I always managed to get on well with my flight surgeons and I managed good relations with them. This did not mean I could avoid some circumstances though and in 1986, while in Germany, My Blood Pressure was too high on my flight physical and I had to start medication to maintain it. Because of some other irregularities in my physical, my flight surgeon decided he should be cautious and sent me to get checked out by cardiology. This was no big deal to me as I had been sent there before. This was nothing to get all excited about, just routine, I or so thought.
The cardiologist also decided on a cautious approach and he felt that I needed a stress test to ensure that there was nothing wrong with my heart. Okay, I’ve done this before too. Running on a treadmill, wired for sound, no big deal, again. Aside from the blood pressure, I was in pretty good shape and I was feeling good about myself too. The stress test was just another let’s get this done moment I had to endure to get on with the flying business. When started the test, all was going well. The speed of the treadmill increased and the incline increased, and slowly, my pulse started to rise from a resting 56 beats per minute (BPM), toward the 130 BPM goal of the test. I’d worked up a pretty good sweat and felt like I was getting a workout when I hit 102% of the stress goal and the doctor said I could stop. Before I could even begin to slow down on the treadmill, the doctor started cursing. When I caught my breath, I asked him what was the matter? He replied you just threw a PVC.
Premature ventricular contractions (PVCs) are extra, abnormal heartbeats that begin in one of your heart's two lower pumping chambers (ventricles). In pilot speak it meant; “You’re Grounded”. I started inquiring with him what all this meant. I had over 15 minutes of Electrocardiogram and one errant heartbeat, no big deal, right? He said, that if I hadn’t been a pilot, no one would have cared. But, since I was on flight status, we had to follow up on it. He told me that for most people, they would simple do an echo-cardiogram as an outpatient and I would be good. He told me while that was fine for most normal humans, because I was a US Army pilot, the Army Aeromedical Board, had to approve my flight physical, would require a cardiac catheterization as well, just to be sure. He told me there was no point in doing the echo test as the cath was going to occur if I still wanted to fly.
I was stunned! There had never been any question about my heart, even. I had to admit that there could really be something wrong with my heart and until you’ve had that realization yourself, you really can’t understand what that meant to me. Sadly, concern about my heart was secondary to my concern about my flying career. I had been passed over for promotion shortly after arriving in Germany and I only had this one year left before I would most likely be passed over again and out of the Army. Every flight counted and any grounding was less opportunity to fly. This also brought about a second round of health concerns (The first time had been in flight school when I had been diagnosed with a Parathyroid Tumor that nearly ended my flying career before it began.) Would I get cleared to fly again? Could this permanently ground me? Might this prevent me from a civilian aviation career? These thoughts began to keep me up at night.
Since I was in Germany, none of the required testing could be done in the local clinic or the Wurzburg field hospital. I had to go to the Army Medical Center in Landstuhl (4 hours away) for the test. This required a temporary duty assignment (TDY) to travel to the hospital and once there it couldn’t be an outpatient procedure either. I had to be admitted, and the test had to be performed in an operating room. The only good thing was that I was scheduled for the following week, limiting my angst to a few days instead of several weeks or months, which I considered a minor miracle in and of itself.
The trip the Landstuhl itself was uneventful. Landstuhl was a huge sprawling medical complex that had been built after the second world war. Like all hospitals of the time, it was a group of 50 or so buildings all connected by hallways. I managed to check in without any problems and was ushered to my room to spend the night alone and hungry. I could have nothing to eat (the Latin medical term is nil per os or NPO meaning "nothing through the mouth") as I was going to be under anesthesia the next morning. Food in the tummy and medically induced sleep tended to cause you to be nauseous and should be avoided. I woke the next morning and followed procedure to bathe with the antiseptic soap and put on a clean gown sans skivvies. (You can’t every have your underwear in the OR you know.) and then I waited for the appointed time. (8 AM sounds about right.)
The test almost didn’t happen that morning. The nurse came to tell me that an orderly was on his way to transport me and asked me if my pre-op medication had taken effect. I soberly replied “What pre-op meds”? It seemed that I should have been given two Valium at 6 AM so that I would be good and relaxed by the time they began the procedure. The nurse started to call the whole thing off and I somehow managed to convince her that I should go ahead and take the Valium now then and that it really didn’t matter much because the test didn’t scare me and I was pretty chill to begin with. With just a minor bit of coaxing, I managed to get my meds about ten minutes before the orderly arrived. It was at this point that things began to get interesting.
I was wheeled into the operating Room and got to make the obligatory less than graceful transition from the gurney to the table in front of two cardiologists and five or six nurses. You can never move around in a hospital gown horizontally without displaying your private parts to all concerned, apparently, it was a rule of the medical profession that had to be followed. They wanted me to be awake for the catheterization process, but they didn’t want me paying too much attention to what they were actually doing. To facilitate this, they had one nurse, whose only task was to keep me occupied and distracted from the mechanics of the catherization. She was wearing full scrubs and a mask when we met, so all I ever got to see of here were her gorgeous eyes. I must admit, looking into her eyes was a distraction. She was very pleasant and she had a warm contralto voice, I was giving her a great deal of my attention. We did have a good view of the fluoroscope monitor though, so we could see all that was going on.
They started the process by installing a shunt in my right femoral artery. Just a poke of the local anesthetic was all I felt, then some pressure as the shunt was inserted into the artery. This in itself is a pretty major even, as one mistake and you can bleed to death before they get the flow stopped. They used the fluoroscope to see the catheter insertion and the dye injections. The cardiologist inserted the first catheter (It was kind of imposing to me as it was over three feet long) and she very quickly slid it up into my aorta. This part is painless as your veins and arteries have no nerves, so there is no sensation inside your body at all. She injected the dye and Viola! My left coronary ostium (Arteries of the left side of the heart) was displayed on the screen. The doctor quickly took some video and still photos with the equipment and slid the catheter out to insert the one designed for the right side. This is the point where things got extremely interesting.
With the second catheter in place, the she injected the dye just like the first time. The only problem was that nothing appeared on the screen. Puzzled, the doctor injected dye a second time with the same result. Finally, she injected the rest of the syringe, and still nothing appeared upon the screen. My distractor was trying to do her job and keep me occupied as she was concerned I was getting nervous. By now, the Valium had kicked in and I think they could have cut off my foot and I would have only commented that it would have been interesting to watch. Then the cardiologist had a minor epiphany and she removed catheter number two and reinserted catheter number one. (She did this very quickly and it seemed like she was just slamming that catheter back in like it was nothing unusual at all to do.) She attached a full syringe of dye and said “watch this”! She injected the whole syringe in one big push. (Her saying “Watch this was reminiscent of an army joke. What are the three scariest things you can hear in the Army? A lieutenant who says: “I have us on the map.” A Captain who says: “I’m in charge!” and a Warrant Officer who says:” Watch this!”) As the dye went in, the left ostium lit up like a Christmas tree. Then the image appeared across the bottom of my heart, the right ostium started to appear. Soon all the arteries of my heart showed up. The Cardiologist commented that I had “unique plumbing” and that this situation occurred in about one of every 300 or so patients.
In a normal heart, the left and right coronary ostia receive blood from the aorta. In my case however, the left was the only connection to the aorta. There was a large arterial branch from the left to the right ostia and in essence I just had one ostium and it connected from the left side. She also commented that it was one of the largest coronary arteries she’d ever seen. More film and still photos were taken then the shunt was removed. My heart was fine. The PVC that had been recorded was a result of my unique plumbing and that the aero-medical board should have no issue clearing me for flight.
The post-operative experience was also a trip. It turns out that the actual procedure is not the most concerning part of a cardiac cath, but making sure that you don’t bleed to death after the procedure. They have just poked a rather large hole on one of the largest arteries in your body, now they had to keep you from bleeding out. To do this, someone had to place direct pressure on the artery for twenty minutes, after which they placed a compression bandage on the site. They chose an orderly who could have easily been a lineman for a football team for this task. For twenty minutes I laid on a gurney while a 280-lb. guy had his hands pressing firmly on the femoral artery just a few inches from my groin. This was “disconcerting” at the very least. They finally put on the compression bandages and I was released by Bubba so he could go crush someone else. Then came the best part of my day, lying flat on my back for SIX HOURS!
Somewhere around 2PM, I was treated to a late lunch which I devoured without much thought to the flavor as I was starving. I was released from the hospital the next morning and put on light duty for a week before I was finally cleared to go back to doing pilot stuff again. None the worse for the wear. Oh, the things pilots will go though so they can fly!
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