Over the next couple of days the opposite happened: the heartburn persisted, particularly at night, but the twitch went away.  To me this suggested that the beta blocker was in fact inhibiting the twitch, implying a heart-related phenomenon rather than a gastric one.

Through all of this my wife was anxious but patient, fretting mostly about the quality of the doctors I was seeing.  I presented her with my view, based largely on my experience of my own profession, that while I believed in a hierarchy of excellence among doctors (as I knew for a fact existed among lawyers), most issues that are so commonplace and well-understood that any number of reasonably well-trained specialists can handle them essentially as well as the very finest of them, though when confronted with one of a much narrower range of very strange or very complex problems, you really did need the best.  So far whatever I had seemed to be in the “commonplace” category, and I therefore had confidence that the no-doubt reasonably (if not exquisitely) well-trained doctors I was seeing could follow the manual as well as most.

My wife was completely unpersuaded.  She had watched two parents die in hospital settings at relatively young ages, and had came away from those experiences with a deep distrust of medicine, hospitals, and in particular doctors, except perhaps those that were certifiably at the very top of their game, and even those, in her view, bore close watching.  Since our move to Ohio had entrusted her own medical care to the Cleveland Clinic, to which we drove two and a half hours each way for her routine checkups and hormone replacement therapy appointments.  She loved her doctor there – a buxom, vivacious woman whose sons attended the college in our town — and contributed what I regarded as large sums to the Clinic’s Center for Specialized Women’s Health. Where one’s health was concerned – particularly mine – she had no interest in half measures. I agreed that we’d see how the stress test went, then reassess who would treat me for what.

The test was administered at a clean, post-modern block of a building a half hour from our home.  A nurse too young to be my daughter giggled while I wisecracked and she took another resting EKG.  She left and shortly the cardiologist bounced into the room in his white lab coat, trailing clouds of self-confidence and an assistant with a laptop.  He introduced himself but not the assistant, which I thought a bit rude to her, alighted on a chair and chirped, “What can I do for you today?”

I told him that was a very good question and that I had no idea what he could do for me.  This backed him up a little and he rephrased: “What did you say to the referring physician that made him send you to me?”

Much better question.  If we were in court or in a deposition things would be moving in the right direction.  In this case I was fairly sure I was just pissing him off.  I repeated my account of the twitch and what I thought was heartburn, and summarized the prescriptions administered to date.  The assistant pecked away at her laptop. His eyebrows went up at the mention of the beta-blocker. “Your EKG is normal and we can probably take you off the pills, but let’s give you a stress test and see what there is to see.”  I agreed that that was what I was there for.  He stood and smiled, the assistant snapped shut the laptop, and they flew out of the room.  They had been with me maybe five minutes.

The stress test consisted of twelve minutes of very brisk walking on an increasingly inclined treadmill while monitored by another EKG machine.  Two giggling young technicians (they admitted under questioning that they were not RN’s) shaved my chest and affixed a half dozen electrodes to various spots on my torso with round white pasties, then guided me, laden with wires and a plastic harness to hold them, onto the treadmill.  The goal was to get my heart rate up to at least 165 beats per minute and to keep it there for a minute or two.  This took my runner’s heart ten minutes and a lot of incline.  For the last two minutes I was walking uphill with strides about as fast and long as I could manage without breaking into a jog.  But all in all, not terribly stressful.  The girls acted impressed with the old guy, unhooked me, and sent me out to my waiting wife.

The next day she and I were sitting, uncharacteristically, in the family room of our house when we both suddenly looked up at one another and exclaimed, “Was that an earthquake?”  With our west coasters’ sensitivity we had indeed detected a temblor with an epicenter in Virginia that had briefly rocked the eastern seaboard.  What did it take to get away from those things?

Later that same afternoon, while we were still marveling at the ubiquity of earthquakes, the phone rang.  It was the cardiologist’s assistant, telling me that they’d found an “abnormality” in the stress EKG and wanted to follow it up with a CT scan, which she would be glad to scheduled for a couple of days later.  I sat down on the couch a bit heavily.  What kind of abnormality?  The doctor would explain it to me, she said.  I assured the assistant that I did indeed want to talk with “the doctor.”

To be continued…..