‘Is this what dying feels like?’

Many thoughts thunder in your mind when you think you’re dying.

“Why am I so winded? I hardly exerted myself at all, and the altitude here is only 1,200 feet. I shouldn’t be this winded.”

“I’ll just rest here in my truck a few minutes; catch my beath before I go back inside.”

*20 minutes later*

“Jesus, it’s been 20 minutes and I’m still gasping like I’ve been running wind sprints at football practice! Why can’t I breathe?”

“OK, work through the problem. I’m not tight or wheezing, there’s no bronchoconstriction.”

“Jesus, my hands are shaking so bad I can’t count my own pulse! Is this what dying feels like?”

“Okay, I have no pedal edema, no cough or congestion, and I have no problem laying back. Probably not heart failure. So why can’t I breathe?”

“No chest pain, nausea or weakness, so probably not an MI. No palpitations, so it’s probably not arrhythmia either. Wait, tachyarrhythmias often present with dsypnea and no palpitations …”

“Go back inside, you idiot. They’re going to find you dead in your truck in the morning if you don’t go back inside.”

*20 minutes later*

“OK, I’m inside and laying down. Help is only three buttons away on my cell phone … if I can reach it. Crap, I am not calling 911 for myself. Work through the problem. I’m breathing 48 times a minute after nearly an hour of rest. Why am i not having carpopedal spasms? Answer: Because I’m not exhaling CO₂, that’s why. Oh my god, it’s a pulmonary embolus.”

When my cabin mate finally emerged from the shower a few minutes later, he stopped talking in mid-sentence and stared at me in shock. All I could do was point one finger at him weakly and order, “Don’t you dare call an ambulance for me.”

In retrospect, I’ve probably said stupider things in my life, but I can’t really remember when.

It’s time to see the doctor

That was Friday night at an invitation-only writer’s retreat I was attending. Eventually, my breathing eased, even though even the mildest of exertion left me panting for several minutes. Walking 20 feet to the bathroom left me dyspneic enough to need to sit for several minutes to recover. By Saturday afternoon, I felt strong enough to rejoin the festivities, although I relied on a few close friends who knew how sick I was to bring me food and drinks from the cooler. As long as I was sitting down, I felt fine.

They were good friends. They urged me to go to the hospital, and I ignored them with a steady stream of rationalizations. “I’m asymptomatic now,” I told them, even though I was far from it. “It’s damned hard to diagnose an asymptomatic patient. Better for me to go home and see my personal doctor rather than some ER in the middle of nowhere that doesn’t know me.”

Privately, I was worried. I had almost convinced myself that I had suffered a transient arrhythmia, but the lingering exertional dyspnea had me concerned enough that I arranged an office visit for first thing Tuesday morning.

Sunday afternoon when we were alone, my friend Ian, a former EMT, checked my pulse. “You’re breathing 20 times a minute and your resting heart rate is 112,” he said flatly. “Stop being a stubborn ass. You need to see the doctor as close to three days ago as possible, not friggin’ Tuesday.”

Reluctantly, I agreed with him and headed home a day early, obsessively checking my heart rate, pulse oximetry and respirations for the entire 8-hour drive.

‘You do realize what this signifies, right?’

My doctor listened attentively to my history of the event, examined me carefully and grudgingly agreed with my self-diagnosis of transient arrhythmia. “It could have been that,” he said skeptically, “but there are several other things to rule out.”

My 12-lead ECG was fine, however, as were all my vitals. Lung and heart sounds were clear. No hepatomegaly. No pedal edema. Yet still, there was that nagging exertional dyspnea.

He ordered a battery of lab and diagnostic tests, among them a B-Natriuretic Peptide level, which is a biomarker for CHF, as well as an echocardiogram. As he was scribbling orders, I asked, “Hey, on an entirely unrelated note, I’ve got a nagging left calf strain that has been bothering me intermittently for nearly a year. Whenever I dorsiflex my left foot, I can feel it.”

He examined my calf and said, “Kelly, have you noticed how much larger your left calf is than your right?”

I looked down and said, “Huh, so it is.”

“And how long have you felt this calf pain?”

“Since last April in Tulsa.”

“You do realize what calf swelling and pain signify, don’t you?” he reminded me.

“Yeah, but dorsiflexion of the foot usually elicits knee pain with a DVT,” I argued, “and only my calf hurt. Besides, Homan’s Sign isn’t considered an accurate diagnostic sign of DVT any more.”

“I’m adding a D-dimer to your orders, as well as a venous Doppler ultrasound of your left lower leg and a CT angiogram,” he said firmly. Left unspoken was the rest of the statement: “You idiot.”

When death taps you on the shoulder

You can imagine how it went from there. D-dimer came back extremely elevated, and my BNP was slightly elevated, both consistent with DVT and pulmonary embolus. I sit typing this now with my phone close at hand, awaiting scheduling of my CT angiogram, echocardiogram and venous Doppler ultrasound to tell me how bad it was/is. I’m taking a loading dose of Eliquis, and I’m resting. The exertional dyspnea is getting steadily better, and I may even be able to return to work in a week or two. Things are almost back to normal.

What is not going back to status quo is my physical fitness. Death tapping you on the shoulder has a way of accelerating the timeline of, “I really ought to get myself back into shape soon,” to “Get your health under control, or I’ll be back for you.”

Four years ago, I could legitimately call myself “fat, but fit.” My lipid panels were fine, my vitals and EKG were good, my cardiovascular conditioning and recovery were on a par with the twenty-somethings I worked with. I passed my fit-to-work test after my spinal surgery in December 2021 with flying colors, even if I did have to rely on stoicism and a high pain threshold to disguise the ache and stiffness of my knees.

Now though, I’m just fat. I am fit no longer. I take antihypertensive medication, an NSAID for my knee arthritis, and now an anticoagulant to dissolve the clots in my leg and lungs. I let my depression affect my physical health to an unhealthy degree, and being largely sedentary for the past month coupled with an 8-hour car ride put me in an at-risk demographic I never thought I’d belong to.

I’ve been open in this column about my mental and physical health issues, because it occurs to me that I am a case study in the way a medic’s mind works – both good and bad. We are notoriously bad at taking care of ourselves even as we care for others. We’re also capable of an astounding degree of compartmentalizing; even when I thought I was dying, I was still rationally working the problem, going through my list of differential diagnoses so that … when I died, I’d at least know what killed me.

Don’t be as stupid as I was. Take care of your own physical and mental health, right now. We can take this journey together, and I’ll keep you updated and motivated along the way.