Part
1
Despite knowing that you may be at risk (family history, a bit overweight, too much of the wrong foods, etc.) and despite knowing what the symptoms of a heart attack are (foremost among them being chest pain) – when the heart attack appears at your doorstep, it’s still, well, unexpected. Stepping out of the shower Sunday night, December 4 (it was about 9:00 p.m.), I experienced chest pain across my chest; not incapacitating, but significant. My first thought was, “Really – could this actually be a heart attack?” I dried off carefully, got dressed, and then sat quietly in my studio chair waiting to see … well, you know, “maybe it will go away.” I know, I know, this is not the right thing to do if you’re having these symptoms … but I confess, I did it anyway. I popped eight baby aspirin (in lieu of two regular ones, which I couldn’t find), remembering that aspirin (not acetaminophen) thins the blood if the heart is in trouble.
Thoughts: 1) “Maybe it’s just a false
alarm and if I call Hatzalah, I’ll look foolish.” Then I remembered my own best
advice: “Better to look foolish than to be dead.” 2) “Going to the hospital:
Yech! And then incarcerated for however long you’ll be there in those horrible
hospital gowns.” Then I remembered: “Better to be incarcerated than to be
dead.” Right – the message is starting to creep in. 3) “This is going to ruin
my week and all the things I’m supposed to get done!” Enough already! Call the
ambulance – because: “Better to have a bad week (month) than to be dead.” I
know these thoughts sound a little bizarre, but I’m being honest here.
Fifteen minutes later: It wasn’t going
away. I said to my wife (sitting at her computer across the studio), “Sweetie,
I’m having chest pain and I think we need to go to the hospital.” She was calm
and collected; “Should we drive or call the ambulance?” A good friend, who
semi-boards with us, said, “Call the ambulance so that you’ll get priority
treatment.” Five minutes later we called Hatzalah, and five minutes after that,
they were at our door with the ambulance lights flashing, parked outside on our
narrow street.
Very important lessons from Part 1: A) If you have
chest pain (or other symptoms) and you think you’re having a heart attack, don’t
mess around and don’t dilly-dally (like I did, although really I only
dilly-dallyed a teensy bit – but even that’s wrong). Time really is of
the essence. B) Remember: Better to look foolish (or whatever) than to be
dead. It’s that serious; don’t mess around with your life (assuming you’d
like to stick around a while longer). C) Take two regular aspirin immediately.
D) Call 911/Hatzalah. Don’t even think about driving to the hospital –
certainly not yourself, not even if someone else is driving.
Part
2
The three Hatzalah guys are
super-competent and super-cool (that is, keeping calm at all times). They ask
questions and I answer. They set up the EKG at once and within five minutes
they have a reading (not a good one; i.e., the one that says, “problem here”).
I am praised for taking the aspirin. I walk outside and down the front steps
and climb onto the stretcher – I am going in the ambulance. I am shivering: too
much excitement combined with the shock and realization of my current situation;
it’s a bit surreal. It’s very cold outside and I’m lifted into the ambulance on
the stretcher. Neighbors are watching (of course). My wife sits next to me. The
siren is screaming out our important passage; I’m holding on so as not to fall
off the stretcher as we go around curves. We are called in to Sinai Hospital:
we’re “Priority-1” (I’m guessing that’s serious; certainly more serious than 2
or 3, right?). It’s cold in the ambulance; I’m really shivering. My chest still
hurts. We’re there in no time.
I’m wheeled into emergency without
stopping anywhere to check-in (“Do not pass GO; do not collect $200” is
a crazy thought that zips through my head). I am alert and remember to tell
them that my wife needs a wheelchair (she is handicapped and cannot walk long
distances). We’re in one of the emergency patient rooms and my clothes are
being taken off super-fast and stuffed into a plastic bag: “Don’t worry,” they
say, “you’ll get them back from Security!” Okay, I think, I’m not worried about
that too much right now. But, they’ve slipped me into one of my “favorite”
(blue) hospital gowns; oh well, part of the price of admission, right? Another
EKG, same results; chest still hurts a bit, but it’s background noise.
Chatter in the ER: “Is the cath-team
ready?” “Just about.” In record time, I’m on a hospital stretcher moving
beneath long neon lights (seeming to point the way), driven by two nurses
through cold white corridors and onto stainless steel elevators. We ride up to
the catheterization lab, and the cath-team – consisting of a highly-trained
cardiologist, a PA, a nurse and an instrument tech – are there waiting. It is
now less than an hour-and-a-half hour since I first felt chest pain.
Very important lessons from Part 2: A) If you’re
going to have a heart attack, try very hard not to have it during a blizzard
(like in Buffalo, NY) or when you’re abroad, or when you’re on an airplane or a
cruise ship (not an exclusive list, but just a few things reflective of my
current stream of conscious-ness). B) Well, of course you can’t arrange
for this unexpected event in advance!!! Therefore, be very grateful if
you are at home (literally, or in your community) and have access to
extraordinary emergency services like Hatzalah and modern hospitals staffed
with individuals who will gather at a moment’s notice in your time of distress.
C) Chasdei Hashem, on Sunday night December 4, these people saved my
life and I am modeh (grateful) to them for their sacrifice on my behalf.
D) Chasdei Hashem, I am modeh to Him for arranging that my heart
attack occurred in the most optimal time and place … and for keeping me in the
game and granting me an extension.
Part
3
In the cath-lab there are multiple screens
all around, lots of computer terminals, and an x-ray plate that hovers over
your chest and moves with robotic precision quickly and effortlessly from one
position to the next. All the members of the cath-team work together smoothly
like a well-oiled machine. The cardiac cath-lab is equipped with
state-of-the-art imaging technology used to view the arteries and check how
well blood is flowing to and from the heart; you feel like you’ve just landed
in the middle of a futuristic sci-fi set. From all appearances, it seems that I
am on center stage!
I’m talking to G-d while waiting for the
director to call for “action”: “Thanks so much for all You’ve done for me and
for my amazing family! Thanks so much for taking care of me and for arranging
for all these people to help me! If I don’t make it out of here, please watch
over them. Please forgive me for all my foolishness and for making poor
choices. Shma Yisrael … Vidui.”
Dr. Cummings (Woodholme Group) is the
expert in charge; we actually know each other! As he is in the process of
inserting a catheter into my femoral artery, he tries to keep things light in
this otherwise charged atmosphere: “How are you doing?” Er, great … but I’m
still shivering and very cold. “Try to hold still.” Really? They cover me with
warm blankets and I try very hard to hold still.
The image of two blocked arteries
is up on the big screen: there is dark blood filling the vessels up until the
entrance to the blocked valves, while the blood vessels on the far side of the
obstructions are colorless, simply outlined in grey. There is great truth
encapsulated in this black-and-white graphic image; there is no denying its
power. It is ironic that even in the midst of this unnerving scenario, my
artistic sensibility nevertheless comes to the fore and takes a brief moment to
admire this medical illustration now taking center stage and overlooking this
dynamic drama!
Within five minutes a stent is in place,
opening the blockage and allowing blood to flow in to those previously blank
spaces. “Ah,” says Dr. Cummings, “there we go; a thing of beauty!” I agree
wholeheartedly (sic)! And here we find that even the doctor has his own sense
of artistic beauty, from a medical perspective. I think – we are kindred souls.
The pain in my chest is gone. Within just two hours of my heart attack, a
life-saving stent has been inserted with both love and great precision.
Very important lessons from Part 3: A) The bracha
that we say every morning upon rising and after every visit to the bathroom now
jumps into stark relief: “Blessed are You, Lord our G-d, King of the
Universe, who has formed man in wisdom, and created within him numerous
orifices and cavities. It is revealed and known before Your Throne of Glory, that
if but one of them were to be opened or if one of them were to be closed [i.e.,
when they should not be open or closed…], it would be impossible to
exist and to stand before You! Blessed are You, Lord, Healer of all flesh, Who
performs wonders.” B) I think of my paternal grandfather (Pa, z”l),
whom I knew only as a young boy before he passed on. Whenever we went to visit
him, he would always be lying down on that couch in the connecting foyer,
barely able to speak and gasping for breath. This used to be the fate of heart
attack victims: death or living out one’s remaining years as an invalid. How
grateful must we be for this truly miraculous cure, so that we can continue to
exist and stand before Him! When the Bais Hamikdash will be rebuilt I will, b”n,
bring a korban todah and we will celebrate all together!
Part
4
B”H, I’m in the Cardiac ICU. I’m hooked up to the monitors, and all systems are
go. The support staff is very helpful and professional. Believe it or not, the
hardest part of immediate recovery is waiting four long hours until the wound
by the femoral artery is sufficiently sealed so that one can get out of bed
and, well, use the restroom.
Early the next morning, I’m sipping water
through a straw when I get a surprise visit from a couple of members of the
heart team. First announcement: “Hey, who gave him that water? You can’t drink
that; you going down to the cath-lab within the half-hour!” This was to fix the
second blockage (only 90% blocked, as opposed to the first one which was at
100%). Second announcement: “You’ve had a heart attack!” Well, I guess that
made it official. “How do you feel?” B”H, no chest pain. Third
announcement: “We’re keeping close tabs on all your other systems, because you
know what they say: ‘If there’s a problem with the plumbing, the electricity
may be next!’” Well, that is shocking news; but, good to know. B”H,
the other utilities are looking good!
Back in the cath-lab, a different
cardiologist who is on call that morning inserts a catheter through the radial
artery (the one where you feel your pulse on your wrist) and fixes the
offending artery within ten minutes. I now have three stents (the first put in
four years ago during a planned procedure). During the small-talk interlude, I
ask the team why they didn’t just do both stents the night before? “Because
last night, we were just trying to save your life.” Oh; I am humbled and
thankful.
Monday night, they introduce some new meds
and I have a very bad reaction to a beta-blocker; even a small dose the next
day proves counterproductive. So, no beta-blocker. Tuesday morning, I am moved
to a regular hospital room.
On Tuesday afternoon I have an echocardiogram
(ultrasound) to see how the heart is functioning (i.e., has it been damaged
by the myocardial infarction?). Chasdei Hashem, the ultrasound shows no
overt damage to the heart muscle! Before the procedure, I ask the ultrasound
echocardiologist (her actual title) if she would tell me if it was a boy or a
girl? (C’mon, that’s a good one, no?). She is not even a little bit amused.
“Not today,” is her tight-lipped answer. She is also very upset that I
was sent down to her station in a wheelchair and not in a hospital bed –
and she is yelling at me! I assure her I had nothing to do with it, and
that she should definitely yell at someone else who is responsible for
this grave error! Afterwards, we keep everything strictly business. P.S. she is
very good at what she does, and I am amazed at her level of expertise (she even
lets me watch the screen). I thank her for her great work. I guess being a
pedant has its plus-side. I get a ride back to my room … in the wheelchair.
P.S. Every night I am in the hospital, my
wife, Sima-Leah, sleeps in a recliner in my hospital room, watching over me.
She is a precious soul, a tzadekes, my true soul-mate. I am so grateful
for her and for everything she does.
Wednesday afternoon, I am discharged. P.S.
Although I have a signed receipt for my clothes (an itemized list; remember –
the ones I should not worry about?), Security instead brings me a (heretofore
misplaced) bag of hastily packed sefarim and other personal items which
my wife had brought into Emergency … but my clothes are nowhere to be found!
“But, where are they?” I ask; “Surely you can look for them,” and I give them a
copy of the itemized list. In response, I get a big bureaucratic shrug. Not
wanting to get upset, I convince myself I have lost my luggage after traveling
to faraway lands (actually, not a bad mashal). Since my “favorite”
hospital gown is quite revealing, I wait for new clothes to arrive before
stepping out. I am in touch with Patient Relations, and a very nice lady from
that office finds my clothes (“Guess where I found them?” “In Security?” “Yes!”
Where else?) and brings them to my home the very next day. That was above and
beyond, and I give her a framed Jerusalem print as a small token of my
appreciation; she is ecstatic. Besides the big acts of life-saving, it is the
small acts of kindness that make the world go ‘round.
Very important lessons from Part 4: A) Although we
have become used to the modern miracle of catheterization and the insertion of
stents into previously blocked arteries of the heart, it is really a highly
technical procedure and not without its inherent dangers (e.g., punctured
arteries, malfunctioning stents, etc.). This is another reason why the
cath-team is anxious to get-in-and-get-out and not perform two insertions at
the same time. Like the miracle of being healthy and being alive, we should not
take this for granted either, Chasdei Hashem. B) When I’m in the
hospital, I’m very careful to thank every caregiver for every act of kindness.
Giving is the basis of loving. If you are surrounded by givers and those who
love you, you are truly blessed. Thanks to the kids and grandkids for
keeping in constant touch. More than
that blessing is the blessing you receive from Above when you become a giver
and show your love to others (a key aspect of Imitatio Dio).
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Postscript
1
On Thursday morning I go to my regular
minyan, layn from the parshah, Vayishlach (which contains the incredibly
relevant pasuk, “I have been diminished by all the kindness and by
all the truth that You have done for Your servant.” Gen.32:11) and prepare
to bench gomel. Before saying this special blessing of thanks, I give
the following little speech:
“I am about to bench gomel because
just 3½ days ago I had a heart attack and was just released from the hospital
yesterday. In a different time and place, I probably would not be standing
before you as I am now. I am greatly indebted and thankful to Hashem and to all
those who literally saved my life during this episode. In our parshah, which we
just layned, we see that Yaakov Avinu is worried that perhaps all the
kindnesses that Hashem has performed for him over the years has caused his
celestial bank account to become diminished (Rashi) – that he was
unworthy to have received them and therefore he no longer has collateral which
he can use to protect his family from his present danger. If Yaakov Avinu was
worried about this, then what can we say? Maybe my celestial balance is
down to ‘zero’ after this great Act of Kindness?”
“After every other bracha that a
person may make, the proper response of those listening is to simply answer
‘amen’. However, after benching gomel, the congregation gives the
narrator the following unique response: “Amen! May He Who has granted you
all the best continue to grant you all the best forever! Selah!” Why is it
fitting to say this now? The congregation is thus giving the one benching
gomel a special bracha: ‘Do not be worried! We are giving you
a special bracha that Hashem will always continue to grant you all the
best forever – without one iota of diminishment of His care and concern for
you!’ This is a powerful bracha and a tikkun for the worries one
may have of diminished blessings. I am privileged to stand here before you and
recite this blessing; thanks to the congregation for the blessing you are about
to give me in return!”
The response to my benching gomel
this morning is robust.
Postscript
2
When one emerges intact from a
life-threatening situation, the proper response must be to have A) overwhelming
gratitude, and B) realize that “If Hashem has given me this wake-up call and
kept me in the game (so to speak), then I must think of how I can ‘up’ my game
and live a more meaningful existence.” I don’t think that when Daniel emerged
from the lion’s den he just turned to his comrades and said, “Okay, so what’s
for lunch?” That would be more than inappropriate.
Business-as-usual can really no longer be
my modus operandi – nor should it be for any of us. Having a brush with
death can, and should, effect a genuine wake-up call. Every morning, the first
thing we say is “Modeh ani – I offer thanks to You, living and eternal King,
for You have mercifully restored my soul within me; Your faithfulness is great!”
Our Sages have taught us that sleep is “1/60th of death” [Berachos
57b]. So, every morning, after emerging from a brush with death, we say that we
are modeh – grateful and indebted to the One above, Who watches out for
us and always has our best interests at heart. In truth, we must always be
thinking of ways to ‘up’ our game (even in little ways) … but it often takes a klop
on the head (or heart) to cause us to redirect!
Davening, mitzvos, learning, chesed, derech eretz – all these can always use a little fine tuning. In
the phys-ed department I’ve lost 10 pounds by reconfiguring my eating patterns.
Although “on paper” everything with my heart looked good, nevertheless in the
weeks immediately following the heart attack, I experienced a clear loss in
stamina and had to carefully measure out my energy expenditure every day. B”H,
almost six weeks later I am feeling better and stronger. I’m slated to begin a 12-week
cardiac rehab program (three times per week) very soon and hope this will
contribute towards a refuah shleimah. I hope and pray that I can show
that my real-life extension was a gift worth the investment.
Postscript
3
Some words of advice to all those entering
into your senior years (let’s say 50+): If there is a history of heart disease
in your family, then you are at risk for arteriosclerosis that may lead to
heart disease and pre-mature death. In the cath-lab, the well-informed PA put
it like this: “It doesn’t really matter if you eat well, exercise well, and have
all the best intentions – although all these things will work in your
favor. But it’s the family history that really calls the shots here.” A heart attack is called the silent killer; try not to let one sneak up
on you. That’s the take-home message, and you should take it to heart.
If you are at risk (and maybe even if
you’re not), make an appointment with a cardiologist and have them do some
baseline studies. A quality, hi-level EKG and a nuclear
stress-test will often tip them off if there is a problem brewing, and that may
lead to a catheterization and stent implant (as happened to me four years ago).
I should have kept up with my cardiologist – but I didn’t. Looking back,
perhaps I could have saved myself the trauma of the current medical misadventure
described here. Of course, exercise and good eating habits will help you to
help Hashem to keep you healthy. Bracha v’hatzlacha – a bi gezunt!
Avraham
Cohen is an artist and teacher living in Baltimore, Maryland. His children,
grandchildren and great-grandchildren live in many places in the United States
and in Israel. He is 73 years old.
