Heart Attack Diary: (Part 2)
A medical writer foolishly ignores his own advice
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. In this excerpt, he talks about "foolishly" deciding to take the trolley to the hospital after experiencing symptoms of a heart attack.
The trolley, surprisingly, arrived immediately and, not surprisingly, had standing room only at that early hour. The ride was interminable. I was increasingly aware of the ache in my chest. The trolley seemed to be filled with medical personnel. Two medical students in short white coats, their pockets bulging with medical kits, stood next to me. A licensed practical nurse studied a pamphlet on, of all things, coronary-pulmonary resuscitation. A nursing student in the seat in front of me studied a textbook, I thought of asking if I could sit in her seat, but the anticipated dialogue sounded ridiculous:
Excuse me, young nursing student, I saw myself saying, as I tried to maintain my balance on a rocking trolley, I'm having a heart attack and I'd feel better if I could sit down for a moment. Would you mind giving me your seat?
I said nothing and waited for the 37th Street stop, got off, walked up the long escalator -- which hasn't worked for at least the two years I've been using the trolley -- and walked slowly the four blocks to the emergency room.
The trek was very foolish. Two-thirds of the million Americans who suffer heart attacks each year die before they reach the hospital.* Some die because the attack is so devastating that death is almost instantaneous, and nothing could have saved them. Others die because they are foolish -- they deny the symptoms for too long. They overexert their hearts during the critical hours after the first attack. Unable to get the extra blood needed to support the demands of a moving body, the heart begins to die, like a suffocating man. If too much tissue responsible for the heart's rhythm is destroyed, the heart goes into fibrillation, a wild ineffective beating during which no blood is moved. Within four or five minutes, the brain begins to die.
That is what I risked by taking the Route 13 trolley.
There was no one waiting for treatment in the emergency room when I arrived. A nurse wrote down a brief history, then checked my pulse and blood pressure.
My blood pressure was high, but that could have been attributed to anxiety.
The nurse assured me that everything looked fine and that a doctor would be out to see me immediately.
I suddenly realized I was crying. I was so overwhelmed with emotion that tears were streaming down my face. I wasn't scared or sad; I was just crying, and I didn't know why. I apologized to the nurse. She touched me and said it was OK to cry. I felt better. She directed me to the receptionist, who seemed bored and said my Blue Cross card was old and weather-beaten. She thought I should get a new one.
A few minutes later, the nurse came back and led me to a treatment room, where I was greeted by a young woman, a doctor. I gave her my medical history, and she said she would immediately order an electrocardiogram -- an EKG, as the reading of heart activity is called.
I was sitting in the treatment room only 10 minutes, but it seemed like an hour. Looking past a curtain, I could seem the "crash unit," a section of the emergency room reserved for critically ill patients. It is equipped with electrical devices to shock enfeebled hearts, oxygen to sustain those who cannot breathe, intravenous bottles, carts with drugs -- all the paraphernalia modern science has created to bring people back from the dead.
All morning at home I had catalogued positive things in my medical history to reassure myself. Now I began to consider negatives: The pain was sufficient to rouse me. I was male and 45, an age when heart attacks frequently strike in this stressful society. The cholesterol and other fats in my blood were unusually high. Uric acid, another biochemical that predisposes one to heart attack, was also high.
I could -- no, I did envision what was going on in my body at that very moment: Blood vessels clogged with atherosclerosis were unable to deliver enough blood to the heart. Without enough oxygen, the heart muscle was crying out in pain. Heart tissue was dying for lack of oxygen. If too much tissue died, the heart would go into fibrillation. If fibrillation lasted a few minutes, brain death would occur.
Those thoughts preoccupied me as I sat on a garbage can in the emergency treatment room, too nervous to lie down on the nearby litter.
A few minutes later, a technician came in and took my EKG. I waited some more. I got up and went to the bathroom. It was 7:15. For most people the day was just beginning. I thought back to a time, many years ago, when I walked into every emergency room in the city as a reporter, feigning heart-attack symptoms to see how long it took to get care. The average time was, disturbingly, 35 minutes.
The young intern, who was beginning her first week as a doctor, came back into the room and, trying to manage a smile, said, "Mr. Drake, would you mind stepping over here and lying down on this table?"
She was leading me to the crash unit.
*According to the latest statistics from the American Heart Association, 37 percent of the 1.2 million people who have heart attacks every year die.
See part 3