine goes off with Lucy, Lu to move her car to give the ambulance access, and Justine to figure out the best way to get me out. Lying down on my bed, the highest point of the house was probably not the smartest move. Finally the pain lessens to about a 7 or 8. Bearable.
Justine: “We’re not going to be able to carry you out. Are you ok to walk down the stairs?” Well yes, I think. I mean I climbed up the stairs didn’t I. Hilariously I’m just worried about slipping ‘arse over kettle’ in my socks on the wooden steps. The sort of thing Lucy would do. I chuckle.
8:25 am: It’s been an hour since we rang and eventually we’re on our way. They manouvre me from the bedroom to the kitchen stairs in a ridiculously unwieldy, fold-up wheelchair, then help me down the steps. Again down into the garage. I look at the Ducati wistfully as they pop me on the trolley. This is ‘First #2.’ First time on an ambulance stretcher.
Then it’s into the back of the ambulance. ‘First #3.’ I’ve never been in an ambulance as a patient.
8:31 am: Bronwen in the back with me to Justine in the drivers seat: “We’ll meet them on the way.”
She explains to me they need a second paramedic in the back for support in cardiac cases. In other words if I crash they need two to keep me alive. I’m happy about that.
It’s less than a couple of minutes when Clare joins us. “Hi Clare, I’m Roger. Geez, it’s like Charlie’s Angels in here” that gets a laugh. Good.
HTSAHA #5 Humour is good. It keeps you engaged, it’s good for the crew, and the positivity drives towards a good outcome.
Clare asks Bronwen whether she should oxygenate me, they decide on a nasal tube. Then they ask about my pain which is still at a 7ish. “More morphine?” Sure. They pop another 2.5mg into the canula. This time my arm goes ever so slightly cold & itchy. More bliss.
I try to figure out where I am by playing back the turns and recognising the trees through the rear window. Just so I can figure out a rough ETA but I give up in vain. I’m starting to drift with the drugs and concentrating on not rolling too much as the ambulance rolls around turns. The sirens are remarkably comforting in Sydney morning traffic. Comforting to me anyway.
Bronwen suggests to Clare that the hospital is bound to phone her because we’re late. As if on cue she gets another call, I make a mental note to rib her about that bloody ring tone.
“We had problems extricating the patient, still about 10 mins out.”
Clare asks: “Hey Robert, how’re you doing?”
I snort: “It’s Roger. Doing fine thanks.”
“Oh sorry Roger, I read the paper wrong. Why does it say Robert?”
I have no idea. In fact I have no idea why we’re still writing things on papyrus in 2016. I do, however, have a crazy compulsion for ensuring people know who I am. A person with an identity, not someone who’s name no longer matters.
HTSAHA #6 Your name matters!
Cardio Cath Lab
8:51 am: We’re at Westmead hospital. First #4, first time admitted through ER from an ambulance.
Justine and Bronwen walking the trolley in. The first person in view is an Indian who looks like he’s 17.
“Hi I’m Roger.”
“Rahul, I’m your admitting doctor”
I want to chat to him about my good friend Rahul from HP, but it seems hardly relevant as they whisk me down the hallway. Straight to the waiting team at the Cardiac Cath Lab, which as you’d expect is First #5.
Rahul: “Are you on any medication?”
“Just Sevikar, I think the active ingredient is Olmesartin, for High BP.”
“Is that all? What dosage?”
“Yep, that’s all. 40/5”
Then all the ‘lifestyle questions.’ No, I don’t smoke. I rarely drink (<5 units per week on week-ends). I don’t use prescribed or unprescribed medications. I have sex with a single partner. My wife. In the overall analysis apparently my life is boring. I have no life. No questions about my job, my passions, travel, my family. Nothing about diet, or sleep, or exercise.
The first attending nurse comes into view. An energectic Asian lady, probably in her late 40’s.
“Hello my name’s Vicky. We’re going to put you on the table and it might be a bit cold.”
“Hi Vicky, I’m Roger.” As ever I make a note to address people by their names, and to remember them. But there are too many people around, and few introduce themselves to me.
“Roger, what’s your next-of-kins name?”
“Do you know her phone number?”
I give it to her, and Vicky writes it on a length of micropore tape. Then tears that off and sticks it to her scubs. What a great idea.
HTSAHA #7 Make sure someone can contact your family
A voice from the door. “This is Mr. Robert Lawrence, 50 year old male.”
I pipe up, indignant, “I’m Roger, Roger Lawrence, and only 48 thank you very much.”
The crew laugh. Good spirits, I like that more than dislike the mistakes.
A tall man peers over me: “I’m Dr Mark Cooper. We’ll be putting a stent in to sort you out.”
He picks up my right wrist. Somebody calls out “His radial was ’tissued’ by the paramedics, let’s go through the groin.” Mark agrees.
“Are you ok if we put a sheath through your groin?”
“You are going to lignocaine me, right?” I ask.
A chuckle “Absolutely, you won’t feel a thing.”
“Go for your life.”
Another go at my full name, my date of birth, allergies, lifestyle choices. There’s a bit of hilarity when we confuse my year of birth and age. I’m calling out “48,” the nurse simlutaneously saying “’67.”
“An immunosuppresant I took as part of treatment for Ulcerative Colitis.”
“Ok, and what was the reaction?”
“All the side effects. Nausea, dizziness, bleeding gums, sore joints, painful kidneys. The works.”
“Good thing we won’t be giving that to you then.” Good thing indeed.
“We need to take your clothes off, are you ok with that?”
“Well I’m hardly in a place to argue.” Another laugh.
HTSAHA #8 Don’t care about modesty. Your wellbeing is much more important than whether someone sees your bits or not. Go for speed of care.
To someone else I can’t see: “We need everything off, including underwear.”
And then hands are slipping off my pants, hoodie, shirt and singlet. StarWars boxers. Good one.
“Nice socks” Vicky comments.
I try to remember what I’m wearing. Oh yes, the Christmas socks I got a couple of years ago from a church friend Kathie. They leave the socks on. Which I find hilarious. Talk about vulnerable.
9:12 am Then “Small sting.” It’s the lignocaine injection into my thigh. Compared to all the other pokes and prods this is essentially painless. Or maybe that’s the morphine. First #6.
Mark: “We’re going to have to tap the vein as well, the arm is useless.” Funny, I’m pretty sure that’s what Kaz our fitness instructor thinks as well. I let the team know. Another laugh. Focussing on the positives now.
I notice the monitor on my left which I presume the pictures are of my heart. It’s hard to figure out what’s going on. I’m conscious, but don’t have the angle to see who’s working on me or what they’re doing.
9:52 am: Then the pain goes away. Mark: “We’re done. Well done everybody.” A slight cheer from the team.
10:31 am I don’t recall passing out, but I’m aware of waking up. I’m being cared for by the Cardio Cath Crew. Mehdi from Iran and Kiri from Tennessee spend the most time with me. Also Virginia who’s just been on holiday to China. Another nurse comes to pop a canula in, Nicole.
“Which arm is good for you?”
“You know, my right is usually the best, but it seems screwed today, so best try the left.”
“Ok.” And before I know it she’s tapped a vein on the inside of my left elbow. It’s entirely painless. I didn’t feel a thing.
“That is absolutely the best canulation I’ve experienced in my life!”
Nicole beams. “I’ve done one or two.”
No shit, Sherlock. She’s a master. Later I find out that she was a pathologist before becoming a nurse.
11:33 am Brenda Robilliard appears at the end of my bed. She’s a lady from church, and the chaplain at Westmead. A welcome sight.
She gives me a small, knitted Teddy Bear, with a card: “Things are more bearable with Jesus.”
They are indeed.
“I saw you were in, and have caught up with Lucy. How’re you doing?”
OMG. Lucy. She must be beside herself with worry. Has anyone let her know that I’m ok, over the worst, and on the way to recovery? I hope so.
“Above ground, which is a very good thing, thanks.” This has become my common refrain. I know it’s cliched, but this is after all where that cliche makes the most sense. “How’s Lucy?”
“She’s ok, a bit anxious and teary.” Quite possibly the understatement of the year.
“Well, her husband has just had a heart attack. I’m doing fine with the best care in the world, she probably needs more TLC than I right now.”
Brenda smiles and agrees with me. After a welcome, brief visit she asks if she can get me anything.
My phone please.
HTSAHA #9 Get connected
11:51 am I have my phone. Time to reconnect with the world. For most people it’s been about 4 hours since hearing I’ve been rushed to hospital with a heart attack.
It turns out that Amanzi, Charis, & Leah are 20 minutes away. Essentially at home. Em who’s just come off nightshift is sleeping but should be able to join in the afternoon.
12:00 pm: Between SMS, WhatsApp, Email, Twitter, Instagram, and Facebook I inform most of the people I know, and update the close family and friends that Lu contacted earlier.
I have a standard message:
I figure most people don’t want ‘War and Peace’ but do want to have some unambiguous detail that let’s them know more than “Roger’s had a heart attack and we don’t know what’s happening.” As to my clothing, hunger and ablutions and motorbike, refer to Rule #5.
01:24 pm: John, the orderly, and Vicky wheel me up to Ward A5B Coronary Care. This isn’t the Acute Care that’s A5A (good sign?) but is still a high dependency ward. I meet Monika, a wonderful German nurse who reminds me a lot of Ika, the midwife whom helped deliver Charis. Also Leonie, a student nurse studying at WSU. Leonie is in her late-30’s, perhaps early 40’s, and making a career change from working at the ‘clubs.’
On the plus side, Lucy is there. It’s the first time we’ve connected since I was taken in an ambulance. She hugs me. Cries. It is so good to see her.
Now begins the cycle of observations, blood tests, and ECG’s. I’m catheterised with a combo of ReoPro (First #7) and saline in the one arm, cuffed to a BP monitor that fires every 15 mins in the other, have one finger in an SPO2 monitor (Blood Oxygen Saturation) and a 12-line ECG that connects to all four limbs plus around my chest.
Monika and Leonie handover to Adrian and Carissa. I also meet Angela who pops her head in to say hi before heading out to other patients.
Before Monika heads off, however, they want to remove the sheaths from my groin. One in the Femoral Vein, the other in the Femoral Artery. It appears this is a tricky procedure as you’d imagine. They need to keep the pressure on the blood vessel so that:
- I don’t bleed out – the femoral artery is particularly dangerous, this combined with hours of anti-coagulant and blood thinning drugs.
- I don’t bleed under the skin – perhaps not as urgent as if I spurted, but could be pretty debilitating nonetheless. Not to mention would prolong recovery
- I don’t lose bloodflow to my leg and foot – this is a tricky balance.
Adrian wants to perform the procedure, with Monika supervising and Leonie observing. I understand it’s not his first go, but stenting through the groin rather than the wrist has now become a relatively rare procedure. Always good for practice and educational purposes.
They talk through what’s going to happen. Digital pressure (i.e. Nurse thumb) on the vein, C-clamp on the artery. The pressure will be applied for 30 mins on the vein, 40 on the artery, after which I’m to lay flat for 4 hours without moving my legs, coughing, laughing, sneezing etc.
Still, on balance, having my artery bleed out is an pretty motivating alternative for compliance.
2:00 pm First #8. Leonie empties my ostomy bag. In 18 years since my operation, no-one has ever emptied on my behalf. Even the day I came back from theatre.
2:42 pm This is another first, having a femoral sheath removed. Twice. First #9. Not as they say, comfortable, either. In fact quite the opposite. I welcome the offer of another 2.5mg of Morphine. I know it’s not going to take the pain away. Just the care.
“Holy Jeebus!” Perhaps not even the care.
Monika has removed the venal sheath, and Adrian has his thumb buried about 6 inches into my groin. And holy crap it hurts. Not as much as this morning, but pretty bloody sore nonetheless. I can only imagine what the C-clamp is going to feel like.
3:20 pm Ok time for the arterial sheath to come out. The C-clamp is a contraption straight from the Spanish Inquisition, or your woodworking class at school. It attaches to the bed. The nurses place a plastic disc under the clamp foot on the groin. Then wind the clamp on to maintain tension.
“Ready?” Adrian asks.
“Sure let’s do this… ….Holy FUCK!” It seems I can’t avoid swearing in front of nice people today.
The pain is excruciating. I find myself focusing on my breathing again, like this morning. Ah well, only 40 minutes of this. The end is in sight.
As it turns out the discomfort was a lot shorter than 40 minutes. Firstly I normalise the pain after a while. Secondly Adrian keeps letting off the pressure bit by bit, every 3 or so minutes. We end up having a great conversation about his entry into nursing through USyd. He did a combined Masters, Batchelor of Sociology and Masters of Nursing.
From here on out a nurse is going to check my groin every 15 minutes pretty much for 24 hours. The fact that they tried to put a gown on me is ludicrous. It just gets in the way of the ECG, the IV Drip, and has to be moved every 15 minutes anyway.
Adrian is needed with the patient next door, who sounds like she’s having a stroke. Complete with slurred speech. So Carissa takes over the primary care.
6:30pm They serve Roast lamb with veggies and gravy for dinner. I’ve been ‘nil per mouth’ since my heart attack and am ravenous. But I’m still not meant to be moving. I can smell the meat and begin salivating.
“Hey Carissa, what’s the chance of eating before that lamb goes cold? Is there any way perhaps you could cut the food, and I’ll just shovel it into my mouth?”
Carissa feeds me. Wow. First #10.
3:30pm The family and I can spend time with each other. Everyone is here: Lucy, all four girls, and all three boyfriends. It’s like a deathbed scene from Macbeth, only without the jealousy, bitterness, and waiting for the old man to die.
Just as well because I don’t have any pithy sayings or wise words for them.
On the contrary, everyone is in high spirits. We’re bantering as ever. I expect that each of them will feel the pressure in their own way and own time. Despite the speedy care, and fantastic prognosis, this was a near-death experience of someone very close to each of them.
With that in mind, however, the family rallied together as they always do. They all support each other, with transport, navigation, meals, emotional care. If you read the family WhatsApp conversation, there’s no change in the cadence, just the content. The humour is as black as ever. Leah suggests I only had a heart attack to get the family together because Amanzi was lamenting July-August as the months we don’t have a family event to celebrate.
It’s not like the family is merely resilient to disaster, but thrives despite what’s happening. Whether things are going well, or up shit creek without a paddle, the family just rolls on. Not resilient vs fragile, rather anti-fragile.
Beyond the family, friends from all over the world and all times of my, Lucy’s and the girls’ lives are reaching out. Connecting. Some are continuing conversations, some re-initiating contact, and some meeting others for the first time.
I know that over the coming days and weeks it’s this vast caring network that is going to make the difference for my recovery.
HTSAHA #10 Build an anti-fragile network of family and friends
And I honestly can’t tell you how to do that, except it takes time and investment in peoples lives.