Denver Bar Association
September 2004
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Arresting Developments

by Marshall Snider

It took some doing, and skillful lawyer-like arguing, but on July 3 of this year I persuaded myself that I was not having a heart attack. The symptoms were there, the things you read about all the time and promptly put out of your mind. But the symptoms weren’t that bad, so the denials and rationalizations flowed out of me like the sweat that was running off of my forehead.

I am healthy, relatively young (in heart attack years), eat smart, keep active and in good shape; people like me don’t have heart attacks. These cardiac events (one of the great euphemisms) happen to other people, not me (I mean, excuse me, but do you know who I am?).

So, whatever I experienced on Independence Day weekend had to be something else. An exacerbation of the stomach upset I’d recently brought home from an overseas vacation. A bad speck of mustard, Tiny Tim? Yeah, indigestion, that’s the ticket. So feel free to ignore the tightness in your chest, the vice-like grip in your left armpit, the funny sensations shooting down your left arm, the sweating, light-headedness and nausea, and finish this round of golf. Go have a beer. Stop being such a worry-wart.

It may sound incredible that anyone could ignore these classic heart attack symptoms for over 12 hours, but I did (sadly, I’d have waited even longer had my wife not rained on my denial parade). And I am not alone. It turns out that denial of a myocardial infarction (now, there’s a really good medical euphemism) is very common, especially by men. But, and really listen to me here, the symptoms should not be ignored (now I tell myself this). Not all heart attacks are massive coronaries in which you clutch your chest, fall to the ground and feel like there is a truck parked on your chest while someone shouts "call 911." Not every heart attack involves all of the symptoms you hear about (for example, in my case I never was short of breath, which is generally a big hint). Many heart attacks are the mild kind I experienced and some never even get reported; they hit and run and are gone, and you figure you are OK.

You’re not. So don’t be afraid to ruin your weekend plans by heading to the emergency room. Don’t think you’ll feel foolish when the cardiologist tells you it really was just indigestion; the ER staff will nonetheless applaud you for responding appropriately (in my case they jeered me for waiting so long).

The emergency room part of this experience was surreal. I expected to be sent home in short order with a pack of antacids. Instead, with little discussion, I was stripped to the waist, an oxygen tube was placed in my nostrils, I was connected to electronic monitors and various intravenous fluids were pumped into my arms (there was a blood thinner, a blood vessel expander and, for all I know, two liters of margaritas just to calm me down).

After hearing my history, the attitude of the Rose Hospital ER staff was clearly to treat now and ask questions later; no one is going to have a second heart attack on their watch. It reminded me of the time I had a fire in my garage in the dead of winter. An unused back gate was the closest access from the fire trucks to the garage, but the gate was shut tight by snow and ice. I expected to have a deliberate discussion with the firefighters about how best to get to the garage. Instead, they blew right by me, demolished the gate with two swings of an ax, and got right to the fire. Apparently, emergency room people have the same approach; get right to it and we’ll talk about the details later (kind of a different mindset from lawyers).

In the ER, the initial evidence of a heart attack was ambiguous, but the cardiologist on-call figured something had happened and asked for my consent to perform an angiogram (a radiographic look at my blood vessels). If there was a blockage, he said, maybe they could roto-rooter it out right there. I said fine; worst case scenario, I’ll have to stay here a night or two, right?

In an angiogram they run a catheter up the femoral artery from your groin to your heart, inject it with dye, and see where the dye, like your blood, can and can’t go. Blockages and narrow arteries can be easily identified in the pictures (that is, if you are a cardiologist. I watched the pictures during the procedure and everything looked to me like a fluttering roadmap of West Virginia).

My plans for a mere overnight stay went downhill quickly from there. A look at the photos showed several blockages; angioplasty (the roto-rooter process) was out of the question. Bypass surgery was my only real option. They kept me in intensive care for a couple of days wired up to electrodes of some sort and pumped tropical cocktails or whatever into my veins. Then they put me in less-than-intensive care for a couple more days (still wired and pumped) and finally unhooked me from everything when they decided I was in no danger. Still, they watched me for another 48 hours before springing me loose.

This mild heart attack was a blessing in disguise. I received diagnostic tests in the hospital that never would have been done in an annual check-up; I did not have serious risk factors for arterial disease (my cholesterol was just dandy, thanks). The diagnostics in the hospital revealed several arterial blockages, one that is 70–80% of a main artery and literally a ticking time bomb set to go off in 3 to 5 years. As I write this, I am biding my time, awaiting bypass surgery that I wouldn’t have known I needed had this MI not happened. And if I didn’t get the surgery, my time as a Docket writer would have been prematurely cut short, a great blow to the Denver Bar Association.

So that’s what a heart attack is like. Stay tuned for the next installment; in a couple of months I should be up to telling you what heart surgery is like.

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