Heart Attack Diary: (Part 3)
To his surprise, a writer lives to tell the tale
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 chronicles his arrival at the hospital after taking a trolley there with symptoms of a heart attack.
"No! No! No! No!" I yelled. I smashed my briefcase down on the table. The young doctor looked startled, almost scared.
"I've got a god---n heart attack."
Another doctor, a slightly older man, tried to calm me, saying that the EKG merely showed some irregularities and that he wanted to play it safe. He persuaded me to lie down. "We want to give you some morphine and put an IV line in," he said.
"I got a heart attack. I've got a god---n heart attack. Damn it, damn it, damn it."
Reluctantly, I laid down on the table as people began pouring into the room: a third doctor, two nurses, a porter, an emergency room with a clipboard and legal papers for me to sign.
I didn't want morphine, not just yet. I had to keep a clear head. None of my friends or relatives was here. To these young doctors, I was a pathology, a line on an EKG that didn't bend in quite the right way. I was an emergency to be treated. Immediate and effective treatment, of course, was essential. But at that terrifying moment I had an unbelievably strong need to be appreciated -- maybe even loved -- as a whole person, with emotions and intellect. Even with the fearful possibility of imminent death -- maybe because of it -- I had an urgent need to relate and be related to, not just be treated.
It was 7:30. I asked the young doctor to call Dr. Anna Marie Chirico, who is on the staff at Penn and my personal physician. She could not be reached. I asked for Dr. Michael Simson, chief of the medical intensive care unit. He couldn't be found. I asked for Dr. John Kastor, chief of cardiology at Penn and a professor of medicine at the University of Pennsylvania School of Medicine. A few minutes later he was standing beside the crash litter, shaking my hand.
"Things are looking fine at this stage," Kastor said. "There are some irregularities on the EKG, but you're having no arrhythmias, no congestive failure. Your lungs are clear. There is reason for optimism. At this stage, it seems like an uncomplicated MI," he said, using the abbreviation for a myocardial infarction, a heart attack.
"John, I'm scared to death," I said. "The figures keep going through my head: 25 to 30 percent of heart-attack patients don't leave the hospital alive. I've got a 30 percent chance of never getting out of this place."
Kastor shook his head.
"Those were the figures before intensive care and the anti-arrhythmia drugs. We've cut the statistics in half. Across the board, the figures are more like 5 to 15 percent now. And so far you've got everything going for you."*
As he was speaking, the young woman physician was beginning to drop lidocaine, a drug that would prevent fibrillation, into the IV that was stuck into my arm.
"But it's important that we treat you aggressively now," Kastor said "We want to limit further damage to your heart. That's why it's important that we start the morphine."
"But I'm not in pain right now," I insisted.
He shook his head. "It's not just for the pain. It's also to take the edge off your anxiety. You are scared. You have enough adrenaline pumping through your body to float a battleship. This is making your heart work harder. Your blood pressure is much too high, and this is putting an additional strain on your heart. If we don't do something about these things, the amount of damage to your heart will increase and we want to prevent that."
They wheeled me down the hall into an elevator to the seventh floor and into the medical intensive care unit, the very unit I had been writing about. I was taken to one of the rooms in the intensive care unit, moved into a bed and hooked up to the electronic leads of the monitor that would follow the activity of my heart.
Kastor introduced me to Dr. David Zimrin, 26, who had graduated from Mount Sinai School of Medicine in New York City and was in his second week as a physician. I was also introduced to Pat McNeal, a friendly woman who greeted me warmly and said, "I'll be your primary nurse while you are here."
Kastor explained to them that I knew more than the average person about medicine and that it was important they be very frank with me.
They began pumping in the morphine, trying to bring the blood pressure down -- first two milligrams on top of the two they had given me in the emergency room and then more, until 10 milligrams had been reached. But the blood pressure stayed at 180/120, much too high. The strain of that pressure was a serious threat to an ailing heart. They wanted to get the pressure down to at least 160/70. Then they started the valium.
By 11 a.m., four hours after they had begun treating me, my blood pressure was no lower. Ms. McNeal wrote in her nursing notes: "Anxiety related to level of patient's knowledge. Has good understanding of complex cardiology but is still relatively a layman. Don't take for granted he understands you completely. He knows enough to worry but not enough to reassure him."
Zimrin and Ms. McNeal couldn't have been nicer. They thought of every possible positive thing to boost my spirits: I was relatively young; I didn't smoke; I had no shortness of breath; I had no history of heart disease. But I was convinced I was going to die.
Ms. McNeal busied herself checking all my leads to the monitor. Simson, the head of the medical intensive care unit, came and kidded me about going to great lengths to get a story. It felt good to see him.
Then Zimrin came in with the results of the second EKG. It looked as if the damage to my heart was very small; in fact, there was even some question of whether there was any damage.
My blood pressure dropped dramatically. Within minutes it was 140/90, well within safe limits.
The next hours went smoothly. Trying to keep blood pressure in good limits, they added morphine and Valium. Every two hours they took vital signs to make sure everything was going well. Wires attached to my chest were constantly transmitting information on my heart function to a panel of monitors in another room, where a nurse was stationed. At times, they were taking my blood pressure every 15 minutes. They gave me oxygen to decrease my heart's workload. They gave me a nitrate drug to open the blood vessels and provide the heart with still more blood.
Even with all the drugs in me, it was hard to fall asleep. Every time I began to doze off, I would catch myself and think, This may be your last time as a conscious human being, and suddenly I was awake again. The night nurse sensed my distress and came over and held my hand. Finally I fell asleep.
I woke up about 7 o'clock last Thursday morning. The sun was streaming in the window. I remember having been wakened many times during the night, but I felt much more rested. I was groggy but quite alert. My spirits were strangely positive. I had passed the first 24 hours of a heart attack. And I was alive.
Reprinted with permission from the Philadelphia Inquirer July 3, 1980. Donald C. Drake's e-mail address is firstname.lastname@example.org.
*According to the latest statistics from the American Heart Association, 34 percent of the 1.2 million Americans who suffer a heart attack die.
American Heart Association. Heart Attack and Angina Statistics. http://www.americanheart.org/presenter.jhtml?identifier=4591
See part 4