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The Widowmaker

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If I were poor, I'd be dead. As it is, I'm resting comfortably in Cedars-Sinai Hospital after a balloon angioplasty and insertion of two drug-eluting stents in my Left Anterior Descending artery (that's the one my cardiologist once cheerfully called "the widowmaker").

Having felt a slight tightness in my chest after exercise last month, I went to my primary care doctor for a check-up. Chest x-ray, EKG, blood work -- all was fine, but he thought, given the tightness, I should get a thallium stress test pronto.

I missed the first appointment for the stress test when Blue Cross refused to authorize it. The cardiologist had to yell at them before they relented.

I went in to Tower Imaging on Tuesday afternoon. The test is in two parts, at rest and after exercise. I got shot up with radioactive thallium and fell asleep on the gamma camera bench. Everything looked great (thallium mingles with the blood and binds with heart muscle: lots of thallium in the heart means lots of blood flow there). I did smashingly on the treadmill, surpassing my previous eleven-minute effort by forty seconds with a maximum heart rate of 158. They shot me up with thallium again, and again I fell asleep on the bench under the camera. Yeah, there had been a slight tightness, but how bad could it be?

Well, kinda bad, actually. 24% of my heart muscle was getting no oxygen under stress. It's unnerving when the doctor says, "the results are abnormal," and shows pictures of dead black regions of the heart where it ought to be (and was in the resting test) a nice bright Halloween orange.

"Michael would like you to come over now. He has seen these pictures already." Michael N_______ is my Romanian-inflected cardiologist, the one who told me about the widow-maker a couple of years ago when I refused to get an angiogram after I'd had a few episodes of atrial fibrillation.

He sat me down and said he was checking me in to the hospital right away. Didn't want to wait. In fact, since he thought it was potentially life-threatening, and Cedars won't let a doctor check anyone in right away unless they come in through the emergency room, I had to go to the emergency room and lie to the ER doctors: "yes, I've been having chest pains..., about a six on a scale of one to ten" (then I saw the chart on the wall...) "or maybe a five, oh, for a few hours, uhh, since about uhh one o'clock... I was late and rushing to a lunch... no, not so bad now... call Dr. Neumann pls... uhh... those red blotches on my chest? uhh..."

The blotches were adhesive burns from the EKG leads used during the thallium test, which are extra-sticky so they wouldn't come off while I was jogging and sweating my way to my eleven minute forty second personal best, but I couldn't say that because then they'd say i didn't have an emergency and shouldn't be there. Even though it actually was a kind of emergency, just a slow-rolling one, an emergency in progress, a pre-emergency emergency.

That route, however pragmatically necessary, was a ridiculous waste of resources, with my getting an EKG I didn't need, a chest x-ray I didn't need, blood work I didn't need. The ER was jammed and I was on a gurney that could have been used by someone with a real emergency, but that's just the way it's played here.

I got a bed around seven-thirty, having come in around five, so that was fast work, and spent that night negotiating my way around the hospital room attached to a wireless heart monitor and a couple of drips on wheels. What with the iPod headphones and the charging cord for the Mac laptop (they may not have enough beds, but this new wing has WiFi!), it was tangled in Room 4S58.

The actual procedure was mostly anti-climactic, or maybe that was the anti-anxiety drug kicking in. I was marginally awake through the whole thing, though I may have napped. I had only a glancing view of the angiogram and had a hard time making sense of it. I did wake up when I heard Michael say "uh-oh." No matter how quiet the mutter, that's not what you want to hear when someone's fishing a wire through your heart.

Seems that the LAD, as it's called when the nickname's not used, which feeds the lower third of the heart, was completely blocked. Fortunately some blood was diffusing into the muscle from another smaller artery, as a natural work-around but not the original design. If not for that adaptive response from the heart, I'd have had an infarction a while ago. Or at any moment up til then.

But back to the 'uh-oh." Michael wasn't sure that he could get the wire through the blockage. If not , then it's time for a transplant. Luckily or skillfully, either way he got the vessel open, inflated the balloon to compress the plaque, slipped in two stents (the blockage was a long one), and yanked the assemblage out the small hole he'd made in my groin to get to my femoral artery and through which he'd threaded it all originally.

Three doctors came in my room separately this morning, and they all said the same thing, in the same words: "You're lucky."

I have to agree. I'm lucky to be able to afford health-care insurance. I spend more than fifteen thousand dollars a year on Blue Cross medical premiums (that's post-tax income, mind you). I'm lucky I can pay the non-covered costs, like my annual check-up. I'm lucky I can pay the deductibles on a cardiologist who can yell at my insurance company to get me the test on time. I'm lucky I can pay my share past the deductible of Cedars-level health care. I'll summarize the bills for you when they come in, if you're interested, but it's going to be well up in the tens, maybe scores, of thousands of dollars.

If I were poor, I'd be dead. But I'm neither, and I'm lucky, so I'm going to go home now and sit down for dinner with my wife and children, tell them I love them, and tell myself, "The widow maker is just going to have to wait for a while."

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