I HAVE A DOCTOR’S NOTE

Yes, I know, I missed my blog last week. I’m very sorry to the two or three of you who have come to rely on my blogs weekly. But hey, I have a doctor’s note.

I have long suspected that the universe will, at some point, present each of us with his or her own mortality. It’s that a-ha moment when one realizes that life is transient. When you come face-to-face with the prospect of your own mortality. I mean, we all know we’re going to die. But do any of us actually believe it? But then that moment arrives. Perhaps we were very nearly killed in a car wreck, or maybe we watched someone very close to us die, or maybe we are diagnosed with a terminal disease. The revelation will be different for each of us. But it is a point in your life when you stop and look at where you have been and where you are going. You ask yourself “Self, what am I going to do with the rest of my life?” Or, perhaps I just watch too much television and I’ve come to expect revelations such as this to be overly dramatic.

I recently had a close friend from work pass away. John was a great guy and always had a positive outlook. Two years ago, he had a fainting spell shortly after work on a Friday afternoon. He was rushed to the hospital where he was diagnosed with brain cancer. He had surgery and most, but not all, or the tumor was removed. I have often wondered if that was his a-ha moment. He was back at work almost immediately. For a couple of months, while he was receiving chemo, he had some type of apparatus attached to his head. My wife, the nurse, said it was probably for drainage. After the apparatus disappeared, I assumed it was a sign he was getting better, although he didn’t look it. John had always been thin but now he seemed a little pudgy and bloated. Still, he continued coming to work three and sometimes four days a week. But towards the end, you could see his mental facilities were just not there. His short-term memory was fading quickly. I applaud the company for allowing him to keep his dignity and continue to work almost until the end. Unassuming and without fanfare, John quietly packed up his belongings one Friday afternoon and simply never came back to work. He passed away about three weeks later.

While not the best of friends, John and I had an easy work relationship and had always been able to talk. He was our HR manager and even before he was diagnosed, John used to watch me at work. I think we both had the same work ethic; we came to work every day no matter what, we worked late and weekends if asked, when we were on the clock, we were 100% focused on the job. I was always working hard in the machine shop, and he knew I also had multiple side hustles. He would tell me that there are times I just need to slow down and enjoy my life. Do the things I want to do and don’t work so hard. In retrospect, I think maybe he was talking to himself as much as to me. I didn’t really talk to him much about his condition. I wanted to give him his space. In reality, I don’t handle these types of conversations well. I don’t know what to say or how to sound sympathetic. While I can relate to people, I don’t seem to have a lot of empathy. It’s just the way I’m wired. John probably knew he was dying. How do you approach that subject? Then again, he probably had a lot on his chest and would have welcomed the opportunity to talk about it. More is the pity. I know it sounds morbid, but I wonder what his thought processes were as he watched his life wind down. I had been told that he continued to work because he really couldn’t afford to do anything else, and he didn’t want to be idle, sitting at home thinking about it. I think I knew John well enough to know that, had I asked, he would have said that he was satisfied with his life. He had a good run; it was simply shorter than most.

I thought I might have been having my a-ha moment the weekend before last. I had come down with the flu over the holidays. I got over it in a week to 10 days, but it left me with a lingering cough. The cough had been getting worse of late. Also, for about the past two weeks, I’ve been having trouble catching my breath. Didn’t seem like a big deal. I might be walking around the machine shop or at home and I’d have to stop for a moment and take a couple of deep breaths before moving on. It didn’t seem to happen often, maybe a couple or three times a day at most. Some days not at all. So, initially, I simply ignored it.

On Sunday, though, my breathing became a real problem. I walked out to the garage to get my laundry and, when I came back to the bedroom, I had to sit down for a minute or two. Later, I was walking out to my workshop in the back, and I had to stop again. Something just didn’t feel right. Had this been 30 years ago or so, when I was immortal, I probably would have shrugged it off. Not that I’m a hypochondriac, but these days, if I get a hangnail, going to the doctor is one of the first things that comes to mind. I had already decided to make an appointment with my doctor for the following week regarding the cough, so I decided to head into the emergency room just in case.

Looking back, I think I can safely say my body was sending me a lot of signals. I simply misdiagnosed them. I had either thought that I knew what the underlying problem was, or they had come on so gradually I hadn’t really paid attention. Of course, there was the cough and shortness of breath, which got me to the hospital in the first place. I was also feeling very fatigued at work. Most evenings, when I got home, the first thing I did was take a long nap. I attributed all of this to two things. First, I have a nasty habit of going to bed at 10:00 or 11:00 o’clock at night when I have to be up at 5:00 AM for work. On a good night I might get seven hours of sleep but most nights five or six is the norm. I also get up several times to pee. Some nights you can practically set a watch by my trips to the bathroom. I know I have an enlarged prostate, which is common for older men, and that is what I attributed all the extra bathroom breaks to. I had also been suffering from a dry mouth for the last few weeks. Again, I thought it was the funky weather we’ve been having. Cold and wet one day and hot and dry the next. Something in my sinuses.

I dutifully checked into the Kaiser emergency room on Stockdale and told them what was going on. Of course, they took all my vitals; blood pressure, oxygen, heart rate, etc. A short time later they hooked me up to an EKG. After that I was confined to a gurney, flat on my back, while the doctors went over my tests. About 30 minutes later the doctor came back to say that they knew where the problem was although not specifically what it was. Something was wrong with my heart. When I first arrived my heart rate was 90 BPM but then it spiked up to 130 BPM on the EKG. They wanted to send me over to Adventist Medical Center, about four miles away. On that short drive over, I had time to think and process what was going on. I don’t know much about the heart, but I was beginning to think maybe I was having a mild heart attack. My a-ha moment? For some reason, the ER was very busy that day and it took me almost an hour to get in to see the doctor. That was fine by me. Other than the shortness of breath thing, I felt just fine. I tried not to think about the possibility of a heart attack. Once again, they took all of my vitals before sending me in for another EKG as well as chest X rays and a CT scan. This was followed by another long period of waiting on a gurney while they went through all of the tests. Finally, a doctor sat down and said they suspected cardiac arrest caused by arterial fibrillation or A-fib.

The doctor said they wanted to examine the tests more thoroughly and consult with the staff cardiologist before deciding if they were going to admit me into the hospital overnight. As soon as he left, I googled arterial fibrillation. First, I discovered that cardiac arrest is not a heart attack, which is what I thought it was. The two phrases tend to be used interchangeably, although they are two very different things, both affecting the heart. Your heart beats in response to electrical signals sent to it from your brain. For some reason, either the signals going to my heart became jumbled or the heart was misinterpreting them. This was causing my heart to beat irregularly and rapidly. Long term, this can damage the heart muscle. But it also can be controlled. The difference between this and a heart attack is, with a heart attack, a clot or something is blocking a major artery shutting off blood supply to the heart. The heart actually seizes up. So, two completely different things with two different causes. Given the choice, I think I’ll take A-fib every time. They eventually decided to admit me overnight so they could run additional tests and see if they could get my heart under control with drugs.

A lot of medical issues came out as a result of all of the testing. For starters, they discovered I had fluid in my lungs, which was causing the cough. It also may have had something to do with triggering the A-fib, or not. Regardless, they were concerned about possible pneumonia, so they put me on antibiotics to prevent that. I have hypertension, high blood pressure. I have been taking medication for a number of years, but my BP was rather high when they were admitting me, so they raised my dosage from 75 milligrams to 100 milligrams. Next, they told me I have diabetes. I have been a borderline diabetic for some time, but I’ve managed to avoid it, so far. It does run in the family, though. I had a physical for a life insurance policy just last year and it was negative for diabetes then, so this is obviously a recent development. It did explain a lot. I probably became a full-blown diabetic sometime shortly after the first of the year. That would explain the constant dry mouth of the last few weeks. Also, the peeing three and four times a night, the enlarged prostate notwithstanding. As well as the fatigue I have felt lately.

I spent Monday flat on my back in a hospital bed. At least I had the room to myself. Every time I got up my heart rate would spike to about 160 BPM so the nurse wouldn’t even allow me out of bed to pee. They took so much blood I felt like I was being held prisoner by vampires. They took a few more tests, including an ultrasound of my heart. In the afternoon Dr. Roberts, my new cardiologist and best friend, came by to talk to me. He said I was still in A-fib but, thanks to the drugs they’d been giving me, the spikes were closer together in terms of highs and lows. When admitted, I had been spiking out as high as 180 BPM but now it was down to about 130 BPM. He wanted to see it down around 100. He told me that the symptoms of A-fib can be subtle, shortness of breath, heart palpitations, chest pains, fatigue. Many people ignore them as minor and the way they have A-fib is they throw a clot, and then it’s too late. It was a good thing I came in when I did. He also talked to me about the results of my ultrasound. The heart is a living pump, and its main purpose is to pump blood throughout your body. Every time it beats valves open to allow the flow of blood to be pushed into your arteries. Typically, when these valves open, 60% to 70% of the blood contained in the heart is forced out into the body. In my case it was only about 35% to 40%. This was a result of my heart beating too rapidly and not allowing all of the blood to exit. In a prolonged situation, blood has a tendency to pool, and clots may form which can lead to stroke or death. He said he wanted me to take a stress test the following morning to see how my heart was handling all of this. While they were getting my heart rate under control I was still in A-fib. There are only a couple of ways to get the heart back into a normal rhythm. One way is electric shock. In that case they would first have to go through my throat with a probe and check for clotting. There is a specific area in the heart where clots might form, and they need to be sure this area is clear. Another option is called an ablation. It is a surgical procedure whereby they would go through my groin. They would still first have to check for clots and remove any they found. Then they use either heat or cold to put minute scars on the wall inside my heart. This would force my heart into a normal rhythm. Dr. Roberts was leaning towards the ablation option. He said, in his experience, patients in my situation, I suppose that meant my age and the fact that this was a fairly new occurrence, respond better to this procedure long term while the electric shock treatment is more of a short-term measure. Kind of like pneumonia, once you have gone into A-fib once, you are more susceptible to having it reoccur. I would also have to take blood thinners, possibly for the rest of my life, to prevent clotting. In fact, with either option, electric shock or ablation, I need to do a 21-day drug protocol of blood thinners before he could do anything. In the meantime, they would control the A-fib through different drugs.

Now, I had a wedding to attend on Tuesday evening. I guess I had talked about it so much someone had even put it on my chart. Dr. Roberts said he would try to get me out of the hospital in time for the wedding. I mentioned that was a good thing because if I didn’t get out of there in time for the wedding, Red and I had a plan to tunnel out and head down to Mexico.

Tuesday morning I had the stress test. During the procedure Dr. Roberts stopped by and told me that at about 3:00 AM my heart had stopped for seven seconds. I already knew this because, when it happened, Mary Jane, my nurse, had come into the room to wake me up and tell me I was dead. Dr. Roberts wasn’t particularly concerned as this is not unusual. He said he did want to check me for sleep apnea, but he felt I could still get out in time for the wedding unless there was something really surprising on the stress test, which he did not expect. Throughout the rest of the day, they continued to monitor me. Regular BP checks, the vampires took more blood, and they began checking on my blood sugar and giving me insulin as needed. I watched a lot of TV. Around 3:00 o’clock another doctor came in to see me. She was the head doctor on the 4th floor, where I was being held prisoner, and she was quite a character. A small Asian lady with lots of energy wearing two face masks and a face visor. Even if you didn’t know her name, she was easy to spot. Unfortunately, she had bad news. She felt my heart rate was still high and it would be best if I stayed one more night. She knew I had to make the wedding and she kind of let me make the decision. She didn’t want to bar me from the wedding, but she also let me know that she was concerned I would have a relapse and end up back in the hospital. Since everyone had told me to take care of my health first and not worry about the wedding, I decided to go with her recommendation. She also wanted to fit me with a sleep apnea machine that night to see how I responded.

She ordered a small, portable device that I could take home with me. It was actually delivered an hour or so later. For that night, though, a nurse came down and set me up with the hospital standard version. She said the small one I pointed to on my chair was a different version of the same machine. She referred to it as the Cadillac version. For $1900 it better be a Cadillac. Even with my insurance I still had to pay $800 out of pocket. I am claustrophobic and wearing the face mask is a bit of a challenge. I lay there staring at the ceiling thinking I would probably have to work up to wearing it all night. For now, I would wear it as long as I could. Eventually I would call the nurse in to help me take it off. I would see if I could wear it a little longer the next day and slowly build up to a full night. I’m thinking all this and then the next thing I know it’s 3:30 in the morning and the nurse is waking me up so she could take my vitals. Afterwards, I dropped off almost immediately and slept through the night. It was actually one of the better night’s sleep I’ve had recently.

The following morning Dr. Roberts stopped in. He said it looked like my heart operated better with the sleep mask on, which I had already concluded. He was a little surprised that I was still there as he had talked to the floor Doctor and told her he thought it was safe for me to go home. I know she was just being overly cautious. He said he would speak to her again and make sure I got out of there sooner rather than later. He also said somebody from his office would call me and schedule a follow up appointment where we could discuss the next steps. Someone else stopped by with dietary information on my diabetes. I was scheduled to have a follow up with my primary care physician and she said he could refer me to a dietitian if I would like. Later, the floor Doctor came by and said she had spoken to Dr. Roberts and would be releasing me. She gave me a list of new drugs I would be taking and said she would contact the pharmacy on Stockdale to make sure they would be ready for me to pick up.

So, for me, this is the new normal. I started this blog by writing about that a-ha moment. At first, I thought this might be mine but, as I progressed, I had decided to write in my conclusion that it wasn’t after all. I was expecting something dramatic, maybe the sound of trumpets in the background. Yeah, I probably watch too much television, but I don’t think drama usually stretches out as long as four days. I’ve changed my mind, though. I plan to retire in two years. Between now and then, probably closer to then, I want to buy a C-class RV. My wife and I will probably spend a year or so breaking it in and tweaking it to make it our own. After that we are planning an extended excursion. One of the first things I want to do, and cross off my bucket list, is drive Hwy 66 from Santa Monica to Chicago. After that I have an invitation to be a campground host, or we might hit the East Coast and see the civil war battlefields. Maine, in the late summer and early fall, is really beautiful. We might travel down to Baja and spend some time fishing one winter. None of that has really changed. What has changed is how I go about living long enough to do all of that. There were no trumpets, and the drama did last four days after all. Sometimes, perhaps that a-ha moment is more than just a moment. Sometimes, if you really pay attention, maybe life is telling you something plain as day. Maybe you don’t have to look all that hard to see it either. If you know what to look for. In my case I suppose I did see my mortality and the end of my existence. Through some miracle, I was given a choice of how to approach the rest of my life. This represents a major lifestyle change and isn’t that what happens when you have that a-ha moment.