The Cardiac Chronicles

Take a look inside, see what you can find.

The day starts with the almost 2-hour car ride to Salt Lake City. After multiple failed attempts I managed to get inside the parking garage and find a parking space. To get to the hospital entrance, we must take an elevator. Without consulting the map, I pushed a button on the elevator panel, and we begin to descend, the entrance is above us…

The doors open to reveal on the bottom of the parking garage. Emily is not impressed. My confidence takes a hit, and I consult the elevator directory, select the right floor and we ascend all the way back up to the top of the parking garage, right outside the entrance.

Once inside, now that I’m a believer in maps, I search for the nearest hospital directory. Before I can get my bearings, a hospital employee is asking us where we need to be.

“MRI?” I say, unsure if that will get me where I need to be.

The employee spouts a lists of directions: Down the hall, turn right. End of the hall. Left there. Through some doors. Another Left.

We do our best to follow the instructions and wind up in a windowless corner of the hospital. It feels like a place they’d keep mops and vacuums, but there on the wall, above a reception desk, are the words “Imaging” and “Nuclear Medicine”. A couple of other people are sitting in a nearby waiting area. To the lady under the “Nuclear Medicine” sign I say, “I’ve got an appointment for Paul Bradford”, still not sure we’re in the right place. She checks her screen.

“Looks like you’ve filled out everything online, Do you want to go over the pre-test questions again?”

Twice already, over the phone, someone from MRI has asked me the same 100,000 questions about all my experiences with medical implants, tattoos, piercings and metal grinding. I think I’ve got it by now.

I sign a form, then she hands me a small slip of paper and tells me to write down what kind of music I listen to during the MRI. I’m not ready to answer such a difficult question. I start to write 90’s rock but decide that’s too exciting for an MRI. I need to lay still the whole time. I’m also not sure I want to admit to the MRI techs that I enjoy some Oasis and Red-Hot Chili Peppers. I scribble out the 90 and settle for 70’s rock, a more laid back, less assuming choice. We take our places in the waiting area.

A few minutes go by, a tech comes out, calls my name, hands me a hospital gown and some hospital pants, and shows me to a changing room with lockers. I go in, lock the door behind me, and change. Hospital pants are the definition of “one size fits all”. They must fit every waist between 68 and 28. For better or worse, I’m closer to the 28 side of things so I cinch down the drawstrings, tie a big knot, and pull on the robe. I’m starting to look like I belong on the set of Karate Kid.

After changing, I wait a few minutes for another MRI tech to call me back to the imaging room. I follow him through large double doors, through a dimly lit office into the MRI room. I take my place on the bed. I feel like C3P0 about to board an escape pod. When they start hooking up monitors and tubes I feel more like Luke Skywalker after Vader chopped his arm off.

The first item is the IV. The phlebotomist asks if it’s hard to get an IV into me. It isn’t. Soon he’s telling me if a new phlebotomist couldn’t stick my vein, he would suggest they pursue a different career. He quits talking after a few minutes because he can’t get any blood out of the IV. He’s missed and stuck the needle all the way through the vein. Don’t get cocky kid.

Another tech arrives to place the EKG leads and the rest of the instruments. Then they slide me back into the tube. I am reminded of the lyrics from a Marshall Tucker Band song:

“I’m gonna find me a hole in the wall, I’m gonna crawl inside and die.”

The techs voice comes in from the other room over a headset: “Were going to do a few images where you hold your breath, then we’ll turn the music on and take some other images. Just listen to the instructions.” The machine begins to grind and whir; I imagine a large magnet spinning around my body at near-hypersonic speed (I have no idea how an MRI actually works).

A voice comes over the headphones. It sounds like the same guy from the pacer test: “Take a deep breath in.” Pause “breathe out.” Shorter pause “hold your breath” longer pause “Please continue breathing”. I follow ‘the voice’ through a series of directed inhales and exhales before the techs voice comes back on: “We’re done with the first portion of the scan, well get your music going for the rest of the test”. Then his voice is replaced by Buffalo Springfield. Something really is happening here1.

For 20 or 30 minutes I lay there, listening to the music. The imaging center at the U must not have Spotify premium because I hear a whole lot about beer and car insurance too. Occasionally, the Eagles or Creedance Clearwater Revival (CCR) are interrupted by ‘the voice’ instructing me to stop breathing.

A few times the tech got on the microphone to check in on me and update me on the status of the test. In the middle of the test they start some IV contrast which makes my mouth tase funny. I loss track of time.

Eventually, the tech comes on to tell me we were starting the last set of images: “You’ve done great so far, just keep holding as still as you can. It’ll be another 6 minutes or so”. He signs off just as Stevie Knicks is finishing up her woeful ode to landslides. A commercial tries to convince I’ll have my best summer ever if I start drinking Coors Lite (it’s too late nothing will top this summer). Then Joe Walsh comes on with, Life’s Been Good. I realize this 8+ minute ballad should last longer than the duration of the test. One more song, then I’m free! My backside and arms are starting to tingle. I focus on the song and try to tune out the pain.

For those familiar with this musical masterpiece, after song ends the track continues as someone calls out: “Uh oh here comes a flock of Wah Wah’s …”2. As my ears are assaulted by Wah Wah’s I realize: the songs over and I’m still in the tube. Six minutes has come and gone and there are no signs of this ending. I’m losing it. Everything either tingles or aches. I start to wiggle my feet. I try to lift my butt off the table without moving the rest of me. That earns me a call from the tech: “Just try to keep still, sorry this is taking so long”.

Eventually he comes on to say, “I’m gonna have you hold your breath to see if we can speed things up, go ahead and hold your breath for as long as you can.” I hold.

“You can breathe again now.”

A few seconds go by.

“Go ahead and hold your breath again for as long as you can”.

Hold.

I start to count how many times the machine revs while I hold my breath.

1… 2… 3… 4… 5… 6… 7… 8… 9… 10… 11… 12…

“You can breathe normal now”.

This happens a few more times. I’m getting desperate. The feeling is awfully similar to mile 24 of a marathon.

Two or three times he says: “This’ll probably be the last one, hold your breath”. Finally, I hear: “Alright, hold your breath once more and then I’ll come and get you out.” I oblige. “You can breathe normal now”. Phew. The whirring slows. The machine lets out one last grinding noise and it stops. The door opens; I’m moving out of the tube. It doesn’t seem so bad anymore.

Getting back on my feet takes considerable time, everything is stiff, and the combination of IV contrast and heart attack medication makes me woozy. I manage to stay upright long enough to walk to the lobby where the lightheadedness begins to subside. I don’t feel totally normal until I’ve changed back into my clothes and we’ve walked back to the car.

“You good to drive home?” Emily asks.

“Yeah”

On the way home we stop at Costco for Hotdogs and Pizza.

The aftermath

The next day the waiting game began. The U uses the MyChart app to send messages and test results to patients. The 48 hours after the test lasted at least 6 weeks. I spent as much time refreshing MyChart as some people do scrolling Instagram. Every time I thought I felt my phone buzz, I jumped. I got very little done at work. I tried to deduce Dr J’s work schedule based on my appointments and previous phone calls so I could predict his next move. What time should I expect a call? Is he even going to call this time? By Wednesday morning, I was a mess.

At 4:00 I got out of class and headed to the gym. I had given up, no way he calls after 4:00.

At 4:47, halfway through a set of frustration-fueled cable rows my watch and phone start to buzz.

The caller id reads: +1 (801) 213-3200

Below that: ‘Salt lake City, Ut’

That’s Dr J’s number; I don’t need to save it to know.

I drop everything, and head outside. I’ll be back, but I’ve got bigger fish to fry.

While we go through the formalities and Dr. J starts catching me up on the test results, I put the phone on speaker and open a note. Per Emily’s request, I need a written record of this conversation.

For the most part, it’s nothing we don’t already know. My Ejection Fraction (EF) is low. Theres significant scaring on the apex of my heart. We should go ahead and meet with the electrophysiologist and do an electrophysiology study, rule out any pesky rhythms.

There’s more. The MRI picked up something the Echo didn’t, clotting in my heart chambers. The scar tissue at the tip of my heart doesn’t move like normal heart tissue so blood is pooling in the ventricle. This puddle creates an environment for clots.

We’ve already discovered blood clots are not good. The solution is to change medications. Before this phone call, I was taking Aspirin and Prasugrel which are anti-platelet medications. They prevent clots in arteries (the kind that cause heart attacks), by preventing blood cells from sticking together. Anti-platelet drugs aren’t as effective in the heart chambers. To help there, Dr. J switched me to anticoagulants, specifically clopidogrel (PLAVIX) and apixaban (ELIQUIS). These should thin the blood everywhere, including in my heart chambers. We’ll check on these clots with another MRI In 6 months.

What do we do from here?

Since Dr. J called about my echo and first Holter monitor I’ve been under strict instruction to be “very chill with the running”. After the MRI, this remains the status case. Practically, this has turned into about 30 miles a week, all with Emily or Dad. Emily has set my limit to 5 miles in a single run. Occasionally, I’ll do two or three very slow miles on the treadmill at the gym as a second run. For all this my heart rate remains below 125 bpm. I get to keep my normal effort at cardiac rehab so that’s been a bright spot in my week, but I’ve only got a few more visits left.

I’ll meet with Dr. J in early September, hopefully by then my second Holter monitor results will be in. Then in early October I’ll meet with the EP.

My mood ebbs and flows between acceptance and mourning but not quite despair. I’m lucky none of these emotions are enough to keep me from experiencing the joys life still has to offer. I’ve discovered a love for fly fishing YouTube videos. I busted out my collection of old trail-running magazines to re-read.

As a “disappointing news” present Emily got me a Tenkara-style fly rod and I’m excited to take it for a spin. I’m toying with the idea of some new writing projects and trying to get back into the swing of things at work again.

So if anybody knows of any good fly-fishing spots, has something they think needs to be written, wants to talk running or just go get lunch, I’ve done worse.

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Thanks for tuning in.