Archive for October, 2013

ASF’s The Coronary Chronicles: Act Three – You have now entered the Twilight Zone…


“There is a fifth dimension beyond that which is known to man. It is a dimension as vast as space and as timeless as infinity. It is the middle ground between light and shadow, between science and superstition, and it lies between the pit of man’s fears and the summit of his knowledge. This is the dimension of imagination. It is an area which we call the Twilight Zone.”

Pale yellow light bathed my hospital room as I tried to figure out in which direction my home was. Call it my training or whatever, but knowing which way is North always makes me feel better. I needed to do what I could to try to make more sense of the world because right then my personal gyroscope was malfunctioning. I had no real frame of reference to understand why I was there, and what had really happened.

I guess once they have severed and cooked and served you your perception of reality on a plate, you grasp any straw you can.

Double Big Mac Supersize Me. Nom nom nom.

Double Big Mac Supersize Me. Nom nom nom.

A heart attack. Un-buh-leave-ah-bel.  Un-f*-king-buh-leave-ah-bel. Morbidly obese people who chain-smoke and eat their Double Big Macs supersized with a barrel’o’coke have heart attacks. Frail old men who are at the end of their lives have heart attacks. And on the rare occasion, élite athletes who have doped, get heart attacks.

Yes, 48-year-old men can have heart attacks – but not this 48-year-old man.

I lay there beating myself up for almost 2 hours as I watched the sky lighten. Occasionally I became aware of my surroundings and wondered why my window provided such a shitty view of the inner bowels of the Hospital Courtyard. My only company was my new roommate’s snoring – the one I had yet to meet…no one is really friendly at 0430hrs. And as I found out later, no one even notices any noise on the floor – it is like hearing the sentry coming to wake you up for your 0200 -0300 hrs shift when deployed on manoeuvres. Your best bet is to pretend it’s a bear and play possum.

To add to the misery, I was starving, and there was no food forthcoming – I’d even take a cholesterol friendly rice cake. Breakfast may or may not show up – I was a late arrival at the starting gate so who knew.  And even though my mind was racing, I guess eventually even it had enough and so it shut down to let me doze off for a bit.

And later, after the new shift nurses took blood, my O2 levels, my temperature, my blood pressure, listened to my heart and lungs, made sure my legs weren’t swollen and I was not retaining water, I waited for someone to come and be with me. And then the day brightened and became more bearable the moment my wife walked in.

With a sheepish grin, I shrugged my shoulders and with my eyes said, “I’m sorry. I’m sorry to introduce this steaming pile of dog doo into our lives.  I wish I could take it back.”

And her eyes and body and hug said, “You’re an idiot. It’s not about what has happened it’s about how we fix it.”

Things are always better when you’re with the one you love.

After what seemed a long time, because time drags on when you are wearing one of those ill-conceived gowns and your world is upside down, the Head Honcho of the

I love the beer....

I love the beer….

cardiology ward came in and chatted. His assessment was pretty fantastic! Yes, I had contributing factors – 10-15lbs, high normal cholesterol, ex-smoker, cream ales and red meat. But I had a lot of things going for me: I was a “runner”, an active fella, relatively healthy – I mean I aced the Forces’ fitness test (those in uniform can groan now); the only unknown was my ancestry.  As many find out, you can run from a lot of things, but you can’t run from your genes. But that is Act Four…

And we spoke. He was a runner, too, and a triathlete and he saw my numbers and my history and my chart and he was fairly confident. He talked about an angiogram – an Unmanned Aerial Vehicle for your heart – and from what I gathered, an angioplasty and stent would probably be enough to take care of any nasty constrictions in my arteries. He ended with a chuckle and a grin, closing with how I might need to do things in a different way in the future and told my wife that I should be back and running in 30 days.  The angiogram was scheduled in 48 hours, on Monday, unless something changed.

So I settled in. With Wi-Fi and my laptop and Netflix, I was set for a slow but not necessarily an unpleasant weekend.  I would rather be home, enjoying a weekend with my lady, but if I had a coronary incident, it was playing out rather tamely. I realised that heart attack may be too strong a word; what I really had was a heart “skirmish”. Things were ok.

And then things got even better. Mid-afternoon, I learned someone had a critical heart attack and Team Angiogram, led by the “Interventionist” (yes, no kidding, that was the term used to describe the expert who does the angioplasty. I prefer “Master AngioPlaster”…but I keep thinking of Mr. Wolf of Pulp Fiction fame.) was coming in and that they would be able to “fit me” in immediately after. And if all went well, I would be able to catch Sunday Night Football and all would be right with world with some follow-up and good care. I felt a wee bit guilty that someone else’s critical heart attack was making me happy – but, hey, you take your small joys where you can.

This heart thing wasn’t turning out so bad after all. Not great, but not at all as dismal as I expected. The health system seemed to have responded very well to all our triglycerides and trans fats and sugars and stuff.

And not too long after I was prepared with a happy pill, locally anaesthetised and wheeled into the operating room. As is my nature, there was banter. In the space of 10 minutes the angio team and I had talked about running and half marathons and how it was surprise I was there and how it was probably going to be a quick in and out and how an angiogram worked and the steps of the angioplasty procedure and the mechanics of the stent and an overview of the anatomy of a heart. And because I had been given joy juice to ease the anxiety, I kept up with the conversation and probably even increased the revs by inserting questions to keep the conversation going because I was nervous and a little afraid of the unknown.

Well, it's a little smaller than this....

Well, it’s a little smaller than this….

The angiogram was a lot like watching a military drone fly over a target area. The heads up display board of six TV monitors provided vital stats, some sort of spatial referencing system, catheter status,  and then on one main screen, a picture of my heart.  That looked like a thermal image through a weapons system’s lens or a pregnancy ultrasound – depending on your experience you’ll get the essence. The Doc gave me an aerial tour of my heart and she explained it all.  But it was like the Enigma code to me; I could not understand any of it.  To tell the truth, I was really, really lost. The Grade 12 frog’s heart I dissected looked nothing like this.

The banter continued and then abruptly, it stopped.

“Hmmm…that’s interesting…”

Those words mean so much in so many contexts:

  • At home reading a magazine, it usually means, “Here’s an interior decorating idea we should use.”
  • About the internet it means, “we should try this restaurant”, or “let’s go see this movie.”
  • Amongst guys at the bar rail it means, “Sum up. Your story sucks.”

But in an operating room, while a cardiac interventionist is looking at your heart from inside your body, it sounds a lot like,

“Hmmm…you’re f*cked.”

And for three of four minutes she looked at my heart with all the intensity of a….of a… a….well,  with all the intensity of a heart surgeon, I guess.

And then she said, “you have a fair bit of arterial hardening.” And she showed me what can only be described as opaque lines in sea of billowing gossamer spider webs. I had no idea of scale or scope or whether it was the front of my heart of the back. I was hearing terms and references that were foreign to me. But this was my heart and I had to understand exactly what she was saying.

So I parroted back what I thought she was saying in terms in that I understood. And after that layman’s read back, I understood that while my major arteries were in fantastic shape, two smaller ones were heavily, and quite extensively, blocked.  At times all I heard was a Charlie Brown-like “bwah bwah bwah” as my mind scrambled frantically to understand what was being said.  Some words resonated, others didn’t:  heart disease, atypical, unique locations, awkward dispersion, angioplasty may not be the best option, must confer with my colleagues.

Wish mine looked this good...

Wish mine looked this good…

And all I could get was that this was now a whole lot more complicated and that I was not going to be a “quick patch and go”. There was no easy fix, no small stent, no going home quickly. No Sunday Night Football.

My heart skirmish was telling me that my heart was not just pissed at me…no, it was telling me any more bullshit and it was about ready to go on strike! I was not just a guy who suffered a scare – I had some serious heart disease. And running, or eating better, or cholesterol medicine, or happy thoughts weren’t going to fix this puppy.

I was crushed.


But much worse than before because after the first news there was hope this was might be easy. Now, as far as I knew, that easy road had been cratered. I had no idea what to tell my wife, or my kids, my family.  And I was speechless.

All I could hear was the Rod Serling voiceover “…the Twilight Zone, the Twilight Zone, the Twilight Zoen…” over and over again.

End of Act Three…

Later (like after my surgery and when my Tyrannosaurus Arms can use a keyboard again…),



ASF’s The Coronary Chronicles – Act Two: What the f*ck am I doing here?

Stack 'em up! Roll'em out...

Stack ’em up! Roll’em out…

Fade into a crowded, burgundy coloured hallway – smelling of hand sanitizer and ventilated by a cold breeze entering from the frequently opening automatic doors – harshly lit by many fluorescent lights, and dotted with computer monitors, hospital stretchers, and paramedics in uniforms of various colors and hues, and nurses and doctors in trendy scrubs with paramilitary cargo pockets…

I lay on a stretcher in the full Emergency ward, parallel parked in the high traffic hallway stretching from the ambulance entrance to the Nurse’s Station.  As I was witness to the multitude of people who frequent the Emerg (note the use of hospital savvy jargon), I couldn’t help but remark how lucky I was – save for the fact I was possibly having a heart attack.

My lovely wife and I sat in that hallway, in single file, her at my head, because there was no room for her to sit beside me in the crazy corridor. We were together – yet slightly apart – and silently thought about what was happening. Though we shared occasional encouragements, and commented on the goings on in the ward, we were both worried. I was here because I thought maybe I had suffered a heart attack, but really I was hoping that they would tell us I was a fool – that it was massive noon-hour meat loaf or a not quite “best before” sandwich.

And about 20 minutes later, the doctor came to me with the results of my first blood test.

“All is good, young lad! Your numbers are great, and there is no sign of troponin – our first indicator of a heart attack.”

No issues whatsoever...

No issues whatsoever…

We were so relieved.

But soon my relief was replaced by a temporal resignation, and an internal voice saying “I told you so, you pussy!” as the Doctor told me to dig in and get comfortable. Cardiac protocol dictated a second blood test at about 6 hours after the first incident. Ugggh. I was stretcher bound until at least 1230am, the first time that they could draw more blood accurately.

Ouch! I pondered my kitchen stupor decision – but the die was cast. I was, as the pig says, committed.

So I got comfortable, asked for a blanket, and with a mind more at ease, I started looking around to occupy my time between the occasional social media creeping.

An Emergency room is a fascinating documentary when you are waiting – especially on a weekend evening. Since it wasn’t after school, there wasn’t the stressed line of parents waiting for the docs to pronounce on Johnny’s concussion or stretched knee ligaments after rugby practice.

Nope, it was the Friday Night Club: an airlifted and unconscious car crash victim on a backboard and neck stabiliser; the obscenity hurling drunkard who wanted to beat up everything – not just everyone – in his path, but thankfully was restrained; the possible drug addict who looked as if she had crashed hard; and sadly, the poor young university student who appeared to be the victim of a drug-laced drink – or 10 margaritas. She and her friends shared a convoluted story about how she met a guy over the internet and had joined him for drinks. Her case, among all of them, disturbed me most; she was catatonic. I honestly have no idea what happened to her and neither did one of the Kingston’s Thin Blue Line who was trying to piece together the puzzle that was her evening. As I looked at her, not even knowing the ground truth but fabricating one of my own, I felt shame as a man, and I felt anger as a parent. As I looked at my fellow citizens in angst and those charged with taking care of them, it was amazing how thick the air was with a tension and turmoil. If I had to describe the atmosphere as a colour, I would call it a mist of reddish-black.

I asked myself again, “What the f*ck am I doing here?”

And time ticked on…slowly. And my mind explored unconsidered thoughts and memories.

I remember reading newspaper stories of the elderly who die unattended in the hallways of the Emergency room. I never understood it, but I get it now. As I lay there, the staff moved to and fro dealing with this and that – every “that” more urgent than the previous one. They were busy. And when it was my turn to be looked at – to give blood, or have an ECG, or have vitals taken – the staff were friendly, responsive and professional. But then their attention diverted to the next priority and I became part of the landscape – a part of the furniture. And though it is tragic, and inexcusable, I could see that if something went amiss, like a misplaced file or misdirected lab result, that people could sit and wait and wait and slip through the cracks if they were unable to speak for themselves or cast nasty looks.  As the administrators and clerks and porters and cleaning staff and medics who had nothing to do with my case management went by their business, there was no salutation or warm comment, not even a sideways glance. It was as if a kind moment would divert them from their quest, would implicate them in some longer interaction that was just not helpful to their work day.  No water, no food, no nothing for six hours.

I fortunately, was ok. I had my wife with me, and I was fine – the first blood test said so!

But if I was a lonely, scared, and sick or injured person, it would be absolutely terrifying and an unbelievably shitty way to pass time.

And time continued to march on. Thank goodness for my smart phone and the hospital’s free WiFi. The hours whittled away as I Stumbled-Upon and Tweeted and had virtual conversations on Facebook.  I was convinced that I was wasting my time, the staff’s time and holding up someone who was really ill from getting looked at because I was a priority over the laceration or contusion.  In fact, we were so optimistic that my wife, feeling tired and not so well herself, went home to look after the dog.  Whether it was the nitroglycerine sprays, the baby aspirin, or just time, my chest stopped feeling funny and I moved to the dodgy tummy and gas stage. I’ll spare you the descriptions – but if it was a colour, think greenish-brown!

Then, suddenly it seemed, 1245am arrived and the clinician took my blood, all the while asking me if I knew her friend Sanjay, who was Indian, but born in the UK. Sadly I didn’t, and strangely enough, she found that surprising. She was sure that Kingston was not

I'm here, I'm here....

I’m here, I’m here….

that big a town after all, you see.   And 45 minutes later, the hip looking senior medico – looking all young Bob Dylan-ish in his green scrubs and Levis – came to see me with file in hand, as if all of sudden I had pulled a Walt Disneyesque sleight of hand, and changed from a chest of drawers to a human being.

White dove and seas, man...

White dove and seas, man…

“Dr. Bob” looked a little surprised – and secretly I was hoping it was because he couldn’t believe someone would waste 8 hours of their Friday night for nothing. I was already dreaming of a nice hot shower and my comfy duvet, snuggled up to my wife.

But that wasn’t to be.

“Uh…mmm…wow. I would never have guessed it from your history, your activity level and your age, but…uh…the numbers for troponin in your 1245am sample seem to show you have had a ‘coronary event’…crazy, man.” (“Man” thrown in for literary effect…)

A coronary event – what the hell is that?! I don’t recall reading anything about that when they were talking cholesterol or blood pressure. Is it like the Farm Team version of a heart attack?  And if I heard it right – because I was a bit stunned – he explained it could be coronary arterial spasm (rare in men but possible), or angina, or a heart attack. He wasn’t ready to pronounce judgement as it wasn’t his specialty – I guess the answer was blowin’ in the wind.

The on duty cardiologist intern would check the data.

I remained stoic and calm and cheerful on the outside; but inside, I was a raging torrent of confusion. WTF? Seriously? A coronary event? My ticker was busted?

I guess it's something to do with your heart...

I guess it’s something to do with your heart…

So with that premium upgrade in patient status, I moved from “hallway hanger-on” to a full-blown patient of the emergency ward. I was moved from street parking and backed into my very own private parking spot. The curtain was drawn and I was left to ponder what just happened.

Being alone with such news is a freaky-deaky. Not for the last time over the next few hours, I asked myself again, “How the f*ck did I get here?”

Now, I know that I came to Emergency  because I thought I as having a heart attack, but what I really wanted was someone in green scrubs to pat my wrist and say, “There, there, Sir, the voices are just in your head. You’re fine…just lay off the fatty food and keep running.”   When it came to my read of my symptoms during the run, there was absolutely no joy in being right. It wasn’t as if I had just won a bet by looking up something on Google; I had just had a bloody heart attack!

Twenty five minutes is a long time to ponder such news. I dug deep and kept busy. As my phone was on its last 4% of power (ASF’s Top Tip: Free advice…if going to Emergency, grab your phone charger. You’ll probably need it),I did a quick assessment of who would need to know at 0330am that my heart was telling me I was an idiot.  And so followed a quick round of texts to my wife and e-mails to my bosses giving them the news – the first was necessary and needed; the second was because that is what we do in the Army. But, unfortunately I had to inform them that they would have limited opportunity to contact me on my phone because it was dying. In a burst of coherence, I changed “dying” to “running out of juice” –  dying may not be a good word to use when telling people you have had a heart attack.

And so at 0430am I was wheeled to the Cardiac Ward, pumped full of blood thinners and anti-coagulants, anti-clotting agents, aspirin, and beta-blockers and left in the quiet dark to ponder my fate.  It was late and I had been up for over 22 hours but I knew that there was not much sleep coming.

Again and perhaps for the final time of the day, I asked myself,  “What the f*ck am I doing here?” I did not have many answers.

End of Act Two…



ASF’s The Coronary Chronicles – Act One: It’s HRH’s fault…

Seriously, a heart attack? Seriously?

Seriously, a heart attack? Seriously?

I had a heart attack.

And as I think on it,  I don’t blame genetics, or an elevated cholesterol count. I am not mad at the few extra pounds I am packing or my penchant for BBQ and red meat, or tasty craft beers.

I blame the Royal Family for my heart attack. Them and the Royal Canadian Signals Corps…

As it happens, on a crisp, cool Friday afternoon when I should have been hoisting a few pints with my brothers-in-arm, I wasn’t.

Yes, Your Royal Highness, they were hoping you would join them for a pint..

Yes, Your Royal Highness, they were hoping you would join them for a pint..

The Worshippers of Mercury – the Spawn of the Sappers – had invited Her Royal Highness Princess Anne to Kingston to celebrate some kind of antenna raising or something. And on the very night when I should have been enjoying the comforting oak panelling and leather of the Keg Room, quaffing Paulaner and munching on potato chips and popcorn, recalling my exploits as a young dashing Sapper officer in faraway places, I wasn’t.

All because HRH was dining in the Officers’ Mess later that evening there was no Happy Hour.  Mesdames et messieurs, la messe des officiers, elle est fermée.


I suppose I could have gone elsewhere to imbibe. But I didn’t. I wanted the moral high ground and I did not need a pint really. So, I decided that I would take my faithful furry companion for a little joggle on the trails around the house and make room for a little weekend living.

And that’s when my royal pains really signalled their intent…and again, if I had  been to the mess, I would never had have an heart attack. If P then Q. (And for those that know, a small homage to Dr Ramkeesoon…)

Anyway, the run started nicely enough, confident strides, and an occasional stop to let Lola sniff the glandular calling cards left on the path by her canine neighbours. But after a steady 1500m, things went awry. I was no longer loping and enjoying. The run was harder than I thought it should be – even though I knew it had been a slog of a week. I was not enjoying it like I usually do. This time there was discomfort.

Not in my chest and not in my stomach, but in between.

In my diaphragm and lower sternum.

There was unhappiness around that barrier that protects me from the Scoville tsunami after a particularly challenging jambalaya or vindaloo. The barrier that says, “Hey man, smarten up! That capsaicin ain’t coming this way, but it sure is gonna sting coming out the other end.”

But I couldn’t really place it, I mean it’s not as if  it was like a finger at an awkward angle or a compound fracture. So, I sort of ignored it. Because that’s what guys do: “sort-of-do” stuff and “sort-of-ignore” stuff.

But after a few minutes, the discomfort moved from “this-is-just-a-shit-run-so-get-over-it-and-suck-it-up” to feeling funny. Not ha-ha funny. Funny in a “somebody-gonna-get-hurt-real- bad” kind of way. So, after slowing down, and then stopping all together, I did a mental inventory of the classic heart attack symptoms.

Now, let’s be clear. That I did an assessment in itself was an uncharacteristically mature reaction from me …nothing like the 18, 25, 35, or maybe even 45 year-old me – the one who would tell the rugby physiotherapist to add another layer of athletic tape on the disjointed pinkie, or tell his wife that a doctor is irrelevant as it has happened before and it would heal – eventually. You know the guy; the kind who would run a half-marathon with a pulled groin. (By the way, “ran” is bit of an optimistic term…)

And in hindsight, I think with that action,I have finally arrived at that age where I actually might be paying attention to my body’s flashing lights and warning indicators. I think Maslow called it “Stage 5A: Waking-the-F*ck-Up-ilization” which gladly is just mercifully short of Self-Actualization – which in this instance, unfortunately, would be reached with the exclamation of, “Oh, shit! That was a heart attack! Aaaaaaaaarghhh!”, clutching my chest as my essence headed towards the light.

I remember how, way back in 2007, I thought I was an Old Bull. Back then I felt as if I was tempering the actions of those young officers under my command. But really, I was still just a young bull myself – an older, young bull – but still a Young Bull.  But last week, on that Friday afternoon amongst the fading leaves and naked branches, as I forced myself to execute this self-triage, while bathed in the sickly unease that maybe I had jogged a step too far, I realised I may have finally earned entry into the Old Bull Club.

Sadly, however, the only cow in the lower pasture was me…

I did the run through of all the symptoms I remembered:

  • Sharp pain in the left arm – nope.
  • Radial pain in the back – nugatory.
  • Shortness of Breath – nada. All systems check.
  • Clamminess, sweating? Who knew, I had just “run”, and it was cool out.
  • And I just did a half marathon four weeks ago – really…you can’t be serious!!!

I then started rationalising. No, it couldn’t be heart attack. There just weren’t enough symptoms. But then again, it just wasn’t right.

It was not as if Sweet Daddy Siki was sitting on my chest, but it sure wasn’t that loose rack of man-boobies that it always was before. So I wimped out, screwed the run and

Bring it on Sweet Daddy!

walked the short way home (all the while carrying a plastic bag full of Lola’s doggy doo – because that is what responsible pet owners do). I fed the dog her little princess meal of Caeser’s (dog food, not cocktails) and Royal Canin – and then I thought briefly of making dinner.

And then it got weird, time sort of became elastic. I stood in my kitchen – staring at some Italian sausage that was supposed to form part of a delicious pasta for me and my beloved – and I thought to myself, I don’t feel well.  I don’t remember if it was a minute, or twenty…

And I debated with myself. There was no way I wanted to spend 8 hours in Emergency on a Friday Night, waiting for some Attending to tell me it was nothing but an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of underdone potato….more gravy than grave. “Take your antacids and stool softener – don’t forget the fibre and drink lots of water. Cure thyself, kind Sir!”  I was not keen on that idea.

But then I looked at the other possible outcomes. What if it was having a heart attack? Did I want to laying in a heap on the kitchen floor, hoping that my dog would dial 911.

“911, Emergency, can I help you?”

What' s the number for 911?

What’ s the number for 911, again?

“Grrrrr woof, woof, woof. Bark, woof!”

“Right, got the address Lassie, your Master. Stuck in the well out back?…Oh sorry, heart attack on the kitchen floor? We’ll send an ambulance right over!”

Just the thought of my wife finding me on the floor, all useless and damaged in a puddle of sweat, foaming at the mouth, was enough to convince me that being told “it was nothing” was worth it. So I sent the text that tried to downplay and diffuse what I knew could only be received with panic.

“Feel funny. Going to hospital. Tightness in my chest. Can’t shake it.”

And so I drove myself to the hospital. Now, as an aside, I think there is a common law of relativity, alongside Einstein’s E=MC2 that:

Quantity(Red Lights, Assholes, and Sunday Drivers) ∝ Urgency (desire or need to reach the destination quickly) 2

I cannot believe how bad drivers are – the 30kph in the 50km zone, the light is not yellow yet, dammit! But even in a heightened state of concern, I was a courteous Canadian. Only three honks to get people moving when they were dillying instead of dallying. But I digress, car driving habits would take a whole blog in itself, and I am supposed to keep my heart rate down. So moving on…

Now, after parking the car in the lot that is far, far away from Emergency – because I knew my car would be staying where it was for an indefinite period, and I did not want to create any parking turmoil as that would be rude –  I walked the 300m to Emergency, plunked myself down at the Registration and said, “ I think I am in cardiac distress.”

Prompt attention.  Use that if you want to be seen quickly; but be prepared to stay for a while.

Paperwork started at quick time. And my wife arrived moments later, having had her Relative Physics moment of Asshole Drivers Theory en route. And after looking at her face and her demeanour, at that moment I was not so sure who was having the heart attack. Leaving her to finish off my registration, I walked into the very, very full emergency ward.

I stripped off all my top layers of running gear – in the public hallway – and put on the very fashionable, useful, and most modesty-protecting hospital gown. And after showing all my ink, and middle-aged man hairy back to the lovely elderly couple who shared hallway accommodations with me, I was given my supper – two orange flavoured baby aspirins . Surprisingly, those bad boys taste just as lovely as they did when I was a kid. Some blood was taken and then I lay me down to await the medical onslaught, amidst the cacophony of paramedics wheeling in drug overdoses, car accidents, university RUFFI victims, and the generally unlucky – it was a great way to relax my heart rate and share some tender moments as I contemplated life with the person who is closest to me.

And then, my wife and I waited.

End of Act I…