Medical Journal: 8/28/18

Having noted the angiogram results below, some notes on the process:

I was instructed to show up for the angiogram at 7:30 a.m. so I could be hydrated intravenously before the procedure, as one way of minimizing the impact on my kidneys. Not very cheerfully, I did so. My cheer factor was not increased by the Lyft driver’s devotion to sports-talk radio; even fifteen minutes of that goes a long way. Arriving on time gave me the opportunity to spend a pleasant hour or so in the lobby before the cath. folks were ready to deal with me.

I got completely undressed, put on a gown, and lay down on a gurney. Then the consent process, EKG, blood pressure (a little bit high, to no one’s surprise), and they started the IV. Apparently someone took blood for lab work at that point, but I don’t think anyone mentioned it to me; a couple hours later someone asked me if I’d had my labs drawn and I said no, leading to what turned out to be a second blood draw (not, alas, through the IV line).

The unit is very heavily staffed; I think ten different people did things to or for me, all ofthem friendly and efficient.

Next step was shaving the two potential sites to insert the catheter: my wrist (in case the cardiologist chose to use the radial artery) and the groin (for the femoral artery). I asked about Brazilian wax, but apparently that’s an out-of-network expense. After the shaving, the groin area was cleaned with alcohol.

At some point in here, black x’s in what looks like Sharpie marker were placed on the tops of my feet and the insides of my ankles: roughly, but not precisely, symmetric. I’ve tried to figure out what that could have been for, but to no avail, and I didn’t notice until I got home.

Finally I met Dr. Feldman; up to this point he’d spoken to Dr. Weiss but never to me, which seemed odd. Like just about every physician I’ve dealt with in New York, he was more than willing to provide as much technical detail as I wanted. In order to minimize the dye load, the procedure took place in a specially equipped “bi-level” operating room that allows two sets of images to be taken simultaneously. Despite the precautions, he estimated my risk of needing dialysis at about 30%, but apparently the typical pattern is a decline over a period of days rather than acute failure. (That’s why Dr. Bomback wanted labs two days and seven days post-procedure.)

We discussed the wrist v. groin question. The wrist option has a lower risk of bleeding, but the groin option uses less contrast. That seemed to me like an easy decision to make. I’d had no food or water since midnight to allow the use of anaesthesia, but that turned out to be entirely optional, simply to help the patient relax rather than because of any pain from the procedure. Normal dosage would be 1mg. of fentanyl (a narcotic) and 10 mg. of Versed (a very short-acting benzo). I voted against it, partly on general principles –those are fairly hefty doses –and partly because I wanted to have all my faculties in a case significant blockage appeared and a decision had to be made about intervention.

The options seemed to be –depending on the degree of disease -a stent (which could be done on the spot), or something more drastic, all the way up to open-heart surgery, which would have to be scheduled separately. Dr. Feldman was agnostic as to what the test would find; apparently my PET results were worrisome but unspectacular. I was pessimistic; my exercise tolerance has dropped markedly over the past few weeks, and walking at full pace for even half a mile is now a strain.

At 11 a.m. –just as I was about to get on a conference call –I was wheeled in to the procedure area, marked by a huge nine-screen array of monitors (which I couldn’t see during the procedure, so I have no idea what they were for). The insertion of the catheter wasn’t entirely painless, but it wasn’t uncomfortable enough to make me regret the decision to go without the narcotic. I’m not sure why –maybe I wasn’t holding sufficiently still –but early on Dr. Feldman suggested that I get 1 mg. of Versed, and I agreed.

I don’t recall feeling it subjectively; I almost asked if it was in yet a couple of minutes after I’d agreed to it. When I mentioned not feeling it, Dr. Feldman said that in fact I’d drowsed off; one of the reasons I don’t like Versed is that it produces a strong prograde amnesia; for example, I have no memory at all of the three hours of back surgery I had in the mid-1980s, and in fact asked with some asperity when we were going to get going, only to find out I was in the recovery room. That was an extremely freaky experience, and I thought then and still think that patients ought to be warned about the possibility that they will lose a block of time before being given Versed. But I’ve never had that warning, and this was no exception.

After some period –maybe an hour, maybe less –Dr. Feldman said, “Good news. Some cardiomyopathy, but no significant arterial blockage.” I asked whether that meant the problem could be managed with medicine rather than surgery, and he said that it could. I suspect the Versed somewhat blunted my emotional response to this, but I did have the distinct sense that I’d just dodged a bullet.

Then back to the room and two hours of bed rest. Finally I was allowed food and water, if a somewhat stale banana muffin counts as “food.” The rest wasn’t very restful, as I had to keep my left leg straight, a significantly uncomfortable position for my back. Moreover, the patient in the next bed –separated from me only by a curtain –found the remote control for his TV and listened to a basketball game at full volume. Why hospitals don’t hand out headsets –as every gym does these days –is utterly beyond me. For admitted patients, I half suspect it’s a way of selling more private rooms, but that didn’t apply here. Fortunately, his sentence expired about half an hour before mine; next time I’m goingto remember to bring earplugs.

At 2:45, I was told that I could get up, and walked up and down the corridor to demonstrate that I was fit to go home. The single milligram of Versed I’d had meant that I had been “under sedation,” which meant that Richard Hahn had to leave work to come to the hospital. In fact, I was led out of the prep/recovery room into the lobby and left there, so I could have escaped without an escort, but since Richard was already on his way I dutifully waited. In the meantime, I had managed to reschedule my radiation treatment –conveniently just across the street from the angiogram –so I went for that, got in right away, and headed home.

As far as I can tell, neither the procedure nor the benzo had any after-effects; I had a good appetite when I got home.

It occurs to me that I haven’t written anything about the mechanics of radiation treatment, but (as some modern Bible translation no doubt phrases it) each day has troubles enough of its own.

Author: Mark Kleiman

Professor of Public Policy at the NYU Marron Institute for Urban Management and editor of the Journal of Drug Policy Analysis. Teaches about the methods of policy analysis about drug abuse control and crime control policy, working out the implications of two principles: that swift and certain sanctions don't have to be severe to be effective, and that well-designed threats usually don't have to be carried out. Books: Drugs and Drug Policy: What Everyone Needs to Know (with Jonathan Caulkins and Angela Hawken) When Brute Force Fails: How to Have Less Crime and Less Punishment (Princeton, 2009; named one of the "books of the year" by The Economist Against Excess: Drug Policy for Results (Basic, 1993) Marijuana: Costs of Abuse, Costs of Control (Greenwood, 1989) UCLA Homepage Curriculum Vitae Contact:

2 thoughts on “Medical Journal: 8/28/18”

  1. Finally a time when unspectacular = good.

    I hate having to be places early too.

    I had to have a catheter put in once when I was young. I recall promising myself I would never get married.

    You do not want to get waxed. Don’t ever let someone talk you into it. If they do though, ask me first bc there’re ways to make it hurt less.

    It’s amazing you felt up to making decisions in a situation like that. I’d have to have a relative there, pain or no pain.

    The noise pollution from the next bed sounds just awful.

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