Anatomy of a Heart Attack


In one pivotal moment, doctor becomes patient.

Written by Kurtis W. Eaton, M.D., MBA

Photos by Edward Badham

“Dr. Eaton…. are you OK?”  The words hung heavy in the air between us while April looked at me around the edge of my office door.

The moment was palpable.  Something was changing.  Something had changed.  You know that feeling you got when you saw the plane fly into the World Trade Center?  Or (if you’re as old as me) when you saw the space shuttle Challenger explode on live television while you watched frozen in time, the DVR in your mind kicking automatically into record mode because you know something important is happening right in front of you? You’ll replay it over and over again to capture all the detail, the flavor, the smell, the acrid taste of adrenaline in the back of your throat.  You’ll replay it later when you feel safe once again and you want to see what really happened right before you.  To you.  I knew this was one of those moments.  Life- changing.  Perhaps even life-ending… like my father before me.  “I don’t know,” was all I could manage weakly.  “I don’t feel good.”

No otherwise healthy young adult in this country nearly dies as many times as the second-year medical student.  Devoid of any semblance of normal life for two years, figuratively locked away with our fellow students, we listen and study and read and memorize and then regurgitate on endless exams first the minutia of the fantastic human body, the myriad processes and reactions and interactions that give rise to the awe-inspiring miracle of life.  Once we form our first simplistic and inadequate understanding of the amazing machine that is the body, we then are presented with graphic evidence of how truly fragile and tenuous human life can be.  Professors assault us with colorful images of suffering, graphs depicting painful decline in function and complicated yet delicately balanced equations that prove (as we suspected all along) that this fantastic machine really does break down.  We read case studies of carefree people going about their lives completely oblivious to the malevolence growing within them — the scratchy throat, stomach ache or shortness of breath at the top of the stairs the first hint, often overlooked.  The Grim Reaper does exist, after all, and we have caught his eye.  We assimilate this awful knowledge and study case after tragic case, projecting this disease or that infection or malady onto ourselves.  Surely this gnawing in my abdomen is early pancreatic cancer.  This nagging headache must be a glioblastoma, and that missed step on the way to class my first sign of the ataxia associated with Jacob-Creutzfeld (Mad Cow) Disease.  We feel and believe that we have every disease we learn about, or most of them anyway.  Yet with our evolution into the third year an interesting thing starts to happen.  We see, for the first time, disease, infirmity and, yes, even death, beaten back.  We force it into submission with powerful drugs and razor- sharp instruments and the unseen power of the atom.  Faith is restored.  Good prevails over evil, and life over death.  Things are once again the way they should be, and our new experiences tell us that our superior knowledge and cutting-edge technology can force demon disease back into its box.  Sure, sometimes we lose, but just look what we did for Mr. Jones!  See how well Mrs. Smith is breathing today?  And her cardiac output has improved 20 percent!  Etc., etc.

We become callous again, but this time through our ego and arrogance rather than the innocence of the uninitiated.  We believe, because we need to believe, that disease is manageable, and besides, that’s what happens to our patients, not to us.  Certainly not to me!

I was in Exam Room 3 explaining in my usual confident, self-assured manner exactly why it was so important that Ms. White follow the low-cholesterol diet I had prescribed for her.  Couldn’t she see that this was important and all the awful things that would happen to her if she didn’t?  I recited the statistical correlation between elevated LDL cholesterol levels and the incidence of cardiovascular events from memory, the familiar song of these words flowing across my lips.  I did care about her health and well-being, of course, but it’s a story I’ve told many, many times to many patients before her.  Then, suddenly, something sucked all the air out of the room.  I couldn’t breathe.  Like a fish out of water I opened my mouth wider, lungs pulling, but still I couldn’t get a good breath.  I felt my heart racing and in that moment felt the warm wave of nausea rush over me.  Quickly excusing myself, I found the bathroom and closed the door behind me.  Instinctively I splashed cold water on my face and then looked up at the bewildered, now truly concerned, person staring back at me in the mirror.  “Get it together,” I told myself, “she’s still in the room waiting for you.”  Composing myself, I forced a smile and re-entered the exam room and apologized for leaving so abruptly.  I sat back down on the stool and continued explaining the risk factors for heart disease, hoping my false projection of confidence would reassure her that everything — that I — was all right.  I was thinking about what important point I wanted to make next when I became aware of the salty rivulets of sweat running down my forehead and into my eyes. In seconds I was profusely sweating like an athlete in a hot gymnasium.  Excusing myself yet again, I stumbled into my office and fell into the chair behind my desk.  Only in that moment, that life-changing moment, did I feel the pain.  It was the most intense, indisputable, all-encompassing pressure I’ve ever experienced, right in the center of my chest.  It was exactly as if I was lying on my back in the parking lot, and someone had driven a large truck over me and stopped with the tire directly over my sternum.  As April slowly poked her head around the door to check on me, I was wondering if this was what my father felt when, at the age of 48, he came into the house after raking the yard and died suddenly from a massive, unexpected heart attack.  I remember a weirdly inappropriate inner chuckle as I wondered if I would be making an appearance in tomorrow’s obituaries.

“I really don’t feel good” was all I could muster as April continued to stare, wide-eyed, at me slumping in my chair.  I simply couldn’t find any other words despite my extensive medical vocabulary, and I couldn’t explain my predicament any more clearly.  “I must be quite a sight,” I thought, and felt a tremendous sense of relief when she turned away, and I heard her telling someone, in a voice a million miles away, “I’m calling an ambulance.”

The 10-minute ambulance ride to St. Vincent’s East took forever in my mind, the events unfolding in slow motion.  Yet upon arrival, things started to happen lightning fast:  different people asking me questions at the same time while others pulled away my clothing and started my IV.  The nitroglycerin patch that had been applied in the ambulance kicked in and, despite the now pounding headache, the awful pressure in my chest was abating.  “I’m fine,” I told them, disbelieving it even as I said it, “I’m sure it was just indigestion.”  Dr. Jason Thompson, a cardiologist with Birmingham Heart Group, entered my room in the ER.  Now I remembered that I had asked Amanda, my office manager, to contact him as they were lifting me into the ambulance.  Reviewing my chart, he told me that we needed to act right away.  “We could wait and do a stress test, but in patients like yourself who are a little heavy (he said diplomatically) it’s possible we could get a false negative result.  Considering your classic symptoms, I think we need to do a heart cath right away and really SEE what’s going on in there.”  I’ve sent hundreds, probably thousands, of patients for heart caths over the years.  It is a routine diagnostic test, and the decision to order one is done thousands of times daily by physicians all across the country.  The reality and gravity of it, however, seemed nearly overwhelming in that moment, and all I see in my mind were the potential (but rare) complications that could occur, like a perforation of one of my coronary arteries.  Desperately searching my mind for a reason to say no, I looked over at my friend Renae Dyer, who was holding my hand, a reassuring smile on her face, and gently nodding yes to me.  It had to be done.  So I did something out of character for me; I decided to listen to my newfound cardiologist (we DO make the worst patients, you know) and agreed to the cath.  Grasping the reality of the situation and understanding that it would be happening to me in a matter of minutes was very sobering, and the fear that patients everywhere feel every day began to creep into my consciousness.  I experienced the fear of death, of complications, of leaving my children behind.  I tasted the fear of having to place my fate, my life, completely and utterly into the hands of others.  What if something went wrong and I couldn’t work any longer?  How would I take care of my daughter?  I stood at the edge and peered into the darkness, scared and uncertain.  As the doubts grew and circled within my mind, it was the calm, confident manner of Dr. Thompson that allowed me to see past my fear.  He stood there awaiting my answer with the poised demeanor of someone who had navigated this journey, successfully, many times before.  I put my everything into his hands in that moment.  “Let’s do it,” I heard myself saying.  Renae squeezed my hand, silently, not feeling the need to speak but instead just being in that place, in that moment, with me,  just like a friend should.

Although the incidence of coronary heart disease (CHD) has been declining over the past four decades, it is still a major cause of death and disability in developed nations around the world.  In the U.S., it accounts for about one-third of deaths of individuals over 35 years of age.  It is the leading cause of death in men and women of every ethnic group and claims the lives of approximately 2,500 Americans each day.  To give you an even better idea of the scope of this problem, it accounts for more deaths each year than the next four leading causes of death combined:  cancer (all types), chronic lower respiratory disease, accidents and diabetes mellitus.  The major risk factors for the development of CHD are readily identifiable, and with the exception of family history they are also modifiable through lifestyle changes and/or medication.  These risk factors include smoking, sedentary lifestyle and obesity, hypertension, high serum cholesterol levels, diabetes and elevated c-reactive protein (a marker of systemic inflammation).  Your physician can teach you ways to lower your systemic inflammation markers, the “new kid on the block” as far as risk factors are concerned, but treating the others is relatively simple and intuitive.  The problem is that it involves those things that everybody knows they should do but few people actually accomplish.  Eat right, eat less and exercise more. Treat your elevated blood pressure and cholesterol.  Treat your diabetes if you have it.  It’s really not rocket science, but millions of people fail to achieve these goals because they require fundamental change of our behavior on a daily basis.  Hard stuff, change.  My ingrained sense of invulnerability and belief that heart disease was the “other guy’s” problem nearly cost me my life.  After all, CHD was something that I treated, not something that I had.

Over the next 36 hours, I underwent two heart catheterizations.  I had three serious blockages in three different arteries, including a critical blockage in the left anterior descending artery (the “widowmaker”).  Dr. Thompson and his colleague, Dr. Townshend, used the femoral approach the first time (the traditional site in the groin…ouch, and free bikini wax with purchase!) and the radial approach the second (in the wrist…piece of cake…will get my vote every time). Three coronary stents were placed, including one that is nearly four centimeters in length.  I entered the hospital taking Nexium for my acid reflux and Lisinopril for my hypertension, and I left taking EIGHT different medications.  Believe me; lesson learned.

I’ve started the heart-healthy Mediterranean Diet, which is not only delicious but is also associated with very low rates of CHD in areas around the world where it is in wide use.  It is based upon delicious seafood, healthy mono- and polyunsaturated fats, fresh veggies and fruits, whole grains and nuts.  I’ve lost 15 pounds the first six weeks.  I’m also at the gym at least five days a week, doing 45 minutes of cardio.  I have nearly eliminated caffeine (got to have that first cup in the morning, however) and drink mostly water.  My journey to fitness is now a priority in my life, and my brush with death all the motivation I’ll ever need to keep it going.  I’ve always known I had a stubborn streak, but it’s a shame that it took something this serious to get me going.  Be smarter than me. Get off the couch.  Walk, jog, bike, swim, whatever!  Just move and eat right.  Your heart will be glad you did.

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2 Responses to “Anatomy of a Heart Attack”

  1. Jody Stallings says:

    Dr. Eaton,
    I’ll always know you as Kurt. We grew up together on Philsdale in good ole Memphis.
    My mother talks to your mother frequently. Mom sent me your article and I just finished reading it. Very well written…great content. I was “on the fence” about going to the gym this morning but you sealed the deal.

    Hope you are doing well. I’m in Birmingham occasionally and would love to catch up with you on our last 50+ years….

    Send me an email.

    Jody Stallings
    Smith + Nephew Orthopaedics
    Regional Technical Director-SE Region
    1689 Eagle Trace Blvd.
    Palm Harbor, FL 34685

  2. Lanna Alwine says:

    Dr. Eaton,

    Wow, what an eye opener to those of us in the healthcare field. We preach to our patients all the time the importance of eating right, excercising and taking medications as our MDs order. But, as you know many of us still don’t live the healthy lifestyle that we preach. I am so glad that you made it throught all of this and that you shared your story. This is an eye opener for me with a family history of CHD,and DM. Thank you again for sharing your story.

    Lanna

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