by Anthony Neil Smith
I didn’t know I’d had a heart attack until the morning after, once the stent was in and I’d had a good night’s sleep flat on my back with a weighted pillow on my upper thigh where the surgeon cut into my femoral artery.
“That starts bleeding, you die.”
A nurse came to the room, checked the cut – looked good, no worries – then said I needed to attend a “class” down the hall with some other patients.
Okay. “Can I wear my jammie pants?”
Meaning the first thing I grabbed at four in the morning on my second trip to the ER in less than a week, early March in Minnesota, a blizzard on the way. Roads covered in ice and snow. Me in acid green jammie pants with little black swirls on them.
I was forty years old.
Anyway, “No,” I was told. I could not wear my jammie pants. The good news, though, was no one else would be wearing pants either.
I was fine to walk, so I walked down the hall with the nurse, pantsless in my gown, to an honest to fuck classroom – white board, posters, the works – with a handful of chairs and three old guys, pantsless in gowns as promised. All of them smiling, laughing. Why? They’d all taken this class before.
Last guy, Jesus. Looked like he’d already stepped through death’s door.
The nurse sat beside me and explained, “We’re going to talk about your next steps, your diet, and exercise. Especially important for you, because you had a heart attack.”
I mean, I knew I was having heart problems, but I thought by getting the stent, I was preventing a real heart attack.
Nope. All my shooting arm pain and squeezing tight chest and neck aches and sense of impending doom, all that shit was the heart attack.
So I’d been having a fucking heart attack for several days. Miraculously, no lasting damage. Good as new.
After the class, they let me go. Discharged by early afternoon. They finally let me put on my jammie pants and put me out on the front drive-thru in the bitter cold waiting for my wife to drive up.
I called my two closest friends, who my wife already called in the early morning hours as she drove two hours drive south to the heart hospital in a blizzard while I took a plane.
I was still more afraid of dying from a plane crash than I was of dying from a heart attack.
Told them both, “I had a goddamned heart attack.”
Red beans and rice
The male nurse in the ER wore an LSU scrubtop. I told him my family’s from Louisiana. I was born on the Gulf Coast.
“Really? How about that?” Definitely a twangy Southern voice, a little high-pitched.
Then he sat beside my bed and listed all the great food we’ve got down there.
My wife and I looked at each other. Is this guy ever going to shut up?
Then the blood test results came back.
My other nurse, full of worried energy. “Okay, it’s real.”
“Oh shit.” The LSU nurse stood and got busy. Tubes, syringes, tape, the works.
My wife’s eyes went wide. “What going on?”
I gripped her hand. “What’s it mean?”
But we both knew what it meant.
Brandy parked the car while I walked inside, the pain in my left arm and chest subsiding for a moment – where it had been screaming fucking awful right before we drove over. I mean it. Screaming when I climbed down the stairs, but to the nurse at the ER entrance I was so polite – “Hi, uh, yeah, I was in Friday thinking I was having a heart attack? Well, now I’m actually having one.”
Another round of screaming fucking awful pain woke me from a not-so-deep sleep. Just before bedtime, I’d had another screaming fucking awful bout of pain, but my stress test was scheduled for a few days away, and my doctor didn’t act like this was an emergency earlier in the afternoon. Prescribed a beta blocker and arranged the test. Go home and rest.
The first ER doc said it was exoskeletal or muscle pain. The EKG was normal. Take Tylenol. Go home and rest.
I went back to work.
I already told you the rest.
I didn’t think I was going to die. I can’t say why I didn’t think so. But whatever it was I was supposed to feel, it wasn’t, I’m going to die.
The surgeon told my wife afterwards I’d had a ninety-five percent blockage in my left anterior descending artery while the rest of my vessels looked pretty much fine.
Shocked the hell out of me, because I wasn’t a health nut. I like fast food, red meat, fried chicken, all those New Orleans dishes, BBQ, Chinese, my oh my favorite Mexican, and chocolate peanut clusters.
And Coca-Cola. The real stuff, not “Diet.”
I’d already been diagnosed with type-two diabetes, but it was under control. My numbers had been great for a couple of years by then.
My cholesterol sucked, especially my triglycerides. But after trying my best (ha ha) to lower them with diet and exercise, and my doctor prescribing generic Lipitor, he shrugged and said, “Some people have naturally high trigs. We don’t know why.”
I developed sleep apnea and was prescribed a CPAP machine to force air through my nose all night.
And anxiety pills. I’d been a nervous wreck before my wife suggested I give them a try. Believe it or not, they helped bring my blood pressure down.
So when I said I’m not a health nut…
Still, the surgeon told my wife I was relatively heart-healthy except for a single artery blocked nearly all the way.
He told my wife it was probably a genetic quirk.
Also, “When we wheeled him into surgery, he said the pain was starting up again. It would’ve been the last one. We got in there just in time.”
When she told me later, I think I smiled and said, “Neat.”
It was a gym in the hospital, supervised by an older lady who had no idea what to do with a relatively healthy forty-year-old man.
For the seniors, it was “Can you pedal the stationary bike one time around?”
For me: “Get on the treadmill and walk uphill for a half hour, then tell me your pain number.”
After a few weeks, she told me to do whatever I wanted. I liked the rowing machine.
For my last several sessions, I carried a plastic milk crate full of weights up and down the floor of the hospital.
She also wanted me to visualize. Meditate, sort of. Pick a pretty place and imagine yourself there. Mindfulness. Be aware you are present and you are breathing.
Did I mention I had a goddamned heart attack?
She gave me a certificate. It was on red construction paper with a drawing of a happy heart on it. I had passed!
No grand epiphanies.
No revelations or religious experiences.
No pledges to “Live more,” and “Make every moment precious” and “Love harder.”
No new exercise routine, no new diet.
Did anything change? Really?
I was halfway through writing a novel I called Worm when the heart attack happened. So when things settled down, I sent out a query to a few editors I knew personally at independent presses I admired. I asked, “Would you please look at the first half of Worm and see if you might be interested? I just survived a widowmaker heart attack.”
None of the three got back to me about it.
It did get published later, yes, by my friend Allan Guthrie at the digital press Blasted Heath, but I didn’t have to play the heart attack card for him.
In the eight years since my heart attack, there have been a few scares along the way, especially in the first year. The biggest reasons were 1) I carry a lot of my stress in my chest and neck, which means the pain is very similar to angina, 2) hypochondria runs in my family, and 3) I couldn’t tell the difference between “getting old” pain and “you’re going to die” pain.
The “getting old” pain showed up more and more over the years. Fuck.
Maybe it’s a good thing. Maybe men who did not have a heart attack at forty overlook “you’re going to die” pain as “getting older” pain, and, well, my hypochondria is looking pretty good right about now, isn’t it?
Still, I’ve visited the ER several more times to be on the safe side. In every case, I was fine. I’ve had two stress tests, one not long ago, and passed with flying colors. My diabetes is still under control, I’m maintaining my weight – my fat ass and overhanging belly – and slowly, maybe, starting to lose some. I avoided Covid, got vaxed, and got boosted.
But even though I didn’t think the heart attack was going to kill me, and was surprised to learn it almost did, I think about death more often than I used to. I think about the difference between facing it straight on or not knowing it’s right around the corner. I think about the afterlife, or lack of one, and kind of hope there’s just…nothing. Nothing it the hardest thing to imagine, but also, to me anyway, the most comforting. I mean, seeing your family members again for all eternity, even in paradise, still sounds like a drag after, you know, a week. Or the other Christian option: an never-ending lake of fire or outer darkness or an infinite repeating horror show.
I think about an episode of The Outer Limits where Beau Bridges invents a serum that mimics death to help stabilize a patient having a heart attack. However, when he has to use it on someone having a real heart attack, it works! Meaning the guy is still alive, thinking, seeing, and feeling everything, as the coroner starts the autopsy.
I think about an episode of The Twilight Zone (1980s version) where Elliot Gould plays a nasty food critic who discovers a Chinese restaurant with magical fortune cookies. After posting a nasty review of the restaurant and doing other nasty food critic things, he ends up eating and eating and eating until he’s miserable, but when he tries to leave, he gets massive hunger pangs. So he eats even more. Tries to leave again. Same debilitating hunger pangs. He shouts out, “What’s happening to me?” He opens his fortune cookie. The fortune reads; “You’re dead.” He stumbles outside to find the entire street – all the streets, everywhere – are Chinese restaurants.
I also think about all the funerals I attended, family and friends. Some tragic, a suicide, some a relief, after a long illness. I think about my stepdad’s job as a funeral director in New Orleans, and his stories of what he experienced in the weeks after Katrina hit the city in 2005.
I think about my Dad’s untimely death when his van flipped over and threw him out. He was thirty-three. I was ten. I’ve outlived my own dad by a lot. My dad’s dad died a few years after him. Massive heart attack mowing the lawn. No extra ER visit for him. My mom’s dad died two years after my dad. He was seventy-two, and it was due to heart disease.
I think about all of this way too much because my mind doesn’t like to be quiet. It doesn’t understand what “be aware of your breath” means. It doesn’t like dropping out, repeating a mantra, closing our eyes and thinking about nothing.
Because thinking about things is what my mind likes best about life.
Shutting off the noise in my head, even for a little while, sounds boring as fuck.
I have plenty more books to write. Plenty more stories to tell. Plenty of travel destinations I’d like to see. Plenty of surprises once the James Webb Space Telescope starts beaming back pictures. Plenty of pets to adopt. Plenty of jalapeno chilis to grow, roast, and eat.
There’s not some grand design or perfect plan or destiny out there I’m searching for because of the heart attack.
It’s just…keep going, do the best you can, enjoy it.
Fuck the Widowmaker.
Anthony Neil Smith is a novelist (Yellow Medicine, Slow Bear, The Butcher's Prayer, many more), short story writer (Cowboy Jamboree, Juked, Exquisite Corpse, many more), and professor (Southwest Minnesota State University). His nonfiction has been published in Concho River Review, Flyway, and Crimespree Magazine.