How I Almost Died

For the past few years I've been making small changes to improve my life. Eat less, walk around more, things like that. Last March I decided it was time to add a real exercise program, so I started Couch-to-5K, where over the course of eight weeks or so you work up to running for thirty minutes without stopping.

The first day felt really good, and I was excited. The good start did not last. I kept pushing hard, but a few weeks into the program it was clear I wasn't getting better. I was getting worse. I felt like I had hit a wall where the more effort I put in, the worse I got. The data supported it: I was covering less distance in the same amount of time. I decided it was time to see the doctor.

The doctor listened to me and started running tests. Blood work was first, and he told me to keep exercising, which I did. The lab here in WA is very fast, and I had the results the next day. Everything was normal except for an elevated white blood cell count. An infection could explain my symptoms, so the next round of tests was ordered: more blood work looking for proteins related to muscle degeneration, plus a chest X-ray and a sleep lab appointment. I was nervous about the X-ray, because I knew the differentials for a positive result were not good. It came back negative.

All of this took a couple of weeks, and over that time my symptoms got worse. I started having episodes where my heart felt like it was racing. I would just be sitting at my desk, or on the couch, and my heart would feel like it was trying to burst out of my chest. I would feel like I should be out of breath, but I wasn't. It got weirder when I tried to measure my pulse. It read perfectly normal, 70 to 80 bpm. A few times it was even very slow, in the 40 to 50 range. I didn't know what to make of it, but the feeling would pass after a few minutes.

At my next doctor's appointment, the nurse had trouble for a moment finding my pulse. She asked me if I was "in afib." I didn't know what that meant, but it's a type of irregular heartbeat. I said no, and combined with my new symptoms, the focus turned to my heart. An EKG at the office looked normal, but a stress test was scheduled a month out, the earliest available appointment. The doc told me to keep exercising, so I did.

My symptoms continued to get worse. The racing episodes went from every other day, to every day, to multiple times a day. When I was jogging, it felt like I was working against an inverted gear: the harder I pushed, the harder something pushed back. It felt wrong, but in a way that is very hard to explain. It felt like impending doom, as though something very bad was just about to happen but hadn't happened yet. I started getting sudden fatigue while biking, where I wouldn't be able to lift my leg to pedal. These things scared me.

I was getting frustrated with how little I knew about what was happening to me. I started looking at EKGs to buy, so I could get readings at home while I was actually having an episode. It turns out they are not complicated devices, so I was able to build a three-electrode EKG out of an Arduino. After some tuning I got a good reading, and my heart looked normal. Then I waited for another episode so I could catch my heart in the act.

This turned out to be harder than I thought. The episodes only lasted a few minutes, and it took about that long to get the device connected and reading cleanly. I had to place the electrodes and calibrate every time, all while feeling like I had just run a marathon and was about to die. The first time I got what I thought was a good reading, I was very puzzled. The rhythm looked completely normal. So did the rate. I wondered if I was having panic attacks. I started thinking my symptoms were just psychosomatic, and that made me feel better.

The last day I exercised was a few weeks before my stress test. I was sure the problem was all in my head, so if I just pushed hard enough, my body would have to fall in line. I started running and I pushed hard, and then I couldn't push at all. I couldn't lift my legs, and in fact I couldn't support my body. I was lying on the ground feeling like my heart was about to explode, completely sure that I was about to die and with no idea why.

I recovered in about five minutes. I was able to stand up, and then I started the long and very slow walk back to my apartment. I had no idea what to do next. After that, my symptoms progressed rapidly. The episodes came more frequently, and all I could do was wait for the next test.

I was excited for the stress test. I was finally going to get some more information, and I could push myself in a controlled environment, which helped counteract my fear of suddenly falling over dead. If you don't know what a stress test is, they hook you up to an EKG and then stress your heart. This is usually done by running on a treadmill, though it can also be done chemically. I was going for the treadmill. They record your EKG throughout, take blood pressure every minute, and pause to take a sonogram of your heart. All that data is then sent to a cardiologist for analysis.

While I was waiting for the test to start, I watched my heart pattern very carefully. I started to notice a blip every once in a while, a beat that didn't quite work right. I tried to correlate it to something I was feeling, but it was difficult, and I couldn't be sure whether the feeling came from the blip or from my noticing the blip.

When I got on the treadmill, they told me my goal was to reach 160 bpm. I knew from exercising that my symptoms could be triggered at 120 or 130, so this seemed great. The treadmill started, and things seemed just fine. But pretty quickly the EKG started showing erratic beats. At first it was one or two, and then it was ten or twelve in a row, and the feeling of impending doom returned. I kept pushing anyway, because I wanted to get the most data possible. They stopped the test before my heart rate even hit 130.

I didn't know what that meant. I sat there, very confused, feeling like we hadn't gotten the data we needed. One of the nurses asked another if we had reached 160 and got a very quiet shake of the head. Something had gone very wrong. Then they asked me if I had a scheduled appointment with the cardiologist to go over my results, and I said no. The test had been ordered by my GP, and I assumed I would follow up with him at some point yet to be scheduled. They told me to go wait in the lobby.

About ten minutes later, they told me I had an appointment with the cardiologist later that day. Clearly something was wrong. I let work know that I wouldn't be back after all, and found a coffee shop to kill a few hours in.

The cardiologist showed me some of the stress test results and told me that something was definitely wrong with my heart. He didn't know what, but we would start with more tests. Given everything that had been done, he felt pretty sure it wasn't coronary artery disease. My lab results were all green, and I was so young. But due diligence said we needed to take a look, and if that came back clean, we'd move on to electrical issues. We scheduled a cardiac catheterization. Because of scheduling, it was a month away.

My symptoms began having a big impact on my life. Any movement for more than a minute or so would trigger it. I began walking very slowly. I dreaded the moments at work where I needed to walk somewhere with other people, because I wasn't able to keep up at all. Sometimes something would trigger it while I was sitting still reading. I visited the Jet Propulsion Laboratory during this time, and while I was able to see the highlights, I wasn't able to see everything and had to leave early.

I was really looking forward to going through the procedure at the hospital. I was going to get more information about what was wrong with me, and I figured it would be a nice little adventure. I had been feeling pretty depressed, and it gave me hope to think that some progress would be made. I arrived and got prepared. The cath lab was an impressive room. The cardiologist stopped by to take a look at the artery in my right arm where they would be inserting the catheter. Everything looked great and he gave me some encouragement, though he told me he thought it unlikely that we would find anything specific. It was simply the next logical step.

Time stopped while I was in the lab. I don't know how long I was in there. There was a lot of preparation, and they gave me some pills that would help me relax but not fall asleep. I was aware, but things didn't really register. Things happened. I could feel the catheter snaking up my arm, but was surprised to find that it didn't bother me. My mind wandered until I felt a tugging on my arm from the cardiologist. He said that they had found something, and that they would try to fix it so I wouldn't need open heart surgery. I thought that was a great idea. I heard them planning without understanding the details. Then they were done.

They explained that my left anterior descending artery was occluded almost completely. They called it 99% blocked, and one of them said, "or any other number between 99 and 100." They placed three stents and opened it back up. Everything looked good again, and I was a 34-year-old with a diagnosis of coronary artery disease. I accepted the facts, but I didn't understand the why. And I was cold, the coldest I think I've ever been. I think it was a bit of shock. My teeth were chattering so hard I couldn't think, but they wrapped me in these amazing warm blankets and it got better. They kept me at the hospital overnight, and I decided it was indeed an adventure, and one I never want to experience again.

Heart stents are magic. I was immediately seeing results. Once I got through the 48 hours after the procedure, I was feeling fantastic, the best I've felt in years. I could walk without trouble. I spent that weekend just walking around. They told me not to do anything but walk, and I followed directions. It would be a few months before I could jog. I entered a cardiac rehab program.

Cardiac rehab is great. It's data-driven exercise. They hook you up to an EKG while you work so they can see if something is wrong. They take your blood pressure at certain points to make sure it's looking good. They adjust your program as things get easier to make sure you keep pushing yourself. It lasts 14 weeks. I finished the program during the first week of September.

In the time since, my progress has accelerated. I ran for 10 minutes at a time, then 15, then 20. I kept pushing. 30 minutes, 40 minutes, 45 minutes, 50 minutes, 52 minutes, 61 minutes!

This morning I completed the Puget Sound Heart 5K, sponsored by the American Heart Association. I ran as part of the cardiac rehab team from Virginia Mason, or as I think of them, the people who saved my life. I am full of gratitude for them and for the other doctors and nurses at Virginia Mason here in Seattle (and a nurse named Emily, now of NYC). They stood between me and death, patched me up, and got me back on my way. They are true heroes.