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Wednesday, November 25, 2009

I'm going to die of something, but likely not this

Heart disease will apparently not be the cause of my death. I had an ECHO stress electrocardiogram (EKG) yesterday. My doctor recommended it because she had recently discovered a change in my routine EKG. The transmission time had increased for an electrical signal from my "right bundle block," I think she said. She thought we should try to rule out the possibility that there might be a coronary artery blockage.
    Having been reading Nortin M. Hadler, MD's book, Worried Sick: A Prescription for Health in an Overtreated America, I asked a few questions designed to find out whether the test were really necessary. "Would whatever we find have any practical value?" "Would possible interventions make any sense anyway?"
    She stuck by her recommendation that I have the test.
    The otherwise nice technician didn't use enough lather (if she used any?) to shave some patches of hair off my chest before sticking the EKG leads to me and taking readings of me lying, sitting, and standing prior to her greasing my chest for the pre-treadmill sonogram. The sonogram took so long that I fell asleep during it. I was, after all, lying down—in my favorite position on my left side, and the lights were out so she could see the graphic image of my pumping heart on the monitor.
    Then the cardiologist came in and explained the treadmill procedure. She always uses the "Bruce" schedule that calls for 3-minute intervals, with the speed and incline of the device increasing for each after the first.
    I guess the cardiologist thought I was doing pretty well, because after three or four intervals she asked me what I did for exercise.
    "Well, not much really. I just walk across campus as part of my commute. I pass most of the undergraduates, even the twenty-year-old girls in tight pants whom I might prefer to slow down and follow at a good watching distance if it weren't for the exercise."
    "Oka-a-ay," she said, "maybe we'd better not go there."
    I'm not sure in which ordinal interval I called it quits, but it was after about twenty seconds into it, after I'd finally begun to jog rather than walk fast. It was at a pretty good incline, too.
    I was instructed to lie down again, quickly, no talking, for the post-treadmill sonogram. I lay down breathing fast and deeply, feeling good, maybe a little smug.
    After the cardiologist did the sonogram, she said everything looked "super," she could see nothing to be concerned about.
    I asked her how fast the treadmill was going during the last interval.
    "Six miles per hour. And you went more than two minutes longer than the last time we did this. Nothing wrong with your heart!"
    "You mean, if I'd kept that up for an hour I'd have covered six miles!" I think the chart on the wall said that at 6 MPH, the treadmill was inclined to 18 or 20 degrees.
    "That's right," she said.
    "Or died along the way," I added.
    "Yes, that's entirely possible," she said.

A principle of my old friend (and Yale roommate), Dr. Hadler, in his book mentioned above is that since we all die of something, we need to weigh the value of any medical intervention against the possibility that we might die of something else before we die of whatever the intervention is supposed to forestall. I trust that this layman's paraphrase is accurate; in no way can I convey the elegant definitiveness of Nortin's text.
    It would appear that no medical interventions on behalf of my heart will be necessary. The cause of my death will most likely be the failure of some other part or system or my body (or accident).

11 comments:

  1. From my friend Jim, who has long shared Nortin's reservations about the medical profession (without knowing it):

    I'm more anxious now than ever to read Nortin's book.

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  2. From my friend Keith, who has battled cancers and continues to win:

    Glad to hear that your ticker is going strong, Morris. May it and you have a long and prosperous relationship without intervening accidents or other nasty occurrences.

    Thank you, dear Keith! I think you're saying that may all of the other things that might fail, fail to fail until my very strong heart fails, thus ensuring a very, very long life? Sounds good! <smile>

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  3. From my friend Douglas, Yale classmate and fellow philosophy major:

    I'm glad to know that it won't be your heart. You have so much heart.

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  4. From my friend Bettina, whom I've never met but feel I've known a long, long time:

    I read your blog with great interest. I recently had a check-up and the doctor wondered why I didn't come in on a yearly basis. My response was that I'll get something and eventually die regardless of what they do in their attempt to mitigate it. <smile>

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  5. From my friend Fred, comrade-in-arms from our publication ease-of-use days at IBM's Santa Teresa Laboratory, San Jose, California:

    Congrats on avoiding that particular inside fastball.

    Ah, yes, the proximate cause of our death as an inside fastball. Apt metaphor. Perhaps, for those who believe in an afterlife, death is but a slow, fat pitch over the center of the plate?

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  6. Fred comments:

    Better yet, perhaps, being intentionally walked.

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  7. From my friend Bart, one of the two finest writers I know personally, the other being Fred (see above):

    This is a great post. I love Hadler’s take on all this preventive intervention stuff, which I have always had a knee-jerk reaction against. I will probably buy his book.

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  8. From my friend Kat, also known as Sunkat:

    I also heard about this book recently and, as a result of your post, just now reserved it from the Wake County Public Library system. Hope it comes soon, as I'm also very anxious to read it. I'm also rather pleased to hear that that heart of yours is physically great, in addition to being the wonderful big one we all know and love.

    Nortin cautioned me this morning that another question to ask is "Is the test reliable?" I'm not sure that the ECHO stress EKG actually proved that my heart is "physically great," but at least the cardiologist didn't see anything troubling, and she seemed to lay stress on the fact that this time, me two years older even, I went longer on the treadmill than I did the previous time. Six miles per hour, wow! I think that competent marathoners run 26 miles even faster than that, however. Yes. For example, someone ran the Boston marathon in 2 hrs, 55 minutes, which calculates to an average speed of 8.9 MPH. Now, there's a physically great heart.

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  9. Today I added a bit of conversation with the cardiologist that I failed to report for the original publication of this post:

    I guess the cardiologist thought I was doing pretty well, because after three or four intervals she asked me what I did for exercise.

    "Well, not much really. I just walk across campus as part of my commute. I pass most of the undergraduates, even the twenty-year-old girls in tight pants whom I might prefer to slow down and follow at a good watching distance if it weren't for the exercise."

    "Oka-a-ay," she said, "maybe we'd better not go there."


    I alerted one of my friends that I'd done so:

    I just added to the "I'm going to die" post a few lines of conversation between me and the cardiologist while I was on the treadmill. You'll find them about six or eight paragraphs down....

    Recalling that part of the conversation puts me in mind now, of some of our walks (that is, yours and mine together), when we had to go single file because of the narrowness of the path....


    She replied:

    * your regular daily exercise
    * girl-watching

    Is that correct? Otherwise, I missed it and/or it wasn't very obvious to me.


    I clarified:

    I'm sorry it wasn't clear. My exercise is pretty much limited to the campus walking I do, and I concentrate on the exercise, even to the extent of NOT slowing down so as to remain behind a winsomely gyrating butt, however pleasant that might be...I just hurry on to the next few moments with another cute butt (as I pass it in its turn), there are so many among the co-eds of Chapel Hill!

    Oh, I confess: sometimes the cute butt is so extraordinarily fetching that I do slow down for a little visual indulgence. There really is a great range of cheek motion among women. (Have you noticed anything similar among men?) Some women walk more like a man than like a woman, with hardly any hip rotation at all. Occasionally I'll see a woman who gives the impression of having practiced an exaggerated hip rotation—as though she may have taken lessons for modeling or a beauty pageant.

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  10. From my friend Susie:

    Our 72-year-old (too young) neighbor with heart problems woke us twice on Thursday night: (a) She fell/slid out of bed because she had taken a sleeping pill and was a little out of her mind, and could not get back on her feet to get in (she is heavy and not strong enough in her legs or arms to make the transition). (b) She woke with one leg swollen, bruised, and painful. The paramedics (those cuties I’d follow across any street or campus) first came and got her up, then came again and took her to hospital.

    Also Thursday and again today, I listened to my demented friend for whom I am guardian bitch that I had taken away her drivers license. Patiently (well, sort of) I replied that it was not me but the doctor, or more accurately the DMV on the doctor’s recommendation. Then she got off into being furious that I destroyed her photo albums. Well, I did, as I cleaned and sold the house’s contents. At that time she was really out of it.

    The hell of it is, they have upped certain medications, supposedly to improve her balance. They have, but not to the extent that she is at zero fall risk, and the meds have brought her back mentally to where she is angry at times and insistent on leaving but still lacks the planning and consistency to actually achieve anything. I don’t know, I have real issues with what I think DNR means and what the legal/medical staff say it means. I think that if you can’t plan and you can’t read, and the dementia is irreversible, let it be. Let the swallowing failure take you out. Let the fall take you out (if her hard skull would crack). Unless you have family friends who feel you so dear (and you them) that they want to keep on seeing and caring for you. Now I hear they are going to give her an antipsychotic drug to calm her down. They should just take her off all but pain meds in my view.

    OK, rant over.

    Dear Susie, I am sympathetic with your position/attitude toward when the end should be allowed to be the end. And I know that I really mean it, not just in theory (for other people), for I have performed the imaginary act of seeing myself at that end and recognizing me there as ready to go, unfearful, no regrets.

    I don't think I could deal with other people in that condition, however; I'm not good at that, and I admire your fortitude in dealing with your demented friend. That is, you're a better man than I am, dear Susie, and bless you for it.

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