Stress Echo Print

3513174235 2a8a31be88(Yale Journal for Humanities in Medicine, June 27, 2013)

In San Diego, at the hospital, I, a three-heart-attack patient, lie down for my annual check-up, an echocardiogram, a two-stage procedure. My shirt’s off, my chest’s swabbed, the electrodes are attached. First, the echo technologist goops a wand with gel and rolls it across my chest, my heart at rest. She takes four ultrasound videos, close-ups of the four chambers. Next, I walk for twelve minutes on a speed-and-incline-raising treadmill. My heart pumps madly, I stride and push, grasp the bar, a sailboat rail in rough seas. I lie down, and she ultrasounds the organ again. (I’ve pushed my resting rate from 69 beats per minute to an agitated 151.) The moving images record what’s termed “wall-motion abnormality,” that is, my heart-attack-weakened muscle cannot respond with full vigor as it once did.

Post-stress, on my back, I spot on the screen the damage from my initial heart attack five-plus years before. Its grizzled grey mass is eerily spectral like moonlit fog. I ask, “Can that be repaired?”

“You’ll have to speak to the doctor about that,” says the tech.

I think, well, of course; techs can’t diagnose, at risk of lawsuit; so she defers. Schooled woman. System-protective system. But I want answers. Or reassurance.

“Your heart,” she offers, perhaps seeing my muzzy look, “is contracting and expanding well.”

In the image, she says she’s searching for “wall thickening” in the left ventricle. Thickening means the heart muscle inflates with sufficient blood to squeeze and send blood—the ejection fraction—into the arteries. A robust ejection is what you want.

The attending cardiologist, a Chinese woman, enters. She reads the screen before sending the pictures to my guy, Dr. J, who will interpret them with me/for me later. Still, I ask, “Can that gray patch be repaired?”

“No,” she says.

Ah, the truth.

“But,” she hastens, “there’s nothing here to worry about.”

My heart, relaxed, starts pounding again. I squirm on the paper I’m lying on, paper like a Denny’s place setting. If part of my heart’s dead, how is there nothing to worry about? I strain my neck to see into the image but I regard the Chinese doctor, her perfectly clipped raven hair, a tiny silver cross dangling against her Alpaca sweater. What do I want from her? She’s told me the truth. Why do I think she (or any of these healthcare professionals) owe me anything more?

When a copy of my echo report arrives, I spend a morning underlining all the pertinent phrases, Googling them for definitions, trying to grok its jargon. An hour of holding my head up on the desk as if it were a bowling ball on a table, and I write it out in my journal.

“Abnormal resting electrocardiogram”; “abnormal stress echocardiogram”; “no new stress-induced wall motion abnormalities”; “flattened inferior-lateral T waves at baseline with non-diagnostic inferior Q waves”; LV (left ventricle) wall motion at rest “mid-apical lateral wall hypokinesis” and “mid-basal inferior wall akinesis”; LV wall motion under stress “mildly hypokinetic” and “inferior wall remains akinetic from mid to base.” “Global systolic function is mildly reduced.”

The damage to my heart muscle, I estimate, is ten to fifteen percent. A chunk of my left ventricle, the harder working of the two, has decreased mobility; it’s hypokinetic. That chunk is motionless; it’s akinetic. That’s why, when I walk up four flights of stairs or hike at 8,000 feet, I’m breathless, pinched.

The truth rears: Nothing’s changed in five years. Although, I am alive.

I want to tell Suzanna I’m treading water but I don’t. I retreat, saying, “You know, a shitload of online papers to read,” spend a weekend in my office, map the results of my echo with red, green, blue, and black pens. Though I’m blue-black woozy figuring this stuff out—I do it anyway. I cup my face and stare at the diagram, no more penetrable than if I stared at my chest, trying to see my heartbeat.

One week, then another, creeps by. I’m back in the cardiovascular center waiting room, my foot-shaking a nervous pulse on the carpeted floor. I keep rereading my notes, my colored grid.

It’s then I hear the all-caps phrase at the report’s end shouting at me, an emergency siren pushing through this diagnostic snowstorm: “CHRONIC ISCHEMIC HEART DISEASE.”

My disease is chronic. It’s here to stay—and it’s going to kill me. It’s here to kill me. Perhaps not tomorrow. But sooner not later. That’s what the no-comment techie and the nothing-to-worry-about doc were saying. By not saying it.

Ushered into the cubicle, I wait twenty minutes for my cardiologist, Dr. J. He enters briskly, shakes hands, and I’m thrusting him my data—diagrammed, red-underlined. Soon I shut up, defer to him, as always. Because he talks/I listen—the illness is more salient than the patient—I hear that my arteries are as wide as they can go, the large, ruddy sump of my heart that’s working is working well, there’s no sign here of an impending wreck. I think of this loquacious, balding man, while he’s so overwrapped in his intellect, of making these little speeches to frightened heart patients all day long.

And then something happens, the thing I don’t know. Each time his talking stops, when he ear-plugs his stethoscope to listen to my heart. One hand palms my shoulder, the other guides the floating silver disc on my back and chest. The long quiet is basementy, conspiratorial. His concentration, submarine commanderly. I sense we’re breathing as one, Lamaze-like. Then, his admission—“the sound of that thump is quite strong”—and I feel cared for, immensely cared for.

Push the numbers back. Bury my penchant for them.

What am I feeling? What your condition is asking you to do.

My heart—its blast-scar irreversible—wants consoling. Wants to be attended to. Wants to be seen, wants to be heard. Much as it was that frightful first night I rushed in: I need help—I’m having trouble breathing. How elastic that need I had to be attended to stretches then to now. To be consoled, comforted, assured, listened to, more than talked at. Commiseration to match the infarct anvil I’m carrying.

My thump felt, it is, for the moment, as it was before. (Not as it ever shall be.) The heart—for a long moment—recalls its adolescence, its strength and verve, its cocky attitude, its full-bloodedness—a first baseball glove, parents leaving me at college. This turn back spites the ever-narrowing passageway.

I also realize I need to participate more with what I want to happen than what I fear will. I’m called in. I’m medicated. I’m treated. I’m done. Lifesaving yes, but it’s not good enough. Let the numbers go. Let intimacy, as rare as it is, ravish me. Love it for its one-night stand, its Lottery-like unlikelihood. Let it linger as long as it can. Be thankful it’s not any less. Be the person being seen, being heard, hope outweighing diagnosis.

So, for the rest of our session—the thirteen minutes HealthNet stipulates we get twice yearly, the report feeling moldy in my hand—I’m clutching our give and take like a piglet on the teat. The sound of that thump. I seem to float up to the ceiling and observe us.

From there, I’m performing a bit, though not falsely. I want him to notice my softening. I want my passions to stimulate his. His, mine. I listen, put my notes aside, ask whether there’s any procedure yet invented for a cardiologist “such as yourself” to detect an unstable plaque in the arteries? It’s like feeding a sardine to a seal.

“You mean,” he replies, “if we could send a catheter up there and see the plaque that’s going to burst next Saturday at two in the afternoon? If I knew how to do that, I’d get the Nobel Prize in Medicine.” A ticklish laugh sidles out.

I’m nodding at Dr. J like a groom to the preacher. Surely, he knows what patients want. The surfacing, the buoyancy, lingering above water, not dying, saved. I feel I must care about him as well. Such things he can’t give he must know he can’t, and I must accept that.

Outside the hospital, I fall to my ritual gloat. I get coffee, now with soy milk, sit and admire the fact that my next blood test is three months off. I’m content. Exiting the parking lot, I recall a statistic I forgot to tell him: ninety-two percent of heart patients who have interventional surgery, take medications, eat good food, and work out do not have a heart attack in the five years after their first.

Wait a minute! I had a second. I had a third. This stat doesn’t represent me. No, it does: I’m in the eight percent. The numbers are like relatives staying on, uninvited.

That’s when I’m hit by one of Dr. J’s pronouncements: Your arteries are as wide as they can go. TL’s in the eight percent, and he’s at the widest width possible. Isn’t this what he told me last time, before I went to Dr. M—We can’t do anything more?

Shit, I didn’t ask what he meant, so busy was I under a spell. Are my arteries as wide as they are because my left ventricle pumps only so much? Is it because the ventricle is forcing its eighty-five/ninety percent capacity to flex harder than before? Is it because arteries can’t repair themselves and are fated, post-heart-attack, to compress like a python digesting its prey?

To what degree am I fixed? Unfixed? Unfixable?

The tizzy rises. Hands palm the steering wheel. Numbers nag me nutty. If I want an answer to this indeterminateness, I won’t get it desiring the determinable.

The only thing I can count on is his touch, Suzanna’s, Dr. M’s, awakening me. That if I widen my heart’s yearning to connect, I—and much less so the Vegan diet, the cleansing pills, the yellow-highlighted stats—I know I steady those wall-motion abnormalities, relax that coronary constriction. There’s so much and so little the medical people can do. The rest is mine.

In “The Patient Examines the Doctor,” Anatole Broyard writes, “I just wish he [the doctor] would brood on my situation for perhaps five minutes, that he would give me his whole mind just once, be bonded with me for a brief space, survey my soul as well as my flesh, to get at my illness, for each man is ill in his own way.”

I doubt Dr. J realized it but he did get at my illness, if only briefly. The other half is, I took his getting at and made it mine. Our bonding space was stethoscopic, our “five minutes” closer to one. That halcyon familiar. My heart being heard. The moment I felt his heart go out to mine. Indeed. Physicians survey souls. They can. Too bad they seldom do, though I’m saying now that this, above all else, is what we patients and our wandering souls want.