The Nightmarish Miracles Before Christmas - Part 1

I've been writing... just brain vomit... trying to get the events of last week out onto a page so I can let the painful details and memories start to fade a bit.   There have been several of you who have asked about the details, and I've noticed a bit of increased traffic on my blog from people checking regularly, so I thought I'd post what I have so those who are interested can read it.  Really, this is more of a journal entry, so the thoughts may seem a bit scattered.  It's been written in snippets of time over the past few days... here a paragraph, there a sentence, whatever I have time for in between the festivities of celebrating our modified Christmas and enjoying our visiting families.  If you're mostly wondering what, medically, happened to Brian, scroll down until you see pictures.  It's there that I explain the medical jumbo.  I have not written about the final diagnosis yet... that will come, paragraph by paragraph, soon. 

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The home phone rang through the chaos of the night.  I stepped over the remaining gingerbread house crumbs and wove around several of the 12 adults we had chatting together in the family room before I reached the handset to check the caller ID.  "It's Brian!... ?" I said with a little laugh and an exaggerated eye roll.  He had been chatting with us just minutes before, but he's funny that way sometimes.  Our house is not very big, but he'll pull the lazy card occasionally and call me from one room to the other to get my attention.  I picked up the receiver and hurried into the living room, knowing that the sound coming from the 20 children downstairs would be muffled enough in there for me to hear.
"Hey!" I said.
"Can you... come here?," came the strained whisper on the other side.
"Brian?"
"Yeah... just come." ... something was wrong.
"Are you okay?"
"... um.  No."
"Where are you?"
"In ... the bedroom."  I dashed down the hall and opened our bedroom door to see Brian writhing in pain, arm squeezed up against his chest, eyebrows and corners of his mouth downturned and puckered in pain. 
"Brian!" I gasped, rushing to his side, "What's wrong?!"
"I... don't... know.  Just... pain... like... crushing... it's not going away... and it's spreading to my left arm... I think... it might be... ... ..." he couldn't bring himself to say the words, but we were both thinking them. 

... Heart attack?

But... what?  Certainly not.  He's 32.  He's healthy.  We were just making gingerbread houses.  I stood above him, my right hand absentmindedly brushing the hair from his forhead, my own face contorted in a mixture of concern and confusion.  Laughter from our guests rang down the hall, but my world suddenly seemed so silent.  "Can I ask some of the guys to give you a blessing?" I asked.  A nod.  "Do we need to go to the hospital?"
"Um... maybe," came his response.  "It's just... not... going away."

That was enough for me.  A maybe from Brian, ever the downplayer on his own discomforts, was like an iron clad get-there-as-fast-as-you-can.  I'm sure I looked like a deer in headlights as I stuck my head outside the bedroom door and motioned quietly for the first priesthood holder I saw to come.  And then the second.  They slipped down the hall and found Brian as I had.  The blessing was quick and beautiful and confirmed my decision that we needed to get to the hospital.  Fast.

But, my brain, you know.  The one that doesn't process things very quickly these days.  The one saturated with pregnancy hormones and sleep deprivation and managing a household with three children all during the chaos of the holiday season.  I just stood there.  "I think we should probably go to the hospital..." I finally said, waiting for the three doctors in the room to verify my feeling.  The two standing just stared at the third, writing in pain, with the same concerned, confused look I had.  And then they snapped into action.  "Yep.  You should go," one said.  I sped out of the bedroom to find shoes, keys and purse while the men helped Brian.  In the instant I rushed to the coat closet, the people in my home turned from a several conversation casualness into a mastermind of efficiency.  The words 'chest pain' and 'hospital' were thrown into the air and I was swept up in a whirlwind of help.  Bending down to find Brian's crocks, I grabbed one and started searching for the other when one of the women came to me with a sharp and pointed, "What do you need?"  I held up the crock, "I need to find the other crock."  Grabbing the first crock from my hand and bending to shuffle through the shoes she said, "You go get your keys and purse and get out to the car."  Bless her for thinking clearly.  I followed her instructions and by the time I got my purse and keys together, she had the crocks on Brian's feet and the men had him in the car.  I rushed to the drivers seat and half-heartedly warded away the offers for someone else to drive us in... we needed our car... right?  Indecision froze my brain again as people looked at me expectantly.  "Linds, I'm worried about you driving," one friend pointed out.  Was I okay to drive?  I was certainly in a sort of panic.  Instantly, a wash of clarity came over me and I felt comfortable and capable and knew I needed to have the wheel (and the gas pedal) at my control in order to manage my own stress.  "No.  I'm fine," I concluded.  "Really.  I feel good..."  I sat down in the drivers seat, immediately realized I had forgoten my phone and jumped back up to run for it.  One of our doctor friends standing close said, "You really should go."
"But I need to grab my phone."
"No, you should go."
"I need a phone, though."
Another friend, Mark (who is a dear friend of Brian's and a fellow ophthalmology resident), reached in his pocket and handed me his own phone and just before I shut the door, thankfully remembered to tell me the password.  I sped out of our driveway leaving my kids... had I even said goodbye?... leaving 20 kids in total and 10 adults in my home behind me. 

The roads were practically deserted as I flipped on my brights and sped down the road.  The trees whipped past in a blur of motion, but my eyes and brain became hypersensitive to my surroundings as I scanned the sides of the road for deer or other animals that could cause an accident.

Clear. 
Clear.
Clear. 

Brian put his seatback all the way down and continued to writhe.  "Will... you... sing?" he whispered.  His request sent a surge of adrenaline through my body and bathed my eyes in the fresh pain of hot tears.  His sentence bore his truest emotion... an unfamiliar emotion that, in ten years of marriage, I had never seen like this.  He was scared; and in immeasurable pain.  I responded by taking a deep breath to clear my own anxiety, by pressing the gas pedal a little closer to the floor, and by slowly letting out my breath in the words and tune to Silent Night. 

Silent Night,
Holy Night.
Brake a bit for the red light and hold on as the inertia of the right turn pulls me and sends everything in the backseat crashing into the door behind me.
All is calm,
All is bright.
Stop sign ahead.  Left turn.  Car coming slowly from the right.  Left side clear.  If I stop completely, the car coming from the right will pass and I will be stuck behind him.  If I go, they'll have to brake for me, but we won't be close enough to crash.  Brake a bit and hold on as the inertia throws everything in the backseat crashing against the other door. 
Round yon virgin mother and child.
Holy infant so tender and mild.
Red light.  Have to stop.  Unsafe to cross.  Feels like seven years.
Sleep in heavenly peace.
Sleep in heavenly peace. 

Through two more verses of Silent Night and another two of The First Noel it felt like time was racing by faster than I could make the tires go.  Another red light, but this one just barely.  Intersection still clear, my lane clear, cars stopped on all sides.  I tore through the intersection with hawk eyes on the lanes that would start moving in response to their newly green light.  They didn't move. 

"I'mjustgonnago," Brian slurred out as we pulled up to the Emergency Room entrance doors.  Before the car had even come to a complete stop, his door was open and he was stepping out onto the hard pavement.  I watched him stumble into the hospital as I practically threw my whole keychain to the vallet parking attendant.  "He duzn't look too good," he said.  "But he be alright.  He at Duke now."  I tried to smile, put my half of the bright orange tag into my purse as he put his half around my keychain, and then ran in after him.  The emergency department was practically dead and Brian was hooked up to the EKG 90 seconds after leaving the car.  The nurse tracked his heartbeat for a few seconds before Brian said, "Can you... turn it?"  He motioned for the nurse to turn the screen towards him so he could see what she was seeing.  She lifted her eyes to meet his without lifting her head and slowly shook her head, no.  "Just... turn it," he repeated.  "I want... to see."  She turned the monitor to face him and his lips contracted into a straight line.  "Okay," he said.

Okay? I thought to myself.  Okay?  What does okay mean?  I tried to open the vault of information I knew I had learned in my human biology classes to decipher the EKG reading myself... but it was rusted shut by a decade of unuse.  The nurse ripped the newly printed paper from the machine and with a small, "I'll go give this to the doctor," left the room quickly.

"That didn't... look good, Linds," Brian whispered.  "That... showedthatI'mhavingaheartattack."  Within seconds he was lifted up on a table with 10-12 doctors and nurses buzzing around him like bees.  I slipped into the corner so as to not get in the way and, clutching my friend's phone, watched as people dressed in white and blue worked together like a well oiled machine around him.  One barking orders, others stripping him naked, attaching wires, inserting IV's in both arms, asking questions, shoving papers under his nose to sign, all the while using doctor talk and occasionally taking the time to look me in the eyes and ask, "Are you okay?"

Am I?  I wondered.  How can I tell?  I felt as if I were watching it from another place... an action filled movie playing out before my eyes.  But that tall man lying on the table was not an actor.  It was my husband, and there was no remote control in my hand.  No way to push pause to get a drink.  No way to turn down the volume.  No way to rewind to figure out what I'd missed in order to make sense of it all.  No director suggesting the doctor language be supplemented or replaced with regular English so the average American could understand better.  No way to fast forward to make sure the ending was a happy one.

After all the research I did later, I know now that if it had played out like a movie I would have understood the seriousness of the situation a little more deeply in that moment.  The doctor would have taken me aside and explained to me that they were very concerned for the life of my husband.  That they were going to take him up to the catheterization laboratory (cath lab), insert a catheter up through the artery in his groin, down into his heart vessels through his aorta, and there inject a certain dye that would help them see exactly where the problem was.  They would have told me that things in the cath lab could go badly.  Very badly.  They would have mentioned that for the next two hours Brian's life would be in a perilous condition, but that they would do their best to keep him alive.  As they hurriedly pushed his hospital bed down the hall towards the cath lab, I would have been running alongside the bed, holding Brian's hand, tears streaming down my face.  And at the point where he was wheeled into the elevator that I could not go into, there would have been an emotional separation - expressions of love and a nagging realization that it could be the last time we ever saw each other alive.

But there was very little of that.
I didn't understand.  I kept calming the worst case scenerio in my head with the comforting words from the parking attendant.  He be alright.  He at Duke now.  He wasn't going to... die?  Right?
Certainly not. 
 
And, after thinking about it, my lack of understanding makes sense in a way... the doctors recognized Brian when he came in and, because of that, felt a personal attachment to the case.  Their normal protocols of explaining the situation to the patient and family members were interrupted because they knew that Brian understood on a deep level exactly what was going on.  They knew that when they said, "We're getting the cath lab prepped," that Brian understood all the bold print and all the fine print behind that statement.  But, they forgot that I didn't.  Even with a background in human biology, I did not know what the 'cath lab' was, what would be done in there, how long it would take, or whether the doctors were optimistic that he would pull through this.  One of the doctors did take the time to tell me about the procedure that was to take place in the cath lab, but none of the risks that accompanied the procedure were explained.  So, I held his hand while they waited for the cath lab to be prepped.  I wished I could call my family to alert them to the situation, but all of my contacts were in my own phone... and I only had my friend's phone sitting in my hand. I made a phone call home to see how the kids were, and to ask someone to bring my phone.  Becky was staying at my house tonight with the kids, and my phone was thankfully already in transit to me.  The only helpful number I had memorized besides my own home phone number was Brian's parents' land line... thankfully memorized back in the day before cell phones were standard and memorizing phone numbers was common.  I stepped outside the room to place the call (I stepped outside... proof again that I did not understand the severity of the situation completely), and was disappointed to hear the answering machine pick up.  I left a brief, shaky message informing them of the heart attack and asking for prayers and as I hung up the phone, was introduced to two social workers that had been assigned to me.  I wasn't sure how I felt about having social workers assigned to me, and I was sure I didn't want to make small talk, but there they were so I smiled and nodded.  Glancing at my belly, they politely asked questions about when I was due, and whether or not it was my first.  My answers sounded curt, even to me, so I apologized and said, "I just want to go back in with my husband."  They understood.

I took Brian's hand again and a nurse handed me a bag full of his clothing.  Mark showed up at the doors, wearing his Duke badge, with my phone and a small bag full of my belongings that another dear friend, Kim, had thrown together for me after I'd left my house.  Pajamas.  Toothbrush.  iPad.  Then, just as if a hive of bees had exploded behind me, doctors and nurses started pushing Brian's bed out through the doors and down the hall.  My own phone in hand, I picked up my pace to follow him and opened a new text message along the way.  "Brian is having a heart attack," I typed, "please start praying.  I'll call later."  I paused just long enough to see them push Brian's bed into the staff elevator and hear my social workers say, "We'll need to go this way now."

The terror of the possibility of his death didn't hit me until forty minutes after I watched those elevator doors shut on that last chance I had to tell him just how much I love him.  Once it hit, I watched those elevator doors close over and over in my mind.  Brian said later that the reality of the situation hit him just as those elevator doors closed.  Wait, he thought, cath's can go badly.  I wish... I should have told Linds how much...

Dropping my head back to my phone I started scrolling through my contacts to select my family's names as my social workers led me down another hall and up another elevator.  Amber ... Brother ... Dad ... I couldn't think clearly and kept scrolling through alphabetically.  How many were left?  Oh, there's Mom ... Michelle ... did I get them all?  I was vaguely aware of the two social workers flanking my sides and felt a bit rude for burying my nose in my phone when they were there, waiting to talk to me.  Keep scrolling.  "Sorry," I mumbled and motioned to my phone, "just need to send a few messages."  Finally I got to the end of my contacts list and had to assume I got them all.  Send.

My social workers and I were left with just another minute to walk through the halls together and we passed the time with little chit-chat.  As we arrived at the waiting room and I explained that I wanted to be left alone to make a few phone calls, I realized I didn't know what to expect next.  "So..." I began, "what's going to happen now, exactly?" I asked.  They looked at me, confused, so I explained, "I mean... how long am I going to wait here?  And, is anyone going to come and give me updates or anything?"  I could tell they didn't know, but they gave me a rough estimation that I would receive an update within an hour and probably see Brian again within two.

And then they left.

I put my bags down in the waiting room and sat in the chair to try to process my thoughts.  Too much noise.  Too many people chatting and laughing around me.  Too much movement as they milled around.  Too distracting.  I wanted to herd all of the people out, turn off the lights and sit in the darkness for a few minutes.  Impossible.  So I closed my hand around my cell phone and stepped into the quiet hall to make the phone call I'd been anxious to make anyway.

Ring....

The flood of tears I had been fighting all night all caught in my throat at once and made it hard to breathe.
Ring....
"LINDSAY?!" came my mom's panicked voice.
"Mommmm...." I managed to say, though it came out as more of a moan.  The tears slowly started seeping through my crumbling face and my left shoulder fell into the wall beside me.  I left it there, unsure whether I would be able to stand on my own.  Something about hearing my mom's familiar voice in my ear brought the deserted hospital hall demandingly into perspective.  I was alone. 
"What is happening, honey?!"
I explained, in broken words, that Brian was in the cath lab, and that I was just there... waiting... all alone with nothing to do and no one to talk to.  Questions were asked by both of my parents and, piece by piece, the sequence of events that had played out that night were told and met by a sort of disbelief on both sides.  In my mind's eye I saw them, huddled around my mom's iPhone, listening to my voice on speaker.  In their voices, I could hear their hearts pulling for mine and I believe that, as much as I wanted them there, they wanted to be there, too.
"Lindsay..." came my dad's gentle voice.  I couldn't answer.  "You need to call someone to come and be with you."

I knew he was right, but... who?  There are several women here that I love, but I needed someone who was completely effortless to be with.  Someone who knew me so well that all the walls and barriers of new and forming friendships had been broken.  Someone who could sit in comfortable silence or engage in unceasing conversation.  Someone who knew me well enough to read between the lines of my emotions, sense what kind of words to say, and let me cry.  Five years ago I would have had a number of people to call - but those dear friends had all moved away.

"I don't know who to call, Dad," I finally responded.  "The only person I feel completely comfortable with is sleeping at my house tonight watching my kids."
"Call her," came my dad's advice.  "She will find someone else to come sit with the kids... you need someone with you."  Eventually there was nothing left to say... had it really only been 15 minutes?  My dear mother-in-law, Jean, beeped in on the other line and I quickly ended my phone call with promises to keep my parents updated.  Jean must have heard the message.  She must be terrified. 

My conversation with her followed a similar path that the conversation with my parents had taken and lasted just ten minutes as well... what is there to say after all the details have been laid out?   So, I called Becky.  "What do you need?" she began. 
"Well, I don't know..." I sputtered.  "I'm just feeling..."
"Do you want me to come?"
"Yeah... I think so..."
"I'll be there as soon as I can.  I'll call Kim to come sleep with the kids."
"Thank you..."

I hung up the phone and went back into the waiting room.  Still distracting.  Overwhelming.  Confusing to  be in an atmosphere so contradictory to my feelings.   So I left again to call my dear friend, Katie.  We cried together and after another ten or twenty minutes, a familiar pain started shooting in my lower back each time I stepped on my left leg.  Slow walking... pacing back and forth was starting to take it's toll on my weakened back.  "I need to go, Katie," I said regretfully... though, again, there was really nothing else to say.  I needed to sit down for a while before the slow pacing eventually rendered me unable to walk at all.  As I sat, the reality of the situation started settling into my heart.  How long had it been?  Would I be getting any updates soon?  Was Brian... okay?  I hung my head and quietly let the tears fall into my lap.  For the first time I dealt with the possibility of his death... was it a possibility?  Two agonizing minutes passed before Mark stuck his head into the waiting room and caught my eye through my tears.  He came and sat next to me and quietly mentioned that there were better places to wait if I wanted to leave. 
"But, they said they'd come give me updates," I mentioned.  "I don't want to be gone when they come..."  Mark furrowed his eyebrows slightly and nodded his head.  "I don't think they actually leave the procedure to come with updates," he said, "but I can go tell the fellow where you are, just in case."
"...Okay," I said.  I felt immensely blessed to have him there... both as a doctor and a friend.  As we walked through the halls I wondered what he had been doing over the past 45 minutes since I'd seen him last.  "Have you just been here, the whole time?" I asked.
"Yeah..."  He told me he'd gone back into an observation room where he could watch and hear the procedure.  "I don't know why they let me in there," he commented.  "The fellow just motioned for me to come."  He told me that Brian was still okay... that he was mentally involved and asking questions when Mark left.  That the major artery in Brian's heart had split open and that they had placed two stents inside and were in the process of placing a third.  I asked questions about how that worked... how could they stent something if it had split open?  And it was here that some of the differences in knowledge between an ophthalmologist and a cardiologist began to be clear to me.  Mark didn't understand very well, either.  Eventually, I worked up enough courage to start asking the question that had been tickling the back of my mind, but it came out like a sporadic, uncontrolled waterfall.  I was afraid to stop talking because I was afraid of the answer.  "So... is he... going to be okay?  I mean now that he's here and getting surgery?  I know that heart attacks are serious, and if left untreated can be fatal, but now that he's here?  I wish I would have been brave enough to ask in the emergency department, but I was too afraid of the answer... I just wanted to ask them what they were thinking - if they were concerned for his life, or if they knew that as long as they followed specific steps, that the outcome would most likely be a good one.  In the end, I'm okay that he needed this surgery, and I'm okay if the healing process will be long, or he needs to take medications the rest of his life as long as he'll be fine now, but I don't know if that's true... or if the doctors are optimistic at this point.  So..." Mark patiently waited for me to finish, "... so... is he... you know... like... out of the woods, now?"  I watched as his face scrunched up tightly and as tears sprung into his eyes.  He took a deep breath and started shaking his head.  "No," he whispered and turned his head slightly away.  His eyes kept flitting up towards mine, but neither of us really wanted them to connect. 

In fact, after later research, Brian and I discovered that there was a 35% chance of failure once Brian was in the cath lab.  They were discovering that the source of the problem was that one of the main arteries in his heart had torn, or in medical terms, dissected.  The left anterior descending artery.  The LAD.  The widowmaker (an uncomfortable nickname for this artery that I learned in college).  The dissection happened just after the LAD branched off; serious, because now the entire artery was receiving no blood:

It's hard for me to put into words exactly what a 'dissected artery' means, so here are two illustrated pictures that help:

 source for picture 1 . . . . . . . . source for picture 2

The innermost layer of the artery became detached from the rest of the layers and folded down into the lumen of the vessel.  The blood shunting through the artery at that point started ripping its way through this new passage created, essentially creating two pathways for the blood where there should only be one.  (One analogy I read that was helpful in visualizing this compared a dissected artery with a lined coat.  If you imagine the lining of your coat ripping up near the shoulder, you know that when you put your arm into the sleeve, your arm may slide through that rip and down the sleeve.  But at the end of the sleeve, you're in the wrong hole, so your hand will not come out where it's supposed to.  The difference here is that the lining of an artery is attached at every point, so ripping through the entire length is more difficult.)  This is, obviously, unsustainable and over the course of just a couple of minutes, the whole artery became blocked off. 

In order to try to repair the damage, the surgeons opted to place stents in the artery to open it back up and start the blood flowing once more.  They had already placed a catheter up through his femoral artery and into his heart (to find the source of the problem initially), and used this pathway to place the stents. The following pictures show the catheter pathway and then what the stent looks like and kind of how it works. The only pictures I could find of stent placements were showing how stents are used to hold the artery open after plaque is pushed away, but Brian's situation was quite different and much trickier than this.  It gives you an idea, though.

 source for picture 1 . . . . . . .  source for picture 2

There are a couple of reasons why stenting a dissected artery (as opposed to a plaque filled artery) is dangerous... first of all, because the lining is torn and folded into the correct pathway, threading the catheter into the right place is difficult.  Second of all, the arterial wall behind the lining can be filled with blood, causing the tear to rip further along down the artery once the balloon is inflated. 

Despite the difficulties, Brian's surgery worked.  Neither of us know how well it went - but we do wonder if there were complications or tense moments along the way.  The case was long (we have no real reference point for this fact other than that Brian heard one of the surgeons say to another, "Wow.  That was a long case."  It was two and a half hours), and in the end they ended up stenting the entire length of the artery.  Five stents in total running down the full length of his heart. In placing one of the stents the doctor told me they had to sacrifice another, smaller artery that branched from the LAD.  "This means that the portion of his heart that relies on this artery for its blood supply will die," the doctor explained to me later, "and he may feel some pain over the next couple of days as that happens, but there was nothing we could do about it.  We had to sacrifice a small portion for the larger portion." 

I was sitting with three friends when they wheeled Brian past our hall.  Becky, Mark, Leah.  Becky and I had spent the last hour and a half sitting together, talking together, crying together, updating family members and friends whenever we could... Mark had been in and out of the cath lab and had tried to put pieces of the puzzle together for us.  Really, his message each time was that 'he's still okay...' and that was enough.  Leah had just arrived to give support and love.  As they wheeled Brian past our hall, Becky was standing closest, "It's Brian!" she said.  I bolted down the hall as they pushed him out of sight and heard one of the tech's say, "Wait a second; there's a young lady running down the hall."  They backed the bed up so I could see them and I found myself holding Brian's hand again, feeling so grateful for it's warmth. For other than watching his eyes move to meet mine, that was the only sign I had that he was alive.  He looked like a cadaver with skin hardly a different shade than that of the sheet wrapped around him.  His eyes were yellow and sunken.  The squeeze from his hand was so weak.  The tech pushing the bed said they were going to set him up in the ICU and that the doctor would be by to see me in a few minutes.  When the doctor came, his tone was incredibly serious as he explained what had happened throughout the surgery.  LAD.  Five stents.  Smaller artery sacrifice.  No smiles.  Hope his heart recovers.  We'll know more in the next couple of days.  Keep praying.  Such a somber attitude and a general feeling of, "... it was hard ...but we did it... now we wait."

The initial crisis had passed.