On Jan. 5, 1998, I experienced a heart attack. I want to thank all those who have expressed their concern and support. I have tried to recount my experiences below for those who are curious about what happened. I am not a medical doctor, so do not assume everything is precisely accurate - it is simply my interpretation of what I understand happened to me.

The Warning - Monday, January 5, 1998
At about 8 PM, I noticed a mild pain in my chest. I was attending a training class at my local church in Moraga where I live. The pain passed in a few minutes, so I ignored it.

I went to bed at about 11 PM, the usual time for Patti and me. I woke up at about 12:45 AM with a stronger chest pain. I wondered a bit about it, but rolled over. It subsided. I went back to sleep.

The Attack -Tuesday, Jan. 6
At about 3 AM, I woke up again, with a much stronger pain. I stood up to see if it helped. While I was up, I decided to visit the bathroom. Coming out of the bathroom, I felt light headed for an instant. The next thing I knew, I felt myself hitting the floor and corner of the closet wall. Patti heard it and called out if I was OK. Thinking I must have tripped, I told her that. My chest pain continued and when I was back in bed, Patti touched me. She said I felt clammy and asked if I was OK again. I told her I had a chest pain.

That was it. She immediately called 911, and I could hear her giving out the address and details. They told her to make certain the front door was unlocked.

The ambulance showed up about 10 to 15 minutes later and the room filled with six men. I could hear the primary person asking Patti generic questions: Did I smoke? How old was I? Had I had these problems before? Had anything unusual happened that day or recently?

He also began to ask me questions: Where did it hurt? On a scale of 1 to 10, how bad was the pain, where a 10 was the worst pain I had ever had in my life? I put it at about an 8 or 9 because gall stones several years ago hurt more. Those pains had left me gasping for breath, whereas the current pain only made me grimace. I later learned that two of the most painful experiences - rated 10 by most people - are kidney stones and child birth.

He was listening to my chest and gave me a puff of nitroglycerin under my tongue. It was bitter. He asked if that helped the pain. I said no, so a few minutes later, in the midst of taking my blood pressure, he gave me another puff. Within a minute, he asked again if my pain had decreased. I said no, and he continued asking Patti more questions about my diet, exercise habits, and so forth. Patti defended me valiantly: I was mostly vegetarian, had low cholesterol, low blood pressure, and a low pulse rate.

He asked me again how my pain was doing and gave me a final nitro puff when I said the pain was just the same. They got ready to get me to the ambulance.

I had to walk down the hallway because the gurney was too wide. Walking was not a problem, but I still hurt and was supported from the people around me. It was cold, however, since I had only a nightshirt on and the temperature outside was in the 30's. The gurney was in the entryway, but it was cold and had only a single blanket on it. Thank goodness it wasn't raining! I remember being carried up the sidewalk, hoping they wouldn't step on any of my plants or stumble and roll me off for one reason or another.

The ambulance was also cold since they had left the door open. The primary person apologized for the chill and said the heat would crank up quickly. It did.

We arrived at the Kaiser ER, Walnut Creek, shortly after 4 AM. I got the impression that Kaiser had no warning I was coming.. Apparently, the ambulance crew had called John Muir or some other hospital and were planning to take me there. Patti had told them Kaiser but they had already contacted the other hospital. I guess the assumption was that someone would relay the message to Kaiser that I was coming. No one had.

It did not really matter much, however. The Kaiser people were all over me in a flash. They pulled me off the gurney and onto the bed in Room B. A nurse immediately began taking my vital signs. I was continually asked by someone, with an almost irritating frequency, what my pain level was. It never changed from the 8 or 9.

Dr. Verre showed up and began taking a report from the ambulance guys. Patti, following in our car, had not yet arrived. The nurse began to poke needles in me for blood tests and IV's. She could not find the right veins in my arms because the cold had constricted them. She came in with some wonderful heated blankets and wrapped them around my arms. She then was able to proceed with her prodding, poking, and pricking.

The doctor was unable to conclude exactly what the problem was. The only classic cardiac symptom was angina (a medical term for any chest pain). My overall cholesterol level was good (205, well below the standard of 240), my HDL was also OK (39, above the standard of 35), my blood pressure was low (about 125 over 80) and my pulse rate was low, at about 65. All were at the healthy end of the scale. I think my proudest moment was when he asked if I was a runner. I'm not. The only quickness I've been noted for is getting to the dessert table.

By then Patti had arrived, and more questions followed while they waited for the first lab tests to get back. Patti had also called our friends Ann and Rawley, members of our small group at church. It was 4 AM on a cold winter night, but they were there, standing beside me, ready to pitch in and fight, come what may.

I got the impression Dr. Verre was in consultation with some other doctors. They did not want to treat me for a heart attack if that was not the problem. One of the most effective heart attack treatments is a drug called TPA, which dissolves blood clots, the most common culprit in heart attacks. But if the real problem were something else, the TPA could prove to be counter productive.

During the course of the questioning, I told them my mother had died at 59 from a heart attack. So had my uncle at age 62 and my cousin at age 60. They viewed this information as a significant discovery, since it meant that my heart was vulnerable due to genetic risk factors regardless of other evidence.

Blood test results were also coming back suggesting a cardiac event. These pieces of information, plus the fact that my pain level was not subsiding, were enough to convince them it was the heart. So around 6:15 AM they began to give me the TPA and within minutes the pain began to go away. I later learned that I received about 100 milligrams of the medicine. At $20 a milligram, I had consumed $2,000 worth of drugs in 45 minutes. Thank God for wonder drugs and also for medical insurance.

The test results had shown that my "CPK" numbers had risen from 70 at 4:35 AM to 353 at 6:05 AM. These numbers indicate the levels of a chemical given off by membranes around the heart that get torn when the heart muscle contorts from too little oxygen. They substantiated the conclusion that my problem was cardiac in nature. The pain I felt were the spasms of my heart.

A notation on the printout of test results reads "Results repeated and verified. Critical results, phoned/faxed to JODY … by RLP." I don't know who RLP is but she was certainly paying attention and doing her job. So was JODY. Later test results showed the CPK level had risen to at least 1003 before dropping back to 695. God bless RLP and JODY.

Once I appeared stable, I was wheeled up to the ICU - a private room, no less - and wired up to all sorts of medical gadgetry. I felt like a bowl of spaghetti. The automatic blood pressure machine puffed up the wrapping on my arm every 15 minutes and beeped if it did not like what it registered. I grew used to the noisome beeping, since it wouldn't work when I turned on my side. It also beeped at the nurse's station, and someone would come in to check me. I tried to sleep, but succeeded only in dosing on and off.

About 8 AM, I met Judy, my nurse. Her professionalism seemed surpassed only by her personal warmth. She touched me whenever she talked to me and answered all my questions patiently and thoroughly while she puttered about my bed, showering me with attention and care. She put a "line" in my arm so I would not get a fresh needle poke every time someone wanted a blood test. Her precaution proved prophetic indeed, as at least half a dozen more tests were done before I left her care. The night shift nurse, Margaret, was pleasant and competent, but since I was dozing most of her shift, I failed to get to know her as well.

The prospect of a bed pan persuaded me to fast until the ordeal was over, a decision I did not regret. I also hoped it would allow me for once to achieve some degree of success with my perennial New Year's resolution and actually lose a few pesky pounds. Maybe my suits would start fitting again.

Patti showed up early, as did my brother, Fred. I had a phone but was not allowed to use it (Judy wisely disconnected it). Word travels quickly on the internet of human friendship, and I began to receive visitors who broke up their busy schedules to pray for me and even visit me if only for the permitted five minutes. I cannot mention them all or even begin to relate how good it felt to see the support system kick in. God's prayer line must have been jammed with prayers for me and He must have dispatched a squad of angels immediately since I never experienced any fear or sense of impending doom. I felt an inner peace that if He really wanted to take me home, so be it - but if He had more for me to do here, I was certainly open to that option as well.

Various hospital staff visited me, also, of course, usually to gather information or take away some part of me for analysis so they could do their jobs. I kept thinking of my son Jason's SOAP model, which he picked up at Georgetown medical school, on how doctors figure out patients' problems and treat them: Subjective (what the patient says), Objective (what the test data say), Assessment (amalgamation of the two into a meaningful conclusion), and Plan (what to do to attack the problem).

The Day of Waiting - Wednesday, Jan. 7
By Wednesday, I was feeling better. Judy, God bless her, gave me a bath in bed, including talcum powder - quite a refreshing experience. I learned that nurses are quite adept at strategic towel placement. I was finally able to get on the phone to tie up some loose ends, including arrangements for a final exam that had been scheduled for Friday for my EMBA students. More friends visited.

Another visitor was the cardiologist, Dr. Waibel. At Patti's savvy suggestion, she and my brother were purposefully in the room with the idea that three memories are better than one. Dr. Waibel explained the procedures of angiograms and angioplasty, repeating much of the information we had already received in brochures Judy had given us. But he added value by answering all of our questions regarding the actual logistics and time table. He had arranged the procedures for me Thursday, the earliest date available.

He also suggested that my first trip to China scheduled for March ought to be postponed, since travelling overseas might prove to be a strategic blunder on my part if I had a repeat attack, which is common within several months of the first. He even questioned the advisability of starting the spring semester on Jan. 22. Better left until the results of the angiogram were known. He also recommended watching a video tape, but Judy later told us that all the VCR's were broken.

The Angioplasty - Thursday, Jan. 9
At 8:30 AM another ambulance crew showed up to transport me to Kaiser SFO. Ambulance transport was used in case of another heart attack enroute. It was a real milk run for the company since nothing happened.

We arrived at 10 AM and headed up to the 7th floor. I shared Room 772B with another patient who was going through the same procedure I was. They do 10 to 15 procedures a day at this facility in two separate lab rooms.

I was hooked up again with medical equipment - an automatic blood pressure machine, a heart monitor, and the ever-present IV's. My nurse Margie was personable but all business. The EKG guy was quite warm and did his job with style. A nurse who did not appear to particularly like her job showed up to shave my right groin so the bandages would not hurt as much when removed later. I prayed for her steady hand.

Patti arrived about 10:30 AM, bringing sunshine as usual. Fred arrived about an hour later, and then my daughter, Geneve, who had taken the day off from her accounting job in Menlo Park. My USF colleague and good friend Ed Shapiro showed up also.

I was to be patient #4 for Dr. Goard that day. I never learned how they set priorities for sequencing non-emergency patients; it was presumably first come, first served. We all sat around and enjoyed small talk with each other. Dr. Goard arrived for a little pre-op pep talk. He gave the appearance of a professional but humble man who knew exactly what he was doing. It was very calming to listen to him, knowing he would be the cardiologist who held my life in his hands. He said they would probably get to me at about 1:30 or 2 PM.

Margie arrived right on time to give me valium and blood thinners, followed by the teamsters to wheel me over to the lab room. I hugged everyone goodbye. My heart welled up as I saw the tears in Geneve's eyes as they pushed me down the hall.

I was parked in a holding area next to another patient, Lee, who had preceded me by a few minutes. We observed the staff milling about the various compartments off the waiting room. The place was structured by partitioning curtains, and the work areas were filled with notices taped to cabinets, telephone lists, and a fridge with stickers and photos on it. It reminded me a homey office with a light atmosphere and a dozen or so people. There was a distinct feeling of confidence about the place, as if everyone felt they were part of a good thing. Perhaps I was simply beginning to feel the valium, but I certainly had the sense I was in good hands.

In about ten minutes, I was wheeled into the lab room. It held a long narrow table draped in sheets (not shrouds, I presumed), three TV monitors cantilevered directly behind the table, a large overhead moveable X-ray machine, and so forth. I was asked to get up on the table (it felt great to move around after so much sluggishness in bed).

While I waited lying face up on the table, I could hear the professional staff in the room chatting back and forth with a banter that sometimes sounded like Seinfeld. They exuded competence, confidence, and a comfort level that was very reassuring. My groin was washed with disinfectant.

At 2 PM, Dr. Goard showed up with a second doctor and greeted me warmly. He first warned me that he needed to give me some local anesthetic to dull the pain when they opened the artery in my leg. He pricked me a few times, and then left momentarily. When he came back, one of the supporting nurses asked me to put my arms over my head. The moving X-ray blocked my vision of the TV monitors, and I feared I would miss the show of my life.

It moved in a few seconds, however, and I saw my heart beating on the screen. I had barely felt him touching my leg. I asked him how long it would take him to snake the guidewire up my body to reach the heart and he said "I'm already there - see it on the screen?" Only a few seconds had passed. The wire was so thin (about three human hairs in diameter), it was actually weaker than the vessel walls and would bend around whenever it hit anything without damaging itself or the vessel. Amazing.

He said he was going to inject the die to see the blood vessels that wound around the outside of my heart. I heard a whirring noise and began to see what looked like puffs of smoke on the screen. It was the aorta gushing away the die instantly because the guide wire was not quite into the opening of the vessel under investigation.

Suddenly a dark shape appeared on the screen, looking like a twig with tiny lines forking off it. He and his colleague talked quietly to each other and appeared to be jointly examining all three monitors.

Before very long, he turned his attention back to me and asked me to look at the lower left fork coming off the main twig, which was my Left Anterior Descending (LAD) artery. There it was - the cause of my heart attack.

It looked a little like Popeye's arm, with a short narrow top and wide bottom tapering down to a thin line. It should have been a straight line without bulges. Plaque had formed there, clogging the top end of the artery to a tiny diameter before widening out again a half inch lower. The plaque had reduced the flow rate by about 95 percent. Its corrosive nature had ultimately irritated or torn the vessel wall, and in seeking to repair the damage, my body had sent platelets to form a clot and seal off the wound. The clot, in turn, had blocked the narrow passage way, preventing the rest of the blood from flowing through the vessel to bring oxygen to that portion of my heart muscle, causing it to spasm.

Dr. Goard slid the tiny cylindrical balloon along the wire and blew it up with liquid to widen the vessel at that spot. I felt a twinge of pain as the blood flow was temporarily reduced by the swelling balloon, similar to what I had experienced before. The blood flow is not entirely shut off since the balloon actually has a straw down the middle of it to allow blood to flow even while it was expanding.

He then skillfully guided a metal stent into place. Like a coiled spring, it expanded slightly when placed inside the vessel to hold it open permanently at that spot. About 45 minutes had passed.

They also noticed a 70 percent occlusion on the second fork right next to the first one and repeated the procedure there. Plaque was noted in several other arteries but nothing looked like a problem. It is my understanding that arteries are about 50 percent larger from a plumbing standpoint than what is actually needed to function sufficiently for most of us anyway, so minor clogging is usually not a problem. Blockages of 60 percent or less are ignored.

Dr. Goard noticed a couple of other things about my heart vessels that were immaterial to my condition but interesting anatomically (at least to cardiologists). First, my LAD had a larger than normal diameter. No cause for alarm; some people have larger noses, too. Second, it exited off the main Aortic Arch over the top the Left Pulmonary artery instead of under it. He said they see this only occasionally, but it is not sufficiently rare to make even a footnote in a cardiology text. Perhaps the angel who designed my heart was simply hurrying to finish the job before lunch.

Shortly before 4 PM , I was back in my room with the people of my life all about me in good cheer. I gave the details as best I could and later on, Dr. Goard showed up to report his results. He must have been tired but showed no sign of fatigue. He answered everyone's questions and even showed us a sample of the stents he used. There appeared to be little if any permanent damage to my heart and everything had gone well, as if guided from above.

Margie the nurse showed up to offer a meal. Geneve gently and affectionately fed me, and I was enjoying it so much, I forgot to tell her that I could feed myself.

After a while, my support group began to leave for home. Patti stuck around until I drifted off to sleep. When I awoke late in the evening she was gone, leaving a message with the nurse to tuck me in. I called her at home and was happy to hear her voice. She had been fielding so many calls, I was surprised when she picked up.

About 9 PM, Margie showed up to remove the sheath left over in my groin through which the marvelous guide wire, balloon, and stents had been inserted during the operation. She bandaged the wound and then covered it with plastic gismo that put pressure on the wound with air pressure. Springing a leak in that artery is a major problem, so they are very careful about it healing undisturbed for at least 12 hours before sending people home.

Home - Friday, Jan. 10
I woke at about 6 AM. Margie came in and removed the plastic gismo, replacing it with gauze and tape. She said I was free to get up and move around provided I did it carefully. It was wonderful to feel vertical again, and walking was very therapeutic. I paced about, exploring the various hallways and spectacular views offered out the 7th floor windows in the visitor areas.

About 10:30 AM, Patti showed up with clothes and a waiting van. Homeward bound at last. My medication included blood thinners for a month to stop platelets from wrecking the whole operation by clotting up on the stents. I also must take aspirin three times a week for the rest of my life, a good idea for anyone. My two greatest challenges will be denying my sweet tooth and getting into a more rigorous exercise routine. I am looking forward to many walks together with Patti, whose quick action probably saved my life and who brought me nothing but sunshine during the entire ordeal. I also have a first hand respect for the medical industry and Kaiser. Both have had some bad PR in the past few years, but based on my personal experience, I would rather have a heart attack here than in any other part of the world.

For a great therapy idea to prevent heart problems, click here.