I Died Last Week

I say I died because I stopped breathing, and while they do not issue temporary death certificates, how else might we explain the next five minutes of which I have no remembrance? I sat down in a chair because I suddenly felt short of breath, and then when the switch came back on, I was lying on the deck, with my wife hovering over me and EMTs beginning their ministrations.

The reason for everything was that I had thrown a blood clot from my leg into my lungs, not just a blood clot, but the Big One, straddling the blood flow of both lungs – a saddle embolus. Many individuals don’t survive those first minutes; when the clot hits, the ability to oxygenate drops, and your breathing takes a prolonged pause. I was amazingly lucky, it could have happened an hour later, and I simply would have been found dead in bed in the morning.

Saddle Emboli

It is a rare form of embolization, when a blood clot travels from most frequently your leg to your lungs, occurring in 2-5% of patients. That percentage may be higher if you count those who immediately die; these are just the ones, like me, who survive to get to the hospital. 10% of those hospitalized die despite all medical measures.

The clot is so large that it rapidly reduces the blood flow through the lungs – think of it as something suddenly clogging up half of a drain. As a result, the flow of blood to be oxygenated is greatly diminished, and the pressure in the right heart increases to try to overcome the obstruction. The combination of increasing workload on the heart in the presence of reduced oxygen will often push older hearts into heart attacks or failure worsening the already compromised circulation and creating a “less than virtuous” spiral towards debility or death.  

The treatment, predicated upon how compromised your circulation and oxygenation are, is to remove the clot mechanically or chemically. I underwent a mechanical thrombectomy by a team of specialists in pulmonary embolism [1], which significantly reduced the obstruction, improving my ability to walk around and get back to life. 

Why me?

I suppose we need to begin with why not? In the 1800s, Rudolf Virchow described the three necessary components to the formation of a blood clot, injury to a vein, hypercoagulable blood, and relatively slow venous blood flow. I had all three. A recent surgical procedure had left me more in than out of bed for a day or so, slowing the flow of venous blood as well as the tying off of little veins that are a part of any procedure. And after two years of dodging the bullet, a case of COVID fiendishly found me on postoperative day three - aligning the thrombotic stars.

Which was the cause? All were necessary, but none were sufficient by themselves. This brings me to the first real-world lesson – with these three dots, I can craft any narrative I wish, simply based upon which one I weigh more. It was the surgery, the COVID, or the laziness of the patient choosing not to move around as much as he should. All the narratives have merit; none are true by themselves.

Much of the misinformation, the mid-information of COVID, has rested on the same process. We have the dots of information, but it is often our worldview, our bias in how to explain what we see, that crafts the stories we tell. It is equally valid for the experts, and what Ronny Chieng, describes as D-average students who feel they can pontificate on the Internet on science issues.

Why didn’t I see the light?

Good question, I suppose; based on what happened, it was not my time. Here though, is what I did learn.

• The line between being and not being is sharply defined and razor-edged.
• People ask how I feel. I feel fine physically [2]. But I feel like I did 10 minutes before the world tilted so dramatically. It is not that I cannot trust my body as much as perhaps I should inject a bit more uncertainty into my feelings and projections. A bit of uncertainty in our beliefs would probably benefit us all.
• It takes collaboration to make literal as well as virtual life-altering changes. There were several physicians, from the initial ED doctor to the cardiologists of the pulmonary embolism team, whose judgment and skill made a difference. But their judgment and skill were based upon the work of many more; nurses, physician assistants, and nursing aides that supported and built their clinical expertise. And let us not leave out the maintenance staff and dietary, and the volunteers who fill your pitcher with water that keep the infrastructure working as smoothly as it can.
• In these moments, both kith and kin rally around. I am blessed with a wonderful family, a life-saving wife, two sons, and daughters-in-law who dropped everything to be present. I am fortunate to have good friends, from the oldest who has been with me since I began to train as a surgeon, and we have had the opportunity to grow old together. To those who serendipitously came into my life in the last few years, bringing along meditation, someone to bounce ideas with, someone to remind me to get out of doors, and one who shares this particular health journey with me; all providing an element of “Bro” power that wasn’t there during the working years.
• The daily news, no matter how urgent, breaking, life-altering, and divisive, no matter how weighty according to the media, talking heads, and politicians, is nothing more than bread and circus. The reality is that it is of little importance to your life.

I am happy to be back on the block; I hope I will prove worthy of this gift, especially to those near me where my energy can be more easily felt.

[1] A heartfelt thank you to Northwell’s South Shore University Hospital’s pulmonary embolism team

[2] My mental health is lagging a bit at this point. After all, how do you process your moment of being Lazarus?

A note from Chuck's colleagues

When we first heard Chuck's story at our weekly group meeting the mood could only be described as a combination of relief and terror. Chuck is the heart and mind of ACSH as well as everyone's best friend. The possibility that we could have lost this exceptional man is too awful to contemplate. While we remain relieved we are still shaken. Chuck gave extraordinary care to his patients during his first career and we are extremely fortunate that others were around to give theirs when he needed it.  

Josh Bloom, for the rest of the group