Actually, I think we need to go back a couple more months, to early October. That’s when I came down with a very nasty cold. It was so bad that I had to take a couple of sick days, and it never really went away, week after week. I was constantly tired, slept even more poorly than usual, with post-nasal drip, congestion. Even before coming down with that cold, I’d decided to get a flu shot—the first voluntary flu immunization of my life. After putting up with the sequelae for far too long, I went to the doctor with complaints about my endless cold, but he didn’t find much of anything. He suggested cough suppressant and nasal irrigation (yuck), which I tried for a week or so without apparent change.
So I made another appointment with the doctor just after Thanksgiving, this time laying out my entire collection of signs and symptoms. Not just the still-lingering cold, but everything from brittle fingernails to depression to the occasional short bout of what I called heaviness or tightness in my chest. This last item piqued the doc’s interest. Hey, I’m an obese 57-year-old male being medicated for hypertension and hyperlipidemia, definitely at risk for coronary disease even though I’m a lifelong nonsmoker. He did a brief EKG rhythm strip right then and there, and scheduled me for a stress test to be taken on Monday, December 10.
In the interim, I continued to feel just as lousy. Then came the early morning of Thursday, December 6.
I awoke that day at about 4am. In and of itself, that wasn’t unusual for me in recent months. Sadly, I seem to wake up briefly once or twice just about every night, usually because of the noise and discomfort of a misadjusted CPAP facepiece. This time, though, what woke me was chest tightness, appreciably greater than ever before. It was as if there was a very large elastic band around my chest. I lay there for a few minutes, asking myself whether this was bad enough to call 9-1-1. Eventually, I chose not to make the call. My principal reason rationalization was that my workplace is just a couple of blocks from a major hospital—in fact, I work in a research office associated with that very hospital. So, feeling anxious and a bit short of breath in addition to the discomfort in my chest, I showered, dressed, and took the bus to work. My chest didn’t seem to be getting worse, but neither was I feeling any better.
After about 90 minutes at my desk with no improvement whatsoever, I decided I needed to do something. When I informed my supervisor that I thought I needed to go over to the hospital to have someone evaluate me, she immediately volunteered to walk over there with me. She said she needed to go there anyway, but I suspect she wanted to make sure I wasn’t going to keel over in the middle of the street. We got to the ER, and she left me there at the triage desk.
It’s quite enlightening to see what happens when you tell an ER nurse that your chest is bothering you. Within a minute I was escorted to an examining table, where three or four professionals quickly hooked me up to a 12-lead EKG monitor and blood pressure cuff, fitted me with a nasal cannula delivering O2, taped a pulse oximeter to a finger on one hand, and placed an IV in a vein on my other wrist. I assume the IV was used to draw blood for my labwork, but I never saw the tube drawn. They did a chest X-ray right at the examining table, and I swallowed an aspirin tablet. The emergency physician was accompanied by about half a dozen students for the first few minutes, and a cardiac fellow also participated in the evaluation. I was asked the expected questions—how long have you had this pain? where is it? does it extend into your arm? how bad, on a scale of 0 to 10? do you have any prior history? is there a family history? what medications do you take?
While waiting for the lab results to come back, the ER staff checked back with me regularly, asking about the nature of my pain. In the hour or so between the blood draw and the report from the lab, my discomfort initially increased a bit but eventually began to fade away. The thick band around my chest seemed to become narrower and narrower, and eventually disappeared completely. At about that time, my lab values came back essentially negative. Normal values for cardiac enzymes and for D-dimer. No sign of myocardial ischemia (recent or remote). Whatever was going on with this episode, it wasn’t cardiac in nature. Whew! After resting comfortably for another hour or so, I left the ER with nothing more than a prescription for something called Neutra-Phos-K ... apparently, my phosphate and potassium levels were a bit low.
Since that day, I haven’t had a smidgen of chest discomfort. Four days after my visit to the ER, my treadmill test was completely unremarkable and uneventful. I was more than a little bit unhappy, however, that the cardiologist ended the test before I’d gotten past a brisk walk. At that point I’d already reached and exceeded my “target” maximum heart rate, which shows how far out of shape I am.
Unfortunately, the story doesn’t quite end there. Since my heart scare, I contracted another head cold. While it wasn’t nearly as severe as the one I had in October, and was much more typical of my usual cold symptoms than the earlier one had been, it too has lingered far beyond the time it normally requires for me to recover from a cold. As I write this, about two weeks after coming down with the more recent cold, I remain stuffed up and nearly without a sense of smell. What I wouldn’t give to make this thing clear up completely…
Whenever someone writes about a healthcare encounter, it’s expected that they’ll say something about the vicissitudes of dealing with health insurance and payments. So far, knock wood, I really can’t complain. During my visit to the ER, the only mention of insurance was a clerk’s request for my SSN during the initial setup on the exam table. I never showed my insurance card to anyone. Then again, I did inform the triage nurse that I was employed at that very hospital (the ID badge around my neck was another indicator). As it turns out, as an employee of an institution owned by King County and managed by the University of Washington, I have extremely good health insurance. I don’t know what I’ll have to pay for either the ER visit or my stress test, because I haven’t yet received either EOBs or bills associated with either of them. Not that I’ll begrudge my portion of the costs, whatever they are.
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