SCAD

 I am a 57 year old male, I exercise regularly, I eat healthy, or at least I try to eat healthy and eight weeks ago, I became a Spontaneous Coronary Atery Dissection SCAD survivor.

I woke up two days after my SCAD event in CCU. For at least a couple days after I woke up, my mental acuity could be described as “swiss cheese”. I had no idea what happened. I thought I was having a serial bad dream. My family and the doctors and nurses told me I was in the hospital because I had a heart attack. It didn't make sense. They told me four or five times and I couldn't, or I wouldn't comprehend. I don't have time for a heart attack.

The cardiologist said I was the luckiest guy on earth since I had died twice. He called me “Mr. Lucky”. I don't know how to interpret that. It's great to be alive but who wants to to die twice to do it? If given a choice, I vote for alive and not dying twice.

Apparently, my wife kept me going while the paramedics were driving to my house to give me a ride to the hospital and I am forever grateful. My wife isn't big or strong but she was able to call 911, pull me out of bed onto the floor and conduct CPR. She had never performed CPR before but I am pretty sure she took a two hour class about twenty years ago. All I can say is “thank you, Darling”.

The doctor said I had six broken ribs from the CPR, all on the left side (thank you, Darling), one of which punctured a lung, and two chest tubes to drain the punctured lung goo out of the chest cavity. The funny part is that I had broken ribs on the right side too but the x-ray machine must have missed those. The doctor said I didn't have right side breaks but that side hurt worse than the left and I had a bruise the size of a dinner plate on that side for six weeks so, you tell me.

I am told that the paramedics hit me with the defibrillator twice to bring me back. A big shout out to the paramedics and the police and the firemen. You guys rock! You work in difficult work conditions with little thanks. I can't say enough good things about the good things you did for me. A million thanks, a million times over.

I used to think that if I ever did have health issues, it would be because of job stress. It just makes sense, right? I work in a stressful job and I was so convinced of that fact that I spent a great deal of time and effort telling friends how stressful my job is. Now, in retrospect, I think asserting that my job induced stress is causal to my SCAD seems wrong or at least a bit dishonest. Everybody works in a stressful job. My stress is self induced. I make a point of doing my job well and I do whatever it takes to make that happen. I work weekends and I work nights if it helps the company. I wake up at 2 a.m. thinking about work. On my commute to work, I think about what I need to do at work that day and on the commute home, I think about what I didn't get done that day. So what? Everybody with a job deals with stress so why can't I?

I just read a post on a SCAD survivors group that really surprised me. The post asked a simple question about the commonality of male SCAD survivors being athletes. My first thought upon reading that post was it was wrong but now, I think it's right. I am an athlete. I exercise a lot. I exercise often. While I never thought I was exercising too hard, I have to admit that I don't personally know many people my age that push physical limits harder than I do, other than some guys that I train with. I participated in four Ironman events between 2012 and 2015. Three were full Ironman events and one was a half. I was in the medical tent immediately after three of those events for medical attention and while that may sound like a super bad thing to you, for me it was normal. Ironman is hard and if I need three IV bags afterwards, then that is OK. Right?

A week or two before my SCAD event, I was on a spin bike doing a 150 heart rate workout with interval peaks up to 165. I felt great. Usually I can only get a 145 heart rate with peaks in the 155 range, so I thought that I was doing good. In fact, I remember thinking that I was having a great workout day right before I got dizzy and had some chest pain that I self-diagnosed as acid reflux. I dropped my effort level by about 30% for a couple minutes, thinking that the pain would pass. It didn't. I got off my spin bike and sat down for 10 minutes. That didn't help. I still felt dizzy and had light chest pain that I thought was acid reflux. After another 20 minutes of sitting, I felt better so I drove home. That workout happened on a Saturday. On Monday I called and made an appointment with my family doctor to talk about what I thought was acid reflux and my slight chest pain. They could fit me in on Friday at 9am. On Friday morning at about 5am, I became a SCAD survivor. That was eight weeks ago.

I don't know what happened to tell the truth.  I went to bed Thursday night and I woke up Sunday in the hospital.  Statistically, most people don't wake up.

When I was in for my last catheterization, I was laying on the table, three or four nurses and the doctor were doing who knows what getting ready to look at my heart.  They were chatting about who was doing what that weekend and then they gave me the fentanyl.  Oh my, that's good stuff, I thought about asking for another hit but I don't want to seem greedy.

I get chatty under chemical influence and I listened to my medical team chat for about three seconds then I got tired of them chatting and me not chatting so I asked if any of them were triathletes.  They all stopped chatting for maybe ten seconds, then the doctor answered and said "No, we are not.  And neither are you."  I was sort of offended at the time since I think he was implying that I wasn't a fast runner or a good athlete and I was getting ready to give him my athletic resume when they stuck the multi-function tool into my person.  Now I know that he didn't mean I was slow but rather that my extreme sports days are over and he wasn't going to save me again.  Fair enough.

Before SCAD, I wasn't afraid of much but this fear thing is really hard to deal with. I feel every slight pain and it makes me afraid. I have a lot of slight pain. I have slight pain in my chest, which I think is mostly the chest wall/bone/cartilage doing some self repair.  Or maybe it's my heart complaining:  How would I know the difference?  I am not a trained medical expert, I just know that its a tiny pain somewhere between my sternum and my heart that goes away after a few seconds.  My ribs on the side still hurt a bit. Yesterday, I had a slight back pain, which I read somewhere is maybe a sign of a pending heart attack. Super. I have had back pain for years but how do I know if this is that same long running back pain or a new warning of a heart attack.

If I was pre-SCAD, I doubt I would have noticed any of those little pains. Now, I feel them all and they remind me that I am “Mr. Lucky”. I feel every PVC and it doubles my fear quotient. I think about the day I came home from the hospital wondering how I could make it through the night without a machine over my bed monitoring my heart.  They had a machine in the hospital doing that job but I don't have one at home so now, that's one more thing I need to do?  Call the nurse if my heart quits?  I think about this stuff non-stop.

I don't sleep well because I listen to my heart for hours when I go to bed, waiting for it to mutiny. One night, I laid in bed from 11 P.M. to about 2:30 A.M., convinced that I needed to stay awake in case I had another SCAD.  I have no idea what my plan was going to be if I did have another SCAD but I couldn't stop thinking about pending disaster.  I even thought about pre-dialing 911 and asking the lady to have the paramedics on standby and please don't use the flashing lights because it wakes the neighbors.  I didn't call but I had the phone on my night stand.

I spend 90% of my day thinking “what if”. What if I have another SCAD? What if my wife isn't there next time to save me? What if I am out for a walk and I fall? What if I cant ever fall asleep again?

I cant seem to find accurate data on my situation. I saw on one website that there is an 11% survival rate for having a heart attack at home. My cardiologist told me that there is very little data on men with SCAD since up to 80% of SCAD victims are women, depending on which study you reference. I am told that there is some data suggesting that SCAD in men is related to extreme sports and high impact car accidents, not that it matters to me now.

For weeks, I was on a mission to identify the cause of my SCAD.  Who is to blame?  What did I do wrong?  I don't always eat healthy, so I feel guilty for that.  I spent six months not working out after my last Ironman.  Maybe that was it.  I fixate on goals for years at a time and if I don't achieve those goals, I can feel the stomach acid build up until I burn it out with a run.  I don't go to my family doctor every year for a checkup.  I figured since my weight was marginally OK and I work out, he can't do anything to help me so why go? Now I wonder if skipping checkups got me.  I know I am not charitable enough with my time so maybe karma got me.  I crashed my mountain bike last October really hard, breaking a couple ribs and I couldn't breath right for weeks.  I didn't pass out but I wanted to, it hurt so bad.  I told my cardiologist about it and he said that wasn't it.  I'm not so sure.  It happened.

I have mostly given up on assigning blame.  In the end, it doesn't matter why.  No matter the cause, no matter the statistics, no matter the risk, it happened.  It is what it is.  I thought I was immune from health issues because I work out. I thought I was adding years to my life by working out.  Maybe I was wrong. 

I am hoping for the best. In my last echo-cardiogram, it looked like the dissection has healed and the area that they thought was a blockage turned out to be a sympathetic coronary artery spasm. Or something like that, I am not a doctor but I think that is close to what I was told.

If you would be so kind as to listen to me just this once, heed this:  If you are an athlete, listen to your body.  Listen to your doctor.  You only get one heart.  

Alone

The just-cut grass on the churchyard lawn,

invited us to linger, to talk about nothing.

So we sat in the sun while the cars drove by,

watching the birds pick through the clippings.

Lost in the day, we forgot about time.

Then you jumped up and ran and I didn't know why.

I didn't know what waited on you at home,

the fear you lived with.  

Your brother taught us important things like

how to steal squirtguns shoved down the front of our pants at the dime store.

A man with a badge grabbed you, so I ran.

We were seven years old.

They wanted to be near you, 

to know you as I did,

and when they saw us together,

maybe they would think I was like you.

Our moms paid the school for the overhead projector

that we broke when we fought in the fourth grade.

We were too young to know what we meant,

when we didn't talk for a month.

You were already gone,

when I thought to try.

We smelled each others shoes and you laughed when you smelled mine.

Years later, I smelled my own shoes, and I tried to laugh like you.  

Now, that memory fades like a solders story from the war before the last one. 

In a few days, or a few years, it will be gone forever.

Yet I see your face in stale-gray silhouette,

all the colors faded like a bugle singing taps at sunset.

You are barely a whisper now,

and you haven't told me a secret these forty years.

Everybody met at the same church where we sat those years past.

They lied to each other with made up stories about what you had said,

just the other day.

Then, no shit, your mom turned and looked at me,

she thought I was you, 

and she called me your name.  

She cried and asked me to visit her, to sit in her kitchen chair like I used to.  

Like you used to.

Years gone and now its just me,

and I wonder where you are.

It wasn't supposed to work out this way,

I wasn't meant to be alone.

I hope you are back in that churchyard, 

forever watching the birds picking over the clippings.

Reflection

 In November of my fiftieth year, I realized that the time was proper to perform an act of contemplation and self reflection, or at least attempt to do so. I set out to measure fairly, as well as I was able, those parts of my life which I deemed to be of value, and pause there, committing no act of self condemnation for the parts I found lacking, nor did I intend to crown myself with olive branches for any meritorious aspects of my life. I wished to discover some truth about myself, to better know who I was and, if possible reflect on the path I had taken to come to this place.

I know I am not burdened with an overabundance of original thought and to put a none-too-fine point on it, I refer to Ecclesiastes, "there is no new thing under the sun".  Its true.  In fact, much of my life is most probably a reenactment of some deceased persons life, but I do not intend it to be so.   I do not think of myself as a plagiarist at heart, and I have not, as far as I know, copied an other's work without proper attribution and I will not start now.  Perhaps Thoreau, while sitting in personal reflection at Walden, did not commit an act of self-analysis such as I contemplated but it sounded like something he probably would have done, or could have.  Had he thought of it.

Some time went by while I tried and failed to complete my task   It would not strain my schedule to commit some portion of my day to my goal and it didn’t seem to overtax my mental capacity.  Still, I made no progress because the whole thing just did not sit well and I was therefore vexed.  Quite vexed. 

The problem was that the task, as I thought of it, sounded like something Thoreau might have done while he sat and contemplated Walden Pond and, since I overthink things, attempting that act caused me to think and think and then it hit me like an outbreak of chickenpox in a daycare.   It inflamed my privates.  It abraded my undercarriage.  It chafed my frank and beans.  

So, since I could not commit myself to steal the thoughts and literary awesomeness of the great Monsieur Thoreau through an admittedly obscure form of plagiary, I couldn't get over the fact that I was approaching a line in the proverbial sand that cried out to me "Thou Shalt Not Pass".   Like I said, I was vexed.

However, I do profess to conduct myself, in word and deed, on the goodly side of the mean, so I can hardly walk away from the battlefield unchallenged and still claim victory, so, I then cast aside my goal of self reflection and moved on to something at bit more productive. I do then claim these newish postulates for my life;

For myself - I choose to live my daily life better, to more perfectly complete the remaining portion of my life, as far as I may, in the hope that, should I someday complete an act of honest reflection, I could be then proud of the person I have been, lacking in all shame or regret.

For my children - I elect to offer a better example of how one might choose to live intentionally, with both unrestrained zeal and full definition of purpose. I further resolve to let my children lead lives that they chose instead of causing them to relive mine.

For my employer and co-workers - My profession had become a nuisance to my life, an act I pursued partially and with reservation, I elect to perform to a higher level, completing at the end of each day such acts as would, if possible, be judged exceptional, leading when leadership is called for, following when appropriate, I chart a new course for that portion of my life.

For my wife - I vow to recommit myself to being a man worthy of her affections, to become that which she envisioned at the birth of our marriage. Given that I am incapable of glorious acts on the world stage, I admit that this effort may be insufficient of all that she deserves, but I would strive for some degree of sufficiency and hope for success as best I may.

For others - I understand my failure to discover forgiveness for those wrongs I perceived to have been committed against me, so as an act of contrition, I vow to offer service to others.

For my God - My failure to honor my God in thought and deed has been a source of shame so I should and would therefore attempt some small measure of undefined restitution.