Heart Attack

February, 2010

Well, here is another of one of my ‘newsletters’ about my life overseas. First, let me start off by assuring you that my surgery was successful, my heart is fine now and Gordana is on her way back to Cairo to take care of me. So I guess there is really no reason to read any further.

But, if you are curious for a little more information, here’s what happened.

Monday evening, just this week, February 15, I was lying on the couch as I always do, watching TV on the wall through my video projector, sipping a little California wine and winning play money at PokerStars.com, when I tried swatting some insect I saw in the corner of my eye. It turned out that it wasn’t an insect I saw, but a streak of light. I thought, “That’s weird”.

Soon, my left arm started to ache. Now I’m beginning to worry. Gordana was still in Belgrade planning to return when I returned from the school trip to Italy I had planned for next week. Well, there was nothing I could do, but the pain persisted all night.

The next morning I went to school but headed directly to the school medical facility. Angie Tipton, the head nurse, was busy with a couple of elementary kids, but when she saw me and heard my complaints, she got on the phone and called for the another nurse to rush to work early. When Claire got there, we had a school driver take us to the As-Salam International Hospital emergency room.

I showed them my insurance card and to my surprise, there was no paper work to fill out and I was promptly rushed in. They treat foreigners very well here and in minutes I was hooked up to an EEG (we call it EKG) machine and also had blood taken for testing. They discovered some problem, but more tests were going to be necessary. I agreed to do these tests as an outpatient and we left the emergency room about 11AM.

I went to my office and did a little work. Fortunately, I didn’t have any classes on Tuesday (I teach 3 out of 4 periods one day and none the other, one of the many reasons I like Cairo). My physician, Dr. Ghaly, was due to be at the school at 3PM and I made an appointment to see him then. After we talked a few minutes and he reviewed my test results from the emergency room, he insisted that I be admitted for more tests immediately. He called a well-known cardiologist, Dr. Ayman, and made arrangements for me to be admitted. So by 5PM, I arrived by taxi at the hospital.

Remember please, that I am living in a Third World nation. It’s a beautiful place with more history than any other place in the world, but still a Third World nation with many things we take for granted missing.

The receptionist told me to go to the 2nd floor to admissions. I went around the corridor to the bank of elevators – 6 elevators with 5 taped up for repairs (to be fair, I think they were newly installed). On the second floor, I found a small room with the word admission on the door. After a short wait, I introduced myself and presented a note that Dr. Ghaly had given me. They did not seem to understand why I was there and their English was only a little better than my Arabic.

A man took me down (by stairs) to the emergency room and they started the same routine that I had just done a few hours earlier. I told them that and said I just wanted to be admitted and not go through the time consuming EEG and the painful blood test, again! They insisted that I put on a gown and go through the tests. I almost walked out. I didn’t really want to be there in the first place.

It turns out that what they were doing was the proper procedure for admissions at As-Salam Hospital – even though I had just done it. In any case, I was eventually wheel up to CPU. That stands for Chest Pain Unit. My room in the CPU was a typical hospital room but since it was for monitoring, there were two beds separated by a curtain, ordinary hospital beds, monitors and a flat-screen TV with one remote control.

The nurses hooked me up to an IV in each arm, one to thin my blood and one to enlarge my arteries and veins. That’s the one that gave me headaches. Being strapped down with IVs to the bed like I was made going to the bathroom a problem. Yet, the solution was a little plastic bottle that sounds like it might be a good idea for home, but I’m sure Gordana would never go for it. Too bad.

The next morning, I was wheeled down in my hospital gown to a waiting room full of normally dressed strangers to shed the last shreds of any dignity I had left. Soon, I was taken to the x-ray room and after another wait in a second waiting room with new strangers, I was taken to a room for an echo exam of my heart. The technicians said it looked good. No damage. So now all I had to do was wait until noon to see the cardiologist, Dr. Ayman, and go home.

Two o’clock passed and I was told he would be in at 3. At 4, it was going to be 5 and I was losing all hope of going home that same day. Finally, at 8 PM, Dr. Ayman arrived and apologized for being late due to a family problem.

Dr. Ayman is a well-dressed Egyptian in his late 50’s who speaks very good English even with a pronounced Egyptian accent. After listening to me recount my symptoms, he went into much detail explaining the situation. I won’t go into all of that for fear of making this letter too long (I think an LOL is appropriate now). But the point is that we have 3 arteries and the left one is the most important. I had a constriction in the left artery from cholesterol and blood platelets. I’ve always had low a cholesterol count, but I’ve never been 61 before. He wanted to operate the next day at 2PM. Angioplasty.

Well, I have never had any fear of asking doctors questions. My first question to Dr. Ayman was, “just how many of these operations have you done?” He smiled and made some weak joke of not having to bring any books into the operating room. Then he raddled off several impressive qualifications: first surgeon to perform an angioplasty in Egypt, doing them since 1986, worked for a while at a prestigious hospital in Washington, D.C., published often in medical journals and much more. I was impressed and agreed to the operation.

I then called Gordana in Belgrade for the first of many times with the news that instantly put her into tears. Later, I called the school’s head nurse, Angie, about my decision. She made it clear to me that I had other options about where to get the operation and she suggested Israel because of its good medical facilities and nearness to Cairo. She did not advise me to do this here. She promised to call the next morning with more information.

After a second sleepless night anchored to an uncomfortable bed, Angie called. The insurance company would approve a doctor in Israel and she would set up a flight that night. It would take a few days before I could be operated on and I wouldn’t be able to return to Cairo until the following weekly flight (Egypt and Israel are not that good of friends), but I agreed and told her to go on with the plans and to ask Dr. Ghaly to inform Dr. Ayman.

So now I’m waiting to be dismissed to take the night flight to Israel and the only person who could dismiss me was Dr. Ayman who I wasn’t going to see until 2. I called Gordana again and told her when I had more details I would tell her where to meet me.

At about 2:30, Dr. Ayman arrived and said that based on the latest EEG, my clot was getting bigger and even though it was my choice, he would not recommend my flying anywhere due not only to the stress, but even the lack of oxygen in the pressurized cabins. He said of the 3 patients he had at this time for the same thing, mine was of the most concern to him. So again, I was faced with a vital decision to be made all by myself. One person insisting for me to proceed in haste with the operation and another saying she did not feel comfortable recommending surgery in Egypt.

But I trusted Dr. Ayman and he assured me that despite my fears, this minor operation would be done to his standards and while he would not give me any guarantees, he would take personal responsibility. I said that since I cancelled earlier, when could I be worked in. He said, “now.” I said, “I trust you so let’s do it.”

He left, and a nurse rushed in with a safety razor and told me to shave. I did need a shave, but I soon learned she meant my abdomen and groin area. So in less than 5 minutes, my faith in Egyptian hospitals was waning. Yet, I agreed to do what she said and asked her to fully close the curtain around the bed. But it was hung up and would only partially close. I put my foot down and said fix it or disconnect me from my tubes so that I could have privacy in the bathroom. They let me go to the bathroom. As it turns out, she didn’t like the barbering I did (frankly, I couldn’t see where I was shaving over my belly) and she finished the job with me just lying sideways on the bed with the open curtain! But remember, I had lost the final shreds of my dignity in the waiting rooms.

Soon I was wheeled down to the Cardioatric Unit where they layed me down on a bed in a small waiting room. I noticed a receptacle guard was missing from a electrical wall plug-in. The walls needed fresh paint especially since it wasn’t done carefully the last time. The ceiling tiles showed water stains. I was beginning to wonder if I had made the wrong decision.

When I was rolled into the operating room, I felt a little relieved. The room was clean with modern equipment and everything labeled and sorted efficiently. Three or four nurses greeted me with, I am sure, smiles behind their masked faces. Next to the operating table were three large LCD monitors that even Mike would envy. I’m feeling better. I laid down on the operating table and Dr. Ayman entered – no mask!

But he was very comforting and told me he would talk to me throughout the entire operation. What! I’m going to be awake! Let me out of here!

It turns out that he sterilized my upper leg, deadened the area, and made a small incision at the top of my right leg (wasn’t it my left artery that was the problem?) about an inch below the fold of my leg and my abundant abdomen. I didn’t feel a thing. He then inserted a probe that he could track on the monitors through an x-ray machine that was positioned hydraulically in several positions over my chest. He first went through my right artery and, as he expected, found no problem. The same pleasant results through the center artery. And finally, he somehow magically threaded the probe to the problematic left artery, I think with only the assistance of me turning my head far left or far right.

When he found the constricted area, which was blocked 80%, he inserted a metal stent, a thin metal tube, which would open the clogged area. He could instantly see the results on the monitor. The whole thing lasted less than 40 minutes and he was proudly satisfied with the procedure.

The next morning after the Thursday operation, I was dismissed from the hospital. Unfortunately, it took an agonizing 5 hours to get through the inefficient hospital administration hurdles and actually leave the place, but now I’m home, up and around and doing fine. I’ll be back at work Monday and Gordana will return soon.

Looking forward to seeing everyone in late June when Gordana and I will be in the states for a month. Hope we can have another reunion somewhere. Inshallah (God willing).