His Heart

I have been wanting to write this one, but yet find myself procrastinating. It’s sort of a difficult story to tell, one that has changed our lives.

John’s heart.

John’s heart holds within it memories of his grandparents, now all gone. Memories of his younger years, of Marine Corps boot camp and Camp Lejeune. The day we met, the day we said “I do”.The day Evan was born, his first steps, first words and everything since. Zachary. Me. Our hearts, our lives, are completely intertwined. I live in that heart as much as he lives within mine. Of course, we’re speaking of the metaphysical heart, not the one made of muscle and sinew. And after all of my years working in all things cardiopulmonary, one would think I could separate the two. I’ve had years of cardiopulmonary anatomy and physiology, pathophysiology, pharmacology. I hold certifications that say I know what to do if your heart were to stop beating. My coworkers and I function in this capacity daily.

But on June 7th, all of that experience, all of that education halfway went away while at the same time breaking my heart.

It started a couple of weeks before that. I noticed John breathing a certain way after carrying a small load of clean laundry into the living room to be folded. I asked him what was wrong, and at first he told me nothing was, completely forgetting that I am a respiratory therapist who makes a living recognizing and treating disordered breathing. He finally told me he was just out of shape. This exchange happened a couple more times throughout the course of the next couple of days. Then I caught him rubbing is chest along with the breathing. Again, I asked what was wrong. “Oh, nothing, Andrea. I’m just out of shape. My chest hurts just a little after climbing those stairs.”

Chest pain and dyspnea on exertion. Classic. I tried to get him to go to the ER. He wouldn’t citing the recent medical bills we had for Evan’s testing, which was astronomically expensive. But nothing I would say to him would convince him to go. I had to concede and just settle for an appointment with our family doctor. We went the next day. A stress test was scheduled for 2 days later, as well as some labs. The day after the test, the Saturday before Memorial Day, the third-year resident called me back to tell me his labs looked much improved. His A1C was done, is triglycerides were down. The stress test showed some minor changes that could just be anginal, so John was placed on nitrates. All seemed to be okay.

Four hours later, evening by this point, the same resident called back. She told me that something was just nagging her about the situation, that John has a personal history of diabetes and hypertension, and a strong family history of cardiac disease, that she would just feel better if a cardiologist saw John, just to be extra safe. It was a holiday weekend, so I had to wait until Tuesday to make the appointment, but when I called, the caller right before me had cancelled an appointment on the following day. John got in to see the cardiologist the next day, Wednesday. The cardiologist, for the same reasons, decided to do an angiogram, and asked permission right then to do stents if he found anything while he was in there. We were told it would be scheduled and they would call us that it would be the following week, since it was non-emergent.

They called later that day to ask if we could have John there on Friday morning, just 2 days from the appointment. Someone had rescheduled, leaving a hole in the schedule for John to take.

He had his heart catheterization on June 7th. His mom and sister had come into town to help me with Zach because John was going to be given some sedation and, if they found anything else while in there, they would need me to give consent as his next-of-kin.

I was so terrified. Heart caths are very routine. They do them all of the time. As an RT, I have been in on them many times. But the problem is that the ones I am called to are because the patient has coded. The worst case scenarios are literally all I have witnessed. So for my 38-year-old husband to be the patient, for me to know exactly what they are going to be doing to him and how they were going to be doing it…I was scared. Not of what they would find, but of the procedure itself. And then there was the whole weirdness factor. On the trackboard they have in the waiting area for family, it lists part of the last name and the age of the patient so you can tell where your loved one is in the process. John, 38. Everyone else? 68, 80, 72, 67. And back to John: 38. People in the waiting room were asking Zach if he was there to see his grandpa. A parent young enough to have a 3-year-old should not be going through that. Coworkers, seeing me in denim capris and fleece, were asking me what the hell I was doing there.

My husband. My heart.

John was back there, asleep on that table for over two and a half hours. At some point, his nurse came out to tell me that he was getting a stent, but she didn’t know where or how many.

I was at his side as soon as he came out. The cardiologist came out to explain to me. I wasn’t trying to be dramatic, but my knees almost buckled when I heard.

John’s right coronary artery was 95% blocked. His left anterior descending artery was blocked over 80%. There were 3 more blockages of smaller arteries on the posterior side of his heart that they estimated had been there for some time and they could do nothing about. The cardiologist said he had consulted another physician while Jon was on the table. Immediately upon him saying the name of the doctor, I started to cry. John, his mom, and his sister didn’t understand, but I did. The name belonged to one of our top cardiothoracic surgeons. He and the cardiologist were in agreement that open-heart surgery would be in John’s best interest, but they has started blood thinners 2 days prior to the cath as a prophylactic measure. Open-heart surgery would mean too much blood loss, disordered clotting. Normally, in these situations, they would put the patient in the hospital to be monitored while they stop the thinner and wait a few days for it to be out of the system before doing surgery. I just had a patient go through this this past weekend. The problem was, with the location and severity of two of the 5 blockages in John’s heart, taking him off of blood thinners and sitting on him until the following Monday could have resulted in his death. He would have coded while in the hospital. They had no choice: John got 2 stents while the two doctors hoped for the best and I nervously sat in a waiting room, wondering what was taking so long and completely oblivious.

I heard the doctor talking, and all I could hear was the What-If’s.

What if that third-year resident hadn’t acted on her hunch? If the cardiologist hadn’t had a cancellation? If the cath lab made him wait until the following week to schedule? Those 2 major vessels could have completely blocked at any moment, depriving his myocardium of oxygenated blood. And the location of the blockages would have basically cut off almost all of his heart. He would have died. I could have done CPR. But I don’t think I could have kept him from death. I doubt that, had he coded in the hospital with the entire team present with our equipment, he could have been kept alive. It was that bad.

John's right coronary artery was blocked 95% and his left anterior descending artery (a branch of the left coronary artery) was blocked over 80%.

John’s right coronary artery was blocked 95% and his left anterior descending artery (a branch of the left coronary artery) was blocked over 80%.

What if I wasn’t with him? If he were out driving the kids somewhere?

What if I lost my husband?

We are in our thirties. We are too young. And I realized a lot. First of all, I can do none of this without him. And I wouldn’t want to, even if I could. After all of these years, he is where I belong. The degrees, the plans I have made, the life I have tried to build–without John, there is no point. And the boys. What would become of these two little boys without their daddy?

All of this, everything I have just said, is what went through my mind in the blink it took the cardiologist to explain. And with that, it was all over. He was being admitted. I could not allow myself to leave his side. The next day, we were sent home. We weren’t really told how to live with this information. We weren’t told how to process the concept that the only thing keeping my husband alive is two very tiny (albeit expensive and high-tech) pieces of metal mesh.

stents

 

We weren’t told how to live life, how to get the most out of life. Yeah, plenty of couples go through this, but not at this age. They don’t have this much left of their lives together to live.  So we are doing all we can. Low-fat diets, with no saturated fat, no trans-fat, and very little unsaturated fat. Whole grains, fresh veggies and fruits, low sodium. Exercise. John is going through cardiac rehabilitation 3 days per week. To minimize the risk of re-stenosis of those vessels, John will likely be on blood thinners for a long, long time. Plus a beta-blocker, a statin, and a full-size aspirin daily. I remember the cardiologist telling us that John will eventually need open-heart surgery, but I can’t remember any more. His follow-up is tomorrow, so I will get more information then.

We are doing the best we can with what we have. Instead of gradual lifestyle changes, we’ve had to make massive ones because John’s life literally depends on it.

We have to protect his heart. Within his heart is all that I hold dear in this life.

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3 thoughts on “His Heart

  1. Sounds like you both are on the road to recovery and have a good plan. You have a good team who were proactive! Best wishes to you both.

  2. Being in our 30s we think we are too young for illnesses like this, and in some ways we are. But they happen. My friends sister in law died of breast cancer at 36 and my husband had something removed from his face that would have done considerable harm had he not been having full body scans. Like you, we’ve made some lifestyle changes too, because like you said, what we have- there is no point without our beloved.

    • So true. I see it in my patients, but for some reason, I think I just never thought it would be us.. ad I ad any clue, we would have made some serious changes long ago…

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