Frederic W. Platt, MD

It was the coffee that did it to me. “You can’t have real coffee,” the room service dietary person said, “decaf. You’re on a cardiac diet.” She had already refused my request for orange juice, for waffles, for a short stack of pancakes—“You’re on a diabetic diet.” But, I remonstrated, my sugars are normal and at home I eat a regular diet. “Not on your life,” she replied. You have to get your doctor or your nurse to change the diet order. “You’re on a cardiac-diabetic diet.” But I’ve talked with my cardiologist and he says a couple of cups of coffee a day are OK. “Nope, not from us, it isn’t.”

My last meal was the evening before. Nothing to speak of for breakfast and then no lunch, of course, since my cardiac angiogram had been scheduled for 2:30 pm and then started an hour late. It was now dinner time and I was famished. I especially wanted that cup of coffee. My doctor had gone back to his office and in a hospital staffed with many many nursing people, I didn’t know who my nurse was. Worse yet, I had sent my eyeglasses home with my wife along with my clothes. I couldn’t see the button to summon help (although it wouldn’t have been much help, I also couldn’t see the TV up on the wall). Besides, flat on my back, after strict instructions to lie flat for 12 hours after the angiogram femoral stick, I couldn’t even find the nurse call button.

I tried pulling rank. “I’m a doctor myself, you know.” No luck. The dietary limb of this new hospital stood firm.

Eventually, many hours later (maybe ¾ of an hour), maybe days later, my real nurse came in. She introduced herself, “Susan,” and told me she was to be “my main man” and that “she had the keys to the kingdom.” Specifically, she could change the dietary order. Breakfast appeared at 8 pm. Yum! Real coffee, not decaf.

I was in the hospital to figure out why my angina pectoris had returned.

It arrived about 20 years ago. A diminution in the distance I could run without stopping because of a new sensation, a heavy rock in my chest. No big problem; I could pause for 15 seconds and the pain would subside. So I still ran, just lopping off a few miles each day. And finally I went to see a cardiologist who put me on a treadmill until the ST segments dropped and then he stopped me with an ominous “the test has gone positive.” What does a cardiologist do when his middle-aged physician friend has a positive treadmill test? An angiogram of course. So we soon had pictures of my coronary arteries and yes, there were blockages, but not very severe, maybe I could keep jogging.

It took a few years for the angina to become really disruptive. Another angiogram led to an effort to open up the main obstruction, one-half way down the anterior descending artery, known familiarly as “the artery of sudden death.” OK, let’s do something! And that something was a stent, placed with difficulty and a great deal of chest pain. I think my 2 (now 2 to do this difficult procedure) cardiologists were fearful that they would end with a patent vessel and a dead patient. After the procedure I noted no change in the chest pain trouble but surprise, a belated blood count showed an anemia. So we treated the anemia and the angina got better. I began to wonder if we could have avoided the stenting if we had just checked a hematocrit before the angiogram. But of course, insurance didn’t include that test for that diagnosis.

That was a dozen years ago and the angina remained but at a very stable level. Some of our young physician colleagues use that word “Stable” to mean something that will probably not kill you in the next hour or two. I prefer to use it to mean unchanging. And the angina remained but didn’t change. I had to give up running, a terrible loss for me, but I could walk and do some gym work. I could still read and write and play bridge. Jogging a block or two was enough to bring on the familiar pain; I could give up the jogging.

Then, a year ago the dam broke. My angina increased. Instead of a mile fast walk to provoke it, now a block’s walking did it. And recovery that used to take a few seconds now took a minute or two. We were in Buenos Aires, a city with lots of easy hills, but no longer so easy for me. So I thought it time to go back to the cardiologist. Another angiogram surprised him and me both. The old left coronary artery with its stent was perfectly open, but the right occluded at its orifice and the good Dr. Rainwater couldn’t open it with any of his catheters, wires, or brushes. I needed a real operation, a coronary bypass to that right coronary artery. Not my favorite idea. Joe sent me to a surgeon who he said had the best results in Denver.

Those surgeons love to do what they know how to do. A man with a hammer sees everything as a nail. The surgeon saw me as a bypassable artery.

Big things can be awfully easy to do. I was in and out of the hospital with a nice new bypass in a few days. And though depleted of strength by this strange attack, I happily did not have a pump brain, could still sort a bridge hand, and began my exercise rehabilitation. Within a few weeks I saw hope of regaining strength and no angina. A chance to cut indeed had been a chance to cure.

That was January. Summer spent up in the mountains at 9000 feet, lots of walking, some easy hikes, doing well. And then, all of a sudden, my heart rhythm changed. Frequent premature ventricular beats, often paired to sinus beats (bigemini), sometimes in triplets (trigeminy.) And worse still, I no longer could walk around the block, my usual 3/8 mile with the little dogs had to stop several times with faintness and then with pain. The angina was back, with a vengeance.

So once again to the cardiologist. He and I discussed the odds. 70% probable: something had plugged up, maybe the new graft. If so, he thought I would have to go elsewhere, perhaps to Scripps in San Diego, where people were better at un-plugging vessels with tubes and wires. 5% possibility: plugged vessel that Joe could clear up. That left about a 30% probability: maybe vessels would be OK but it was the fault of the new arrhythmia. And ventricular arrhythmias are notoriously tough to treat. Antiarrhythmia drugs are also all pro-arrhythmic. The treatment may be worse than the disease. I might have become a cardiac cripple.

This was my fourth cardiac angiogram. It seems true that we spend most of our medical expenses in the last year or two of our lives. Maybe that’s where I am. But I agreed—we had to know what was causing the problem even though I didn’t want more dye squirted into my vessels. Well, big surprise and a pleasing one: the coronary vessels were wide open. It was the PVCs that were causing the trouble. So Joe asked Charlie, his electrophysiology pal, to come look at me. Charlie arrived full of joy. He had just the trick. He could stick a few wires into my left ventricle and fry the place that originated the extra beats. How sure was he? Oh, maybe 90% sure—if the wires didn’t perforate the heart wall and if he fried the right spot, maybe I’d be better. Oh? I wondered if there weren’t any drugs, any pills to try first. Yes, he grudgingly admitted, but seldom successfully. Well, let’s try.

The nurse brought me a single pill, approved for treating atrial arrhythmias, not the ventricular extra beats that were attacking me. But nonetheless, 2 hours later an ECG showed 3 PVCs per minute. There had been 30 before. The new drug works! Hooray!

And the coffee had been great.

But I want to tell you about the 2 days in the hospital, when my nurse Susan told me what she had figured out. Her father was a physician, in fact, a fellow I knew well. He had cancer and was suffering chemotherapy. She said that the hardest part for him was giving up control. “You doctors are used to being in charge,” she said. “Now you’re gone over to the other side.” That was it. The total loss of control—of my chest pain, of the cardiac arrhythmia, even of the head of the bed and a late breakfast. That coffee was the worst. I didn’t want decaf.

Once understood by Susan and then even by me, the loss of control seemed less painful. And now the PVCs are almost gone, the chest pain has vanished, and I’m back to walking my 2 little dogs a half a mile 3 times a day.

Corresponding author: Frederic W. Platt, MD, 396 Steele St., Denver, CO 80206, [email protected].

It was the coffee that did it to me. “You can’t have real coffee,” the room service dietary person said, “decaf. You’re on a cardiac diet.” She had already refused my request for orange juice, for waffles, for a short stack of pancakes—“You’re on a diabetic diet.” But, I remonstrated, my sugars are normal and at home I eat a regular diet. “Not on your life,” she replied. You have to get your doctor or your nurse to change the diet order. “You’re on a cardiac-diabetic diet.” But I’ve talked with my cardiologist and he says a couple of cups of coffee a day are OK. “Nope, not from us, it isn’t.”

My last meal was the evening before. Nothing to speak of for breakfast and then no lunch, of course, since my cardiac angiogram had been scheduled for 2:30 pm and then started an hour late. It was now dinner time and I was famished. I especially wanted that cup of coffee. My doctor had gone back to his office and in a hospital staffed with many many nursing people, I didn’t know who my nurse was. Worse yet, I had sent my eyeglasses home with my wife along with my clothes. I couldn’t see the button to summon help (although it wouldn’t have been much help, I also couldn’t see the TV up on the wall). Besides, flat on my back, after strict instructions to lie flat for 12 hours after the angiogram femoral stick, I couldn’t even find the nurse call button.

I tried pulling rank. “I’m a doctor myself, you know.” No luck. The dietary limb of this new hospital stood firm.

Eventually, many hours later (maybe ¾ of an hour), maybe days later, my real nurse came in. She introduced herself, “Susan,” and told me she was to be “my main man” and that “she had the keys to the kingdom.” Specifically, she could change the dietary order. Breakfast appeared at 8 pm. Yum! Real coffee, not decaf.

I was in the hospital to figure out why my angina pectoris had returned.

It arrived about 20 years ago. A diminution in the distance I could run without stopping because of a new sensation, a heavy rock in my chest. No big problem; I could pause for 15 seconds and the pain would subside. So I still ran, just lopping off a few miles each day. And finally I went to see a cardiologist who put me on a treadmill until the ST segments dropped and then he stopped me with an ominous “the test has gone positive.” What does a cardiologist do when his middle-aged physician friend has a positive treadmill test? An angiogram of course. So we soon had pictures of my coronary arteries and yes, there were blockages, but not very severe, maybe I could keep jogging.

It took a few years for the angina to become really disruptive. Another angiogram led to an effort to open up the main obstruction, one-half way down the anterior descending artery, known familiarly as “the artery of sudden death.” OK, let’s do something! And that something was a stent, placed with difficulty and a great deal of chest pain. I think my 2 (now 2 to do this difficult procedure) cardiologists were fearful that they would end with a patent vessel and a dead patient. After the procedure I noted no change in the chest pain trouble but surprise, a belated blood count showed an anemia. So we treated the anemia and the angina got better. I began to wonder if we could have avoided the stenting if we had just checked a hematocrit before the angiogram. But of course, insurance didn’t include that test for that diagnosis.

That was a dozen years ago and the angina remained but at a very stable level. Some of our young physician colleagues use that word “Stable” to mean something that will probably not kill you in the next hour or two. I prefer to use it to mean unchanging. And the angina remained but didn’t change. I had to give up running, a terrible loss for me, but I could walk and do some gym work. I could still read and write and play bridge. Jogging a block or two was enough to bring on the familiar pain; I could give up the jogging.

Then, a year ago the dam broke. My angina increased. Instead of a mile fast walk to provoke it, now a block’s walking did it. And recovery that used to take a few seconds now took a minute or two. We were in Buenos Aires, a city with lots of easy hills, but no longer so easy for me. So I thought it time to go back to the cardiologist. Another angiogram surprised him and me both. The old left coronary artery with its stent was perfectly open, but the right occluded at its orifice and the good Dr. Rainwater couldn’t open it with any of his catheters, wires, or brushes. I needed a real operation, a coronary bypass to that right coronary artery. Not my favorite idea. Joe sent me to a surgeon who he said had the best results in Denver.

Those surgeons love to do what they know how to do. A man with a hammer sees everything as a nail. The surgeon saw me as a bypassable artery.

Big things can be awfully easy to do. I was in and out of the hospital with a nice new bypass in a few days. And though depleted of strength by this strange attack, I happily did not have a pump brain, could still sort a bridge hand, and began my exercise rehabilitation. Within a few weeks I saw hope of regaining strength and no angina. A chance to cut indeed had been a chance to cure.

That was January. Summer spent up in the mountains at 9000 feet, lots of walking, some easy hikes, doing well. And then, all of a sudden, my heart rhythm changed. Frequent premature ventricular beats, often paired to sinus beats (bigemini), sometimes in triplets (trigeminy.) And worse still, I no longer could walk around the block, my usual 3/8 mile with the little dogs had to stop several times with faintness and then with pain. The angina was back, with a vengeance.

So once again to the cardiologist. He and I discussed the odds. 70% probable: something had plugged up, maybe the new graft. If so, he thought I would have to go elsewhere, perhaps to Scripps in San Diego, where people were better at un-plugging vessels with tubes and wires. 5% possibility: plugged vessel that Joe could clear up. That left about a 30% probability: maybe vessels would be OK but it was the fault of the new arrhythmia. And ventricular arrhythmias are notoriously tough to treat. Antiarrhythmia drugs are also all pro-arrhythmic. The treatment may be worse than the disease. I might have become a cardiac cripple.

This was my fourth cardiac angiogram. It seems true that we spend most of our medical expenses in the last year or two of our lives. Maybe that’s where I am. But I agreed—we had to know what was causing the problem even though I didn’t want more dye squirted into my vessels. Well, big surprise and a pleasing one: the coronary vessels were wide open. It was the PVCs that were causing the trouble. So Joe asked Charlie, his electrophysiology pal, to come look at me. Charlie arrived full of joy. He had just the trick. He could stick a few wires into my left ventricle and fry the place that originated the extra beats. How sure was he? Oh, maybe 90% sure—if the wires didn’t perforate the heart wall and if he fried the right spot, maybe I’d be better. Oh? I wondered if there weren’t any drugs, any pills to try first. Yes, he grudgingly admitted, but seldom successfully. Well, let’s try.

The nurse brought me a single pill, approved for treating atrial arrhythmias, not the ventricular extra beats that were attacking me. But nonetheless, 2 hours later an ECG showed 3 PVCs per minute. There had been 30 before. The new drug works! Hooray!

And the coffee had been great.

But I want to tell you about the 2 days in the hospital, when my nurse Susan told me what she had figured out. Her father was a physician, in fact, a fellow I knew well. He had cancer and was suffering chemotherapy. She said that the hardest part for him was giving up control. “You doctors are used to being in charge,” she said. “Now you’re gone over to the other side.” That was it. The total loss of control—of my chest pain, of the cardiac arrhythmia, even of the head of the bed and a late breakfast. That coffee was the worst. I didn’t want decaf.

Once understood by Susan and then even by me, the loss of control seemed less painful. And now the PVCs are almost gone, the chest pain has vanished, and I’m back to walking my 2 little dogs a half a mile 3 times a day.

Corresponding author: Frederic W. Platt, MD, 396 Steele St., Denver, CO 80206, [email protected].

It was the coffee that did it to me. “You can’t have real coffee,” the room service dietary person said, “decaf. You’re on a cardiac diet.” She had already refused my request for orange juice, for waffles, for a short stack of pancakes—“You’re on a diabetic diet.” But, I remonstrated, my sugars are normal and at home I eat a regular diet. “Not on your life,” she replied. You have to get your doctor or your nurse to change the diet order. “You’re on a cardiac-diabetic diet.” But I’ve talked with my cardiologist and he says a couple of cups of coffee a day are OK. “Nope, not from us, it isn’t.”

My last meal was the evening before. Nothing to speak of for breakfast and then no lunch, of course, since my cardiac angiogram had been scheduled for 2:30 pm and then started an hour late. It was now dinner time and I was famished. I especially wanted that cup of coffee. My doctor had gone back to his office and in a hospital staffed with many many nursing people, I didn’t know who my nurse was. Worse yet, I had sent my eyeglasses home with my wife along with my clothes. I couldn’t see the button to summon help (although it wouldn’t have been much help, I also couldn’t see the TV up on the wall). Besides, flat on my back, after strict instructions to lie flat for 12 hours after the angiogram femoral stick, I couldn’t even find the nurse call button.

I tried pulling rank. “I’m a doctor myself, you know.” No luck. The dietary limb of this new hospital stood firm.

Eventually, many hours later (maybe ¾ of an hour), maybe days later, my real nurse came in. She introduced herself, “Susan,” and told me she was to be “my main man” and that “she had the keys to the kingdom.” Specifically, she could change the dietary order. Breakfast appeared at 8 pm. Yum! Real coffee, not decaf.

I was in the hospital to figure out why my angina pectoris had returned.

It arrived about 20 years ago. A diminution in the distance I could run without stopping because of a new sensation, a heavy rock in my chest. No big problem; I could pause for 15 seconds and the pain would subside. So I still ran, just lopping off a few miles each day. And finally I went to see a cardiologist who put me on a treadmill until the ST segments dropped and then he stopped me with an ominous “the test has gone positive.” What does a cardiologist do when his middle-aged physician friend has a positive treadmill test? An angiogram of course. So we soon had pictures of my coronary arteries and yes, there were blockages, but not very severe, maybe I could keep jogging.

It took a few years for the angina to become really disruptive. Another angiogram led to an effort to open up the main obstruction, one-half way down the anterior descending artery, known familiarly as “the artery of sudden death.” OK, let’s do something! And that something was a stent, placed with difficulty and a great deal of chest pain. I think my 2 (now 2 to do this difficult procedure) cardiologists were fearful that they would end with a patent vessel and a dead patient. After the procedure I noted no change in the chest pain trouble but surprise, a belated blood count showed an anemia. So we treated the anemia and the angina got better. I began to wonder if we could have avoided the stenting if we had just checked a hematocrit before the angiogram. But of course, insurance didn’t include that test for that diagnosis.

That was a dozen years ago and the angina remained but at a very stable level. Some of our young physician colleagues use that word “Stable” to mean something that will probably not kill you in the next hour or two. I prefer to use it to mean unchanging. And the angina remained but didn’t change. I had to give up running, a terrible loss for me, but I could walk and do some gym work. I could still read and write and play bridge. Jogging a block or two was enough to bring on the familiar pain; I could give up the jogging.

Then, a year ago the dam broke. My angina increased. Instead of a mile fast walk to provoke it, now a block’s walking did it. And recovery that used to take a few seconds now took a minute or two. We were in Buenos Aires, a city with lots of easy hills, but no longer so easy for me. So I thought it time to go back to the cardiologist. Another angiogram surprised him and me both. The old left coronary artery with its stent was perfectly open, but the right occluded at its orifice and the good Dr. Rainwater couldn’t open it with any of his catheters, wires, or brushes. I needed a real operation, a coronary bypass to that right coronary artery. Not my favorite idea. Joe sent me to a surgeon who he said had the best results in Denver.

Those surgeons love to do what they know how to do. A man with a hammer sees everything as a nail. The surgeon saw me as a bypassable artery.

Big things can be awfully easy to do. I was in and out of the hospital with a nice new bypass in a few days. And though depleted of strength by this strange attack, I happily did not have a pump brain, could still sort a bridge hand, and began my exercise rehabilitation. Within a few weeks I saw hope of regaining strength and no angina. A chance to cut indeed had been a chance to cure.

That was January. Summer spent up in the mountains at 9000 feet, lots of walking, some easy hikes, doing well. And then, all of a sudden, my heart rhythm changed. Frequent premature ventricular beats, often paired to sinus beats (bigemini), sometimes in triplets (trigeminy.) And worse still, I no longer could walk around the block, my usual 3/8 mile with the little dogs had to stop several times with faintness and then with pain. The angina was back, with a vengeance.

So once again to the cardiologist. He and I discussed the odds. 70% probable: something had plugged up, maybe the new graft. If so, he thought I would have to go elsewhere, perhaps to Scripps in San Diego, where people were better at un-plugging vessels with tubes and wires. 5% possibility: plugged vessel that Joe could clear up. That left about a 30% probability: maybe vessels would be OK but it was the fault of the new arrhythmia. And ventricular arrhythmias are notoriously tough to treat. Antiarrhythmia drugs are also all pro-arrhythmic. The treatment may be worse than the disease. I might have become a cardiac cripple.

This was my fourth cardiac angiogram. It seems true that we spend most of our medical expenses in the last year or two of our lives. Maybe that’s where I am. But I agreed—we had to know what was causing the problem even though I didn’t want more dye squirted into my vessels. Well, big surprise and a pleasing one: the coronary vessels were wide open. It was the PVCs that were causing the trouble. So Joe asked Charlie, his electrophysiology pal, to come look at me. Charlie arrived full of joy. He had just the trick. He could stick a few wires into my left ventricle and fry the place that originated the extra beats. How sure was he? Oh, maybe 90% sure—if the wires didn’t perforate the heart wall and if he fried the right spot, maybe I’d be better. Oh? I wondered if there weren’t any drugs, any pills to try first. Yes, he grudgingly admitted, but seldom successfully. Well, let’s try.

The nurse brought me a single pill, approved for treating atrial arrhythmias, not the ventricular extra beats that were attacking me. But nonetheless, 2 hours later an ECG showed 3 PVCs per minute. There had been 30 before. The new drug works! Hooray!

And the coffee had been great.

But I want to tell you about the 2 days in the hospital, when my nurse Susan told me what she had figured out. Her father was a physician, in fact, a fellow I knew well. He had cancer and was suffering chemotherapy. She said that the hardest part for him was giving up control. “You doctors are used to being in charge,” she said. “Now you’re gone over to the other side.” That was it. The total loss of control—of my chest pain, of the cardiac arrhythmia, even of the head of the bed and a late breakfast. That coffee was the worst. I didn’t want decaf.

Once understood by Susan and then even by me, the loss of control seemed less painful. And now the PVCs are almost gone, the chest pain has vanished, and I’m back to walking my 2 little dogs a half a mile 3 times a day.

Corresponding author: Frederic W. Platt, MD, 396 Steele St., Denver, CO 80206, [email protected].