The Procedure Begins

I had to fast after midnight. I woke up Friday morning and wandered around the house. I was nervous, but Beth helped keep me grounded. We had to be on site about 50 miles north at 9:30, so we headed out about 8:00. We stopped for gas, Beth picked up some coffee, and we got on the road. Shortly after 9:00, we pulled into the lot and headed inside.

I’ve been in a lot of hospitals in my day. I have to say that this was one of the nicest I’ve ever been in. The outpatient heart institute had a large, comfortable waiting area complete with a large waterfall. We checked in and took a seat.

Shortly after, a nurse came out; when we checked in, the volunteer assistant noted where we sat, so the nurse walked directly up to us. I hugged Beth, and she was told that she could come in to join me in a few minutes. The nurse and I walked back into the outpatient cardiology suite; she did the obligatory weigh-in (278.1 pounds) and took me to a small room. The room had a bed, a nightstand, a chair, and a wall full of medical gear. One whole wall was a sliding glass door. They had me strip down and put on that most comfortable of items, the hospital gown. I swear the person with the highest self esteem in the world would lose it with his or her nether regions catching the breeze from the non-closing flap in those things.

I climbed into bed and settled down to wait. The nurse returned and started an IV. It wasn’t without some excitement; one of my veins kept rolling and all that ended up happening was copious bleeding. She gave up on that one (she apologized profusely) and popped the IV into the other wrist. My blood pressure was high (170 over something), but I put it off to white coat syndrome. Twelve chest electrodes for my EKG, and then I settled in. Beth came in, and we started to wait.

While waiting, we talked, answered the occasional medical history question, and chatted. I was still nervous, but time passed. After about an hour, I had a couple of visitors: Two folks from the research arm of the hospital briefed me on a study that was running in the unit. The hospital was participating in research on a new stent, and the two asked if I would be interested in participating in the study if I was a candidate. The benefit to me? As part of the study one of the necessary drugs would be partially covered each month, for years. They left and Beth and I discussed whether or not to participate. For me it was easy, because in a previous life I was a research scientist. The two researchers returned and I consented (it took a fourteen-page consent form, which is hard to initial when you’re right-handed and have an IV hanging out of the back of your wrist).

The interventional cardiologist stopped in and briefed us on the process; he was straightforward and put us at ease. He answered our questions and then headed back into the procedure room.

Time dragged on; there were some procedures that took longer than anticipated before me. As an added bonus, the nurse popped in a video for us to watch on heart catheterizations; I was surprised that was never put up for an Emmy. Finally about 12:15 they chased Beth out, and got me ready to go. About 12:30, the team came in and wheeled me into the suite. It was time.

The Cardiologist: First Verse

When I called Beth I used the same "successful" dorky guy “if-I-tell-you-something-do-you-promise-not-to-freak-out” approach. “Honey? The doctor called. She wants me to come in now and see the cardiologist.” This was just as successful as the first time I used it. I could tell she was worried; I told her “It’s going to be OK… I’ll see you in the lobby of the hospital.”

I was nervous driving to the hospital, but I still kept telling myself that things were going to be fine. The bigger part of me characterized it as whistling past the graveyard, but I kept up the mantra: It’s going to be fine. It’s going to be fine. It’s going to be fine. I pulled into the parking lot, locked up the car, and walked inside. Since Beth works four blocks away, she was there already. When I saw her I could tell she was scared and nervous, so I put my arm around her and tried to be strong. Inside, I felt the same way that she did.

We took the elevator up to the top floor and headed to the cardiologist’s office. Within minutes, we were ushered into the exam room and the nurse started taking my history. I tried to keep a stiff demeanor, because I knew that if I let down my guard I’d lose it myself.

Soon enough, the doctor came in. He had enough age on him to make me feel comfortable. He seemed to be my age or a bit older, so that meant he had experience. It’s not like you say to yourself, “Hey. I want to be a cardiologist” and head off to med school in your late forties. He didn’t pull any punches; he asked why I was there and what my symptoms had been. I recited the litany again, and I kept telling myself “You’re just fat.”

The doctor disabused me of that: “You have some blockages. We need to do an angiogram.”

While I was wrestling with that, he went on: “There are three things that can happen. We can go in, find out that the stress test was completely wrong and you have no blockages. We can go in, find out that you have major blockages and immediately perform emergency bypass surgery. Those are the two extremes. Or, most likely, we’ll go in and find out that you have blockages and we’ll fix them right there either with angioplasty or stents.”

Lots of things went through my mind: I’ve taken statin drugs for years. My cholesterol has been good. My LDL and HDL have been good. I had a clean stress test seven years ago. How could this be? The fact was, it probably was what the doctor said.

Now for the vagaries of the healthcare system: Last year, my employer made us an offer. Choose a narrow provider network, and we’d get a reduction in our insurance costs. After discussion, Beth and I decided it made good sense. As I sat there trying to wrap my head around all of this, it suddenly occurred to me that this doctor (who I had grown to like in the short time we spent together) was outside of my narrow network. The doctor who had referred me to him had referred me out of network.

As an aside, we live in a rural area of Wisconsin. The joke is, we’re 100 miles from everywhere: Madison, Eau Claire, La Crosse, Appleton, Green Bay. But we’re blessed to have multiple world-class hospitals within easy driving distance. In one town, we have a major research hospital with another large hospital right next door; in a town of 30,000 there are more than 1,000 doctors. Nearly the same distance north, there’s another hospital that was ranked in the top 50 in the US recently. The hospital to the north is in my network, and this doctor was from the other hospital. When this dawned on me I put the brakes on and asked the doc if I could call my insurance carrier. He stepped out, and the nurse helped me dial out.

Bottom line: If I went with this doctor, my deductable would double and insurance would only cover 80% of the cost. After discussion, Beth and I decided that as much as we liked this doctor, we had to stay in network (we were scared about the cost of the procedure, and as it turned out, rightly so). When he came back in, I explained and he understood completely. I asked him for a recommendation and he gave us the name of one of his former students at the hospital to the north.

Before we left, the doctor told us about his wife. She had started a kitchen store and cooking school in the town where his hospital was. She focused on the Mediterranean diet, and had great success working with patients trying to move to a healthier lifestyle. This doctor was the one who told Beth and me that we needed to come home, turn on some music, and make food together. This has been some of the best advice either of us have even been given.

We left the office, crossed over to our family doctor’s office, and got the number for the in-network cardiologist. We called and they told us to expect a call; they wanted to schedule the angiogram for Thursday or Friday. So, we did what we often do: Instead of going home, we went to our friend’s wine bar and had a glass to calm our nerves. We came home to a message, and at 7:00 AM on Thursday morning I called. We scheduled the angiogram for 9:30 on Friday morning.

Next: The procedure begins. Plus, some good recipes we’ve found just following doctor’s orders.