June 2021 – It woke me at three o’clock in the morning.  It was unmistakable, undeniable.  My heart felt like a clenched fist.  Unlike anything I’d ever felt before, it was squeezing itself tightly, painfully in my chest.  There was no doubt in my mind – I was having a heart attack.  The pain, like a cramped muscle that won’t relax, was intense.  I tried to wake Marty.  He was in a deep sleep. I had to shake him to pull him out of it.  I could only squeeze out a few clipped words “my heart…” to tell him what was happening between grunts from the pain.  He sat up in bed and asked me what I wanted him to do.  I grunted out “give me a minute…” At that moment, I knew the situation could go one of two ways: either my heart would relax and I could contemplate my next step, or I would lose consciousness and all decision-making would be taken away from me.  I didn’t want an ambulance called.  I knew what that meant after having spent several years as an Emergency Medical Technician (EMT) early in my career.  I didn’t want that kind of chaos. No, my heart would relax in just a few minutes, I told myself.  I just needed to give it time.

That moment was the culmination of a few months of warning signs that I had misunderstood, and in the days leading up to the early morning wake-up call, denied as being related to my heart.  It didn’t make logical sense to me that it was possible that I could be having heart problems.  I was in pretty good shape, not thin, but aerobically and physically strong.  I was an avid hiker and generally hiked multiple days each week on the trails near my home, which were many and varied in their difficulty and length.  But I’d had what seemed like a bad case of recurrent heartburn, usually in the morning hours, and sometimes on and off throughout the day.  Although heartburn was not a common experience for me, I’d had extra stressors that spring while assisting a family member with problem-solving.  Heartburn as a consequence didn’t seem out of the range of possibilities.  I took over-the-counter medications to help.  When they didn’t seem to make much difference, I presumed I hadn’t found the right one yet.

I was looking forward to the trip we had planned to Grand Teton National Park and the Wind River Range in Wyoming.  I was anxious to get out on some new trails and even fit in a few short backpacking trips.  Some days were pretty uncomfortable with the burning in my chest that I couldn’t seem to resolve, but I powered through anyway, packing gear and making preparations for a six-week camping adventure with our RV trailer.  By the time we started our trip, the excitement of travel and exploration after over a year of pandemic isolation overpowered my recognition that I had a problem that, though inconsistent in its occurrence, wasn’t going away.  I picked up more heartburn medications.  Nothing was going to stop me from maximizing my fun quotient on this trip. 

When we arrived at our campsite in the Tetons, I quickly mapped out the priority trails, but would allow for a few days for our bodies to acclimate to the higher elevation before pursuing those.  The first hike was a fairly level loop of about 12 miles.  It was much hotter than we were accustomed to, and the distance longer than my typical day hike, but also an easier trail than my usual fare.  It wasn’t surprising that I was tired afterward.  Over the coming days, we hiked about 40 miles on a variety of trails.  I noticed that my chest would burn when my heart rate got up over 135, which I easily monitored using the fitness tracker on my watch.  If I stopped to take a quick break, the pain would dissipate with a declining heart rate.  Despite the clear linkage between my heart rate and the burning pain, I had none of the other typical symptoms of cardiac issues – shortness of breath, dizziness, nausea, profuse sweating, or any chest pain other than the burning sensation.  I didn’t have pain radiating down my left arm – also a classic sign, but I did have some in my right arm.  As the days and hikes and miles went by, the pattern became clearer.  The onset of chest burning was occurring at progressively lower heart rates, and when it got bad, I would eventually get pain in both of my arms.

Marty was frustrated with my continuing insistence that I wanted to go hike more trails despite believing something was wrong.  He watched me suffer through the burning pain as I stopped periodically during uphill climbs to let my heart rate come down and the heat in my chest dissipate.  Even as I write this my denial seems incredibly stupid.  But my uncertainty resulted from the pain resolving during parts of my hikes, plus the many other hours I spent without pain.  I was far from home, and loathed the idea of showing up at an unknown doctor’s office and trying to describe my few symptoms.  I knew what it was like to have my concerns dismissed.  I’d mentioned occasional chest pain to my doctor a few years earlier, but she quickly dismissed it as stress and ushered me out the door.  Given my previous observations as an EMT, I knew that absent some more significant and demonstrable symptoms and the fact that I had successfully hiked over 40 miles at elevations of 7,000 to 8,500 feet, I was unlikely to be taken very seriously.  And I was right.

We had one more night in the campground, and then, at my insistence, planned to take a quick, easy overnight backpacking trip to a little lake that was down a level trail.  Marty thought it was time to stop ignoring the problem I had.  It wasn’t going away and it wasn’t getting better.  But apparently, I was either extraordinarily persuasive or exasperatingly stubborn.  We had the backcountry permit for the hike and had made arrangements to park the trailer.  I was concerned too – but thought perhaps I could squeeze in one more night soaking in the quiet and solitude of a backcountry camp.  We agreed that we would see how I felt in the morning, and make the final decision then.  As I lay down to sleep that night, I knew I was taking a risk of some sort, but I really wanted to go on this last hike before giving in to the need to see a doctor.  I prayed for God to give me a clear sign to resolve my conflicted and indecisive mind.  I guess I got what I asked for.

I sat up in bed, my heart clenched tightly. The pain continued for what felt like several minutes. I prayed for God to let me survive this moment. After a few more minutes, the pain began to ease a bit. My heart gradually relaxed and returned to a state without pain.  I was exhausted.  We discussed what to do.  I promised Marty that I would go to the hospital as soon as we could get packed up in the morning.  The crisis seemed to have passed.  I laid back down and quickly fell asleep.  In a few hours, we were up and preparing the trailer to move out of the campsite.  I didn’t feel particularly bad in spite of everything, but I did feel tired and dreaded what was coming.  But I no longer doubted the nature of my problem and was grateful that God had given me just enough of a sign to convince me, without my having to suffer worse consequences for my stubbornness.

We drove to Jackson, Wyoming’s small hospital.  It was difficult to find a place to park our long truck and trailer combination on the narrow streets, and the hospital’s emergency entrance didn’t look long enough to pull through, so we parked on a side street.  By the time I walked the one hundred yards or so to the emergency entrance, the burning pain had returned with a vengeance.  As I approached the registration window, I unknowingly displayed the universal sign of a cardiac problem – my right hand clutched over the top of my heart.  I nodded to the receptionist’s question about my heart, and they wasted no time getting me onto a gurney and surrounding me with emergency room personnel.  It was all of the chaos that I didn’t want.  I was hooked up to monitors and a grouchy nurse tried and failed multiple times to start an IV on my terrified, shrinking veins.  I described to the doctor what had happened the night before and that I was sure I’d had a heart attack.  I talked about having hiked many trails and miles over the last several days.  In the background, I could hear the skepticism.  It was probably just the altitude they said.  Lots of people come in with chest pain but it’s because they’re not used to the altitude.  I told them I was quite sure that wasn’t the issue.  I’d been there 14 days, was acclimated, and had hiked at much higher altitudes without a problem.  Still, I could see and hear the doubt.  It didn’t make sense that someone who presented as an otherwise reasonably healthy person had a heart attack.  I couldn’t agree more, but I also could no longer deny what had happened to me.

The EKG had just a little blip of an anomaly.  They couldn’t say for sure what it meant.  More skepticism as to whether I’d actually had a heart attack.  Fortunately, after the doctor had finally taken over from Nurse Ratchet and used ultrasound to locate a vein, they’d been able to get blood to run tests.  There was troponin in my blood, a protein that is only released from the heart when it is damaged.  It wasn’t good news, but at least my sense of what had happened to me was validated.  Reality set in and my tears began to flow.  I’d had a heart attack.  I hadn’t imagined my symptoms.  They had been real and trying to tell me something.  What now?  The tone in the room changed.  I no longer feared that I would get kicked out the door and told to take it easy for a few days, dismissing my concerns.  But it was a small hospital, and they didn’t have the ability to give me the diagnostics and treatment I would need.  A hospital in Idaho Falls was the nearest cardiac care facility, but we couldn’t drive ourselves since my situation was regarded as unstable.  I would need to go by my choice of ambulance or aircraft.  I opted for the two-hour ambulance ride and Marty would follow with the truck and trailer.

I was scared and overwhelmed.  I had always been a pretty healthy person and generally resilient through life challenges, but this was different.  This was beyond my control.  I was at the mercy of my circumstances and had to rely on others to help me.  I depended on their skill to salvage my health.  As I was loaded into the ambulance for the ride, I had my first opportunity to see the inside from the patient’s perspective.  I felt vulnerable and dependent.  It would be a long ride up the mountain pass and down the other side, but they would go slow to minimize jostling me about.  My heart had relaxed again for the moment, but my energy was spent.  At some point along the way, I fell asleep, entrusting my continued survival to God and the paramedic that sat beside me in the ambulance.