Take care of your heart — Malcom Daly

As I came to I was vaguely aware that I was strapped to a gurney in the back of an ambulance, the glare of the cabin lights making me squint and want to return to the dark place I’d just visited. The residue of chaos was scattered around me—pieces of torn up bandage packaging, medic supplies strewn around, and strips of tape, ready to apply, still hanging free from the bottom edges of the cabinets. I had tubes coming out of my arms, wires glued to my chest and I could hear the insistent beeps and buzzes of modern medicine going off all around. The EMT’s were high-five-ing with the flush of a tough job well done and were saying things to each other like, “Good Job! That was a close one.” Recognizing that I had come to, one of them leaned over me and said, “You’re a lucky guy.”

I had just had a major heart attack. It came out of the blue, with no warning, no family history: a wake-up call for me as I was strolling into middle age with the cavalier confidence shared by many ageing athletes.

Here’s my story:

I pulled into Ouray at about 8:00 pm Friday night (March 6, 2004) and went to the Buen Tiempo where I expected to see a lot of friends and climbers. No one I recognized was there. I hung at the bar and had a margarita, fully expecting someone I knew would come in. Nope. I’d totally forgotten that there was a fund raiser over at the theatre for Jim Novak’s dZi Foundation. They were showing the good stuff from the Banff Film Festival. I missed it and, instead, drove up the Camp Bird road then hiked up to Skylight area. It was one of those crystal clear, moonlit nights when headlamps are an intrusion. I was good and sweaty by the time I headed back down to doss at Donini’s. I felt great and there was no hint, whatsoever, of what was to come.

Casual morning. Tom Englebach and Cindy Foley were there so we had a slow breakfast and lots of Vic’s espresso that Tom had brought over. Man, that stuff is gritty… Tom had a bum knee and Cindy was climbing with Sandy Hiesman so I hooked up with Jeff Whitfang and we planned to meet at the upper bridge around 11:00. After stopping by Ouray Mountain Sports and cleaning Bill Leo out of Screamers and shake and bakes (to keep the toes I have left toasty), I headed up to meet Jeff. Jay and Kitty were leading up a steep route right under the bridge so we decided to take advantage of their rope to rap in and climb a route just downstream. Lori, a friend of Jeff’s, joined us and we rapped in. I got the lead.

There’d been some recent snow and they’d been making ice overnight so there was a shell of chandelier ice over a layer of snow. The climbing was slow as I cleared the crud off the good ice below. The route was 120′ long and damn near vertical but I felt great. The whole leashless thing has made leading ice so much easier that this kind of pillar is just a fun cruise. I clipped into the anchors at the top and belayed Lori up. As we were talking at the top and Jeff was coming up, my chest started to hurt.

I thought it was bronchitis. I’d had a few productive hacking moments in the past week and, having had bronchitis quite a few times in the past, I recognized the symptoms: sharp pain smack in the middle of my upper chest when I would take a breath. By this time Jay and Kitty were up and I was whining to them about my “bronchitis”. Jay told me about the benefits of Echinacea when he had a cold or a virus and Kitty told me all about the immune system supplements she’d been taking successfully. We talked about whether it would be better for my lungs to go to the hot springs or the vapor caves, all of us certain that the medicinal properties there would make my bronchitis feel better.

Meanwhile, my chest continued to hurt so I left Jeff and Lori and headed down. I stopped and talked to Bob Rotert on the bridge and then Cindy and Sandy came by as I headed for the car. No big deal, right? It was just a lung thing. I decided to go to Donini’s rather than the springs or caves. Tom was there when I got to the house so I lay down in the sun to enjoy the pain. Soon Angela Donini and Cindy showed up, ready to settle in for a fine afternoon of wine and gossip.

My pain got worse. My elbows were hurting. I was sweating and the “bronchitis” was as bad as I’d ever felt. The vapor caves came up again and Angela suggested I get in the bath with the shower on to make my own vapor. It didn’t help so, finally, about 4:00 pm, I said, “You guys, this isn’t right. I need to see a doctor.”

Tom and Angela loaded me into the Angela’s Subaru and we headed into Ouray to find the clinic. Being Saturday it was closed (Who’d need medical care on Saturday, right?) so we headed to Ridgway hoping to find an open clinic there. I looked at Angela and, and finally making some good decisions, said, “No, I need to go to the hospital.”

So off we sped. Five miles north of Ouray, at the Cutler Creek Road the chest pains were becoming wicked bad and my arms and hands started to tingle. I asked Tom to call 911 and tell them to have an ambulance meet us, STAT. I was going down. Then my face started to tingle and Angela floored it. By the time we got to Ridgway, my face was totally numb and paralyzed, my hands and arms were spasming and curled up and I could barely stand the pain in my chest. Some cops met us there and said the ambulance would be there in a sec. To keep up the light conversation they began to tell me how the altitude would affect many out-of-town visitors and that I shouldn’t worry; as soon as I could suck some O’s I’d be fine. Right.

When the ambulance showed up, Carol Dunn and Kim popped out and loaded me onto a gurney for the transfer into the ambulance. Now, for those of you who’ve never been loaded into an ambulance, I’ve got to tell you, it’s the most terrifying experience you could ever have. These things are built on an erector-set of rickety tubes and wheels that are designed to fold up. They strap you in and with a bit of a running start, they bash you into the back of the ambulance, head first, the erector set collapses and voila¸ you’re rolling on the floor where they erect the contraption once again. When you’re lying on the damn thing it’s impossible not to imagine that you’re about to be dropped on your head.

OK, oxygen on, blood pressure cuff squeezing my arm and they ask me if I like the t-shirt I’m wearing. WTF? I don’t give a damn about the shirt but I tell them it’s my favorite anyway. Snip. Off comes the shirt and they shave my chest and start sticking little electrode things onto me. We were heading to Montrose by now and the last thing I remember was looking out the back window to see if Angela and Tom were following—they were—and trying to figure out if the ambulance was running with the lights on—it was.

The scene in the ambulance was incredible, I’d gone into ventricular tachycardia (V-Tac), a heart muscle state where the heart wall, deprived of blood, freaks out and begins to spasm rapidly rather than deliver strong, regular pulses. They grabbed the defibrillator paddles and gave me the juice. There was now a third person in the back with me. It turns out it was a paramedic that had driven down from Montrose. They do that, I guess. He was congratulating the EMT’s for saving my life and high-fiving Kim, who had never had to shock anyone before. The shock burned me and I bit my tongue. Didn’t realize it until later in the hospital when I felt the lump.

When we arrived at the Montrose Hospital they humped me into the ER where a friend and climber, John Warning was on duty. I can’t tell you how reassuring it is to see a friendly face in the middle of a chaotic ER. Luckily, the cardiac surgeon was on call and was there to meet us. He rushed me off to the Cath Lab where they do things like angiograms, angioplasties and, in my case, install stents.

I was conscious and in pain the whole time. To install stents, first, they inject some dye into your blood so they can watch where the blood is flowing or not flowing. In my case they found two blocked coronary arteries. One was totally blocked and the other 80 percent blocked. Ouch. How did that happen? More on that later. To install a stent they puncture the femoral artery in your groin area and slide a big tube up ‘till it gets to your heart. Then they poke around until they get to the blocked area, clean it out and place a small metal tube (the stent) that holds your artery open in the clogged area. As soon as he got the first stent placed half of my pain went away. Placing the second eliminated all of the pain. That was cool.

I got to spend the first three nights in the ICU where I had a room all to myself. It was great because after the first night, we basically had a party in the room every night. Kim Reynolds and Jim Novak brought good dinners, Duncan Ferguson and Suzie Billings showed up. Jim and Angela were there and Bill Leo showed up with a giant bag of buttered and salted popcorn, a pack of smokes, a six-pack of beer and a slurpee. Gotta
love that sense of humor.

I wish I could describe for you, how good it feels and how resuscitating it is to have that kind of support from all my friends rooting for me. I swear, more people showed up in the hospital there than would have showed up in Boulder. Both times I’ve had major epics the outpouring of warmth and good will for me and my family has been amazing. I know I’m not alone; I can feel the vibe. It feels like standing in front of a warm wood stove.

After the third night they moved me into a semi-private room, private in a misnomer. There is no privacy in a hospital. I had some interesting roommates there. Ralph (names have been changed to protect the innocent) was a 63 year-old tree trimmer who had been discovered laying on the sidewalk in front of the house where he was working. He’d been on the job when he felt major chest pains so he went and lay down in the front seat of his truck. Thirty minutes later he got up, started working on the tree again, and immediately had massive, crippling chest pains. He was on the ground for 30 minutes before anyone spotted him and called 911. He’d had a heart attack too. When they brought him in he smelled like an ashtray despite—according to him—quitting cigarettes three weeks prior. When his buddy came in to visit, they snuck out for a smoke.

Next up was Lloyd. He was brought into the hospital because of a series of acute asthma and coughing attacks. Immediately he was whining about western medicine, drugs and pain-killers. He hated docs and had been trying to cure his asthma with acupuncture, Chinese medicine and what he called “Five Element” treatment, which would get to the core of his problems, one element at a time, I guess. When the doc came in to interview him the next morning the conversation—I kid you not—went like this:

Doc (With a strong Aussie accent.): “Have you ever had any trouble at altitude?”
Lloyd: “Never.”
Doc: “When did you first learn that you had asthma?”
Lloyd: “About three years ago when I quit drinking and gave up western
medicine.”
Doc: Are you on any medications right now?”
Lloyd: “Yeah, I take Biu Xin (My memory is weak here. It may have been
something else, but it was some Chinese name.) for my asthma.”
Doc: “How much do you take?”
Lloyd: “Eight pills, three times a day.”
Doc: When did you start taking this (looks at notes) Biu Xin?”
Lloyd: “About three days ago.”
Doc: “And when did you start having the severe asthma attacks?”
Lloyd: “About three days ago.”
Doc: (Rolls his eyes.) “I don’t know about you, mate, but I’d maybe think about
laying off this stuff to see if that’s the problem. ”
Lloyd: “No way, doc. I hate Western Medicine and I know this stuff is making me
better.”

Now those of you who know me know that I’m waaaay psyched for acupuncture and Chinese medicine. I’d still be addicted to antibiotics if it weren’t for Chip Chase’s witch-doctoring. At the same time, there is a very appropriate time and place for good ol’ western medicine. I’d be dead if it weren’t for that defibrillator. In the meantime, Lloyd discharged himself from the hospital and split. Best of luck to you, Lloyd.

My last roommate was normal. An Aussie who been working at the Boot Doctor in T-ride had sliced open his finger, severing the tendon, came in for a night of good rest. Nice guy and we talked quite a bit. My favorite line? The curtain was open between us and I had to use the pee bottle. I explained this to him as I was closing the curtain and he said, “No worries mate. I’ve seen bigger worms in the garden.”

Karen, my wife, has been awesome. I don’t know how I could do it without her. She keeps getting these phone calls from distant places; usually late at night, from a friend with a story about the new way I’ve just discovered to kill myself. She flew out on Sunday and was able to spend the week with me in the hospital. She hates hospitals. Five years ago I set up two friends, Kathy Harrington and Dick Stone, on a blind date. They ended up getting married. Dick is a pilot for United and Kathy is an RN. They offered to fly over in their Cessna 182 and fly me back to Boulder. We flew right over McClure Pass, buzzed Sopris, and Mt. Powell, and then came in to Boulder over Corona Pass. Boy was that a cool flight. I took just over an hour.

Now here’s the heath news:

There was doom and gloom while I was in Montrose. The doc said that there had been major damage to my heart muscle and that I was committed to bed rest for at least a month. An echo-cardiogram (an ultra sound for your heart) showed that my ejection fraction (The ratio of the chamber volume when empty to when it’s full. The normal range for males is between 45 and 65) was just 25. That sucks. He said that there was serious danger of another heart attack and recommend that we purchase a personal defibrillator to have around all the time. My brother went on the internet and found one for only $1500. When I left the hospital I was under doc’s orders to be taking 14 different medications including 2 kinds of blood thinners, beta-blockers, cholesterol meds, anti-anxiety drugs (?) and others I have no idea what they’re for. That’s a picture of Karen after going to the pharmacy and returning with a shopping bag full of nasty drugs. The schedule for taking these meds was so complicated (different meds six times a day, some were PRN’s based on how I felt or my blood pressure.) we needed to make up a medication grid on a spreadsheet.

After returning to Boulder, a week of healing and seeing the cardiologist in Boulder the news is much better. On Thursday (3/18) I had another echo-cardiogram and the results were great. My ejection fraction was 51 in one chamber and 54 in the other; well within the normal range. It doesn’t appear that there was a lot of permanent damage to my heart. It’s still not pumping at full volume so I’m tired, light-headed and have low blood pressure. As time passes and I get into more exercise and rehab, there’s no reason that normal heart function shouldn’t come back. The best news was that the cardio took me off of all but five of the meds and one of those is aspirin. Yeah! No more evil blood thinners.

Lessons Learned
So….no warning, no family history of heart attacks, I get regular exercise, have never smoked a whole cigarette and am reasonably fit. How the hell could I have had a heart attack? Both sides of my family have always had high cholesterol. The last time I checked mine was 230 or so with the LDL’s (the bad ones) at about 120. That’s high, but given the lack of any family history of heart problems, I wasn’t too worried. Neither was my doc. On a scale of one to ten, with ten being the best, my diet is probably about 7 or 8. I wasn’t immune to the occasional Chimichanga or Quarter Pounder with fries but these certainly weren’t a regular part of my diet. The popular theory is that heart attacks result from a long, slow build-up of plaque in the arteries, eventually leading to clogging of one of the coronary arteries and a heart attack. Some new research (See the attached article from the New York Times—March 21, 2004) suggests that unexpected heart attacks can result from a sudden release of plaque, which floats around in your bloodstream until it clogs up coronary arteries.

The therapy? Do whatever you need to do to lower your cholesterol. Now. Diet, exercise and drugs are a proven combination that works to lower your cholesterol. If you start today, that won’t be too late. Heart attack symptoms are cryptic and varied. Classic symptoms to watch out for are chest pain on the left side, shooting pains down your left arm and shortness of breath. I had none of these symptoms. I wasn’t short of breath, my chest pain was centered in the bronchial area and I had no “shooting pains” down my left arm. Heart attack symptoms run the gamut from indigestion, heartburn, tooth pain (really), jaw pain, tightness in your chest, lower back pain, cold sweats and stomach pain. I don’t know what to recommend here other than to say, if you feel anything weird, go see your cardiologist. And do whatever it takes to lower your cholesterol.

Send cards, vibes, flowers, books and any kind of good juju you can, to your friends who are in trouble. I can’t even begin to explain how rejuvenating, uplifting and heartwarming it is to be the recipient of all that good energy. People keep telling me how inspiring my positive attitude has been to them through these last two ordeals, but, I’ve got to tell you, my attitude has been largely due to the outpouring of generosity, good wishes and unselfish support that I’ve received. Thank you.

Peace and love,
Malcolm Daly, president of Great Trango Holdings
March 30, 2004