November 14, 2006
Since the beginning of my new running routine, I've occasionally experienced mild chest pains within the first few minutes of running. Naturally, when my chest hurt, I slowed down considerably or stopped, the pain faded quickly, and minutes later, I could run normally, even swiftly, pain free. I began to associate the pain with scrimped warm-ups. I should add that most of these episodes were before I bought a heart monitor, which Leah still refers to as a "toy." One of the first insights I had with my new toy was how my pulse quickened alarmingly when I started to run too fast near the start. So, I found and activated an alarm on the watch to beep if my pulse exceeds 80% of my maximum heart rate. With care, the pains have become much less frequent, but for the sake of precaution, I still made an appointment last week to get a checkup Student Health Services.
This morning, in a lugubriously designed grey building labeled, "Medical Arts," I saw a nurse and then a doctor, who asked questions and listened to my chest. Everything went well at first: exercise-induced asthma was unlikely; heart disease was unlikely, but an EKG had to be done, just in case. The nurse wheeled the EKG machine into the room and stuck 12 small patches on me (including, what struck me as odd at first, one on each ankle), and then smiled and threatened to shave my chest if the patches didn’t adhere. After a pause, she recanted and said she would only have to shave two small square patches (as though this was a better option! If you’ve seen hilarious film, Forty Year Old Virgin, you should appreciate that I wanted to use the term “Man-o-lantern” here.) Fortunately, the patches stuck despite my chest hair, and the EKG machine ran successfully, but labeled my results "abnormal." Puzzlingly, the nurse said, for this machine, an abnormal result was normal. The doctor thought the results were slightly abnormal, but okay, said the machine was very sensitive (Had I offended the machine?) and would double check the results with a specialist over the phone.
The cardiologist was less upbeat with a recommendation that I immediately be submitted to the emergency room, where, I was told, I would undergo similar tests and then eventually be asked to perform a stress test, probably, the following day. I did not speak to the cardiologist; I was told about the emergency room by the consulting doctor, who concluded in low voice: this is the process. His tone was meek, disbelieving and without a hint of confidence. He even left the room twice to check the recommendation with a supervisor. While logically, I didn’t believe for a moment that I should be taken in an ambulance to the hospital, which by the way, was across the street, primitive parts of my brain heard, “emergency room!” My heart raced, and I briefly worried the phoned doctor's fears would be fulfilled. After the panic passed, I questioned, "what was the emergency?" I had not had pain today, or for more than a week. Wouldn't it be dishonest to go the emergency room without the namesake requirement, and how much would it cost? My questions were met with polite understanding and the ingenious explanation that the cardiologist said so.
After some thought, I decided I would not go to the emergency room. I just wanted a referral to a cardiology office, where I could get a second opinion and the stress test. My refusal was the first time during the office visit that I felt I had any control over the direction of my own health care. Was I being foolish or stubborn? Was the relayed voice of the cardiologist, with whom I had had no consultation, just being cautious with my health? I judged: no. I imagined the doctor’s mortal concern was about losing his or her summer home to a frivolous lawsuit. In fairness, I don’t really blame the cardiologist: unnecessarily cautious doctors aren’t sued, even if unnecessary recommendations aren’t in the patience’s best interest. Because I refused to be taken to the emergency room, I had to sign a form, which removed Student Health’s liability, and left the office, amid grave looks from the staff.
I’ve made an appointment to see a cardiologist on Thursday. If I die in the next two days, I’ll feel pretty silly, and of course there’ll no chance to sue Student Health for lost wages.
