The Big One

 

My first intimation that all might not be right with my world was jacking up the Tahoe with a long handled floor jack and experiencing excessive fatigue for the level of exertion. I rested and the fatigue passed. Two days later on March 8, 2016, I was working out at the Teton Sports Club at near Cross Fit intensity and noticed marked exertion and some dyspnea and having to leave the class after I noticed some chest tightness. I showered and drove home and lay down waiting for the tightness and shortness of breath to abate. I had taken an aspirin worrying that the pain was at least cardiac based angina. When the pain persisted I took some motrin and a Vicodin which had no effect.  The pain increased markedly and I began to sweat in the cool bedroom. I recognized this as diaphoresis ,  another well recognized symptom of an impending heart attack. I called my wife who left work and drove home to carry me to the emergency room. The staff at St John’s Hospital   https://plus.google.com/+TetonhospitalOrg in Jackson rapidly attended to me slapping on Oxygen and monitoring leads as they performed an EKG. The look on the face of the Emergency Room Doctor showed alarm and I turned around and saw the Q waves and the ST segment elevation characteristic of an inferior myocardial infarction. Dr Adam Johnson, the ER Doc quickly put in two large Iv’s and moved me to the code room and began administering a narcotic analgesic and nitroglycerin to control the pain which was becoming more severe. I heard him call for our resident mountaineer/cardiologist, Dr Ellen Gallant. I was fully alert and aware of all the activity and discussion going on around me and I was pleased that the folks were following correct procedure in the right order. I looked at my wife a former ER nurse herself who appeared calm but concerned seated directly across from me. My daughter arrived in tears. I felt very calm myself and decided to relax knowing that allowing fear to take over would release adrenalin which could worsen an already bad situation. I was acutely aware of all conversations going on around me. It seemed my auditory acuity was enhanced.  ER Medicine had been my profession for 15 years and I had taken care of many emergent chest pain patients in the same way that they were taking care of me. The two doctors conferred and told me that I was a candidate for emergency thrombolytic therapy, a relatively high risk treatment to try to dissolve the clot blocking blood flow in my heart. This was quickly administered and it was shortly thereafter that my vital signs deteriorated. Both pulse and blood pressure fell. At one point I heard the word “asystole” and felt my visual fields narrowing. I still felt hyper alert and aware.  Dr Johnson’s face dropped in front of mine telling me “Dr Owens. Talk to me!” I thought to myself, “What am I supposed to say? I am fine and alert.” I decided to try to reassure him and tried to talk but found I couldn’t formulate any words. The thought occurred to me that I now might have had a stroke, a side effect of thrombolytic therapy. My wife also saw all this and said my blood pressure steadily began to fall from 80 to 60 to 40 to 20 and then to 0 along with no pulsation for a 10 second interval. I was surprised to still be crystal clear in my perception even as I heard ominous expressions like “He’s unresponsive. We’re losing him.”

I didn’t feel like I was being lost but I expected to crash momentarily as I saw them bring over the defibrillator. This was the only time I became alarmed because I didn’t want to be defibrillated while fully awake. The staff continued to administer cardiac drugs, dopamine and atropine. At one point there was discussion of the Atropine dose, .5 mg or 1 mg. I wanted to scream out “1 mg! Give me 1 mg.!” And just when the situation seemed most dire I heard someone say, “We got a pressure”. My pulse remained low and I heard Dr Gallant call for a  balloon pacemaker and a cart was brought over. I could see them staring at the monitor and finally I heard reassuring words like”His pulse is coming back. His blood pressure is increasing.”   Being in cardiogenic shock was extremely uncomfortable but as my vital signs improved I could feel the chest pain slowly starting to fade.  Dr Gallant leaned over me and said I needed to have stint placement and she recommended that I be flown to Idaho Falls to Dr Kip Webb, an interventional cardiologist who was highly experienced in the procedure. I remember arguing with Dr Gallant that I might prefer going to Salt Lake City which was the regional referral center I used when I was still practicing. I also said I might prefer going in an ambulance instead of an aircraft. Dr Gallant said she had complete confidence in Dr Webb but  that this was a time critical situation and that I need to get to Dr Webb as quickly as possible. Dr Gallant is a recently arrived cardiologist with many years of experience in one of the nation’s best Interventional Cardiology hospitals, Columbia Presbyterian in New York City. I decided to shut up and go with her plan. By now I was feeling markedly better with minimal chest pain and improving vital signs. From that point things began to move quickly. There was a snowstorm swirling over the Tetons and a helicopter was ruled out. A Swiss built fixed wing aircraft ambulance named a Pilatus PC-12 was already enroute to the Jackson Hole airport and I was quickly bundled up and loaded into an ambulance and rushed to the airport. My wife, Karlene, was told she might be able to fly with me and I heard someone ask her weight to decide if she was skinny enough to go. The ambulance pulled up to the runway and I was quickly loaded into the fuselage of the Pilatus and minutes later we lifted off the runway and climbed steeply into the snowstorm swirling over the Tetons. The aircraft was quiet and powerful and fast and we finally came out on top of the cloud layer into dazzling sunlight. Unfortunately I felt my chest pain returning.  Looking at my EKG  I  saw my ST segment again lifting, a sign of deteriorating cardiac function.  The nose of the Pilatus dropped as we began our descent into SE Idaho and skimmed over bare wheat and potato fields on approach to the Idaho Falls Airport. We landed smoothly and I was loaded into an ambulance and rushed to Eastern Idaho Regional Medical Center locally called EIRMC or “ERMAC”. Dr Webb was standing by the ER doors. He introduced himself to Karlene and myself and briefly stated his plan and in seconds I was taken direct to the Cath Lab where Dr Webb and his staff rapidly busied themselves for a stint placement. Dr Webb uses a radial artery approach instead of the more traditional groin approach which I was more familiar with. I watched him advance the guide wire and the stint on the monitor . I was experiencing moderately severe chest  pain. He said. “It’s in place and I am inflating the balloon to 15 atmospheres”. The next second I felt an immediate abolition of my chest pain. I was simply stunned. The pain was gone…..completely gone!. Dr Webb placed a second stint lower down in my Right Coronary artery and then said “We’re done. I am going to get your wife so she can see what we did.” I think the whole procedure lasted no more than 15 or 20 minutes.

After a night in the cardiac unit , Karlene and I drove back to Wyoming to try to pick up our lives where we left off. I was extremely luck to have been in the right place at the right time, rapidly treated by experts who saved my life. Dr Webb said this approach can be not only life saving but heart muscle preserving if flow can be restored within a four hour window. Lucky me.

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