© 2012 Keith McWalter

We changed donor buildings after lunch and found our way to a particularly immaculate lobby with a waiting room overlooking a huge circular infinity pool with a fountain in the middle.  A young couple sat watching loud and stupid TV shows on their iPhone without benefit of ear buds, much to my annoyance.  As I contemplated censorious Luddite quips that I might direct their way, yet another young nurse fetched me for my stress echocardiogram, and I left my worried wife behind yet again (much tougher duty than what I was going through).

The stress echo is like the stress EKG, except they want to ping your heart with sonar afterwards in addition to taking readings while you’re running uphill for ten or twelve minutes.   I had drawn another couple of wiseacre female technicians, who took great pleasure in looking me up and down in their flirty-sadistic way as I stood there in my running shorts and submitted to the application of the usual thirty electrodes to my torso.  One might have been named Sandy, but the other was, unforgettably, Katrina.  She actually had an Eastern European accent to go with the tough little gym trainer’s body and the haughty laugh.

In the big white room with us was also the actual echocardiogram technician, Max, a soft-spoken guy who may have been gay.  Max explained that what he wanted me to do was, once the stress test was over, to immediately jump off the treadmill, lie down on the examining table in front of him, and stop breathing.  He said that last part would be hard, since at that point the one thing I would very much want to do is breathe.  I pointed out to him that every runner’s manual ever written says that what you definitely should not do immediately after running hard is stop suddenly, as it may give you a heart attack.  And weren’t we here trying to prevent that?  He just smiled.

Electronic equipment hung from the walls of the room like giant overripe fruit.  A very large and techy-looking treadmill sat in the center, and once I was thoroughly laden with cables and hubs running off the electrodes, I got on board and received instruction from Katrina in her Russian accent.  She pointed out, on the wall in front of me, a chart with the numbers 1 to 10 down one side, and opposite each number a description of a degree of difficulty, ranging from “easy – could do this all day” to a middling “somewhat hard” to “This may kill me if I have to do it any longer”.   Or words to that effect.  Katrina went over this several times so I got the concept of gradations, and that she would be asking me throughout the test to indicate which level of difficulty I was experiencing.

I assured her I got it, Katrina gave the word, and the treadmill started turning.  I walked at a modest pace, and on her inquiry told Katrina that this was in fact “easy – could do this all day”.   After a minute the machine accelerated and inclined considerably.  Still easy.  Sandy the technician watched a computer screen and called out heart rates every minute or so.  Five minutes later I was running uphill and puffing a bit, but insisted when asked that it was only “somewhat hard.”   Katrina said something like, “Okay, now we go,” and I was given to understand that what followed would be more than somewhat hard.

It was.  I’d been on the thing for a full twelve minutes and well above the target 165 bpm heart rate for at least two or three when my dominatrix Katrina called out, “Cahn you giff me another two meenoots?”  Oh sure, I said, sweat running down my face as the death-device accelerated yet again.  I was running full-out at this point, uphill, carrying at least thirty pounds of electronic equipment, and had reported a level 9 degree of difficulty to her some time before.  I would never admit to level 10.  I can stand anything for two minutes, I told myself.

It was a very long two minutes, so long that I suspected the sadistic Katrina of fudging the clock.  When she finally yelled “Stop!” I staggered off the treadmill and into the waiting Max’s arms.  He lowered me to the table, turned me quickly on my side, stuck a gel-slathered probe onto my chest, rubbed it around for a second, and said, “hold your breath.”   I did, and felt like my eyeballs would pop.  He finally said “ok,” and I sucked in air and out again and he said “hold,” and he took another reading with the wildly sloshing sound of my frantically beating heart booming out into the room…

That afternoon we went to visit the cardiologist, a tall, dark and gentle-seeming man with a long Hindi name and a long white coat.  Call him Raj for short. His office was small and neat, with a secretary in a cubicle outside and a modest desk that reminded me of the one I had had as a young associate in a law firm, which told me that he didn’t spend much time here and didn’t care what his office communicated about his status, firmly based as it was, I assumed, on what he did elsewhere.

We first went over my blood test results in detail, with Dr. Raj stopping at intervals to explain the meaning of different measures, and emphasizing those – like high sensitivity C-reactive protein — that were related to coronary artery disease.  They were all normal or better than normal.  My cholesterol levels were “well-managed,” meaning higher than ideal (the ideal, I’d learned, being essentially unattainable for carbon-based life forms) but well within advisable limits.

We turned to the CT scan results, which he reviewed on his computer screen as we sat there.  This was what I was most worried about, as there can be no prevarication or denial about having your heart laid bare to the soulless gaze of General Electric.  If my coronary arteries were calcified or clogged with a lifetime of dairy products and the next step should be some awful invasive procedure like an angioplasty, the scan would show it.  Dr. Raj murmured approvingly as he scrolled through the ghostly images on the screen.  “This is very good,” he said, as relief flooded through me as surely as the contrast dye had that very morning.

Finally, the stress echocardiogram results.  These too were normal (or “unremarkable,” as doctors like to say), except for the detection, as before, of a premature ventricular contraction under high levels of stress.  We spent a few minutes bantering about Katrina the Dominatrix, of whom Dr. Raj had developed a certain amused opinion.  In my now-jovial mood, I assured him that she was wonderful, forgiving and forgetting those last “two meenoots.”  And about that PVC?  He waved dismissively.  Basically a wiring issue. An electrical impulse in a sinus nerve node was misfiring, but quickly reverting to normal after each sporadic episode.  As long as it was happening infrequently and only under extreme conditions, but always recovering, nothing to worry about, he told me.

So, almost entirely good news.  But what, I finally remembered to ask, about the twitch?  He gave me a small indulgent smile and said it might be a gastric event of some sort.  Almost certainly not heart-related, and therefore not in his bailiwick (though he didn’t use so antique an Indo-Anglo expression).

We drove home relieved and grateful.  I’d basically been given a clean bill of cardiac health by one of the foremost medical clinics in the world.  Still had to exercise and watch my cholesterol, still had to take the Prilosec for whatever was going on in my upper body, still mortal and ultimately bound for dust, but alive and kicking and generally well.  What more can a rational person ask of a visit to the doctor?

Still, the oddity persisted that, after all that sophisticated technical probing, and after a full-blown “executive” physical exam that would follow a month later, including colonoscopy and endoscopy (a tale for another time), neither I nor any of the cadre of specialists who had so intimately examined my mortal coil had any idea of what had caused the odd sensation that had sent me to seek medical help in the first place.   Occasionally I still feel the twitch, though it lacks the power to fill me with anxiety and keep me up at night that it had before I’d visited Dr. Raj and his friends.

The moral is a familiar one, but worth repeating: specialization is as specialization does, in medicine as in law and other fields of high expertise.   Specialists do what they know best how to do, and rarely stray from their strong suits.  Tests are made of what can be tested easily and best (often with maximum expense), and the rest remains a mystery.   Problems tend to be defined by reference to precedent; that is, how did we deal with this last time? Strong filters are in place to cause the complaint at hand to be heard and interpreted as something amenable to what the hearer knows how to do.  If a particular technology is available it will likely be applied, regardless of the degree to which it is suited or even relevant to the problem.  You must, in the end, be your own medical advocate, as no one within the medical system is constitutionally capable — despite their very good intentions — of being one on your behalf.

Google and the internet can help with medical self-advocacy, but at the risk of hypochondria and misinformation.  Still, heightened anxiety is a small price to pay to go armed with your own amateur diagnosis into your next encounter with the arch-druid that is modern medicine. You might even be right, and that is always good medicine.