On November 20, 1996, I began experiencing chest pains round about 1:00 PM. At the time, I was at a conference in Rosslyn, Virginia. I had not dined at all that day, and I assumed that the pains were the result of extreme hunger. So I persuaded a friend of mine, Dr. Bob Hawkins, to ferry me to the nearest Wendy's, and there I swallowed a fast food meal. He then took me back to my car and provided a jump start (since I had left the lights on) round about 4:00 PM. That probably saved my life, because had I had to wait the customary 3-4 hours for AAA, I would have never reached the hospital in time.
I then drove into the city to pick up Karen, my wife, who works downtown for Bell Atlantic. Her building is close to my building, which is why we commute together. She works until 5:00 and is inaccessible by phone (Ma Bell channels all calls to her voice mail). Having arrived at 5:00, I left two frantic messages on her voice mail. She came down at 5:10, and I drove immediately toward to the Emergency Room (ER) at the George Washington (GW) University Medical Center.
Close to the ER, we ran into heavy traffic. I told Karen that I could not wait for the traffic to clear — I left the car and walked over to the ER and announced my fear that I was in the midst of a heart attack. The ER staff immediately took over and I have little memory of the rest of that night. The following details are from Karen.
My condition proved puzzling to the ER staff — I was not exhibiting the classic signs of a heart attack. The EKG was normal; vital signs were strong. But the pain was real, and they knew it. So the ER staff put me through a CAT scan and found the problem: my aorta was splitting apart and coming dangerously close to rupturing. Had it ruptured, I would have died within five seconds.
By the way, this is a very rare problem. The GW staff averages two bypasses a day, but they only see a dissected aorta once or twice a year (in part because this problem is far more frequently discovered during autopsies than in ERs).
Dr. Judith Hsia, the cardiologist who made the diagnosis, called in Dr. David Alyono, who has no private practice but rather has his office at GW and teaches thoracic surgery as well as practices it. He lead a team of two other doctors. They began work on my heart round about 10:00 PM and did not finish until 6:00 AM. Essentially, they replaced the top five inches of the aorta with a dacron graft.
Had this operation not occurred when it did, I would have surely died. When Dr. Alyono opened my chest and had his first look at the aorta, he could see the blood flowing through it -- there was only a one cell thick membrane at the point of the dissection, and that membrane was about ready to blow.
The good news: unlike a bypass operation, this fix will probably outlast me. My heart is strong; my arteries are clear (e.g., no sludge from cholesterol). As matters are progressing, I hope to be back at work mid-January. In the interim, Dr. Alyono asked that I begin taking short walks with Karen or other companion, in places such as shopping malls (which greatly pleased Karen!).
Update 23 Aug 97
At the nine month mark, I am back to my old optimistic self. I still tire easily, but that is the only long-term affect so far.
After surgery, I stayed at home for two months and then returned to work part-time for another month. In retrospect, I probably returned to work too soon; I should have waited another month.
At the three month mark, I suffered severe depression — that period lasted several months and was due to an unfortunate combination of blood pressure medications — a beta blocker (Atenolol) and calcium channel blocker (Cardizem). My cardiologist took me off all blood pressure medications (except Vasotec — an ace inhibitor) for a month, and the depression disappeared for good. Now I am back on Atenolol and Vasotec.
As far as long-term prospects go, my thoracic surgeon jokes a lot (life is a sexually transmitted terminal disease, so why worry — I am at risk, he says, from being run down by a car every time I cross the street). But my doctors suggest that the long-term prospects are good, as long as I keep my blood pressure (at rest) under 120 (top number).
I devoted a lot of hours to cardiac rehab (treadmills, exercise bikes and the like) at a special facility attached to the hospital, where nurses monitor blood pressure before, during, and after exercise and also continuously monitor heart rate. I have long since graduated from that facility and exercise three times a week at a health spa. The key is keeping the heart rate under 100 (which is hard to exceed when on Atenolol).
We are very lucky. I understand that 75% die before they reach the operating table; and that a sizable percentage do not survive the surgery. Having survived the surgery, my impression is that we are likely to live as long as we would have otherwise.
So do not live in fear; and keep in touch.