An all too real nightmare

 I was lying in the Intensive Care unit, lines running into various parts of my body, the ventilator blowing air into my lungs through the hole cut in my windpipe. My legs were bloated from over 2 gallons of intravenous fluids pumped into my body when my blood pressure dropped like a stone while in the middle of my scheduled angioplasty.  My face and neck were so swollen I looked more like a pumpkin than the handsome guy I am used to looking at as I shave.  Somehow I was still alive and through the one eye that could open I could see my wonderful wife as she held my hand.

 Then I felt myself waking.  It was all a nightmare from hell. Certainly the most vivid nightmare I had ever experienced.  The relief started flooding through my body. Oh my beautiful God…..and then I really woke up and realized it was all true.


It all began six weeks earlier when I experienced a very mild heart attack.  My wife drove me to UCLA Emergency and an angiogram was recommended. Using a dye they would look at the flow through all my coronary arteries and if they found an artery, which had narrowed, they would do an “angioplasty” and place some stents in the artery. A stent acts like a little pipe and keeps the artery open. The next day a friendly cardiac team did exactly that.  I lay awake and watched them working on the monitor and at the end of the one hour in the catheter room I had 3 stents in me and felt like jumping off the table and jogging home.

A week later I was given the green light to return to my regular athletic activities which include running 8-11 miles some mornings and singles tennis (and paddle tennis) battles on others.  For several weeks all was great and then the angina returned and I was told that the body was probably reacting to the stents and closing the artery again.  What I did not understand till them that because the site of the blockage was so narrow, it had not been possible to insert “coated stents” with medications to help stop this kind of response.  As a result I was one of the 30% for whom stenting does not work.

The planned response was to schedule a second angioplasty.  Again the cardiac catheter specialist would feed a balloon into my coronary artery, entering from my thigh.  He would use a balloon to reopen the artery and then use a radioactive seed to give a very local does of radiation.  This would kill the cells at the site from continuing to react to the unwanted stent.  So back I went.  This time I had the head catheter specialist doing the procedure.  The rest of the team gave me a warm welcome. "Oh yes, you are the economics professor.  When are you going to give me a good stock tip?”  The operation began. As the specialist does his work the table is moved along tracks.  I can remember being banged around, as the table seemed to have come off the tracks.  Then someone made some adjustments and the procedure continued…..My next recollection is feeling my hand being held in the Intensive care unit.

Code Blue Cath Room

As I later learned I had been alert through most of my ordeal.  However mercifully I have no recollection. Thirty minutes into the procedure my blood pressure had suddenly dropped very dramatically.  There were no other unusual symptoms.  Fluids were added intravenously as the team pondered their options.  The preliminary assessment was that they may have punctured an artery and I was now suffering precipitous internal bleeding.  A bigger team was needed and fast.  “Code blue Cath room” was announced through the hospital and experts rushed to assist. (One doctor told me he had never heard a Cath Room emergency call before so there was considerable interest throughout the hospital in what was going on!)

More and more fluid was fed into me and the amount of blood left in my arteries continued to drop. One estimate was that eventually I had lost about 80% of my blood. Amazingly I was still alert.  The mood in the room was extremely tense as all the doctors tried to sift through the facts and come up with a solution.  One uninvited Emergency Doctor was watching from the observation area.  He was my long time friend. I had been his best man 17 years earlier and we both named our daughters Ali. He and another doctor concluded that what they were witnessing was an anaphylactic shock.  Somehow the body had responded uncontrollably to the dye and it was now attacking itself. Larry proposed a solution - - intravenous introduction of epinephrine (basically a shot of adrenaline.)  As an Emergency doctor he was the most experienced in administering the epinephrine so the cardiac team stepped back and Larry took over.

The epinephrine rapidly lifted my blood pressure and the tension began to subside.  However the heart began to show signs of stress and my heart rate shot up.  After pounding my chest, the paddles were brought out and I was shocked back into a regular rhythm. (A month later I still have paddle shaped flash burns!)

Again the assembled throng began to relax but then my breathing became every labored.  My neck and tongue were swelling rapidly.  By the time they realized it, they found they  could not get a tube down my throat.  (The efforts appear to have slightly damaged my vocal chords, at least temporarily.)  Larry sprinted off to Emergency to get some anesthetic to put me out completely but by the time he returned the anesthetist had me ready for an emergency tracheotomy to get me breathing again.  They were just tin time to save me from major brain damage.

Some time later I  found myself drifting back into consciousness in the Cardiology Intensive Care Unit with my anxious wife waiting to will be back to my energetic life.

Eight days of recovery

It was eight days before I was ready to leave the hospital. One vivid memory is the ventilator pumping air in through my neck.  I wanted to take slower breaths than the machine but it insisted on being in charge. Just trying to breathe with the machine was a struggle.  Then there was the tube that was fed into my lung to suck out whatever could be found. The pain, the uncontrollable gagging….A further problem was that the emergency trache had left openings under my skin.  As air came up the wind pipe it exited not only through the hole in my neck but also under my skin and I began blowing up like a balloon.  Eventually I was air-filled from my eyes to my waist.  It felt like rice crispies and it looked horrendous.  My neck and head became one enormous pumpkin and a swelling like a small orange covered my left eye. The swelling was sufficiently bad that friends arriving to see me would pop in and then leave again because they did not recognize the body lying on the bed!

 The days were filled with a stream of ever changing doctors, students, nurse and care givers.  Also a wonderful group of friends kept the room filled with life and energy.  The nights were what I feared. I was fitted with equipment designed to stop blood clots forming in my legs.  The machine made me hotter and hotter as the night progressed. Once I could no longer doze I sweated and wheezed and watched the clock moving millimeter by millimeter.

 Pressing the call button at night does not necessarily get a response and I was terrified of being left alone.  For the first three nights Bev stayed with me, cat napping on two chairs and then my brother flew in from Vermont to share the night duties.  I found hand-holding with a family member or friend very soothing.

 Back to school

 Thee are a lot of stories to tell but that will have to wait.  Now, thirty days later I have made a remarkable recovery. The hole in my neck has closed and at first glance I look myself again, albeit significantly thinner. I am back playing tennis and paddle tennis (cautiously) and am trying to jog/walk three miles in the mornings when I am not playing a racquet sport.  Yesterday I headed back to the office for the first time.  It won’t be long before I am ready for a full work-load.  It is amazing to me that my body would recover so quickly.

A year later

All that running up and down mountains last summer and now my hip is bothering me. However the angina has completely disappeared, even when running hard or chasing down Bev's cunning angles shots on the tennis court.  It really is a miracle..

John Riley