aftermath of heart attack

They call it “emerge” here. It’s Canada-speak for “emergency room”, and it confuses me in the same way that “ah” sounds are “aaaa”. Paaaasta versus pahsta. Just off enough to make me pause for a moment so my brain can catch up to my ears.

But whatever. When medical situations arise, Canadians go to the “Emerge”. And so went Rob and I on Friday just shortly before noon because he’d slept late and woke feeling light-headed and slightly heart-attacky again.

“I hope we don’t have to wait long,” he said as we walked in the front entrance of the Fort Saskatchewan Health Centre. Not hospital. It’s not big enough to warrant the title and that’s not my opinion only but the provincial health system’s too.

“Just mention the chest pains and follow it up with the fact that you had a heart attack three weeks ago,” I suggested. “I’m pretty sure that will warrant queue jumping.”

If there is one thing that Canadians pride themselves on it’s queuing up for health care. No one jumps the line. No. One.

Incoming patients are evaluated and served according to the seriousness of their condition but for the most part, everybody waits.

And waits.

I have yet to go to the doctor for any reason and not sit for at least two hours before actually being seen.

And absolutely everyone gets the same slightly understated care.

“Hi,” Rob greeted the admissions clerk, a big haired woman with that “another one” look on her face that they all have.

“Alberta health card please,” she asks even before inquiring what brings Rob to the centre that day because not having that card means that the next question is “and how will you be paying today? Cash or credit?”.

“I was here three weeks ago and had an angioplasty,” Rob tells her when she finally asks the nature of his visit.

Rob still has trouble with voicing the heart attack thing.

“And you’re here today…?” Because “angioplasty” doesn’t clue her.

“I’ve had chest pains …”

To her credit, he doesn’t get any farther. She directs him to the ER intake and asks me to come back for his paperwork.

Chest pains opens doors and makes hospital folk look attentive and even behave in a way that makes one feel as though perhaps their attention has been adequately captured.

That’s just an fyi.

We walked through the packed waiting room. I noted with interest the young punk-ish woman sitting between two RCMP officers manically chatting away for the alarming edification of all. A mother gathering her brood ever closer as the girl babbled.

“I told the operator that they could come get me and bring me to the emerge or send someone for my corpse.”

More on her later.

To gain admittance to the emerge wing, you go through triage which is manned by an EMT trainee – always – no exception that I have ever seen. You don’t see a nurse or a doctor until the trainee has practiced on you.

Rob assumes the position in one of two chairs they’ve set up for patient triage and the young man glances about with a slightly vacant but confused enough to convince me he is tracking mentally look on his face.

“Do you have paperwork?”

Protocol, people, it’s all about the proper paperwork.

“He’s having chest pains,” I explain, “the woman at admitting told me to bring him here and then come back for his paperwork.”

Big eyes. Falters slightly and then he begins intake while I head back for Rob’s passport to health.

At the desk the clerk has finished admitting Rob. She and her co-worker express horror at the fact that Rob is just 48. I am calm. That’s how it goes. Your spouse suffers from something that most people cringe away from and you are calm. Like there is another option, but people, by and large, find it hard to wrap their minds around. Been here before but forgot to get the t-shirt.

Meanwhile, the wild-eyed looking punk girl in the lobby is regaling the officers with her manic tales of suicidal intentions. As I listen, I gather that mental health services here are no better than in the States. The girl had been trying to get help for some time but units are full and the only way in is to suicide or state an intention to do so. She’d called the police, threatened to kill herself and they sent officers around to pick her up and get her admitted. She reminded me a bit of my brother when he is in one of his demonic up periods. I didn’t blame the others in the waiting area for seeking seats far away from her.

It took less than ten minutes to get Rob checked in and into a room. Chest pains rate a room as opposed to sitting in chairs that line the hallway. Which turned out to be good because an hour or so later, they brought a young man in on a stretcher and left him in the hallway – just across from the chairs – and he spent a good 30 minutes violently retching into a basin. Followed by another 15 or 20 minutes hacking up phlegm. I never did discover what happened to him though I knew that when Rob hit the 5 hour mark, the young man was still there. He’d been put in one of the cubicles and was no longer vomiting but they wouldn’t give him so much as a glass of water to rinse his mouth out because they were still waiting on test results. Canadian health care is big on assuming that anything could lead to surgery and therefore, no food or liquids.

Because of his history – Rob has a “history” now and it’s still something we are adjusting to – they followed the standard protocol.

Protocol demands two sets of bloodwork six hours apart and ecgs periodically over the span. In all, with the heart in play, expect to spend a minimum of 8 hours and as long as 12 being “observed”. And be advised that you could be in “emerge” for the duration.

There is nothing to do but wait.

We read and I occasionally broke the monotony by eavesdropping on the EMT as he admitted people.

One guy was quite interesting because it revealed something about the system here that in all ways but one is exactly the same as the plight of the un or underinsured in the U.S.*

He’d broken his arm.

A year ago.

He was in the Fort visiting his in-laws and his mother-in-law made him come to emerge because the arm was bothering him to the point where he couldn’t lift anything.

The nurse, and I, listened to his story and I suspect this is the norm for working poor.

He lived several hours away from the nearest health centre/hospital. He waited until the next day to go in because of the distance and he couldn’t miss a day of work. The x-rays revealed two hair-line fractures and he needed a cast but they wanted him to come back the next day for it. He couldn’t. A trip to the hospital cost him a whole day.

“It would’ve been seven hours,” he told the nurse. “I don’t have that kind of time to waste and the bus service ain’t that good. I wouldn’t have been able to get back until the day after.”

But as he was on vacation and in Alberta, health care works the same in Fort Saskatchewan as it does in Calgary, he let himself be talked into coming.

“i just need you to put a cast on it.”

Of course after a year it wasn’t that simple and the nurse finally gave up trying to explain it. She sent him to x-ray. Let the doctor deal with him – when he got the chance.

There was just one doctor on call. There is only one. There are five rooms and at least ten chairs plus a waiting room full of chairs. So in theory, the doctor can be responsible for over a dozen patients in varying stages of diagnosis and severity over the course of a shift.

The doctor this time – at least – discussed the situation with us and I actually got to listen in.

In the end, it wasn’t another heart attack. It turns out that the Lipitor is a hard drug and it could be that Rob won’t be able to tolerate the muscle pain it causes. Some people can’t. Some people are even debilitated by Lipitor as it breaks down muscle tissue in addition to scouring the veins of cholesterol. Lipitor actually triggered ALS in my cousin’s father within months of his starting it. He died a horrible death.

So it’s the Lipitor. The heart is okay. I am a tiny bit less worried about Rob dying on me anytime soon, but the ghost snuggled up to me in bed last night. Really. So things are apparently dicier than they appear.

*Universal health care sounds nice. You don’t have to worry about not being able to pay for the doctor visit or the trip to the hospital. But … isn’t there always? Drugs are covered. The time off work isn’t covered. And in a country where there are few big cities, many people live hours away from care. Getting to and from is arduous to impossible and that’s if they can afford to take time away from work or children. For the poor and working poor, the obstacles to care will always be. Just having access to care isn’t the end of the problem.

I am big on being prepared. Even if the preparation consists of nothing more than periodic dress rehearsals in my daydreams.

It’s weird to daydream about disaster and tragedy, but I was the little girl whose Barbies’ were all widowed women. And I was the teen who stared out the window of Sister Jean Freund’s South American history class and fantasized Red Dawn scenario’s. The readiness is all, as Hamlet would say once he quit whining.

During last summer’s mini-health alert, Rob put a file together for me containing all the “just in case” information. It was overkill. But it helped knowing that neither of us would be forced to wade through boxes in search of policy numbers and phone contacts. Sometimes having the details worked through in advance makes it easier to face the unthinkable.

But when he had his heart-attack, I realized that I had no idea where the file had gotten to. In our perpetual state of renovation, the minutia of life shifts from room to room, depending on where the hot reno action is taking place.

Rob took the office apart right after Christmas and the contents of the room were scattered in totes, boxes and file cabinets between the living and dining rooms. The file vanished into the triangle.

We’ve been putting the office back together these last few days, and Rob decided we needed an I.C.E. binder.

In case of emergency – crack open.

There are two of them and they have a prominent place in the organizing cabinet. Everything pertinent to life after one of our death’s is there.

“You’ll need it, ” he said, “as it’s clear now that you will outlive me.”

I scoffed and reminded him that I could be wiped out in an instant on the road from town or at the intersection. And for all we actually know, my heart could be riddled with disease just waiting to surprise us.

But I am always cognizant of the promise I made before we married, that I would let him go first. Even though it’s not my call, I did offer and the universe has a way of taking one at one’s word in these matters.

At any rate, Rob was quite sober yesterday as we discussed the I.C.E. book. He’s chafed a bit this last week. He is still on driving restriction, forbidden to engage in work even via email and bored out of his mind.

He doesn’t look sick at all. I had another husband who didn’t look sick to the naked  eye either once.

On his walk yesterday though, he overdid it. Went too far and then had to get himself back because he forgot to take his cell phone.

Six miles.

At about an hour and a half, I began to toy with the idea of hopping in the truck to go look for him. He was surprised to see I hadn’t when he finally got home – which is telling.

“I thought about Shelley, ” he said. “She used to walk that same loop with edema and a compression bandage on her leg and cancer spreading everywhere. If she could finish it, so could I.”

He is stubborn like that, but this morning he is still in bed at 10 AM.

In case of emergency, you break glass or open a binder. I am not there and I may never be. But I could be. So we organize, just in case.

The aftershocks come in waves and they are not proportional to the severity of the event.

Rob’s heart attack barely rocked the cardiologist’s Richter scale, but it lifted us up off our foundations and set us down again hard. I am left feeling slightly askew and wondering about the direction of the path I thought was straight forward and relatively paved.

In the last six months, I’d prepared for a new career path that focused more on the real world rather than the innerscape my writer self shelters herself in. I’d become more or less content with writing for the Internet and questioned the purpose and practicality of finishing the memoir – or even going back to a fictionalized account of how I ended up in such a different life from the one I’d imagined a bit more than a decade ago.

“It’s funny how we end up where we are,” Rob mused as we sat sipping tea on the back deck after his first long stroll yesterday afternoon. “I didn’t ever really picture myself a heart attack survivor or even having one at all.”

I can’t say I haven’t pictured myself a youngish widow again. I am wired for “what if” and have buried everyone I know and love dozens of times as my mind grapples with far-flung scenarios they way other people plan their weeks. But I will admit that I have grown comfortably complacent enough to suppose that Rob and I will celebrate many a double-digit anniversary together.

“You really freaked out on me,” he pointed out later in the day.

I can’t tell if he is disappointed or surprised by this. As I told the older girls while I paced the waiting area during the hour of time we had no idea where he was or if he’d sustained any unplanned damage during his angiogram,

“Grace under pressure is not me, so I hope you weren’t looking for it.”

Indeed, it took me well over two months to adjust to my late husband’s death sentence and the dementia that came with it. Which is not to say that I lost my presence of mind or that I was unable to tend to the details, I function – sometimes at quite a shockingly high altitude, but I am sharper than recently honed blade and my Sagittarian bent for action is idling constantly when not actually propelling me.

“I didn’t know what was going on or where you were,” I said, again.

“Well, were you expecting them to hand me back to you in an urn?” he asked with a smile.

“Yes,” I said. “I had no idea what had happened and no one seemed interested in clueing me in. All I needed was a ‘we were able to fix him during the angiogram but he needs to stay overnight and he’s being admitted, go get something to eat and check with admittance for his room number in an hour.’ Honestly, I would have been a totally different person had someone been bright enough to do that.”

Waiting though did give me time to reassess, and sometimes this is not reactionary as much as it is necessary redirection.

One of the things that was painfully clear as I paced was that I was in no way prepared for a disaster.

Last summer when Rob went into the ER for an abscess, he prepared a file for me with all the pertinent information I would need “just in case” – and no, it’s nice to have him leap to morbid conclusions the same as I do. It makes me feel less of a dark, twisted freak.

But in the interim, the file vanished beneath piles of paper which in turn were scattered thither and yon as we moved our lives from one room to another to stay ahead of reno work.

I was also painfully aware of legalities that still haven’t been completed like Dee’s adoption, my being on the house title and some banking details that would give me access without having to wait on lawyers and courts.

And we’re still fairly non-committal on the whole “last wishes and remains disposal” thing despite numerous conversations.

And yes, this is what races about in my brain in a medical emergency. While all of you superior humans focus on the positive and can readily put hands on rose-coloured specs, I start compiling lists for my worst case scenario action item agenda.

I find myself checking Rob’s colouring and watching his breathing. I ask him constantly how he is feeling and match up my exterior check with his answer. I am always trying to get him to rest.

“You almost died,” I told him last night as I curled up on his lap while he waited for the data recovery program to finish snatching Edie’s life off her barely breathing hard drive.

“I did not,” he countered, a bit annoyed.

“Well,” I said, not ready to let it go, “it could have been much worse. You did ignore your symptoms all week.”

“There’s nothing like waking up with sharp chest pains,” he said.

“And if you hadn’t, you  would have gone to work,” I said, “and anything could have happened. What if we’d been at the family reunion? Miles from medical help.”

“But we weren’t,” he said, “and it was hard to know what was really wrong before.”

“I told you even before Thursday that your symptoms could be heart attack related,” I said.


“Repeatedly, ” I insisted. ” And I was right.”

“It’s important for you to be right?”


And it is. I have been down this road of scoffing, pooh-poohing husband with scary and persistent physical maladies.

“If I had experienced chest pains while we were camping,” I pointed out, “there is no way we wouldn’t have packed up and headed to the ER.”

He couldn’t refute me. Rob is hawkish about my health but very much like the typical man when it comes to his own.

I am uncertain about how I feel. The medical professions thus far appear blase with the discharging cardiologist telling Rob he can go back to work in a couple of weeks (a “couple” means “two” where I come from). He handed Rob a recipe of prescriptions – some of which make zero sense. They want him to take medication for lowering cholesterol even though his levels are fine and in spite of the very serious side effects of statins and the recent studies that show there is no link between high cholesterol (which Rob doesn’t have, or did I mention that) and heart disease. Apparently in the Alberta medical world, heart attack treatment is one size fits all.

And even Rob is agitating to work from home at least via his computer and the phone because he is in charge of some major projects with multi-million dollar scope and long-range implications for his career.

“When did I become a corp whore,” he asked bemusedly just the night before his heart attack.

But I find myself grappling with need to hurry up and finish things – the reno, writing projects and such. Time being suddenly of the essence again in a way it hasn’t for a few years. That’s probably aftershocks. I have a feeling they may continue in unexpectedly ways and waves for a while.