15: The Widowmaker
Welcome to the first annual Circle of Willis Halloween Special, THE WIDOWMAKER, in which I tell the story of almost dying recently of a particularly deadly heart attack. If you have a family history of heart disease, if you had a traumatic childhood, if you have been under a lot of stress, for a long period of time, if you work too much, especially in a sedentary job, if you’re overweight, if you smoke, if you’re hypertensive or have high cholesterol... consider at least chatting with a cardiologist. Make an appointment. Get a calcium scan test. Reflect on your life as it’s happening now, not at some future point where you’ve achieved some kind of goal or real stability or peace and contentment or whatever thing it is. Think about how you’re living this single life you’re ever going to have, or even whether you are living that life.Because The Widowmaker can strike at any time, without warning, on any ordinary day. It almost got me. Don’t let it get you. * * * As always, remember that this podcast is brought to you by VQR and the Center for Media and Citizenship. Plus, we're a member of the TEEJ.FM podcast network. AND... The music of CIRCLE OF WILLIS was composed and performed by Tom Stauffer and his band THE NEW DRAKES. You can purchase this music at their Amazon page.
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Jim Coan
From the VQR in the Center for Media and citizenship, this is our 2018 Circle of Willis Halloween Special! Where I recall the day that I was almost killed by the Widowmaker. Pay attention, folks, because you might be next.
Jim Coan
Hello, all, and welcome to the first annual Circle of Willis Halloween special! I don't know why that sounds so funny to me. Sometimes my life just doesn't seem real. So here's the thing, people. Not quite two months ago, on September 5, I literally came within a coin toss of dying. This was not coincidentally about the time I became more or less unreachable, and stopped working on things, including this very podcast. What almost killed me was something that poets of cardiology like to call the Widowmaker. So named because, well, if it hits you, things don't usually go well. By which I mean, you die, more or less on the spot. I'll get into the details of the Widowmaker in a minute. But first, let me say this: the Widowmaker is not some mildly frightening Halloween ghoul, this thing is real. And it'll sneak up on you on any ordinary day. One day, just some day, you wake up feeling sort of not great. And in a few hours, your heart's very important left anterior descending artery is 100% blocked by a satanic mixture of cholesterol plaque and blood clot. And anyway, judging from the rate at which this sort of thing hits people in the general population, and the number of listeners, an average episode of Circle of Willis gets, I'm feeling confident that the Widowmaker is stalking some of you who are listening right now. So that ought to give you a cold, Halloween chill.
Jim Coan
This too, according to the Centers for Disease Control, heart disease is still the most common killer in the United States. Sudden cardiac events are more common in men, but happened in both men and women. And get this, roughly half of the people who suddenly die of heart attacks have no previous symptoms. Just like me. One minute, you're just boogie-ing along in life, having never even considered you might have latent heart disease, and the next minute, you're room temperature. In fact, and not to brag or anything, but my lipids were pretty good. Not great, of course, but just a hair over normal. I've had a habit of daily, hour long cardio workouts for years. I'm at a normal body weight. Maybe a little overweight, to be honest, but not much! Of course, believing my body is either invincible or not an immediate concern. I have for years also been a workaholic. But then, practically everyone I know is a workaholic. And, yes, lately, I haven't been eating well. I'm just going to say it. Since the last presidential election, I've been stressed out. Especially once family started getting separated at the border. I did an episode about that, wrote an op ed got involved in amicus briefs, started agreeing to talks. And to deal with that stress, I pretty much started eating french fries for just about every meal. And like, you know, whole bags of corn chips in a single sitting.
Jim Coan
And anyway, what I want to say is, maybe some of you are stressed too. Maybe some of you like me are consoling yourselves with simple carbs suffused with saturated animal fats. And of course, maybe some of you have, like me, a pretty strong family history of heart disease. But I don't want to alarm you. Well, actually, I kind of do want to alarm you. I want to tell you that heart attacks aren't terrible just because they kill you. But also because of how they kill you. This is something I hadn't thought of before. I want you to know that there are things you can do to avoid them too. And I want you to consider doing those things before it's too late. And anyway, to drive all this home for you. I'm going to tell you my story.
Jim Coan
Here it is. For me, Wednesday, September 5 started like this. I woke up a little bit pissed off because I had a killer case of heartburn. And as I made the kids breakfast and packed their lunches, I scarfed down a nutritious breakfast of coffee and chewable antacids while preparing my mind for the class I'd be teaching in just a few hours. But not long after the kids left for school, my heartburn started to really hurt. And later, while taking a shower, I started to feel other weird things too. Sort of lightheaded and jittery, and my jaw was starting to hurt. And that's when it hit me. This wasn't heartburn at all. This was a panic attack. Which shit you know. Because in the past couple of years, I've had two visits to the hospital with this crazy chest pain and both times I was sent home with the sort of sad trombone shame diagnosis of panic attack. Both times it felt humiliating to me too, and on this particular morning, I vowed not to do it a third time.
Jim Coan
On the other hand, my chest continued to hurt. A lot. So I canceled class and called my primary care physician. Turned out he had an unexpected opening right away. So in I went expecting to be told either that I was having another panic attack, or that I had a really bad case of gastric reflux. And while he was checking me out, my doc did, in fact, assess both possibilities, suggesting to me that his best guess was that I was having a combination of the two. That my indigestion was maybe distressing me enough to give me a panic attack. Seemed reasonable. But he was also a little concerned, something might be up with my heart. So he took an electrocardiogram, an ECG, and hey, look! It was perfectly normal, perfectly normal, robust, even. And my blood pressure was fine. So he felt reassured, except not completely. I could tell that my symptoms were bugging him. So I said so. Mainly because, you know, if your doctor is looking worried, that's worrisome. And I was right. He was worried. Just to be safe, he wanted me to go to the hospital to get a blood test. He wanted them to have a look at something called my troponin levels. Troponin's are proteins that get released when there's damage to the heart muscle. So if my troponins were elevated, he'd want to get a more detailed cardiac workup. So I went to the hospital, had the blood drawn. I was feeling extremely uncomfortable by then, but I was also trying to keep my cool, be cool. They did the test. And I was sent home. I made some lunch, hoping that a little food might help the indigestion. No such luck there. In fact, the pain in my chest started to increase pretty dramatically, as did the pain in my jaw. For that, I think I took a couple of Tylenol. My plan was to go lie down and give my body a little rest, hoping I'd feel better in an hour or two. If all went well, I'd get a good nap in. And, and that's what I started to do.
Jim Coan
But before I tell you what happened next, I need to do two things. First, I need to tell you in no uncertain terms that had I decided to take a nap right then I would be worm food right now. I would be dead as a doornail, having written off on my pale horse. Second, I want to play for you something that popped into my head at just the moment I started to remove my shoes. Listen to this for a sec. It's from the conversation I recorded with Lisa Feldman Barrett for this very podcast about a year ago. Here it is.
Lisa Feldman Barrett
When women present themselves in the emergency room with symptoms of what could be a heart attack, those symptoms are very similar to the symptoms that you experienced during anxiety attack.
Jim Coan
Right.
Lisa Feldman Barrett
And over the age of-
Jim Coan
That's the classical example.
Lisa Feldman Barrett
Yeah, over the age of 65 more women die from heart attacks than men do. And the reason, one of the reasons why it's not the only reason, one of the reasons why is that they are routinely sent home because they are misdiagnosed as having anxiety, instead of having a full workup and detecting that there's actually a problem with the heart. The women themselves and the emergency room doctors have a classical view of emotion with the idea that there are very definitive fingerprints for things like anxiety and fear and that these are somehow biologically separate and very distinguishable from physical symptoms of illness. And that combined with the mistaken belief that women are more emotional than men, which is also an interesting part of-
Jim Coan
Wait they're not? I'm just kidding.
Lisa Feldman Barrett
Yeah I know you are. You know, leads to people losing their lives, and before- you know, there are a couple of times when I've been interviewed about this, you know, interviewers will say, "really come on really." You know, one of the publicists that I've worked on my book, this happened to her mother.
Jim Coan
That she was diagnosed with anxiety, and had a heart attack?
Lisa Feldman Barrett
She went to an emergency room with symptoms of heart- that were, there was an impending heart event about to occur, and she was sent home with anxiety and she died.
Jim Coan
Holy shit. You know, you think commonly, if you ask lay people about the link - to the extent that lay people are going to know about the link between panic attacks, anxiety attacks, and heart attacks - they're going to say that the problem really is not what you're saying. The problem is that so many people think they're having a heart attack when they're really having an anxiety attack.
Lisa Feldman Barrett
Sure, you can pick apart any single, you can pick apart any single example that I'm giving you. The fact is, though, that what your body, the idea that there is a an objective physical fingerprint for each emotion, and that somehow it is distinguishable and distinguishable in a biological sense, from physical symptoms, is a myth.
Jim Coan
So yeah, this little exchange popped into my head, and I thought, "You know what, fuck this. I'm going back to the hospital." And that's what I did. You know what they had waiting for me? Good news! My troponin levels tested earlier, just that day were perfectly normal. And you know what else? My ECG was normal too. No heart issues at all looked like another panic attack, just like I thought. Just like my PCP thought, just like my wife thought. In fact, just about the only person who wasn't totally convinced I was having a panic attack at that moment, was the virtual Lisa Feldman Barrett in my head, anxiously replaying that little bit of conversation over and over again. That in the fact that the pain in my chest was now starting to get really very bad. In fact, it was the intensity of the pain I reported that kept me in the exam room for a bit longer. They wanted a cardiologist to come and look at me after all, and they wanted another multi channel ECG, just in case. So I lay back on the exam table, they hooked up the ECG. And I'm not kidding now. Just as the cardiologist was walking into the room, it hit me.
Jim Coan
It's hard to describe what the pain was like, because it wasn't like anything I'd ever experienced before, either in type or intensity. As badly as my chest had been hurting, the pain in my chest suddenly increased, it seemed like 1000 fold. It felt like intense burning, and intense squeezing, and my jaw felt like it was being stabbed on both sides by knitting needles. But there was this terrible emotional component too. I could sense suddenly that something was catastrophically wrong. And this wave of terror crashed over me. I've tried to find ways to describe this cocktail of pain and terror. Try this. Imagine you're at an electric stove, cooking something and you accidentally touch the glowing red burner with your finger. And that as your body instinctively tries to jerk your hand away, you find that you can't. You're stuck to it. What would you do as your finger just sort of sizzles away? How would you feel? Now imagine that glowing red burner is actually inside your chest, just under your sternum. It was sort of like that. Adding to the fun, my ECG started showing something those poets of cardiology like to call Tomb stoning. Because, you know, get it? The pattern looks like a tombstone, and it means you're about to die.
Jim Coan
Tomb stoning is associated with a blockage in part of your heart called the left anterior descending artery. And the correspondingly shitty left ventricle functioning that follows that. It's a pattern that gets doctors really excited because when they see it, the patient's prognosis is suddenly very bad. They know for example, that without very fast emergency intervention, permanent damage to the heart muscle might be the best case scenario. Meanwhile, I'm clutching at my chest and making this really horrible sound, this blend of sort of screaming and moaning. Just this, I mean, somehow, just like that archetypal sound of mammalian doom is erupting out of me and I can't seem to stop it. It was like throwing up. So that was pretty bad. I remember the doctor looking at the ECG, turning to me and saying, "sir, you are having a heart attack." And he had to really speak up to because he could barely be heard over my scream moaning. But that's when it got really bad. Because I went into something 10 out of 10 doctors would really prefer I didn't go into, which is cardiogenic shock.
Jim Coan
Here's how the Mayo Clinic describes it on their webpage. Quoting now, "cardiogenic shock is a condition in which your heart suddenly can't pump enough blood to meet your body's needs. The condition is most often caused by a severe heart attack, but not everyone who has a heart attack has cardiogenic shock. Cardiogenic shock is rare," it goes on, "but it's often fatal, if not treated immediately." In fact, here's really why doctors hate it so much. Quoting again from the weirdly optimistically phrased Mayo Clinic entry, "If treated immediately, about half the people who develop the condition survive." Half. So at this point, whether I see the next day is that statistical coin toss. Now, in my case, that probably wasn't as true because I was literally in the emergency room when it hit. Good timing. That meant the doctors and nurses could get right to work. And getting right to work is exactly what they did. Just after the attending doc declared that I was having a heart attack, the room filled with a sort of billowing cloud of medical Super Mario Brothers. One of the nurses asked me if she could cut off my clothes with scissors. And the only response I could manage at the time was this sort of, I don't know, imagine the sound of a moose being impaled by something. After which she just said, very matter of factly, "I'm going to cut off your clothes with scissors." And somehow, as the team was flopping me onto a gurney and starting to wheel me down the hall, that's exactly what she did. So that added a little excitement. And I'm scream moaning and starting to say things like, "I think I'm going to die now." While the nurses realizing they had a big baby on their hand said things like "No you're not."
Jim Coan
At some point, I asked for something to help with the pain. That's actually when I was told I was in cardiogenic shock. I mean, I should have known since I was sweating profusely, all cold and clammy and shaking uncontrollably. My legs were especially animated. Below the waist it was like I was breakdancing. But the point is that because I was in shock, my blood pressure was extremely low. And that meant they couldn't give me any pain medications. Doing so might have just killed me on the spot. They didn't want that to happen. They actually prepared me for a cardiac catheterization through my groin. I'll spare you the details, but ultimately, they went with my right arm right there at the wrist. They poked a hole in my radial artery and threaded a catheter up my arm, past my shoulder, across my chest, and into my heart where they injected dye to see what they were up against, using the big ol' X ray machine hovering above my chest. That's when I heard one of the docs say "100% occlusion."
Jim Coan
I wasn't sure exactly what he meant, and I was still scream moaning and half delirious besides and all that, but it sounded bad. In fact, it was bad. It starts to get a little vague here in my memory. Sorry about that. I started coming in and out of consciousness at about this time. But here's an interesting detail. There was music playing, pretty loudly, as I recall. Certainly loud enough to hear it, clearly. And you'd hope that if you had music in a situation like this, that it would at least be soothing, maybe, maybe something inspirational or connected to you in some way, you know to make your exit from this life a little more meaningful. Well, you know what was playing in the background while the doctors were threading a catheter into my heart?While my heart was not supplying enough blood to my body and while I was thrashing about screen moaning?
Jim Coan
That's right. Paul McCartney and Stevie Wonder's smash 1982, single, "Ebony and Ivory." What was I supposed to do with that? Just, just let me summarize the situation for you at this point because remember, even though I was in good hands, there was still a decent probability that these were going to be my last moments of consciousness before boarding that last train to empty eternity. If I had died, right then I would have exited the world in excruciating pain, feeling intense, emotional terror, my body saturated with adrenaline, shaking uncontrollably while I lay there, totally naked, in a room full of complete strangers while listening to "Ebony and Ivory." It's just, it's just not the death I had imagined for myself. You know?
Jim Coan
At some point, the doctor working on getting a stent ready for my artery said, "Sir, I need you to be quieter. I'm really trying to focus here we are working on saving your life." And you know what? I stopped scream moaning right then. That seemed important, that message. Saving my life seemed like the right thing to do. And I wanted to not make it harder. So, anyway, they got this little balloon into my blocked artery, and they inflated the balloon. And that terrible pain in my chest instantly vanished to be replaced, really, I swear to God, by rainbow winged pegasus' suddenly flying around above me, unfurling a "you're going to live" banner amid sprays of candy confetti.
Jim Coan
There was there was more pain in my wrist as they threaded another catheter into place that stent that was supposed to keep the artery permanently open. And my body continued to shake with too much adrenaline, but I didn't much care in either case. The contrast between the severity of the pain before the balloon and after, was ecstatic. It was as if suddenly my chest felt better than it had at any point in my entire life. My heart was suddenly gulping sweet, life sustaining oxygen. I was too weak to do anything much, but I wanted to high five everyone in the room. And so, anyway, that's what happened, the day the Widowmaker almost got me. That's the story.
Jim Coan
They wheeled me up to the ICU for a couple days and into the cardiac ward for a couple of days more. I was given a crash course in new medications. There's a lot to take in. And uh, here's an important thing. They say that when tragedy strikes, you find out who your real friends are. And I discovered that I'm blessed with an absolute embarrassment of riches when it comes to real friends. People all over Charlottesville started making us dinners. My beautiful and amazing and irreplaceable colleagues in the psychology department here at UVA, collectively made us meals literally every day for more than a month afterward. Others came and helped clean our house and cook and babysit. I'm thinking especially of you, Stefan Beeler. And my superheroic students, Naderina Mackey and Sarah Medina DeVillay. As well as my brilliant and resourceful lab manager, Finn Roberts, have kept the lab humming along without a hitch. My loyal friends too numerous to name, taking me out on walks and amusing me with funny books and videos. My strong and optimistic kids. And of course, my incredible Amazon warrior princess wife, Cat Thrasher.
Jim Coan
Sometimes, life shocks you into seeing with special vividness just how wonderful your life really is. And how precious to this was one of those times. The bigger question at this point is, what do I do now? It hasn't been that easy a question to answer. They tell me major lifestyle changes are headed my way. I'm already eating a radically different diet. I have to work less, of course, which is likely to entail some painful choices. But time goes on. You know? I'm almost two months out now and my heart continues to recover. I feel much better, in some ways better than I did before the heart attack. Remember those panic attacks I mentioned earlier? The ones that sent me to the hospital a couple of times before in the past two years. Turns out literally none of the cardiologists I've talked to now think those were actually panic attacks. They were warnings. They were foreshadowing. In fact, just a week before my heart attack hit, I was out on a mountain bike, in the woods, by myself, when suddenly, while climbing a pretty steep hill, my chest started to hurt a lot. In exactly the same way that would send me to the doctor on September 5. It didn't last that long, so I kind of forgot about it, but that was a sort of shot across the bow.
Jim Coan
If my heart attack had got me on the bike that day, I'd have stepped on my last Radler, right then. Or it could have decided to try napping instead of going back to the emergency room, in which case I'd have expired on my own bed for my family to traumatically discover a little while later. Or could have gone into cardiogenic shock while driving to the emergency room, in which case I might have killed somebody else, you know, while wandering off to try on my pine overcoat. These things occur to you afterward.
Jim Coan
There have been complications since the heart attack. For a while there, I really did start having panic attacks and these motivated two hasty trips back to the ER and ambulances before we were all on the same page and I had to start dealing with the more emotional fallout of the Widowmaker. Fallout that is not trivial. For example, I've developed a habit of involuntarily imagining myself just sort of keeling over at random times. Wondering things like "who might find me? would I be able to close my eyes before the more metaphorical curtains closed?" What I've realized, almost too late, is that I really do need to start taking care of myself. Particularly when it comes to stress and overwork. I have a strong feeling that some of you out there in the same boat. And I want to close by saying this.
Jim Coan
If you have a family history of heart disease, if you had a traumatic childhood, if you've been under a lot of stress for a long period of time, if you work too much, especially in a sedentary job, if you're overweight, if you smoke, if you're hypertensive or have high cholesterol, consider at least chatting with a cardiologist. Make an appointment, get a calcium scan test, reflect on your life as it's happening now. Not at some future point, where you've achieved some kind of goal or real stability or peace and contentment or whatever thing it is. Think about how you're living this single life you're ever going to have, or even whether you are living that life. Because the Widowmaker can strike at any time, without warning on any ordinary day. It almost got me, don't let it get you.
Jim Coan
Folks, original music for this episode of Circle of Willis was written and performed by Tom Stauffer, Tucson, Arizona for information about how to purchase Tom's music, as well as the music of his band, The New Drake's check the about page at circleofwillispodcast.com. Circle of Willis is produced by Siva Vaidhyanathan and brought to you by VQR and the Center for Media and Citizenship at the University of Virginia. And Circle of Willis is a member of the TEEJ.FM network. You can find out more about that at teej.fm (now wtju.net). Special thanks to Paul Reyes, tough as nails editor at VQR. Nathan Moore, General Manager and swell guy at WTJU FM in Charlottesville, Virginia. And Lulu Miller plucky genius, co founder of the podcast invisibIilia, reporter for NPR News, and new mom. You got yourself a little cutie there, lady, and I'm pretty happy about it. If you liked this podcast, how about giving us a review at iTunes, letting us know how we're doing? Super easy and we like it. Or send us an email by going to circleofwillispodcast.com and clicking on the Contact tab. Alright? In any case, the next episode really will be my conversation with Susan Johnson, Professor Emeritus of Psychology at the University of Ottawa way up there in Canada there. Where she's actually a member of the Order of Canada, Canada's highest civilian honor. Saying Canada quite a lot right now, I like that word. I'm just drawn to it. So he's going to tell us the story of developing Emotionally Focused Therapy, one of the most widely used and widely studied therapies ever developed for treating distressed romantic couples. Don't miss it. Till then, bye bye.