Heart attack, Part 3: A survivor's tale

My second heart attack came one day short of two months after my first.

I was leaving cardio-rehab, ten sessions into a projected 36. I had set personal bests on the treadmill and the stationary and recumbent bikes. But pain had settled in my chest. It was different than my prior chest pain but not different enough.

My first heart attack had set me thinking about forgiveness, but, behind the wheel of my car, I cursed myself for having overdone it. I made apologies and promises to God.

The pain didn't clear. I returned to rehab. A nurse hooked me to an EKG. Another called 911. The last thing I remember is a paramedic saying, "We're going to have to cut this shirt off you, sir."

They rushed me to Summit Hospital in Oakland. When Adele, my wife, arrived, the consensus among the dozen doctors rushing in and out of the operating room was, "Damned if we know."

They worked on me for hours. They put a breathing tube down my throat. They pumped in fluids. They raised my stent count from five to seven. I woke up two and a half days later.

Trying to concentrate

I had been in a medically induced coma. For much of it, I'd been in great pain. When I'd become responsive (to a nurse's question), I had pointed at my chest. She adjusted the breathing tube. It had scratched one of my vocal chords, so that foreign particles could enter my trachea. For months, if I swallowed food or water incorrectly (or even saliva or a mite of dust), I went into a paroxysm of coughing.

The first days, that was only one of my problems. I couldn't concentrate enough to read or watch TV. If I tried to write, my handwriting went wavy and scribbly. The tubes that hooked me to machines prevented my lying on either side, locking me upon my back.

A pulpy cyst that had bulged benignly beside my spine for years became irritated and burst, staining my gown with blood and pus and raising the danger of infection. In my dreams, high school friends became Russian agents pursuing world domination. Cartoonists about whom I'd written benevolently ran berserk on murderous rampages.

I was frightened and depressed. I had survived one heart attack. I had followed post-operative instructions faithfully. Yet here I was.

Adele moves in

I didn't think I could go on, heart attacks crashing down upon me out of nowhere every other month, flinging me into new hospital beds. I sickened at the thought of what my despair would mean to Adele.

The doctors wanted to probe through my femoral artery to insure that the stents were working. I said I couldn't handle anything invasive. They agreed to wait three days. When they went in, things looked fine.

Dr. M, my cardiologist, put me on Lexapro.

While I was in Intensive Care, Adele spent all day with me and slept in the visitors' lounge on two chairs pushed together. When the nurses said I would survive but that she needed a good sleep, she went home. But at week's end, when I moved into a room in the heart unit, she relocated to a mattress on my floor.

Adele absorbed everything the doctors said. If nurses didn't respond to my buzz, she sought them out. If they were late with my pills, she pursued them. If their schedules didn't match my needs, she lobbied them for alterations.

What happened to Mapplethorpe?

Each night, she read me a few pages from Patti Smith's memoir about her relationship with Robert Mapplethorpe. Though we knew his fated, hideous end, their tenderness and commitment spoke to us through Adele's voice. If the devil was in my head, she was the angel beside me.

One evening, a nursing assistant remarked, "You must have been a fun couple when you were young."

"We were a fun couple when we were old," I replied.

"We were a fun couple last Wednesday," Adele said.

I slept better. I read the sports section and watched the news. I sat in a chair for an hour. The Lexapro seemed to be working.

Life from here on

At my first meeting with the physical therapist, upon command I changed my socks and lifted an arm overhead and walked ten steps in place. "Excellent," she said.

I was terrified by how little I could do. I wondered if I could have a life. What would it entail? When might it begin?

Friends called or sent e-mails or cards. A doctor, whom I had known since kindergarten, visited— and kissed me. He had just lost another friend to cancer— an obstetrician, the deliverer of his granddaughter, younger, a swimmer, a lovely man. Now, here I lay.

I was moved by this caring. I had never behaved like that. When someone was ill, I said the appropriate words, but I put myself in no one else's shoes. When friends died, I thought, He didn't take care of himself the way I do. Now obits of strangers within a few years of my age punched into me like nails.

I felt myself a terrible person. I promised to do better.

The wrong drug

On my tenth day in the hospital, Dr. M told me that my heart's ejection factor was at 45 percent. That was better than she had expected.

"You rank with the kings of my practice," she said. Fifty-five meant a healthy heart. Thirty-five meant trouble. "And once the fluids are out of your system, you might be higher."

She also assured me that over-exertion wasn't to blame. I had turned out to be among the small percentage of people resistant to the blood-thinner Plavix. So I had clotted and blocked three major arteries.

I was lucky it had happened at cardio-rehab. Had I been driving home, I might not have made it. Effiant, an alternative to Plavix, had been developed only two or three years ago, so she put me on that.

Land of the unlucky

"You must stay positive," she said. "That you have survived two major attacks may mean God has something major in store for you."

Adele had remarked that we had never been unlucky before. Now we were in this foreign land. We had assumed we would continue as we had. Now we would see what we could build upon this new terrain.

"Luckily," she said, "we did not depend on climbing mountains or running marathons for our pleasure. We will not face adjustments of that magnitude."

But those adjustments depended on the new medicine working. How much faith could I have in that, given all the unpredictable that had happened to me?

But by the following night, I was thinking how lucky I was.

"'You would be the first'

I had circled the wing on my walker. I had made it to the bathroom unassisted and shat. I was off oxygen. I had washed my face myself.

I was even regaining attitude. When the physical therapist told me my next step would be a rehabilitation facility, I said, "No. I will be strong enough to go home." Dr. M agreed there would be no rehab facility.

I told her I was worried about the Effient. "It can't work for all people."

"But you would be the first," she said. "You must believe you will live. We will return you to things you loved. Five years ago, you would have died. Developments occur every day. So you must believe."

Then she praised Adele for standing up to everything and refusing to crumble: "How lucky you are to have each other."

More bad news

Before they would discharge me, I had to climb a flight of stairs. With my walker, I did two. I was high from the thought of returning home.

Then the results of an echocardiogram landed. My mitral valve had suffered damage. My heart was not fully pumping out the blood it received, and since a body's organs need the oxygen blood carries, mine were in danger of deteriorating. I would, most likely, require surgery within 30 to 60 days.

But the surgery was minor, Dr. M assured us. They didn't open the chest. They entered through a small incision in your side, and you were only in the hospital a few days.

She wouldn't discuss the risks or the future work that might be needed. "It's not the time or place," she said. "You must keep your spirits up. Summit has one of the best surgical units in the country. You'll be in fine hands."

The next day, I shaved for the first time in two weeks. As I sat in a chair awaiting my discharge papers, I looked out my window at two trees rooted so close together that their branches seemed to embrace. On the drive home, it was strange to see people walking on the street, no scalpels in their futures, at least not that they knew of.♦


This is the third article in a series by Bob Levin. To read "My heart attack: a first-person account," click here.
To read his "Anatomy of a heart procedure," click here.
To read responses, click here.
To read the next installment, click here.