Saturday, December 2, 2017


A heart attack with blockage of a primary artery requires fast, decisive action by highly trained physicians or the consequences are devastating and deadly. I was lucky.

Originally published on Medium. This is an updated version of the story.

“You are one, very, lucky, son of a…” the doctor said as he sat down, slowly emphasizing each word as he said it. He was right, of course, but I was only beginning to understand just how right he was.

I’m 47 years old. My cholesterol levels have been decent. My blood pressure is good. To be sure, I can stand to lose a few kilos, but I’m not yet at the point where metabolic disease and its side effects really multiply risk factors and I’m not showing signs of it anyway. Two days before the doctor sat down at my bedside, however, none of that mattered as my family and I arrived into Frankfurt on a flight from San Francisco after a trip home for Thanksgiving.

I got off the plane, weak, dizzy, and throwing up.

My family asked the gate agent to call the medics and take a look at me. They arrived in just a few minutes. Their first guess was that I was extremely dehydrated. Out of caution, they ran an EKG, saw something strange, but then ran a second and didn’t see anything out of the ordinary. Still, they wanted me to go to the airport clinic and get checked out.

At first, the clinic agreed with the dehydration diagnosis, going so far as to speculate the bit of pain I now had behind my sternum was my esophagus reacting to puking and dry heaving. Katerina, however, wasn’t convinced. As she watched me struggle, she asked them to check further. They hooked me back up to an EKG and this time it looked far from normal. Within minutes, the doctor had me in an ambulance on the Autobahn heading into Frankfurt proper, lights and siren on.

When we arrived at the hospital, they rolled me directly into a room full of cardiac specalists who quickly evaluated what was going on. “I think you’re having a heart attack,” said the woman who was leading the evaluation. She called in the chief doctor who agreed. Soon after, I was in a surgery on a table being prepped for a heart catheterization. Everybody in the room was moving with calm but quick precision and I was reminded of Atul Gawa’s TED talk on building systems for surgery. I found myself wondering if they were using checklists and, if not, that was certainly something I wanted to ask them.

After a bit of local anesthetic and some pressure from an incision near my groin, the chief said, “I’m at your heart” and nodded to the screens projecting a full motion view of my heart. Seeing my heart pumping away on a screen while still being in my chest was nothing short of amazing.

For a few moments, I was lost in the surrealism of it all, the doctor’s narration pulling me along in wonder.

My right coronary artery was clear. My left artery — noticeably smaller than my right — wasn’t. It was totally blocked. Each injection of dye that could be seen on screen showed that no blood flow was getting through. The doctor went to work using a variety of tools to open the blockage. Interestingly, as blood flow resumed through the artery, the pain picked up and I really had to work at breathing through it, even with the help of a bit of extra morphine that the staff gave me.

I don’t know how long that part lasted. Five minutes, maybe ten. Fifteen perhaps. It felt like forever. I heard the catheter wire zip back and forth as the doctor placed two stents, but just focused on trying to control my breathing and just hang in there while the doctor finished what he was doing.

And then, like flipping a switch, it was done. All the pain faded away.

Dr. Teupe finished up, closed the incision point in my leg, and then came around the table and walked me through replays of the imagery explaining what he did. Then I went to the ICU for recovery and to slowly start figuring out exactly what happened.

My first approximation of understanding was blasé.

“Oh, I’ve had a minor heart issue but nothing that a quick little operation couldn’t sort out.” I held onto that thought for more than a few hours. That’s pretty much what the email I sent to my colleagues at work telling them that I’d be out for a week or two said.

As the immediate shock of the experience wore off, and I talked more with the nurses and doctors, it became clear that it was anything but a minor issue.

When older people have some heart issues, the body builds enough collateral vessels around the main artery to handle some load, which gives some headroom for treatment. Also, many small heart attacks have their source in those smaller vessels. For somebody my age, there’s not much in the way of alternative paths. A heart attack with blockage of a primary artery requires fast, decisive action or the consequences are devastating and deadly.

Luckily, the initial symptoms getting off the aircraft appear to be just precursors and the heart attack proper seems to have only started in earnest when I was at the airport clinic. That meant that I was positioned perfectly to get the kind of care that was science fiction not long ago, and to get that treatment immediately. That made all the difference.

Whether you chalk that up to luck, deity, or a miracle — I can’t even begin to fathom how fortunate I am.

The expression “dodging a bullet” comes close, but it assigns credit to the person doing the dodging. It’s more like a bullet was heading towards me from behind, Katerina saw it, and the doctor/guardian angel that just happened to be suddenly standing right next to us was able to gently nudge me out of the way with just the right amount of judo, making it look easy in the process.

So, why did this happen now?

How did I get on an airplane in San Francisco with a ticking time bomb in my chest which had been there for who knows how long? And why did it manifest like it did, instead of somewhat earlier over Arctic Canada or the North Atlantic? Why didn’t I catch this earlier? What symptoms did I miss? What could I have done differently?

There are no good answers. The staff at the clinic have said that my case falls into the category of: “It happens.”

Maybe if I was in marathon shape, I’d have gotten some more time. Maybe not. Six months before, I’d gotten a physical with an eye to picking up on any signs of trouble and the doctors involved in that didn’t see a thing, nor did they see a reason to go to the next level of investigation. Maybe if they had, we’d have caught something then. Maybe not.

Could it be that it’s a side effect of all the flying I’ve done in my life? Maybe there’s a chance it has something to do with the size differences of my coronary arteries. My doctors seem dismissive of both possibilities.

Maybe fate had just written 17,294 days on my timeline and I’d reached the last one.

One thing I’m pretty sure of now : I did have a few symptoms over the last weeks that are clearer now with hindsight. For example, I hadn’t noticed a tightness in my chest building up, but I now have a sense of relaxation there I haven’t felt in a while. The best way I can describe it is that it’s like noticing how good you feel after a quality massage, and how much you didn’t realize you needed it.

A more productive question is: What comes next?

A very real possibility is that this has been dogging me for a long time and now that it’s fixed, it’ll stay fixed for a good long time. The doctors here certainly seem hopeful of that. They’ve seen many examples of people who got as lucky as I did go forward seemingly better than ever for decades without another issue.

Even if that’s the case, however, I’ll have to do my part to approaching the factors I can control. Those last few kilos have to come off. I’ll have to monitor the best practices in the treatment regimes for people like me. And, I’ll have to modify my work stress levels. The last few years haven’t been kind on that front and I’ve already been taking steps to adjust my life there. I have an additional sense of urgency to make those steps happen now.

As I write this from my hospital bed a few hours after the surgery trying to put everything that happened together, I plan on living life, enjoying my family, trying to do work that matters, and making sure that every moment of what now feels like bonus time on the clock is well used.

One year later, again on Dec 2nd, I transited the Frankfurt airport on my way to Helsinki for an event I’ve helped organize. I’ve got a new position in an new organization at work. My health is good shape. My doctors are happy with my progress. I’m 48 now and I’ve still got a few kilos to lose, but I’m working on it. Most of all, I remain grateful. Grateful for the staff at the airport. Grateful to the physicians who treated me at the hospital. Grateful to be alive and experiencing the very unique feeling of life.