a week of travail (1)

Here at last is Part 1 of the chronicle of my latest health misadventure. I have, frankly, little motivation to write this, but since I committed long ago to making certain aspects of my life an open book on this blog, I'm going through with the telling all the same.

Sunday, April 7, 2024 and Monday, April 8, 2024

Sunday night, I Skyped with my buddy Mike, who's based in Fredericksburg, Virginia. Everything seemed to be positive, but little did I know that, barely an hour after I finished talking with my friend, I would start having more breathing difficulties. These were bad; they kept me up all night, which made them somewhat scary: I got to a point where I began to wonder whether I'd live through the night, and by morning, that feeling had changed very little. I could feel my body's energy running out of me like sand out of the top of an hourglass, and a dim sense of urgency started to well up: Should I really go to the hospital? I hadn't wanted to go, and like a lot of people, I hadn't wanted to face the truth of whatever was going on. And what was going on? The more practical side of my brain reasonably noted that it's better to know than not to know (my boss echoed this thought a few days later), so at some point in the afternoon, after a whole morning of sitting against the wall, staring at the ceiling, vainly trying to breathe, and feeling as if I were beginning to drown, something clicked, and I decided I wanted to live, even at the expense of potential humiliation. Gathering my strength up to do the next thing felt as if it took years, but even if it wasn't years, it was hours. I somehow heaved myself up, got dressed, left my building, and caught a cab to the building where I worked because it also has a clinic where I visit my regular doctor.

The doc ribbed me for not visiting before now; I had run out of stroke/diabetes meds last year, but I hadn't come back for my checkup and refill in months. I lied that I'd been busy; I'm sure he saw through that. From an introvert's perspective, one of the nicer aspects of doctor visits in Korea is that the doc isn't interested in keeping you long. Most such visits don't last longer than 5-10 minutes if you're there for a consultation, and they rarely go beyond thirty minutes if you discover you're there to be tested. Monday's visit involved several tests, but even with those, my time with the doctor didn't last much longer than, oh, 40 minutes. There were the usual tests: blood sample (normally done once every 3-4 months), urine sample (usually to check glucose levels among other things), and a check of my pulse and blood pressure. BP is always high for me, partly because it's always naturally high, and partly because, on some level, clinics and hospitals stress me out. When I told the doctor about my breathing issues and thready pulse, I exercised my just-learned vocabulary and floated the idea that I was looking at myocarditis (shimgeunyeom/심근염, heart-sinew [in]flame[ation], inflammation of the heart muscle). The chronology made this make sense: I'd re-contracted COVID back in mid-March, and myocarditis can rear its head—sooner or later—after an infection although, from what I'd seen, it seemed more likely in people who'd gotten jabbed. Some sources listed myocarditis as "rare," jabbed or unjabbed, but this didn't make me feel special.

After this further explanation of my current symptoms, the doc ran two more tests: an EKG (or ECG, i.e., an electrocardiogram, which shows several parallel graphs of your heart's performance) and a chest x-ray. We didn't focus on the x-ray, but the doc didn't look happy when he saw the EKG. He looked, in fact, as if he couldn't make heads or tails of what he was seeing, and he advised me to visit a hospital that had better facilities to get some further testing and treatment. This is the moment that set me on the path to another hospital adventure, and I wasn't feeling hardy enough to walk out of the clinic and simply ignore his advice. What I did do, after I'd been issued a prescription, was to walk back downstairs (the clinic was on the second floor), walk across the building, then walk up the stairs to my company's office, where I saw my boss and coworker. They hadn't been expecting me because I'd texted them earlier in the day about feeling under the weather. When I explained the situation to my boss and told him I wanted to pick up my prescribed meds since the pharmacy was along the way to the hospital (these were specialized meds not available at every pharmacy; there's one specific pharmacy that I have to go to), he offered to give me a ride to the pharmacy and then to Samsung hospital. (I'm reverting to the standard "Samsung" spelling instead of the more governmentally accurate "Samseong.") 

As I suspected would happen, the pharmacy, called Blue Bird Pharmacy (파랑새 약국, Parang Sae Yakguk), wasn't able to provide me my meds. This happens every time I go there: there's usually one or two meds that aren't in stock, so the staff comes up to me apologetically and says it has to order the missing meds, and that I should come back a day or so later to get everything. I cynically mentioned this to the pharmacy staff in anticipation, but they said, "Oh, no—this time, the problem is different: the way the prescription had been written was wrong." Although the prescription needed to be filled within 3 days, the time period for the prescription didn't start until June, which made things awkward for the pharmacy (Koreans obey or ignore rules in a seemingly random way: why not cut me a little slack, this time, instead of suddenly being all by-the-book?). I vaguely recalled my doc saying something about timing, but I hadn't understood him that well. Maybe he'd been trying to say that, before I went back to my regular stroke/diabetes meds, I needed to get checked out and prescribed other medicine first, then I could restart my regular meds in June. I'm just guessing, of course: I have no idea what he actually said or meant. All I knew was that the 'scrip had been a waste of time and effort. Anyway, the end result was the same: the pharmacy let me go back to my boss's car empty-handed, and we sped on up to the hospital, which was just up the street. Had I been healthy, I could've walked from my apartment to the hospital.

Once you enter Samsung Hospital's main entrance, you follow a labyrinthine series of access roads to reach the emergency room. My Korean coworker had elected to come along with us, and he pointed out that the hospital would end up prescribing equivalent meds, anyway, so the failed errand at Blue Bird Pharmacy wasn't tragic. We pulled up to the ER entrance; I got out with my coworker while my boss went to find a place to park. My coworker and I were let in by a guard/staffer, and since I was already in the system as a patient from three years previous, there was much less paperwork to fill out. I waited with my coworker to be called into some sort of intake-interview room; the procedure felt a bit different this time. The wait was long enough that my boss was able to rejoin us after parking. When a young, male doc or staffer finally called me over to the interview room, the ensuing conversation took place in a mixture of Korean and English. I was glad the boss was there; his Korean is fluent whereas mine is inadequate for discussing technical medical problems. A short history of my problem was taken, then I was taken into the ER itself. My coworker couldn't follow us there; my boss had once again been designated as the bohoja/보호자, or guardian, so only he could accompany me into the guts of the hospital. My coworker, looking tired, went home.

I was given a thoracic ultrasound and some drugs to help stabilize the breathing; hours passed. A somber, self-righteous-sounding doctor came up to my berth hours later with the news that my problem wasn't related to COVID at all: I was looking at a species of heart failure. This absolutely floored me, but I made an effort to keep a poker face. I had expected to hear the usual finger-wagging about needing to eat better and exercise, but as my boss interpreted the parts I didn't understand, I was left with the impression that they were saying my condition had been caught just in time, and that a lack of treatment would probably mean my death. Most people have heard of congestive heart failure, but my condition was, specifically, "severe left-ventricular systolic dysfunction." (Read more here.) This was well beyond a merely weak heart: this was close to the actual death of a large part of my cardiac muscle. The doctor said, in that finger-wagging voice of hers, that this was partly a result of my fateful choice, three years ago, not to stay at the hospital for further treatment. This decision didn't seem at all irrational to me at the time. Still doesn't.

So, near as I could figure, the chronology of my condition went back way further than my recent mid-March bout with COVID. This is something that had compounded over time. The other revelation was that this was fundamentally a heart condition, not a lung condition, even if the breathing issues felt, subjectively, as if they were the most urgent problem. The causal chain was: heart problem first, breathing problems next. Fix the heart, fix the breathing. My boss said the doctor was basically saying that, if nothing were done about my condition, I'd die. So: what would fixing my heart entail?

The irony of my life is that one of the things I fear most is being a bother to others. I consider myself a fairly independent person. It's the thing I stress when I rant about expats who never bother to learn the local language beyond a few pidgin phrases: such people, through their own laziness, consign themselves to becoming linguistic cripples who have to depend on everyone around them in order to navigate daily life. A Western guy comes to Korea, quickly acquires a Korean girlfriend, then uses her like a slave to help him out with daily tasks like navigating the bank, dealing with the tax office, or dealing with everyday issues and problems that require more than a 101-level knowledge of the local language. Maybe the girl is okay with this situation and sees this as her lot; if I were in the guy's place, I'd feel like a bother, so I've made sure that I can do all of the aforementioned tasks on my own. What's ironic is that, thanks to my choices and habits, I was now in the hospital again, basically being a bother to everyone. And lacking the language to handle more than the basics of my situation.

At the same time, I couldn't help feeling a sense of cosmic injustice about my circumstances. They say that well over 50% of Americans are obese, and 30% are morbidly obese. There are plenty of Americans who are wider than they are tall, and as bad as my own eating habits might be, these people are undoubtedly worse... and yet, they never seemed to end up in hospital. (This is a subjective impression, mind you; I don't know the real facts.) Also: how did I go from 1.25 staircases from January through mid-March to being laid up in a hospital bed in April? Were my own habits that bad? Could it just be a matter of bad wiring, like the people who joke that they just look at a piece of chocolate cake and gain ten pounds? Dr. Sten Ekberg, in his YouTube videos on diet and exercise, has said that there is, in fact, a strong genetic component to health. There are people with dynamo metabolisms who burn up anything they put into their bodies; there are other people, like me, who are cursed with sluggish metabolisms, thus requiring us to work harder to be healthy. That's life, and a lot of success is about figuring out your own level and playing the cards you've been dealt. I tentatively conclude that, along with my own dietary misconduct, I've been dealt a bad genetic hand. My mother's father died of a heart attack; my maternal grandmother was born with a strange genetic condition: an upside-down stomach that prevented her from digesting anything properly. She never got above 70 pounds, according to Mom. My paternal grandparents were alcoholics, and I think they both died of alcoholism-related heart attacks. My own dad, a teetotaler, had a heart attack in 2006. So my family tree points like a dagger right at my heart. I vaguely recall that, when I'd had my stroke in 2021, I mentally chuckled about dodging a karmic bullet. But, it seems, the cardiac monster has been after me this entire time.

So I grudgingly chose to be admitted. My boss, seeing my face and hearing my tone, joked with the self-righteous doc that I was stubborn. He had a wife and family to go back to, so he couldn't stay, and I was left with the realization that, like Jimmy Stewart in It's a Wonderful Life, what happens to me affects others, pulling them away from their own lives so as to deal with my lame, dependent ass. I personally have little to no fear of actual death; while my life has its discontents, its wishful pangs related to counterfactuals—the would-haves, could-haves, and should-haves—I'm generally content with how things have turned out, and if it's time for me finally to spill over the edge of the conveyor belt, I'm fine with that. But like it or not, I'm going to end up being a bother to somebody because, as I've long known from reading about Buddhism, we're all connected in some way, like it or not.

And that's how I ended up in the cardiac ward, 16th floor. Let the poking and prodding begin!

To be continued.