Chapter
1
The Wake-Up Call
'Nothing in life is to be feared,
only to be understood.'
—Marie Curie
'I feel like I have a vice on my chest.'
I'll never forget those words from my very first 'patient.' It was 1982, and I was twenty-three, a second-year medical student studying for the medical boards in the wee hours of a morning in May. Until that point in my career, medicine was confined to lectures and textbooks. But then came the 2 a.m. knock, knock at my door—and the wake-up call that would change my life forever. It was my dad.
'Dad? Dad, what's the matter?'
If I ever saw a heart attack, this is it, I remember thinking when I saw my father, Joe LaBella, a fifty-three-year-old mail carrier from Syracuse, New York, bracing himself against the threshold of my childhood bedroom. It was like something you might now see in a movie or a television commercial for a heart disease drug: Dad's fist was clenched to his heart, his T-shirt dampened in a stripe right down the middle. Clearly, Dad was in trouble, but at least he didn't have to go far to look for help. To keep expenses down throughout medical school, I lived at home. Dad simply had to lumber up a flight of stairs. Still, what I offered in terms of convenience, I lacked in experience. Dad was probably having a heart attack. That much I knew. But what to do?
Call an ambulance? As it turns out, that wasn't an option. A proud Italian male, my father insisted that I not lift the phone—that we quietly slip out of the house to a local emergency room. 'Don't tell your mother, and don't call the rescue squad, because it will wake her,' he instructed, refuting my plan. That was just like Dad, not wanting to bother or worry anyone. He never wanted to let on if he was having a problem. Still, the fact he came to me for help clued me in. This must be really bad. I thought for a second. If I insist on phoning for help anyway, Dad will probably worry so much about upsetting Mom that he'll have an even worse heart attack and drop dead. I reasoned that I had been a lifeguard for ten years by then, so I knew CPR. I could help him if he had a problem. So that was that. We got in the car and headed to the emergency room.
CPR—An Important Skill
When the heart stops completely during an attack (cardiac arrest), and the person loses consciousness and stops breathing, cardiopulmonary resuscitation (CPR) can save lives. I remember clearly one patient whose life was saved because his wife knew and performed CPR. It's an important skill to know that can help you be prepared in the event of a heart attack or another life-threatening situation. To locate a CPR training center near you, log on to the American Heart Association Web site at www.americanheart.org and check under the 'Find a Class' option.
On our clandestine mission, Dad and I drove down Woodbine Avenue, past the rows of small but well-kept single- and double-family homes. They were filled with the children, parents and grandparents we knew, people who shared everything from driveways to major life experiences. We moved to the Syracuse neighborhood after our family of seven outgrew a flat in the inner city. As I'd done a thousand times since I was old enough to drive, I stopped at the intersection, waiting to turn left onto James Street, which would take us to the hospital. In the middle of the night, the streets were eerily empty. Still, I dutifully waited at the red light for what seemed like hours. Fortunately, Dad had his senses. 'Go through the light, Lori,' he said gently, peering into my eyes. It was then it hit me. Dad's really having a heart attack. He might die. The fear welled up. I pressed on the accelerator.
You can probably imagine the doctors, nurses and orderlies running around in the emergency room, putting IVs in Dad, just trying to do all this stuff. I told the attending physician I was a medical student and pretty sure my father was having a heart attack. When the emergency room physician showed me the results of Dad's electrocardiogram (ECG), which is the most important initial diagnostic test to be administered when a heart attack is suspected, I pretended I could read it, but my mind was spinning. 'Your father is having a heart attack, and I need you to make a decision,' she said. I was filled with dread. Making a life-or-death call was the last thing I wanted to do in that already stress-filled moment. In fact, what began running through my mind like a ticker tape was not, What can we do to treat Dad? but What could we have done to prevent this?
As it turns out, the hospital was participating in one of the early pharmaceutical clinical studies of thrombolytic therapy, testing what we now call 'clot-busting' drugs, which are used to dissolve blood clots blocking an artery during a heart attack. We now know that clot busters open up the artery and restore blood flow to the heart. They're crucial for stopping a heart attack in its tracks. To be most effective, they need to be administered as soon as possible after symptoms begin.
But at that point in medical history, we were still finding our way. Folks in the throes of a heart attack like Dad would be needed to help researchers make that determination. Did I want Dad to participate in the clot-buster study? I yearned to call my mother, who was still at home, asleep, to get her input, but there wasn't time. 'You need to decide right now,' the physician said.
I took a minute to explain the situation to my father, who was by this time rigged to an arsenal of equipment, an unnerving
beep . . . beep . . . beep in the background. Maybe he would know what to do. Don't dads know everything? 'You decide,' he said. My twenty-three-year-old mind ran through the options. If Dad received the new drug, there was some risk of internal bleeding, which wasn't good. But there was also a chance that the damage his heart endured from the heart attack would be reduced. Yes, no. Yes, no. I weighed the options. 'He should participate in the clinical trial,' I told the physician, who promptly made a telephone call that would determine if Dad would receive the experimental drug or not. Unfortunately, we were told that he did not meet all the criteria to be in the study.
I broke the news to Dad, who was cringing from pain, even though he was receiving morphine. Now what? Over 40 percent of first heart attacks are fatal. I didn't know that statistic then. Still, I had a sense there might only be minutes left, so I finally called my mother and broke the news. I didn't want to rob her of the chance to say good-bye. We decided not to wake up my younger brother John, a junior in high school sleeping at home, because he was scheduled to take the SATs that morning. Later, he too, would become a doctor, but for now he was my little brother and I needed to shield him. Then I went back to Dad's bedside and took his hand. 'You're a great dad,' I began to stammer. I could feel myself losing it. He turned to me from behind the veil of tubes. 'Don't start to show it,' he said.
I was taken aback, but I got it. The last thing Dad needed was for me to be a window to the end. He wanted me to be strong. But how could I be? To pull myself together, I took refuge in the nearest restroom. There, I was struck by the hospital-regulation basic white sink with overhanging mirror. Feeling a familiar tug from my Catholic upbringing, I couldn't help but notice how much the fixtures looked like an altar. Kneeling on the bathroom's chilly tile, I pleaded with God not to take my father. Please don't let him die. Hopefully, at a time when there was doubtless ample suffering in the world, I could garner God's attention. I didn't know what else to do.
I just couldn't imagine what I would do without my father. Dad had been my support for so much of my life, through all my forays into competitive sports, from grade school through medical school. And I still needed him. My mother was proud of me, and always there for me, but I someday wanted to walk down the aisle at my wedding on my father's arm.
Everybody deals with crises differently, and when my mother arrived at the hospital, my father got a scolding. 'Joe, I told you not to smoke,' she said. It was true. My father had acquired the habit during his army days, and we were all constantly hounding him to quit. And even though Dad was a mail carrier who got lots of exercise, his physical fitness didn't override his smoking. Interestingly, just prior to his heart attack, he was told his total cholesterol was normal. But we would later learn that he actually had low levels of HDL, the 'good' cholesterol that protects the heart against heart disease, which wasn't reflected in Dad's 'total' number. Admittedly, Dad's diet could have been better. Even walking several miles a day couldn't undo all those years of Italian sausage!
Wisdom 911
I learned so many important lessons on that early morning in May, right before I was to start my clinical training and the second two years of medical school: seeing a heart attack happening and experiencing such a huge loss of control, having to make dire life-or-death decisions in an instant; feeling I was about to lose someone I loved—without the chance to tidy up affairs or really tell him how much he meant to me. With heart disease, the leading killer of both men and women in the United States, it's no doubt that countless people experience a similarly frightening scenario, whether it be a stranger on the subway, a close family member or a coworker who was just a minute ago typing away at his desk. We all hear stories. And based on the statistics, there's a good chance that one day that person could be you or your father, mother, spouse, friend or grandparent—either as victim or rescuer.
What could Dad or we have done differently to avoid this medical crisis? As it turns out, plenty! Because, despite all of the scary statistics surrounding heart di...
