Hypochondria and Diagnosis in the Age of Google, part III

© 2012 Keith McWalter

The cardiologist called back a few minutes later and briskly explained that the stress test had revealed an arrhythmia — more specifically a premature ventricular contraction, or PVC – during the period of highest stress.  While this was not necessarily alarming, he wanted to follow up with the CT scan to rule out any serious heart disease.   He could schedule it for the next day or so.  A bit dazed, I asked a couple of questions about the PVC – what it indicated, whether it could be related to the twitch — which he said he couldn’t answer without further tests.  I thanked him and explained my wife’s inclination to go to Cleveland Clinic for any further testing, and told him I’d get back to him.

The news of the PVC was enough for my wife.  Once I’d calmed her down she was on the phone to her o.b./gyn asking her to pull strings and get me in front of the best cardiologist at Cleveland Clinic before the week was out.  Not really to my surprise, her doctor complied; appointments were set up, and within a couple of days were cruising at an insufficiently high rate of speed up the incredibly dull stretch of interstate between Columbus and Cleveland.

We have friends in Cleveland, but under the circumstances thought it best to stay in one of the hotels on the clinic’s sprawling campus.  We checked into the aptly-named Intercontinental, always full of better-off patients of every extraction, many of whom had indeed jetted in from the aforementioned other continents  — the Middle East, primarily — to avail themselves of the elite ministrations of what was, in the opinion of US News & World Report, one of the nation’s top three hospitals.

Cleveland Clinic is spread over several dozen square blocks on the quasi-residential and otherwise blighted east side of Cleveland.  Its core consists of a complex of buildings that seem to have descended en masse from outer space.  None of these glassy-walled, post-modern structures appears to be more than 5 years old, they’re all interconnected by tunnels and skyways and have the names of the fabulously wealthy donors who helped build them plastered on their ramparts, there are valets in front of each of them to collect your car (leaving the physicians aside, the place is entirely run by very polite black people), and the glistening lobbies and ground-floor hallways are lined with bistros and bookstores and coffee shops and sushi emporia, like an upscale mall.  It’s about as unthreatening, if a bit overwhelming, as a premier medical facility could be.  Sort of a medical Disney World.

I had a full day of appointments scheduled, starting with a full blood workup, followed the CT scan itself, then a stress echocardiogram and, finally, a sit-down consultation with the big-cheese cardiologist singled out by my wife’s doctor friend to interpret the results of all this high-tech probing.

After a dazzled early morning walk through the shiny hallways to a certain sector of the right building and a brief wait among the other multinational pilgrims to this Lourdes-on-Lake Erie, I was escorted by a nice young nurse into a darkened room and told to lie down and be quiet for a half hour.  Puzzled but pleased, I did as I was told (later learning this little rest was to provide baseline adrenal readings or some such) and passed a pleasant time in the dark on a very comfy cot where I would have gladly spent the rest of the morning.  No such luck.  The nurse came back at the appointed moment, flipped on the garish fluorescent lighting, quickly drew several vials of blood from my arm, and sent me packing off to my next rendezvous.

I collected my wife and we found our way to a different deck on the Mother Ship.  There I again left her in a waiting room and this time was told by the nice young nurse (which they all seemed to be) to take all my clothes off, put them in one of the many gym-style metal lockers provided, and put on a hospital gown in a backwards fashion which, despite her very clear instructions, proved impossible to grasp in practice.   Then I and another guy a bit older than me who seemed to have gotten the hang of the backwards gown thing sat around on metal folding chairs and chatted about the weather as though we were in the locker room of the golf club waiting for our tee times instead of the outlandish procedure that awaited us.

Cardiac CT scans, so you know, involve injecting a contrast dye into the body so that the blood vessels light up like neon when passed under the radioactive eye of a gigantic donut-shaped device manufactured by General Electric.  The machine takes detailed pictures of the heart and its thus-illuminated arteries to determine whether they’re clogged up with a lifetime of living and likely to kill you. Like an MRI but with a lot more fuss and drama.

The first thing, then, is to get a plastic port affixed to a vein in your arm for ready injection later.  Then you lie on your back on a sort of motorized stretcher that will ferry you into the human-sized opening in the GE donut machine.  The nurse calmly assured me that when the dye hit my bloodstream I would feel warm, and might feel the need to urinate.  She perhaps thought it unnecessary to say that I should resist that need while in the machine.

She and an assistant got me situated on the motorized stretcher, hooked my vein port to a remote-controlled IV pusher, and high-tailed it out of the room.  After a few minutes her voice came over a speaker in the ceiling saying she was going to inject the dye now, and I would feel warm and the need to urinate.  She did and I felt both.  The warmth — really more like heat — spread in the most eerie way from head to toe, as though diagramming my vascular system as it went, opening up a sensation of interior complexity that, in nature’s wisdom, one is usually spared.  Then the motorized gurney slid me onto the GE hole where I was asked to hold my breath and various loud clickings and clackings commenced.  This was repeated over a few minutes, and I slid back out.

The nurse came back in and helped me sit up.  She said I should drink as much as I could over the next few hours to help flush out the dye, which I certainly intended to do as by this point I assumed it was radioactive.  She also warned me that I might feel a bit wobbly.

I retrieved my clothes from the locker and my relieved wife from the waiting room and found a men’s room for my first of several purging pees.  Then we went down another Star Trek hallway to a nearby Au Bon Pain (which, in a hospital context, seemed to me an elaborate bi-lingual pun) for lunch while I recounted tales of the CT scan.  But little that I had experienced up to that point could have prepared me for…Katrina, she of the Stress Echo.

To be continued…..

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