Heart Attack Diary: (Part 1)

A medical writer lives in terror of a heart attack, firsthand

Editor's note: The story of Donald Drake's heart attack at age 45 begins here in an article he wrote for the Philadelphia Inquirer. Drake, now in his seventies, periodically chronicled his battle with heart disease for years afterward. The pioneering former science and medical reporter at The Inquirer took a buyout after 35 years at the newspaper and went on to become a successful playwright. Here we reprint his diary of the first heart attack, along with a very different story about living with heart disease that he wrote years after this warning call.

The ache in the chest wasn't particularly bad. It was not the fierce, crushing pain that usually signals a heart attack. But it was bad enough to waken me from a deep sleep.

I rolled over and looked at the luminous dial on the clock next to my bed. It was exactly 4 a.m. I tried to forget about the pain and go back to sleep, but a few minutes later I was sitting on the edge of the bed, wishing I could belch.

My God, could this be the start of it? I thought.

Could this be the heart attack I had been dreading with increasing frequency with each story I wrote about heart disease, with each open-heart operation I observed, with each resuscitation attempt and post-mortem I witnessed as medical writer for The Inquirer?

A thousand times the same nightmare had haunted me:

Crushing pain under the breastbone. Collapse. Semi-consciousness. Paramedics entering my house, clad in their big yellow crash helmets. My bare chest arching from the impact of the electrical jolts from a machine used to revive dying hearts. Sirens through dark streets. On a litter, being pushed through a crowded emergency room. Unsmiling faces bent over me, all looking very concerned. Then blackness. Nothingness. Lack of existence. No existence. Nonexistence. Death.

Next to cancer, no other disease is more dreaded than heart disease, and no other medical emergency is more dramatic, in the eyes of nondoctors, than the heart attack.

Loss of kidneys, the liver, the pancreas or other parts most people could not name would kill just as surely as a heart attack, but the heart is a special organ, more a symbol of life and death than any other.

Heart. There may be no other word in the English language quite so endowed with significance: We have our heart set on something. We learn things by heart. We don't have the heart to perform uncomfortable tasks. We put our heart into strenuous effort. We go through puberty with heart in hand, and sometimes emerge from it heartbroken. That remarkable muscle is, in short, the heart of the matter of life.

When something goes wrong with it, we usually react in extremes -- commonly in disbelief, followed by dread. Neither is healthy.

I got out of bed and went downstairs for a club soda. It was probably indigestion, I told myself. A club soda would make me belch and, when it did, the ache would go away, and I could go back to sleep, once again to curse my wild imagination and the hypochondriasis -- the fear of impending death or illness -- that is an occupational hazard of medical writers.

Standing in the darkened kitchen, in the light of the opened refrigerator, I drank a whole bottle of club soda and belched. But the pain in my chest didn't go. I squeezed my chest muscles with my hand and moved my arms up and down, hoping that would show it to be a skeletal-muscle pain. The ache in the center of my chest wasn't at all affected by this maneuver. Increasingly worried, I went upstairs and lay down in bed, but sleep was impossible. It was getting near dawn. It was 5:30 last Wednesday -- eight mornings ago -- and the loneliest hour of my life, a loneliness made worse by my reluctance to reach out to friends or relatives for consolation, because I wanted to believe it was all nothing.

I tried to console myself that I had none of the other symptoms associated with a heart attack: shortness of breath, perspiration, pain radiating down the arms or up to the jaw -- sure signs of a heart attack.

By 6:30, the anxiety had become too much. Slowly I dressed and put into my briefcase the first draft of an article. My plan was to go to the emergency room at the Hospital of the University of Pennsylvania, get a clean bill of health and go on to work. The article was about Penn's coronary care unit, where I had spent days interviewing doctors and nurses about the cost-effectiveness of such expensive technology. If I were having a heart attack, that would be the very unit I would be sent to. It would be ironic for the doctors and nurses there to see me so soon again, as a patient.

Still, I knew exactly what I must do. I had written many times about it. If you have chest pain, seek medical help immediately. Dial 911 and ask for fire rescue. Skilled paramedics will reach your door in four or five minutes. They will place monitoring electrodes on your chest. If you go into shock, they have drugs and equipment to revive you and keep you alive until you get to the hospital. Rich or poor, it's the best way to go to the hospital if you're having a heart attack. I knew that as well as anyone in the city, knew you should call fire rescue, even if it turned out there was nothing wrong at all.

But it did seem silly for a big red truck to blare and flash to a screeching halt in front of my house at 6:30 in the morning because I had to belch.

I took the route 13 trolley to the hospital.

See part 2

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