You were debonair imitating Fred Astaire a half century ago, tap dancing on our kitchen linoleum in your slippers and pajamas with a Lucky Strike cigarette between your lips. Doctors appeared in advertisements back then, promoting that Camels, Pall Malls, and Chesterfield cigarettes were so "mild for the ‘T’ zone (throat, tongue)." I remember, after you began regular visits to our doctor, that our routine was for me to call out in a jocular fashion as you danced "Dad, your heart! Your heart!" I did not fully appreciate how grave your condition was. Each morning you had eggs, thickly buttered fresh pumpernickel bread, and coffee with cream, while you read the Buffalo Courier Express. You would prepare my breakfast, wake me for school, and then you’d go to sleep until late afternoon, ready for your night shift as a cabbie.

You were parked in the cab, waiting to start your first run of the night at Buffalo’s New York Central Railway Station. You probably felt severe pre-sternal pressure pain, and then everything went black, as you died at age 46. The abnormal rhythm stopped your heart on November 9, 1953. Dr. W. had diagnosed angina pectoris - chest pain with exertion due to "hardening of the arteries" - during that past year. Bernie, your friend and fellow cabbie, rubbed snow on your chest, as he tried to help any way that he could. Then Mom got the call at home; I was a 14 year old eighth grader. I’m still proudly wearing your Bar Mitzvah ring that was removed from your finger before we buried you.

Well, Dad, on May 31, 2000, when I was 60, I had my heart attack. I confess I was anxious, and then relieved, when I made it past my 46th birthday. I never smoked. I rode a stationary bike for 30 minutes four mornings each week for 16 years. In addition, I had been following a strict very low-fat diet ever since a chest-pain scare that led to an abnormal stress test with isotope cardiac scan nine years ago. The test indicated an area of low myocardial perfusion from a presumed partial coronary blockage. My doctors and I followed conservative management of the condition without an angiogram. Baby aspirin and a statin lipid-lowering drug were added to my antihypertensive at that time. The stress from my clinical neurology practice of recent years had decreased much of the previous enjoyment that I had derived from my work; fortunately I was able to retire at age 58. I love retirement. I love my family, especially my year old first grandchild who lives with his parents just five minutes away. Holding that baby and kissing his head is my definition of happiness.

On that fateful morning when I "died," I awoke at 6:30 a.m. to start a much anticipated day of sightseeing with out-of-town relatives. I performed my ablutions, took a baby aspirin and my antihypertensive medications. While on my stationary bike, however, I began to feel a substernal sensation. This wasn’t alarming because many different sensations (i.e. quick "pulls" in the chest, aches and skipped heart beats) had occurred so often, and disappeared in a second, that I considered them non-consequential. Vigorous activity and strains, such as hauling up and pulling in the sail on my windsurfer, have never caused these feelings. But, as I continued to exercise, the sensation became more intense, a mild pain now. It was even in my throat. Well, I have a great day planned, let’s hope that it stops, I thought. It didn’t. I even reduced the tension to ease the peddling. Even though these symptoms signaled an ominous development, I carried on with my regimen. True to form, the most common first response to one’s own heart attack is DENIAL! I noted a cold sweat, different from my exercise sweating. I was still hoping that all my symptoms would subside; I had a great day planned. My wife returned from her morning walk, but I didn’t mention a thing. I didn’t want to end my exercise before the built-in timer rang or she would suspect something was wrong. DENIAL! Self-destruction? I suspect denial, and of course, the STUPIDITY so characteristic of many physicians experiencing symptoms. Even worse, I thought, I can’t call 911 and have them find me dirty and sweaty (even if shocky), so I took a quick shower and I took another aspirin. By that time I was visualizing spider web designs whenever I blinked. This probably resulted from cerebro-retinal hypotension and I was seeing my own retinal vasculature while my eyes were closed. By this time I was quite weak; I was able to quickly dry myself, and feeling nauseated, walk to the bed and lie down.

I called to my wife and asked her to come upstairs. She suspected from my voice that something was wrong. She found me lying down, gray and clammy. "Will you get my automatic blood pressure cuff," I asked. "Are you having chest pain?" she asked, handing me the cuff. I said " welllll", and then I emphasized "YES!" She immediately dialed 911.

"My husband is having chest pain!" she said into the receiver, her voice trembling. They asked if I was cold, warm, or sweaty? She answered "cold and sweaty." They advised her to put pillows under my feet. They queried if I was nauseated or vomiting? I responded "nausea." They told her that paramedics were on the way and she should open the door for them. Before she went downstairs I told her to get me some underwear; then I wanted shorts over those—I had to look presentable. She refused, "you don’t need shorts!" She put our three house cats behind closed doors to keep them out of the way and ran downstairs to unlock the front door. By the time she returned my chest pain was worse. She called 911 again to tell them that I was having more pain, but then there was a knock at the door. "We’re up here!" my wife called. A sheriff appeared and asked my name. I could hear sirens. I was feeling extremely weak just lying on the bed. My wife later told me that I was as gray as my grizzled beard. My wife went downstairs and directed the first three of the paramedics up to me. They gave me aspirins to chew, applied an oxygen mask over my face, took my vital signs, and started an IV. "What’s your name, sir?" one paramedic asked me. I vividly recall that I barely had the strength to respond, or even to move my arms. I heard them report to each other that my blood pressure was 80/60, and then they had trouble detecting any blood pressure at all.

Gazing up at my ceiling I thought, "I’m going to die! Well, I’ve lived a good life. I’ve had three wonderful years of retirement. I have provided for my family. So, if this is IT, then this is IT." It really seemed so easy to die. I’ll have to remember that the next time.

The paramedics rolled me onto a litter and carried me down the stairs. I could tell that they were straining to carry me. Once downstairs they said something else to me, but I have no more memory until five minutes later as they wheeled me into the local community hospital’s emergency room. My younger daughter, who arrived from her nearby home just as they got me downstairs, heard the paramedic shout, "He’s going out, let’s move!" Cardiac arrest! Once in the ambulance, a single defibrillation jolt apparently converted my ventricular fibrillation irregularity into regular sinus rhythm. In the emergency room I was awake and aware of severe chest pain. More iuvs and an intracath were started. A nurse asked me to rate the amount of chest pain I had on a scale of zero to ten. I was able to consciously deliberate and respond "seven or eight." "We’re giving you morphine and nitroglycerin to relieve your pain," the nurse reassured me. The ER physician told me that I had had a hyperacute myocardial infarction, and he advised that this was the time to administer a clot-busting drug. I was clear enough to ask if it was tPA, the clot-buster that we use in neurology for stroke. He said no, that it was Reteplase, a different form of tPA, and then he mentioned the side effects, including possible cerebral hemorrhage. "Go for it," I said. My wife was at my side, holding my hand. My chest pain was a very severe, constant pressure, without radiation into my arms or jaw. I became concerned that the Reteplase wasn’t working since the pain was unchanged one-half hour later. They told me that they had just given a second bolus of it. After awhile the pain had eased. My third serial EKG was done and the technician gave a thumb’s up sign with a smile, "it’s normal!" Soon I was pain free and I was wheeled to the ICU. I was able to remember everything that was happening.

My diagnosis was an acute coronary occlusion without any significant myocardial damage. Now, in 2000, reversal of lethal ventricular fibrillation, and then dissolution of an occlusive clot, are routine, if the patient is fortunate enough to reach competent care expeditiously. Dad, you were deprived of these miraculous treatments; I’m sure you couldn’t believe that it would be possible. I’m so sorry that you were lost to me when I was 14.

How fortunate I was that every conceivable facet to save my life was in place, at the right time, despite my foolish attempts to thwart them. From this point forward, whenever someone cautions me that some activity is dangerous, or that I could die from doing something, my response will be "been there, done that."