Heart attack, Part 2: Anatomy of a procedure

Second in a series of articles.

When I suffered a heart attack earlier this year, the surgeons solved my problem by inserting two stents into my completely blocked obtuse marginal artery. (For that account, click here.) A month later I re-entered the hospital, expecting to have a third stent— a tiny stainless steel cylinder capable of holding open an otherwise blocked artery— inserted in my partially blocked left anterior descending. The procedure wouldn't take more than an hour, I was told.

The first operation had been performed on an emergency basis at Alta Bates Hospital, not far from my home in Berkeley, California. Since Alta Bates has only has one catheterization lab, for my second visit I was booked into Summit, on Pill Hill in Oakland, which has five cath labs, allowing for easier scheduling. When my wife Adele and I arrived, I was assigned to one of a dozen beds, separated by curtains and situated around the perimeter of a large room, in whose center nurses monitored each chamber's occupant as if we were different TV shows with competing plots to follow.

While I was being worked up, a middle-aged Asian man was wheeled off toward the conclusion of his episode. To my right, the victim of palpitations suffered while under evaluation for spinal surgery awaited resolution of that twist in his plot.

"'Not the Wild West'

My procedure was to be performed by Dr. Y, a partner of Dr. M, my cardiologist. When he introduced himself, Dr. Y remarked that matters were more complex than Adele and I had known; their resolution might require two hours. "We need to proceed with deliberation," he stressed, while we stressed.

My complexity concerned a "lesion" that encompassed both branches of the fork of a Y. (This was the first time we had heard that term. We much preferred "blockage" to "lesion.") While repairing it might prove tricky, he reassured us, "It's not 20 years ago, when it was the Wild West. They didn't know what they were doing then or what they could do. Now these things are routine."

He paused before adding, "You don't want to be the exciting case."

As it turned out, the procedure took nearly four hours. And instead of one stent, I received three. The problem, Dr. Y explained the following morning, was my excessive plaque and calcification.

"It looked like a bomb exploded in there," he remarked. Then he winked. "You were the exciting case."

Conscious throughout

Like the first time, I had remained conscious throughout the procedure. (I received sedation initially but refused later offers to re-up.) Once again I felt no pain or discomfort, except in my lower back, as a result of lying supine, arms pressed to my sides, for the duration. But I had known the staff was having trouble.

The first stent went in easily. But the second...

From the conversations I gleaned between Dr. Y, the nurse, Carol, and the technicians— Patti, who was in the room, and Jules, who seemed to be in an elevated compartment to my left, following my progress (or lack of it) on a screen— a picture-transmitting probe seemed to have been inserted into the troubled artery, followed by attempts to clear the artery with balloons, and then balloons with stents, and finally stents alone. None of this had worked.

By turning my head, I could see the clock on the wall. Around the two-hour mark, Dr. Y asked how I was doing. "Fine," I said, and asked how things were going. "Fine," he replied.

So I asked if someone would convey that news to Adele and explain that the procedure was just taking longer than anticipated. To professionals, 21st-Century heart catheterization might seem far removed from the Wild West, but we amateurs were still in the Dark Ages. It was easier to believe in witches' cures from toads and bats than cameras traveling from my groin to my heart and relaying pictures.

Carol returned and reported that Adele was fine. An hour later, we repeated the same conversations.

Life flashes before me

Before that though, Dr Y and Jules had engaged in a lengthy discussion about the wisdom of approaching the troubled area through a different blood vessel than they had originally planned. I lay there telling myself, "Follow your breath... Follow your breath..."

I recalled when Adele and I had first met, back at Brandeis University in the early '60s. I recalled our first date, when we had sat back-to-back on the floor at a Pete Seeger concert. I thought about the improbability of our re-connecting four years after college, having been separated by 3,000 miles, and the wonder of the 40 years that had followed that.

By the time they had the second stent in place, Dr. Y had told the hospital to return his next scheduled patient to his curtained cubicle. It would be a while before he was ready for him.

Because of the two stents Dr. Y had added to those previously installed, as well as the pressure from my accumulated debris, positioning the next stent was difficult. Dr. Y and Jules debated different sizes for this or that. They debated other matters that escaped me. At times, the gurney on which I lay shook as if Dr. Y was trying to hammer the stent into position, one-quarter millimeter by one-quarter millimeter.

Part of me thought, "Stay calm. They'll get this." But another part of me"“ a tiny part, but growing larger as time passed"“ prepared for: "We're very sorry. We did all we could."

Sweating from effort

When Dr. Y finally finished, he seemed genuinely excited. "An excellent result," he said, sweating from his effort. Then he rushed off to tell Adele and to prepare for that next patient. He was sufficiently pleased to draw her a pen-and-ink diagram of what he had accomplished. We look at it now and see darkness and scratches. Franz Kline giving way to Cy Twombly.

Patti and Carol seemed excited too. First they showed me what a stent was. (It was humbling to see that I now appeared to be functioning only because of what looked like several ballpoint pen springs.) Then they insisted that Jules project pictures on the screen, so I could see my artery "before" and "after."

I had no idea what I was looking at. But I knew I'd go home the next morning. I'd see Dr. M and receive her treatment plan. I'd begin cardiac rehab. At 69, I'd begin engaging and exploring and wresting meaning and gratification from a new phase of my life.

The whole damn thing was so amazing that I never paused to wonder what became of my exhausted Dr Y's next patient.♦


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