“The secret of the care of the patient is in caring for the patient.”

– Francis Peabody, American physician

September 2021 – Activity begins in the early morning hours at Virginia Mason. I reported to the Cardiac Catheterization Lab, “the Cath Lab,” at 6 a.m. as directed. My nervousness in the waiting area suggested I’d mainlined some strong coffee before my arrival, despite the prohibition on eating or drinking for several hours before the procedure. Marty sat next to me on a waiting room couch, sharing in my silent apprehension about the procedure to come. The minutes ticked by without interruption.

When I had a heart attack in June, an angiogram was used to diagnose and repair my blocked arteries with stents. Last time, everything was new, unknown. My exhaustion and overwhelm clouded my comprehension of the process and what the doctors might find. This time, I understood what to expect. I was wide awake and fearful that I already knew the outcome. Something had gone wrong with the stents. How? Why? What had I done that was contributing to the problem? My chest pain was increasing with each passing day, whether I exerted myself with physical activity or sat quietly at home. The angiogram should provide the answers I needed to move forward, to resume my normal life. Still, I didn’t want to go through it again.

A steady stream of people in hospital scrubs poured through a staircase door and into the hallway outside the waiting room. Watching them provided some distraction. I imagined which jobs they held. Some looked very young, like they might be students or interns, while others had an air of confidence that comes from having survived years of training and experience to become doctors. I took reassurance from their looking alert and rested despite the early hour. I needed them to be at their best, as I was decidedly not at mine. The stream of people reduced to a trickle as the hour wore on, and I was running out of ways to distract myself. I couldn’t focus on anything. No reading of the various magazines in the waiting room, no small talk with Marty. I wasn’t sure how long I had been waiting, but time was dragging and my anxiousness was not diminishing. My stomach growled from its emptiness, and I longed for some strong coffee. I was ready to get this over with. A few other people sat in the waiting room. Even in silence, the tension was palpable. We were all anxious, anticipating the next step.

Finally, my name was called to go back to the procedure preparation area. I only heard about half of the nurse’s instructions for changing into a hospital gown and storing my clothes. My anxiety was clouding my ability to hear and process information. I know this. It’s how your brain reacts to overwhelming stress. You can’t hear, you can’t think. The nurse had to repeat the next steps. Despite all of my career training and experience, I was not immune to panic brain. Danger warnings were firing off in my head. I’ve changed my mind. I don’t want to be here. I don’t want to do this. Memories of the ER nurse in Jackson, Wyoming trying repeatedly to start an IV on me were flooding my mind. It seems like a small thing to get stuck with a tiny needle, but it becomes a big thing when you’re already tense, fearful, and in pain and they keep sticking you without success and you know they have to keep trying until they get it.

A nurse came in and took my vital signs. I needed to front-load her chances of getting an IV started on the first try. I explained how I was a “hard stick” and the formula for success in starting an IV on me, how my veins like to hide and roll and are uncooperative. I pointed to veins on my wrist and hand that would most likely work. Her raised eyebrow revealed skepticism. Nurses try to avoid those veins because they are small and often painful for the patient. She reassured me she would try to get the IV started on the first attempt. I told myself that nurses in the cath lab are doing this every day of the week, many times a day. They should be good at it. She was much more receptive to my suggestions than the ER nurse in Wyoming had been. And true to her word, she got a stable IV going on the first attempt, using a vein I recommended. Relief. That step was done.

As I relaxed for a few moments on the gurney, I noticed a new set of legs in scrub pants visible under the front curtain of my fabric-enclosed private space. The voice of an older man seemed to go with them. Amid the hushed conversation, I heard my name. In a few moments, he stepped inside my curtain and introduced himself as the cardiologist who would perform my angiogram. I’ll call him Dr. K. He wasn’t particularly tall and had a thin, wiry build. His short, straight silvery-gray hair framed the face of a man I surmised must be in his mid-60s. He had youthfulness in his movement and countenance, and his dark eyes shone when he smiled. Dr. K asked me to tell him my story. I explained how I’d had a heart attack after hiking for several days at higher elevations in the Tetons of Wyoming and then had stents placed in two blocked arteries. The cardiologist in Idaho told me I could resume aerobic activity in about 10 days, so I did, with a 110 mile bike packing trip. Dr. K frowned when I described how many aerobic activities I’d undertaken within a month of the heart attack, including the hike up Perseverance Trail on my birthday. I told him about having chest pain during that hike, described my passion for outdoor activities, and my wish list of future hikes. He responded that his favorite activity was biking, but climbing Mount Kilimanjaro was his most challenging hike. We traded stories of adventures for a few minutes, and then he said, “Let’s see if we can get you back out hiking,” signaling that we would get ready to do the procedure. I liked his confidence. He seemed to understand and care about what mattered to me. I was less afraid than I had been a few minutes ago. I still didn’t want to go through the process, but I felt more confident about the necessity of doing it and the doctor who would perform it.

My second angiogram experience was oddly fascinating. Or maybe it was just the anesthesia. As I transferred from the gurney to the procedure table and the nurses were preparing me for the procedure, I shivered uncontrollably, displaying my undeniable anxiousness. My teeth chattered as though I had hypothermia. The nurses covered me in pre-warmed blankets to calm my body while I bantered with the anesthesiologist I called Ketchikan because I couldn’t retain her name, but I could remember where she said she was from. The warmth of the blankets and an anesthesia bolus transported me into a dream-like state, more or less cognizant of what was happening around me. I heard Dr. K’s voice as he entered the room and briefed the staff on our goal for the procedure, to get me out hiking again without pain. I didn’t feel the angiogram guide wire enter my femoral artery or its progress snaking its way into my heart, but I could hear Dr. K vocalizing each step and his instructions to the staff. He would periodically ask me how I was doing. If I felt any twinges or awareness that something was happening in my heart, the anesthesiologist would increase the medication dosage, and I would drift off to dreamy detachment. I had no pain or concept of time, but was never far below the surface level of perception. I deduced that the procedure was nearing completion when it seemed like Dr. K pulled yards of guide wire from my body. In my semi-conscious state, I marveled at the miracles and capabilities of modern medicine. With X-ray technology and contrast dye, Dr. K could see the blood flow of the vessels in my heart and perform diagnostic tests and repairs to the vessels with a fine wire and catheters fed through a tiny incision in my femoral artery, all while I rested comfortably under warm blankets.

The nurses wheeled my gurney back to a private room for recovery and I regained my mental clarity in a short time. I checked the clock on the wall. The angiogram had taken less than an hour, despite it seeming much longer. I had to lie flat for 45 minutes to allow enough time for blood clotting in my femoral artery before subjecting the punctured vessel to the pressure of sitting or standing. Marty joined me in the room, and Dr. K came in shortly after. He explained partial blockages had developed again in both arteries where the stents were placed previously, but he’d been able to open them up again. He changed the blood thinner medication I was taking to a different one that he thought might work better.

Dr. K instructed me to take 30 days off from hiking and any other aerobic activity to give my body time to fully recover. Once I resumed activities, he wanted me to pace myself and slow down or stop if I felt chest pain. Once I recovered enough to be discharged, I returned to the hotel for an overnight stay. Waiting a day before flying was a standard requirement following the procedure. I flew home to my restrictive prescription, having promised to resist the temptation of a sunny day, or even a day without precipitation, as instructed. I busied myself with a photo organization project and other tasks that had been waiting for just such an opportunity. My desire for a healed heart overrode my impatience with having to wait for an entire month to get back out on a trail.

My time spent under house arrest was productive, and also allowed me time to contemplate my circumstances thus far. When I had the heart attack in Wyoming, I was certain of what had happened, but I encountered resistance and doubt from medical personnel. The presence of the hormone troponin in my blood was required to prove what I already knew. Once I returned to Juneau, I knew something was wrong with my heart again, despite the repairs with stents. Even with my medical charts and my reporting of repeated indicator symptoms in front of them, a doctor and rehab specialist resisted acknowledging my concerns. Once again, the angiogram test was required to prove what I already knew. I couldn’t afford to risk my health and life with medical professionals that wouldn’t listen to me, or that wouldn’t take my concerns seriously.

In that month of waiting to heal, I had plenty of time to consult Dr. Google, and learned something else that I already knew from my experience: women struggle to have their symptoms associated with heart attacks validated by medical professionals. There may be substantial differences in the cardiac symptoms of men and women, and while women may have classic heart attack symptoms, they may also have much more subtle symptoms that can be mistaken for something else. Despite statistics identifying heart disease as the most frequent cause of death for women, the resistance to hearing women’s complaints still exists. I was grateful that I trusted my instincts, and that lead me to find doctors that listened and didn’t question the validity of what I was feeling. Instead, they helped me problem solve. That was what I needed. The doctors didn’t have answers for why my body struggled to embrace the standard fix for blocked arteries that has been successful for millions of people worldwide for decades, but at least now I had some people in my corner that would help me search for solutions. I thanked God for the knowledge, skill, and compassion of those medical professionals, and also for the stubbornness and determination that made me willing to push forward in the face of resistance. I was going to need all the help I could get.