My Telltale Heart
It's a horror story, all right. One moment, your life is normal -- endless. The next, a surgeon saws open your chest, freezes your brain and scrambles to keep you alive, literally holding your heart
By Robert G. Kaiser
Sunday, February 29, 2004; Page W10
WHEN I AWOKE LAST MARCH 26, I saw the same old me in the mirror, the paragon of good health I'd been seeing for decades: in fine shape, thanks to regular racquetball, fitness machine workouts, yoga and outdoor activities; no bad habits; healthy parents, then nearly 90 years old. In 12 days I would be 60, a milestone in what had always seemed to be a charmed life.
My mistake. I was confusing the habitual with the perpetual.
On that Wednesday in March the habitual crumbled. After a good early-morning yoga class I was in my bathroom when I felt a sudden, ominous thumping at the top of my chest; tingling and weakness in my left arm; blurred vision in my right eye.
Luckily, my wife of 38 years was at home, and I called out to her. She telephoned my doctor, Robert Hardi, who had given me his cell phone number a few years earlier, for which I was suddenly very grateful. He answered at once, and told Hannah I should lie down. If the symptoms did not disappear in 10 minutes, he said, she should take me to the emergency room at Sibley Memorial Hospital in Northwest Washington.
Ten minutes brought no relief. We got in the old Jeep Cherokee and drove from our Dupont Circle townhouse to Sibley, five miles out Massachusetts Avenue. The symptoms got stranger along the way. In front of the Islamic Center mosque at Rock Creek Park my right eye saw only bright light, no shapes or colors. Scary.
But not terrifying, curiously. Some protective mechanism stopped me from thinking about what these symptoms might mean. I was comforted by the thought that I was fully conscious and would soon be at the hospital. Things were under control, sort of. My best friend was driving, she seemed calm, I had no real pain. There was no panic.
Late morning is a good time to arrive in an emergency room. Business is light. I was quickly registered and put on a gurney, then zippered into my own space behind curtains, known in the Sibley ER as Room 9.
Sibley's chief of emergency medicine is Andrew Sumner, 57, a round, soft-spoken Georgian. He took the job at Sibley in 2001, he told me later, as a way to take it a little easier after years spent closer to the front lines of urban emergency medicine in Baltimore. There he practiced at the Johns Hopkins and Good Samaritan hospitals, and taught emergency medicine at Hopkins. In Baltimore, gunshot wounds, drug overdoses and other manifestations of urban poverty and mayhem were common. At Sibley, a comfortable hospital just off MacArthur Boulevard in a leafy, well-to-do part of Northwest Washington, a more typical visitor to the ER had cut a finger chopping onions, or was having a heart attack after years of heart disease.
Months later, when we could have a relaxed conversation about the morning of March 26, Sumner confessed that his first hypothesis that day was -- an anxiety attack. "I was thinking to myself, blurred vision, numbness in the hand, funny feelings in the chest -- this is mostly anxiety," he recalled. "Then you went on to tell me about your yoga class that morning . . ." In other words, he thought I was an overanxious New Age type.
But this hypothesis did not deter Sumner from looking further. "I stood you up and I had you put your palms out flat. This is a test of subtle motor weakness. Your ring finger and little finger were curled up on your left hand [often a sign of stroke or something else wrong in the brain]. When I saw that, I knew immediately that something was wrong . . . I quickly went from thinking that you're having an anxiety attack to thinking something bad is happening here . . . It was like the light came on, and I said, 'Oh, no.' " Sumner listened through his stethoscope for a telltale sound in the carotid arteries of the neck, which carry blood from the aorta just above the heart to the brain. He didn't hear what diagnosticians call a "bruit," a swooshing sound that can signal a blockage, but he did hear a troubling, harsh sound. He took me downstairs for an ultrasound examination of the two carotid arteries. It showed that the inner layer of one of them had separated -- or "dissected" -- from the outer two layers, partially diverting the normal flow of blood to the brain into a kind of pocket. When a carotid dissection blocks the blood flow, death or a stroke can follow, though some carotid dissections are not so serious.
Sumner started to walk back upstairs to tell Hannah the news. And then he stopped. A far more frightening possibility popped into his mind. Maybe the problem in the carotid artery was not cause, but effect -- the result of a dissection that began in the aorta.
Dissections of the aorta are extraordinarily dangerous. The aorta is the body's primary artery -- really an extension of the heart itself. If it fails, the brain and body get no blood. Actor John Ritter died of an aortic dissection last September.
Sumner had never seen dissections of the carotid or the aorta in his own practice, but he knew about both. For years, he has augmented his income and his experience by appearing as a witness in medical malpractice suits. As a witness Sumner had reviewed one case of carotid dissection, and several cases of aortic dissection -- cases he remembered that morning, walking up the stairs.
A chest X-ray taken soon after I arrived at Sibley showed a normal aorta. But Sumner now remembered that "about 25 percent of aortic dissections have normal chest X-rays. So, rather than go talk to your wife, I turned around and went to see [Sibley's] chief of radiology, Dr. Richard Newman."
Newman recommended a spiral CT scan of the chest. By injecting me with contrast dye, then taking pictures of cross-sections of my heart and aorta, the doctors could now see what the chest X-ray did not reveal.
"We got these beautiful pictures, showing an aortic dissection beginning at the root of the aorta and extending into your carotid arteries," Sumner recalled. "I thought, this is one hell of an anxiety attack! You've transferred your anxiety over to me now."
Unless repaired, dissections of the ascending aorta kill most of the people who have them, instantly or eventually. The risk of death for those who survive the dissection itself rises sharply as time passes -- about 1 percent per hour for 48 hours. The tests at Sibley had already taken three hours, and they began nearly an hour after my first symptoms. My chances were ticking away.
© 2004 The Washington Post Company
Paul Corso, chief cardiac surgeon at Washington Hospital Center, holds a graft like the one he used to repair the author's aorta.
(Sara Hirakawa - For The Washington Post)