3rd Place – November 2020

A Killer Job


Dr. Barna Richards

The snow fall continued overnight to a depth of one foot in my driveway. I couldn’t get my car out and knew an onerous job awaited me. I reluctantly took the snow shovel off the hook in the garage and began the task of clearing the obstacle. I shoveled about half the distance when I felt weak and broke out in a sweat. I rested a moment and resumed my work. The next thing I knew, I awoke in a strange, brightly-lit room with people surrounding me. When my brain fog cleared, I realized I was in a hospital ER.
Weakness and nausea engulfed me, followed by copious vomiting. My chest felt like a heavy weight sat on it, and in my previous forty years. I had never experienced anything like this. I wasn’t pleased with the sensation.
I asked the nurse, “What happened/”
She said “looks like you had a heart attack.”
“May I see the ECG?”
“Certainly,” She said. I examined the tracing and saw some abnormal changes, but it didn’t prove to me that it clearly demonstrated a myocardial infarction, but my symptoms were indicative of it.
As a physician, I knew that, in northern climes, it wasn’t uncommon that shoveling snow preceded a heart attack, but I was relatively young with no previous sign of heart disease, and I had shoveled snow numerous times in the past without consequence. A cardiologist, Dr. Miller, came in, and we discussed my case. He Said “I have no doubt that you have suffered an MI. The ECG is abnormal, and your enzymes are slightly elevated.” (Cardiac enzymes: creatinine kinase, troponin, and myoglobin are released when heart muscle is damaged by heart attack) He then admitted me to the CCU. The nurse gave me IV morphine, and I was in la-la land, but I told her “I feel more short of breath.” I knew I could be in congestive heart failure, but I also felt certain the cardiologist had considered that possibility.
The previous week I had traveled to London for a medical meeting with the Royal College of Physicians. I had jet lag and still felt the effects before my recent incident. Ironically, one of the speakers at the meeting presented a paper on MI related to unusual work effort. I certainly fit that scenario. I considered that, having a recent long flight, I might be suffering a pulmonary embolus, and I felt more short of breath just before the lights went out again. When I awoke, my chest hurt like hell. The nurse said “You had a cardiac arrest and we defibrillated you.” Ventricular fibrillation is an abnormal rhythm that accompanies heart attack and is a common cause death. In V-fib, the ventricle of the heart just quivers and doesn’t pump blood to the organs. Death is certain if it isn’t corrected rapidly. I said “Are you sure the zoo didn’t lose an elephant that came in and sat on me?”
She said “No, it just feels like it.”
Dr. Miller came back and said “You almost bought the farm this time.”
“I guess the farm cost too much for me.” I still felt short of breath in spite of four liters of oxygen through the nasal cannula. I lamented the cigarettes I had smoked for years. Dr. Miller said, “I’m going to implant a pacemaker-defibrillator, and hopefully you won’t have more of these episodes.” He inserted the device, and I gained some confidence, but now I felt permanently damaged and disabled, and I still felt fearful of another attack that could be my last. When the internal defibrillator activates, an individual might feel a thump and some mild pain. I hadn’t experienced that yet, but any sensation in my chest gave me concern.  I felt anxious all the time wondering when the next heart attack might occur.
Two days later, Dr. Miller released me. “No vigorous exercise, but slow walk a little each day. Don’t smoke cigars, lose ten pounds, and eat low fat foods. You have mild CHF (congestive heart failure), and you should take the meds and see me in three days.”
“Ok, but I really hate not smoking cigars.” He rolled his eyes.
At home, I was weak but felt like a caged tiger, not able to go or do anything much, and I worried constantly. My medical practice was being covered by friends, but I feared that I could be permanently unable to work my previous patient load, and my income would suffer. The “rich doctor” myth was just that: a myth.
The second day home, I felt the “thump” and knew the defibrillator had activated. That scared the hell out of me. I didn’t tell my wife; she was worried enough, and telling her would serve no benefit. I slowly regained strength and could walk a block without too much trouble. I saw Dr. Miller who said “You can work half days now, but no night calls.”
“OK, but what about cigars?” He shooed me out of his office.
It has now been 8 weeks, and I am working about two thirds capacity. I don’t like the lump in my chest that constantly reminds me of my vulnerability, but the “thump” has only occurred once. I have learned to appreciate every day and am grateful for modern medicine that saved my life; the paramedics, the CCU, and all the expert care from Dr. Miller and the nurses in the hospital. Without their expertise, I would now be in a six-foot-deep hole in the ground. My wife is a drill instructor and commands: “Don’t eat that cheeseburger, you haven’t done your exercise today, and you are working more than Dr. Miller told you. Don’t even think about smoking a cigar. Are you suicidal?”
“No, but I love my cigars with a little cognac.”
I had quit cigarettes a while back, and after a few abstemious years, with trepidation, I smoked a cigar. Then, I smoked more cigars until it became a daily habit. Now, I can’t even cheat because she’s like a bird dog who can smell cigar on my clothes from fifty yards away.
Well, I no longer shovel snow, and that’s a restriction I don’t resent. The teenager next door does a good job for a reasonable fee. Otherwise, I follow the obvious guidelines for a guy with coronary heart disease. I used to think that physicians should experience the illnesses they treat so they could appreciate the miseries that their patients suffer. After my heart attack, I changed my mind about that.
But I still want a cigar. I guess cognac will have to be my go-to sin.
In moderation, of course.

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