The Golden Hour - Heart Attack, Part II

I love Grey's Anatomy - been watching since the very first season.  I learned about "The Golden Hour" on an episode that aired this past February.  Oddly enough, I would recall this episode months later, realizing that one of the characters suffered a condition similar to mine, with a very different outcome.

The opening monologue:

Meredith: How much can you actually accomplish in an hour? Run an errand maybe, sit in traffic, get an oil change. When you think about it an hour isn't very long. Sixty minutes. Thirty-six hundred seconds. That's it. In medicine, though, an hour is often everything. We call it the golden hour. That magical window of time that can determine whether a patient lives or dies."

On the day of my heart attack, Cameron and I were having a breastfeeding breakthrough.  My milk took 6 days to come in and the lactation consultants from the hospital had me and Brian doing all manner of craziness to ensure a good latch and strong milk supply.  It was SO stressful and finally, we were getting into a consistent routine.  I woke up at 6:00am on Wednesday, April 13th to feed Cameron.  My mom had given me this "maternity" nightgown - a sleeveless pink dress with white polka dots - which had been coming in handy for our late night/early morning feedings.  Usually, it took us about an hour to fill his little walnut sized belly.  Brian, who'd taken the week off from work to enjoy his new little family, sent me back to bed around 7:45am to get a bit more sleep before it was time for our little goatlet (Cam's newborn nickname, because he made little goat noises in the hospital) to eat.  Around 9am, Brian brought me freshly baked cranberry muffins and decaf coffee in bed - such a sweet treat after being up every three hours for the last few days.  After eating breakfast and feeding Cameron, Brian asked if I was okay with him heading to the gym. All I needed to do was brush my teeth and change before he left.  He took Cameron and Mowgli outside to get some sunshine while I got dressed for the day.

I stood over the sink washing my hands when it hit me. I've described it as being hit by lightning or getting kicked in the chest by a horse, but I'm sure neither really illustrates what I felt.  I was in excruciating pain - a pain that radiated across my chest (from my collarbone to my sterum), down the backs of both of my arms (but stopped at my elbows) and underneath both of my shoulder blades.  I wasn't struggling to breathe, but the pain was so intense that I kept holding my breath and had to remind myself to inhale and exhale.  I walked out to the couch and laid down - I remember something my doctor had said about changing positions if you were in pain. And, if the pain didn't go away, it could be something serious.  It felt like my chest was being crushed and set afire.  I could almost "hear" the pain sizzling in my ears because it hurt so intensely.  There was no nausea or lightheadedness as some women tend to experience in a heart episode - just incredible pain.  After a minute or so, I went to the back door and called for Brian.  "I think there's something wrong.... can you call the doctor?"  Using my phone he called my OB/Gyn who was working out of his O'Fallon office that day.  The receptionist indicated we could either drive to his office or go to the ER.  At this point, there was no question - there was not a chance in hell that I would submit to driving to O'Fallon.  The closest ER was St. Mary's hospital (where I was born) so we decided to go there.  I threw my robe on, grabbed my purse and got in the car.  Everything happened so fast, I didn't have time to put shoes on and we forgot Cameron's diaper bag (I'm surprised we didn't forget Cameron, given how new we were to parenting!)

We arrived at the ER and my pain went unchanged.  Brian put me in a wheelchair and put Cam on my lap - because I was post-partum with chest pains, we didn't have to wait.  They wheeled me back to triage immediately and then to a small room.  A nurse started an IV in my right arm and hooked me up to a heart monitor.  When the ER doctor conducted his evaluation, his suspicions indicated a pulmonary embolism - blood clots in the lung.  This is a "common" post-partum complication and he ordered a CT scan.  Brian and I made small talk as we waited for someone to take me to my scan.  As we chatted, I felt a fluttering in the center of my chest.  It didn't hurt at all - it sort of tickled, like a hummingbird was trapped under my skin.  Brian's eyes lifted to the monitor behind me and before I could explain the tickle, a storm of people rushed into my room.  The "hummingbird" feeling was my heart in ventricular tachycardia - a fast and irregular heartbeat that can lead to fibrillation or sudden death.  An EKG turned up no irregular findings, but still, the ER doc decided to call in a cardiologist.  I was whisked away to the CT scan, which show my lungs to be clear.

At some point, my mom arrived at the hospital and Brian left to take Cameron home where his parents would meet him.  While Brian was gone, the ER doctor gave me nitroglycerin to alleviate my pain.  As the somewhat fruity pill dissolved under my tongue, the pain began to melt away.  Don't get me wrong - it still hurt like hell, but it lessened.  My mom, who's been a nurse for over 30 years, asked if I felt better.  Happily, I did.... and it was at this time that my mom told me nitroglycerin relaxes blood vessels and increases blood and oxygen flow to the heart.  The pain had nothing to do with my lungs - I realized something was wrong with my heart.  I was so confused - I remember being worried because I had friends coming to visit the next day and had set up a play date for Mowgli.  I called my friend Jim and asked him to clear my schedule.  So funny the things we worry about when we find ourselves in trying situations.  But I think the day had taken such a strange turn that I needed to focus on something simple. Even so, while Brian was gone, I found myself rattling off to my mom a long list of  to do's. 

• If I die, tell Brian to quit his job and move to Colorado with the life insurance money.
• Make sure he puts some away for retirement and  for Cameron's education
• I am insanely hungry - do you think they'd let you bring me something from the cafeteria?
• I think I want to be cremated and sprinkled somewhere.  And you should have a party instead of a wake.

The cardiologist on-call, Dr. Pacheco, arrived after I had taken my second nitro.  He indicated that based on my symptoms, there were two possibilities - peri-partum cardiomyopathy or spontaneous coronary artery dissection (SCAD).  The next hour moved so quickly -He ordered blood tests and an ultrasound of my heart.  The blood tests came back with elevated cardiac enzymes - indicative of the death of cells in the heart muscle.  My ultrasound caused a room full of nurses, med students, doctors and even the ultrasound tech to fall silent.  Midway down, my left anterior descending (LAD, also known as "the widow maker") coronary artery was 100% blocked.  The diagnosis was SCAD(http://www.spontaneouscoronaryarterydissection.com/). 

I was taken into to surgery so quickly, I didn't even sign my own consent forms.  Brian and my mom wanted to call a family member (currently in a cardiac fellowship). Dr. Pacheco, while rattling off orders to the staff, thrust his cell phone number at Brian.  "You can call whomever you want.  Here's my cell phone number, you can give it to him.  She's going into surgery now." And then I was whisked into the Cardiac Catheterization Lab where, over the course of an hour or so, a catheter would be inserted into an artery in my right leg and fed up into my heart.  The tear in my LAD required two stents.  In the CCL, you are given local anesthesia - I was awake for most of my procedure.  I watched my heart, illuminated with iodine, beating on one huge flatscreen, and I watched the catheter move through my body on another.  I felt a sharp, stabbing sensation as tiny balloons were inflated in my chest to place the stents.  And then, I felt a rush of calm wash over me, as the blood flow was restored to the bottom (apex) of my heart.  My incision site was healed and Dr. Pacheco shared that my heart was in great shape, despite the day's events.

My parents, brother, cousins and husband were waiting for me when I was wheeled out of the cath lab.  Each looked like they'd been hit by a bus.  All day long, I had known that something serious was happening, but it was so surreal that I didn't really feel it until that moment, seeing the looks on their faces.  I had survived something HUGE. I didn't, and still don't, understand how I'm still here.  I was taken to the cardiac ICU where I'd be closely monitored for the next few days.  I hadn't pumped or breastfed for hours and I had wet spots on my hospital gown.  The cardiac nurses had to borrow a pump from labor and delivery so I could keep up my milk supply. I didn't sleep much that night, partially from the noise of the monitors and blood pressure cuff and partially because I was scared I wouldn't wake up.  And, at this point, no one had said the words "heart attack".  In fact, I wouldn't realize until the the next day that I'd even had one. 

To be continued............


  Meredith: An hour, one hour, can change everything forever. An hour can save your life. An hour can change your life. Sometimes an hour is a gift we give ourselves. For some, an hour can mean almost nothing. For others, an hour makes all the difference in the world. But in the end, it's still just an hour. One of many. Many more to come. Sixty minutes. Thirty-six hundred seconds. That's it. Then it starts all over again. And who knows what the next hour might hold