(Caution: This blog contains a description of heart attack. It can be uncomfortable to some of you)
On the occasion of Thanksgiving in USA. HUGE thanks to the first responders, medical professionals, family, friends and fellow hikers
It was Friday, December 14, 2018. Just another day with a long commute, lots of stale coffee, excel spreadsheets and non-productive meetings. I was eagerly looking forward to the social community event in the evening in a cute, small church in Farmington Hills, a suburb of Detroit. In such events, I transform into an excited, hyperactive child hugging everybody, doing a small talk blabber, laughing out loud at any small excuse, and pigging out on spicy red chili chicken and rice pilaf. Then, I dance and dance and dance. The rhythmic Bollywood music flows through my veins and I simply do not care for respectfully bewildered looks of the spectators watching 60-year old fat boy making quixotic moves. Today was another one of those friendly evenings – at least that was what I thought!
I noticed it almost instantaneously! My breathing became heavier. Shooting pain started right at the heart. I frantically looked around for Anjali (my wife) and found her chatting in the crowd. I almost yelled at her to come outside in the lobby. I collapsed on the bench. Joyous kids were screaming and playing “hide and seek” around me. Their cheerful racket sounded like a faraway TV program in another room. I was engulfed in pain. Somewhere inside my head, I was screaming, “Go home, go home!”. But I just could not get up. AND then they called 911.
I lay flat on the cold, hard floor with eyes closed. I could hear the ambulance siren – that familiar sound of the city. From the corner of my eyes, I saw a flashing red light. They came in, checked my vitals and brought in a stretcher. Even while in pain, my mind was admiring those first responders in uniform. They always look smart exuding confidence in ironed clothes and polished badges. I asked one of them, “How will you lift me on the stretcher?” He smiled with assurance. “It is easy. You will see.” I heard one, two, three, then I floated in the air for a second and landed smoothly on the stretcher. I felt, “Wow, these guys are magicians!”
As the stretcher was veered to the ambulance, I gave thumbs up to the entire lobby full of people as if I am an injured football player heading to the locker room. But unlike the stadium, they did not clap.
It was a weird feeling. There was no anxiety of the future, no thoughts on “what” and “why”, no yearning to live, no anguish of dying. It did not occur to me that I may never see a calm face of my wife or see my kids. Somehow, my mind was focused on the moment in front of me. They were struggling in a moving vehicle to insert the needle in my vein for IV and I was thinking, “how cool it is to get a ride in the ambulance!”
I knew that I was in the operating room when I saw a huge bright light on the ceiling and three or four masked nurses moving around my head. One of them with a shaver asked me, “I will be shaving your body. Any questions?” (I guess this was for ECG sensors!) I told him, “Can you draw a Santa Claus on my chest?” Everybody around me started laughing. One of them said, “It does not feel like you are going through a heart problem.” I told him, “I am just happy that I have a heart.” I love humor. I get a tickle when I see a smile on my friends’ faces. But this was not my regular, giggling, I-am-in-my-elements behavior. It was all subconscious, impromptu, involuntary reaction.
Today, when I look back, I remember one incident that happened just a couple of hours before my father passed away a few years ago. He was struggling with pneumonia at my brother’s place in New Zealand. At the age of 88, his lungs were all destroyed. He was surviving on ventilators and heavy dosage of morphine. He was in pain.
Doctor had just entered his room and examined him. Doctor asked my brother: “Can you please ask your father if he has any questions?” My brother translated the question in Marathi, our mother-tongue from India. My father responded in Marathi, “ह्यांचे वडील येणार आहेत का माझ्या शर्टाची बटणं लावायला?” (“Will his (doctor’s) Dad show up to button up my shirt?”) In that drab ICU, when my brother translated it back in English, both the doctor and my brother started laughing on this dry humor.
My father’s basic, “go-to” emotion was humor. I think those intangible genes were creeping up inadvertently in my chromosomes in the hospital.
Angioplasty continued in the operating room. I had no idea that they do not give full body anesthesia for the angioplasty. I was heavily sedated. But occasionally I could feel the pain in the heart. At one point the pain shot up. I moaned in agony. He said, “Do not worry. It will reduce as soon as I finish putting a balloon in your aorta”. WHAT THE FXXX? Balloon? In where? I had no clue what the fxxx aorta was! I cursed again before going back to sleep.
They knew the medical concept called “Time is muscle!” It means that within 20-25 minutes of the heart attack, a portion of the heart muscle starts dying and that dead tissue never recovers. I was in the operating room at 11:35 pm, the procedure started at 11:47 pm and the stent was inserted at 12:16 am. These angels had descended from heaven to do their job, and they did it with finesse!
Eventually, I was taken to the ICU. Entering ICU was like entering a slot machine room in Bellagio on the Strip in Las Vegas. Lots of blinking lights, lots of flashing numbers and lots of beeping noise. In all that chaos, my warrior wife was standing right in front of me, reassuring me with her smiling face and calm eyes. I had no clue at that time that doctor had just told her to get my kids here from across the continent, and that the next 72 hours were going to be very critical for me. High stake gambling was in progress in a slot machine room called ICU.
Within minutes after my arrival in the ICU, I threw up. I splashed a humongous amount of red, bloody puke all over the bed. It felt like a gory, violent scene from a Tarantino movie. There was a panic and commotion. Within a few seconds, many nurses and doctors gathered in the room. My wife was asked to leave. They were all looking alternatively at me and the monitor. I heard the word “blood” from their whisper. And I smiled. I raised my left arm and said, “Calm down everybody. This is just a red chili chicken.” James, my nurse, picked up a small piece of chicken from the mess and suddenly, there was a sigh of relief. I felt like the captain of the ship. I had magical control over all these people.
James was an amazing nurse. After cleaning up the mess, he started inserting various tubes and kept saying “sorry” for sticking adhesive tape on my hairy body. During the conversation, he told me that in his entire 16 years of career as a nurse, he has not come across anybody hairier than me. Then I told him the story. In my all-male college dorm of geeky engineering students, one day they decided to have the Hairiness Index for every student, like gasoline Octane number. The hairiest dude was assigned a number 100. I was away in the classroom at that time. When I arrived back to the dorm, they were humbled in their incomplete investigation, amazed at a fantastic display of Godly creation on my body and I was assigned the highest number of all, a whopping 110 for my hairiness index. Later James started calling me “Macho.” I asked him what he would call a “Macho” who survived the heart attack. Since then I have become the “Macho Square”.
Next day morning, the doctor came to the ICU.
Doctor: “Mr Anturkar, you went through a lot yesterday. You had a STEMI.”
Me: “What is STEMI?”
Doctor: “Oh, that is “S”, “T” elevated myocardial infarction. Your LAD was 100% blocked.”
Me: “What is LAD?”
Doctor: “Oh sorry for medical words. It is the Left Anterior Descending artery.”
WTF! Did my doctor come from some alien planet speaking alien language? What is infarction? Was that just a spelling error for infraction? What is ST? Why is it not AB or YZ or PQ? What the heck is myocardial? I learnt later that STEMI is nothing but heart attack with 100% blockage of the artery and ST are two specific waves on ECG graph. Some medical reports even describe it as a “widowmaker” event. Over time, I learnt from the Khan academy tutorials some very complex medical terms, such as occlusion, thrombosis and atherosclerosis for some very simple words such as blood clotting, clogging of blood vessels etc. Next day, I asked James, “I long for feculence. Can I wend my way to ablution?” That was my revenge on the medical establishment! Ignoring James’ confused look, I proudly went for a poop.
All this funny banter helped me in my hour-to-hour tactical challenges. I was not allowed to move my right leg for the entire 48 hours. I could not even imagine that my plum, fatty bums can hurt “that” much! Do you remember that crazy balloon in my freaking aorta? They eventually removed that temporary balloon after two days in the ICU. At that time, as a standard procedure, they had to exert the full body weight pressure on my open wound in the groin for 45 minutes, through which they had just removed an unbelievable eight-inch-long balloon. Yes, that is correct. EIGHT-INCH-LONG balloon! Pain was excruciating! I wanted to scream! I was holding my lips tight. Tears were rolling from my eyes with pain. But they had warned me. They had my trust, and these angels did not let me down. When it was all over, I gave them a beaming smile through my teary eyes and anemic face. In those 5 days, I gained a reputation as a “Dancing- guy-in-the-church”, “Macho square”, “cool patient” and so on.
But it was not all hell in the ICU. I had some priceless moments as well. Holding Anjali’s hand was so soothing! It took me to my private bliss far far away from the chaotic slot machine called ICU! Kids, Anjali and I watched the hysterical Bollywood movie “Three Idiots” together, laughing out loud while frantically keeping the ICU door closed to avoid disturbance to others. And there were those small pleasures! First successful and accurate pee in the pee bottle, first sip of the apple juice while lying flat on my back, shifting of my butt just a little in the middle of the night (which was not allowed!), little tickling in the nostrils with a draft from the ventilator, high-five to those rare 2-3 friends that were allowed to come in the ICU, and removal of the IV syringe from my body during the discharge from the hospital. Ahh!
Eventually, I started gaining strength over the next 6 months. I no longer needed to sit down while taking a shower. I gradually increased the duration of my physical rehab. I could get rid of my 24/7 life vest called a defibrillator (that gives an electric shock if my heart stops working). I could start drinking the same old stale coffee in my office. My ejection fraction (amount of blood pumped out by heart compared to its total volume) improved from 30% to 55%.
I could block off any concerns or anxiety about my heart attack. I accepted the fact that “shit happens.” I had no control over this shit. But, of course, all the mental and physical training was not easy. It was a daily grind, a daily challenge, facing the demon every day. They say that medals are not won in the stadiums in the competitions, they are won daily while training in the gymnasiums. I have been winning my medal every day.
Over time, it all started gradually. There was a calling – again and again and again. Those perky warblers, colorful wildflowers, intense thunderstorms, shades of green, lakes, rivers and mountains started calling me. Long time ago in the Himalayas, mighty mountains and roaring rivers had already adopted me as their child. These parents wanted to pamper their “newborn” child in person again. The idea of my long journey to meet them right here in America started taking shape. I decided to traverse the entire Appalachian Trail (AT). But mountains and rivers are tough parents, especially if I am going to stay in their home for a long time. They do not hesitate to give time out to their undisciplined children. They want children to follow all rules, do all chores, share all responsibilities and behave well with others. Then and only then, they would pamper me.
It was a very hard decision for Anjali to agree for my journey. But she loved my dream. She felt that I am destined to pursue this wild dream. She embraced it and the preparation began in earnest. So, how am I preparing for this AT thru hike?
Before the trail:
- Block off heart attack as a concern from my mind (100% checked off)
- Gradually increase physical stamina over one year (ongoing):
- One hour of walk in the first month to 6-7 hours by the ninth month on the trail or on the treadmill
- 5 lbs. in backpack initially to 25 lbs. by sixth month. (This will be my target backpack weight including food and water)
- Daily climb of 1,000 ft in the first month to 2,500 ft by sixth month on the treadmill
- Alternate day yoga, core exercises and daily breathing techniques (called “pranayama” in India)
- Thumbs up from cardiologist, knee surgeon and primary physician after detailed checkup (Complete)
- Practice run on AT to test my gear and stamina for 15 days (Complete)
- NOLS wilderness first responder course (Feb’21)
- Vipasana mediation training course to prepare my mind (Feb’21)
On the trail:
- Safety, safety, safety: That is the single most priority
- Go slow, do not allow pulse rate to go up beyond 125 even on sharp climbs
- Start from an approximate center point of AT at Harper’s Ferry (HF) in April’21 (near Washington DC), travel to north terminus in Maine, fly back to HF and travel to southern terminus in Georgia. This way, I get sufficient time to reach Maine before it shuts down by end-September.
- Minimum three lit water to ensure hydration, never allow yellow tinge in my pee
- Daily ECG and peripheral oxygen measurement on the trail using Apple watch
- Carry satellite tracker to call first responders, if required
- Protect myself from Covid-19 in every possible way
Woohoo, I will be ready for this epic, transformative journey. All stars are now lined up, all gear is purchased, doctors and angels have now blessed me. I am jumping up and down in excitement. I am waiting, waiting, waiting …
Nitin (Dadhi) Anturkar, December 2020
