Want to know what I did on my summer vacation? I died.
Twice. Three times if you count when doctors stopped my heart during open heart surgery. Overall, the first week of vacation with sun, sand, seafood and family was fun, the second week with two heart attacks, three ambulance rides, four hospitals and double bypass surgery…not so much.
On the morning of Saturday, August 10, 2013, I was sitting alone on the deck of a beach house in Kitty Hawk NC, drinking coffee and thinking about going for a run. I had been running during vacation, part of my lame pattern of every few months deciding I was too fat so I had to exercise. But this season I was not able to go very far, less than a mile before huffing and puffing brought me to a walk. This was unusually poor performance, but I attributed the weakness to getting up there at age 54. I decided to hold off on running because I felt a little sick to my stomach.
I woke up moments later flat on my back, looking up at the bottom of the table, wondering why I was lying down. Spilled coffee soaked into my shirt and shorts. I felt no pain or shortness of breath, no crushing chest sensation or dizziness. I thought I fainted and when I went inside and told my wife Ruth, she guessed the same. We decided I was dehydrated after a week of vacationer’s diet of coffee and beer, so I would drink more water and we’d keep an eye on it. In the back of both of our minds was an episode I had the day before, where as we went to lunch I remarked that I should be a lot hungrier than I was, having skipped breakfast and all. She told me we had in fact had breakfast together, ate bagels at the table and read the newspaper. I could not remember any of it. I had lost about an hour of the morning. Spooky but not terrifying. Yet.
Two hours after the fainting spell, while walking back from the beach, I began to feel sharply nauseated. It came on fast like sea-sickness. I wondered if the same fainting thing were about to happen and began looking for a place to sit down. Again I woke up on the ground, this time face-down in the sand next to the beach road. Eyeglasses were bent, forehead cut. I went and found Ruth, who drove me through the heavy departing-vacationer traffic to a local urgent-care clinic. They gave me saline drip, and an EKG which showed nothing, but they were concerned and ordered me an ambulance to go to Outer Banks Hospital in Nags Head. The nurse hugged me and told me she would pray. That was scary, as was my first personal – not police-work-related – ambulance ride. Staff at Outer Banks Hospital also found no damage on the EKG nor enzyme-related evidence of heart attack in my bloodwork, but guessed that I had experienced a sudden arrhythmia – a break in my normal heart rhythm that dropped my blood pressure and flow of oxygen to the brain. Further serious tests were not available there, so another ambulance ride (same crew, it’s a small town) took me to Albemarle Hospital in Elizabeth City NC, on the mainland. Preparing for the ride, the EMTs put conductive patches for defibrillators on me, and showed me the big needle I’d see myself getting when I woke up if I went out again. They knew more, and were worried more than I knew to be.
At Elizabeth City the next day, I had a nuclear stress test where radioactive dye that sticks to damaged heart tissue was injected into me, then I ran on a treadmill. The dye revealed no heart injury but my blood pressure skyrocketed during the test – most unusual. I have always had slightly high BP, but nothing ever to trigger treatment or concern. I recently started taking Crestor to begin working on slightly elevated cholesterol, but again nothing that really concerned my personal doctor. I had never seen a cardiologist until this day, when I met Dr. Lindsey White, who saved my life.
Dr. White said I had no apparent damage to the heart, no history to indicate serious issues other than two episodes of “syncope.” Syncope is my new word, it is doctor-speak for fainting but sounds so much more serious, which I appreciated because until that point it was looking like I had triggered a lot of EMS and ER response for just a little dehydration. Dr. White said this was more than fainting, that he heard me when I said I had spilled my coffee all over myself and that nobody spills their coffee when they faint. Even if they don’t remember, they always have a few seconds as they fade out to put the cup down. He decided my syncope was instantaneous, thus very serious. So he ordered a cardiac catheterization, where tubes were run up my wrist to the external cardiac arteries feeding my heart muscles and dye again injected. The dye is monitored in real time via a device like a small CAT scanner over my chest. My wife sat near him as he used this rig to locate first a 100-percent blockage of the LAD (Left Anterior Descending artery, the biggest artery supplying blood to the heart muscles) then an 80-percent blockage of the ramus artery, then a 30-percent blockage of another one. My wife heard his great concern as he related this discovery to his staff. If he like others had mistaken my syncope for simply dehydration, I would have been released that day, likely to die another.
One hundred percent blockage of the LAD is well-known among medical personnel, my sister the surgical nurse told me, as “The Widowmaker,” and is almost always found only on autopsy. As I moved from facility to facility, through emergency room to exam room to surgical prep and recovery, several nurses and doctors confirmed this nickname. Many could not hide their shock and concern when they met me and learned of this diagnosis. It seems I was not supposed to have survived. The most eloquent and direct among them, a much older and traditional nurse at the hospital where my eventual surgery was performed, held my shoulder and said, “God must have something more for you to do here.”
Dr. White said my options were two: cabbage or stents. Cabbage is more doctor-speak, for CABG – coronary artery bypass graft, commonly known as bypass; or stents – flexible pipes inserted in blocked arteries to be widened in place so they open a hole through which the blood can flow. Neither sounded pleasant, but as I had learned from Dr. White and a senior nurse, the most likely scenario involving my syncope was that I died each time, that my passing out was in fact my heart simply stopping due to inadequate oxygen supply, and that I had banged it back to life by the impact of falling to the ground. AKA sudden cardiac death. Twice. They don’t know for sure since I was alone each time and certainly not hooked up to EKGs or other monitors. I took that as an indicator of fantastic luck, and ignored my fear of a little unpleasantness like chest-cracking open-heart surgery.
Another ambulance ride, to Norfolk General Heart Hospital, where cardiac surgeons agreed that CABG, though far more serious and invasive, was the better solution. Stents, easily implanted via remote surgery and little incisions, are temporary, lasting maybe five to seven years before requiring replacement and are not always successful in opening or maintaining arterial flow. Bypass surgery involved sawing the breastbone in two after a foot-long incision is cut down the front of the chest (this is why surviving open heart patients are said to have joined the “Zipper Club”) and requires the actual medical stopping of the heart by drugs and freezing slush poured into the open chest cavity. Terrifying stuff, but not when compared to the alternative. I figured I’d already stopped my heart twice all by myself, so a third time with doctors there could not be so bad, and what’s a new scar? Let’s go for it. Ruth, my absolute rock, my healthy heart at my side every moment, was very but quietly scared. I was not.
Surgery went well. (How should I know, I was asleep. But I woke up, a reliable indicator of success.) Surgeons reached in the hole in my chest, snipped off the end of the non-vital artery that feeds my left mammary gland (tits on a boar and all) and attached the end to the LAD just below the blockage, restoring blood flow to that area of the heart. For the ramus, they removed about a foot of the saphenous artery from my left thigh, apparently an artery I can live without. (For many older CABG patients, it is this harvesting of the saphenous artery that causes the greatest ongoing pain and disfigurement, as removal used to require cutting a trench the length of the artery to snip off each end and scoop it out. Nowadays they go in through a one-inch lateral cut at one end of the harvest, and robotically roto-root around it via cutters of some sort. Miraculous.) The bypass artery is sewn above and below the blockage. The third 30-percenter, they left alone to be monitored for the rest of my life.
Just as miraculous was that the very next day, I was sitting up in a chair, out of bed, and eating a sandwich. Modern medical procedures, good drugs and fantastic staff. Other than agonizing pain when I forgot to get morphine on schedule (the schedule is, take it well before you need it because it takes a while to catch up), one of the most challenging things was getting shaved for surgery. Shaved from chin to ankles. Everywhere except, oddly and thankfully, my arms. Nurses were cute and would say, “Oh, you’ll look good, you’ll look so young, your wife will like it.” Great, like I’m eight?
Morphine was great, but I wanted off that fast, so I worked through Vicodin to Percocet. Vicodin gave me post-surgical delirium – monsters that looked like evil versions of Where the Wild Things Are came out of the walls to eat me – and I learned the next day that this was not uncommon. Percocet got me out the door after four days of recovery to spend a week at my mother-in-law’s home near the hospital, too sick to travel home while Ruth drove the kids to college. The kids were outstanding through all this, never letting on how scared they were, but still not letting me win at Scrabble. Mama was wonderful, she is 90 and as a registered nurse was glad to have a patient to care for again. She about nursed me to death, in that good way. Stepped further down to Tylenol 3.
After a month at home, with visiting nurses monitoring my progress, I began 12 weeks of cardiac rehabilitation, wherein wonderful exercise physiologists at INOVA Alexandria Hospital watched me closely while I pitifully pedaled a stationary bike, walked on a treadmill and gripped an elliptical without pumping the arm bars because I couldn’t do chest work till the sternum healed, six weeks away. I worked out while connected to an EKG, and every so often one of the EPs would rush over and tell me I had exceeded my target pulse rate, which is 126, kept deliberately very low by a beta-blocker drug called Metoprolol. Plus , in rehab I got lectures on proper diet (low- or no-salt, reduced fat and cholesterol) and stress reduction. I didn’t want to feel disabled, but more on that later.
Stress reduction was made very easy from the start. I have not returned to work since the heart attacks, haven’t carried a gun or answered a call – for service or for any commander-related issue. I would read the work emails, but others now answered them since I have been replaced quite easily and ably in both of my assignments as police PIO and Records commander. My family tells me I am happier, and nearly everybody I meet says I look relaxed. I’ll take it. Stress-fighter pro tip: turn your smart phone off at night (or day if you are a night-shifter) and on weekends. I know this actually can’t be done in our work environment, but it is the one piece of advice I truly wish we could follow. We never get down time nowadays because technology keeps us in harness at all hours. If it’s a true emergency, someone can call you on your home phone. Stress makes your heart beat faster in a fight-or-flight response, and makes your blood vessels constrict for the same reason – which makes your heart work harder to pump blood through the constrictions (same as cholesterol buildup in the arteries). I have learned I can lower my pulse rate by, well, thinking happy thoughts. Really. I can also raise it by thinking about work – not the fun stuff like bad guys and handcuffs but meetings and City Manager’s reports.
Diet change was surprisingly easy, too. In the hospitals for nine days, then at Ruth’s mom’s for another five (she is a former nurse who allowed no nonsense at meals) provided a forced period of transition from bacon burgers and fries to boiled vegetables, tuna and fruit. These were never my favorites but they became if not preferred at least appreciated. Sodium restrictions were challenging and oddly fascinating. Sodium raises fluid retention, increasing the blood volume and thus placing pressure on the interior of blood vessels. Blood vessels must be flexible to allow for pulses of blood as the heart beats and for bodily movement, but pressure makes the vessel surface hard and irregular. Hard spots and irregularities are where fat globules (cholesterol) in the blood supply stick, causing blockages. Blockages slow blood flow throughout the circulatory system, making the heart pump harder, and cut off blood to vital things like, well, the heart itself. Cut off enough and things die, like heart muscles, which is what typically happens in a heart attack. I had no apparent or measureable heart muscle damage, although we recently found nerve damage that probably indicates some level of injury.
But back to sodium. I used to be a salt fiend. Ask anybody I worked with as a police Field Training Officer. Forced to dine with their FTO, recruits and I would go to Arby’s where my standard meal was two beef-n-cheddar sandwiches, fries and a soda. After my heart operation, my restricted diet limited me to 1500 milligrams of sodium a day. That is about a teaspoon. Not a teaspoon added to food, but total. Each of those beef-n-cheddars had contained 1540 mg sodium. So I would double my current restriction, add fries, and put table salt on all of it. Imagine the total. Now add constant stress.
No wonder I died.
Sodium is in everything – bread, cheese, almost any processed or boxed food. Read a soup can label sometime just to blow your mind. And low-fat “healthy” items have more sodium in them than their regular-fat counterparts because it hypes the taste. Drives you crazy. Shopping at supermarkets is like a science test during a scavenger hunt but after a while we got good at it. We shop at Harris Teeter, but go to Trader Joes just for the marinara sauce and a specific bag of tortilla chips. Because sometimes you have to have something crunchy and tasty, and low-sodium tortillas are as naughty as I’ll get now.
You have to have help, too. Such complete dietary inversion would have been impossible without my sweet wife along for the bumpy ride (and she has lost 10 pounds on our new healthy diet.) I’ve eaten more vegetables in the last year and a half than in the prior ten. Fish is a huge percentage of our diet now, chicken and turkey are big (as are chicken and turkey sausage and chili, soup etc). I dropped 23 pounds after the attacks, but am now putting some back on. I use the fact I am on baby aspirin as a blood thinner as my excuse to grow a beard and avoid the mortal danger of nicking myself. Actually, I like the beard, and Ruth does too, along with the long non-reg hair.
And for my cop friends: you have to have help navigating the bureaucracy of a serious illness, too. Heart disease is covered under the Police-Fire Heart Lung Bill as a disability related to police work, but it is not simple or clear cut like a car crash or an assault injury. Police Personnel, City HR, the City’s insurance organizer PMA, City Finance, the state Workers Compensation board and the state Industrial Commission – everybody has a piece of this. They overlap, but they don’t always communicate well, so if you think you gave forms to one city agency, don’t be surprised if you get called down for not providing to another. The bureaucracy is challenging and stressful – just what you won’t need. What you will need is a lawyer. Call me.
But there is light at the end of, and at a couple of places inside, the tunnel. (Again, this is mostly for my cop friends: I followed some good advice and applied for a disability retirement a few days before City Council voted to drastically cut our disability pension plan. My thanks to out to the Commanders’ Association for this advice, and no thanks to the Alexandria Police Association from which I heard nothing since this started – I want my 28 years of APA dues back. But as it turned out, I did not pursuing disability retirement. First, the pay is the almost the same but the system is weird and complicated, and the “disability” classification of a disability pension and its tax advantage cut off when you reach “normal retirement age” so the money converts to your standard retirement pay. Which for me was December 2014, while I was out on sick leave when I turned 55.)
Second, I don’t feel disabled or want to describe myself as disabled. Already I am stronger than I was before the attacks, as documented by my performance in rehab. And how could I claim to be disabled when I plan on running (well, sort of running) in 5Ks, and rowing with my son in crew competitions? And hang-gliding, and kayaking. Did you see those former NYPD jerks who took 100 percent disability retirements after 9/11 and were just shown on the news riding on personal watercraft and teaching self-defense? Fraudulent? TBD. Embarrassing? OMG.
Not for me, nope. I retired straight-up, 28-year, honorable, I-did-my-time service. And proud of it, but ready, too, for great change. Those who know me know I had planned on getting to 30 and out, so this was only two years early. The bottom line, the final determining factor for me was my doctor’s simple equation: “Coronary artery disease is caused by stress, and police work causes stress. You should not go back if you want to continue to live.” I will always have to take heart medication, will never be allowed to shovel snow, and my kids will have to check “yes” on doctors’ forms asking about family history of heart disease. Due to the seriousness of my condition, my cardiologist advises me to seek out other less stressful employment, as it appears that I am permanently physically unfit for unrestricted duties as a police officer. So far, it’s writer and lately, blogger.
I am the luckiest man in America. I had a decent career, avoided too much personal violence, rose higher than I thought I could, missed out on few opportunities, had fun and helped people. I think I was a good street officer, a decent sergeant and at least an okay commander. On the job I met my wife (I was in TAC, the street-level narcotics unit and she was a Public Defender, it was love at nearly first sight but she beat me on our last case against each other). We have two amazing kids, “A” students, a dancer and an athlete at big schools, they are happy, strong and smart-assed as they should be. I now get to write my novel, and maybe someday you’ll get to read it if published. If in fact that happens, I will donate 10 percent of my sales profits to efforts to fight police suicide. In my 28 years with the APD, I lost one fellow officer to hostile gunfire and three to self-inflicted gunshot wounds. And that terrible proportion pretty much plays out nationwide. We kill ourselves far more than they kill us. So if it’s ever published, risk some money on “Apprehension” by Mark Bergin. It’s for a good cause.
And some of us eat and stress ourselves to death, so I hope to work on that too. I waas been invited by City Hall to join the pension committee to help develop the Department’s health and wellness programs and maybe take that citywide. I figure I am the poster-boy for what not to do with your life early, and how to save it late. Stay tuned.
I want to hear from, meet and talk with any and all of you, at any time. Friends know I am good for coffee or lunch. Shy folks or strangers are welcome to call or write me to talk about diet or death, or the Department, whichever you want. You know how to find me.
One last thing for my police brothers and sisters (and forgive the boast, because it is not the point.) I recently bumped into a parking enforcement officer whom I have known forever, I won’t tell you his name (but it’s not my friend John Nasibi). He asked after my health, and when I told him it was preventing me from returning to work he looked down and said, “I am sorry to hear that. We liked it when you were working. You always came and checked on us. We felt safer when you were working.”
That was the greatest compliment I have ever received. It was always my goal, to protect and serve my people, so maybe I achieved it. It should be your goal, too. Keep your partners safe always. It means you will be safe, too. I want you to get home every night. Like I get to, now.