Wednesday, May 16, 2012

diagnosis: chest pain

Here's how I ended up spending 24 hours in Emanuel hospital.

Tuesday morning, after Lauren drove off to work the day in Modesto, I started my bike ride to campus, right around 10:15. Going up Del's Lane, I started to notice it was taking more effort than usual, riding into a gusty headwind. By the time I reached the philosophy department, I was sweating heavily and a bit more out of breath than normal (I usually ride at high intensity and velocity, as many on campus can attest).

After maneuvering my bike into my office, I mopped the sweat from my forehead and drank some water, cooling down as usual. I didn't feel right. My heart was still beating fast, and the tightness in my chest seemed worse. I sat, made final minor preparations for my 11 o'clock class, added a couple short paragraphs to something I've been writing, and then headed to class. I had to mop my brow again.

I walked over to my classroom, a hundred yards, if that, from my office, upstairs in the Bizzini building. The stairs were very hard to climb, and I was overheated when I got to my class.

Class was short. I had a spell of lightheadedness about halfway through, but while discussing the whodunnit portion of Aristotle's Ethics and students' term papers due on Thursday, I felt okay.

By the time I returned to my office, I was having trouble catching my breath, and the chest pain was still worse than before. I sat, trying to calm down, trying to let myself cool down, but it seemed like my heart was racing. I decided I needed help. I told our department assistant I was going to the health center, and set off for it.

I was unaware that, for liability reasons, the health center will only see students. I tried to say it was an emergency, and the receptionist referred me to same-day care across from the hospital. I said I couldn't get there, because I rode my bike. Eventually, the doctor on call saw me in an exam room, "as a courtesy," he said, and took vital signs. He did a lot of frowning, and said he thought I should go to ER.

While he called for an ambulance, a nurse took my blood pressure a second time, did some more frowning. The doctor came back in and told the nurse to give me an aspirin and a sublingual nitro tab.

It seemed like this was taking forever. Finally two campus police came in, and asked me, like the doctor had, what was going on, and my basic stats - name, age, etc. Then two firemen came in and did the same thing. They took my bp and asked more questions. Then the ambulance came, and the EMTs asked me the same questions all the others had, hooked me up to a portable EKG and an electronic bp monitor. They didn't frown, but they looked very concerned. I couldn't see the EKG, but when I glanced at the bp monitor, it said 155 over 110 or something like that, with a pulse of 105. I overheard them radio in that the EKG was irregular - I think.

Off to the ER. The EMT placed an IV line, gave me another aspirin, asked me about the nitro tab, declared that the health center's nitro was no longer potent, and so he gave me another.

We reached the ER, where a series of nurses, technicians, and doctors all came and went, asking exactly the same questions, frowning, and so on. At 1, I felt like I could try to call Lauren at work (at her former boss' house, actually), and proceeded to find that I didn't have the number. Eventually I reached Lauren, and she came down.

While she was on her way, a cardiologist arrived, looked at my EKG, and told me I was not going to die of a heart attack, because he was pretty sure it wasn't a heart attack. He wanted me to stay overnight, because, it turns out, to rule out heart attack definitively, you have to have three clean EKGs six hours apart, and three blood draws that test negative for a particular enzyme, also six hours apart. The cardiologist ordered a stress test and echo-sonogram thingy for this morning.

The pain in my chest had waned considerably, especially after Lauren arrived. By the time I was in a room, the pain only felt bad when someone asked me how the pain was.

This morning, after a good 3 hours of sleep, I reported for the stress test. The nurse got me all hooked up, and said she didn't like the bp reading at all: it was 137 over 95 or so. I told her I was anxious, have anxiety and depressive disorder, and that being around anything medical was my major phobia. Yet another doctor arrived. I did ten minutes on the treadmill, reaching 4.2 miles per hour (around my typical walking pace on the jaunt to school), at 14% incline, before I reported I was getting a little tired.

I got off, and within five minutes my bp was 130 over 79. I did not say, "told ya!"

The echo was just an echo.

We waited back in my room for another doctor to free me. I got to eat something. We watched an episode of "30 Rock" on my iPad (it was our "unchallenging, unlikely-to-mention-medical-stuff" choice for entertainment, plus neither of us had seen more than 2 minutes of any episode).

Whatever happened, it was not a heart attack. My official diagnosis is, in fact, "chest pain." I am 99% certain it was the worst panic attack I've ever had, and about 91% certain it was the worst physical experience I've ever had. The echo turned up a slightly dilated aorta they think I should check on yearly. Otherwise, aside from being a basket-case after this academic year, I'm fine.

And now all I have to do is grade 120 term papers, approximately 60 additional short papers, and write two conference paper commentaries, before we head off to Canada on 27 May.

1 comment:

Anonymous said...

Dear Doc Nagel:

Please don't let that beast we call CSU Stanislaus kill you. Easier said than done, I can personally attest to, but I'm hoping you will find a way to dog that particular bullet. Hope you are feeling better now.

Connie Bratten