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A view from the gurney

Lyons, Stephen E., MS, PA-C, DFAAPA

Journal of the American Academy of PAs: February 2014 - Volume 27 - Issue 2 - p 1–2
doi: 10.1097/01.JAA.0000441994.76076.65
Mindful Practice
Free

Stephen E. Lyons is a staff PA at Forte Family Practice in Las Vegas, Nev. The author has indicated no relationships to disclose relating to the content of this article.

Tanya Gregory, PhD, department editor

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It was supposed to be a screening test new to Las Vegas, Nev. I was invited to tour the test facility and have complimentary EBCT (electron-beam computed tomography) of my heart for calcium scoring. I understood calcium scoring to have a rough correlation to plaque burden in the coronaries. I'd never had any type of cardiac symptoms at all and could outlast my wife and friends on the treadmill. But at 66 years old, I did have the usual risk factors as well as a very positive family history. The test was quick and simple as well as free, and after a couple of minutes of buzzing and clunking, I stood up, shook hands, and left.

I had all but forgotten about it when I received a business envelope marked “CONFIDENTIAL” from a local radiology practice. I get these all the time. No, I thought, I'm not looking for a job. No, I don't know anyone who might be interested. I don't know why I decided to open this one, but when I did, it told me that my calcium score was very high (>500), indicating a high probability of a cardiac event in the next couple of years. In less than 1 minute, I had gone from being a happy-go-lucky, healthy guy to being paranoid about my health!

What did it mean? Is calcium scoring accurate? How well does it actually correlate with what's really going on in my arteries? As a medical professional of nearly 38 years, I kept echoing the admonition in my head: “You'd better know what you don't know!” So I did what I thought anyone would do. I procrastinated. For a couple of months.

Finally, I showed the report to a cardiology colleague of mine. His fabulous reputation was outshone only by his humility and humanity. He said, “You know, Stephen, it's really not clear how closely this correlates with the standard tests, but it tells us we should look further.” And that's how, after a whirlwind of standard studies, I found myself in the cath lab being prepped for an angiogram. My colleague reassured me that all would go well, and so without sedation, at my request, we watched the screen as the contrast flowed—or didn't flow—into my arteries.

I saw several of what appeared to my family-practice eyes to be occlusions. I cracked to my colleague that I guessed he'd be reaching for the stents any minute now.

“Uh...no, Stephen, unfortunately these are not stentable lesions.”

Silence.

“You're going to need CABG.”

“Really?” I said, with his words echoing in my ears. “But...but...I've never had even the slightest symptom!”

“All the better. Just consider it an investment!”

While I was lying there with a nurse putting her body weight on my right groin, my mind was going a mile a minute. How long will I be disabled? What about my patients? How will my wife handle this? What if I wake up with cognitive deficits? What if I don't wake up at all?

A few minutes later, a nice young fellow walked up to my gurney. He looked about the same age as most of the second-year PA students I've mentored. He was smiling and friendly and introduced himself as the chief of cardiothoracic surgery at the hospital. My cardiology colleague had asked him to stop by and discuss my options. That was easy because I really didn't have any good ones.

I proposed that since I was healthy and asymptomatic, we might wait. He agreed. “Why don't we wait, say, until Monday at 7:30 a.m.” (Three days away!) “I'd rather operate on healthy tissue than infarcted tissue.” Even I couldn't argue with that logic.

My wife of nearly 43 years knew what to say that night as I tossed and turned. “Let go...and let God!” Those words had never failed me in years past, and as I am a man of deep religious faith, they didn't this time. I fell asleep and slept very soundly. The next day, I found myself looking forward to getting this done with. I called various family members, laid out my important papers on top of my desk, and then we went to the movies!

Monday morning after a 3-minute wait, I was whisked off to preop after one last kiss from my wife and a hug from a couple of supportive friends of ours. I was greeted by an all-business anesthesiologist who asked seemingly hundreds of questions at world-record speed. Then he commanded, “Slide your tush onto the operating table!” I remember him saying exactly two more words: “You on?” No niceties, such as “You're going to sleep now” or “Count backward from 100.” Just, “You on?” Then I was waking up in the surgical ICU.

Incredibly, I was done, and things had gone very well. Six bypasses were done on my beating heart without need of a heart-lung machine. I was aware of one other thing: NO PAIN! I couldn't believe it—they had cracked my sternum, and it did not hurt?! In fact, from that moment until discharge, I had NO PAIN!

Although I felt ready to go after they pulled the endotracheal tube, it wasn't quite that easy. The hospital food was so bad that no prison would risk serving it to inmates. And I'd better never find out who pulled my urinary catheter without knowing I had just been given Lasix! I could've put out any fires on the entire hospital campus! I think they had to call in an extra shift of housekeepers just to keep my bed changed and the floor mopped! How humiliating! “But it's not my fault,” I kept saying. “We know, we know,” they kept saying. My PA strolled in and helpfully said, “Well, you certainly peed your brains out last night!” As he grinned, homicide briefly came to mind.

Well, I've been home for several weeks now and feel very well except I must take at least two good naps a day. I was warned about this, but of course I knew it wouldn't apply to me! Ha! Cardiac rehab starts next week, and I'm sure I'll just fly through that...like a penguin!

Oh, and I have a newfound appreciation for what hospital nurses do. They are incredibly kind, skilled, and dedicated to their calling. My nursing care was superb, as was the support staff care. My doctors, ANPs, and PAs were all very kind and attentive. In fact, they couldn't have been better!

But my last comment surely must be this: “Things certainly look different from the gurney!”

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© 2014 American Academy of Physician Assistants.