The Sounds of Care
I’ve reached the point when a visit to the cardiologist is pretty normal
The driver in the car ahead of me honks angrily at the rusty farm truck that’s stopped in front of them. Seems the truck doesn’t know the drill, which is understandable.
The Durham VA hospital garage has a gated booth, making it seem like it’s necessary to interact with an attendant. But it’s not. In fact, the booth attendant isn’t concerned at all with drivers as they enter, only as they exit. Simply edging up towards the gate is enough to trigger the gate’s arm and grant access.
But since the truck doesn’t know this, the impatient driver lays on the horn and throws her flailing arms in the air. When the truck finally scoots forward, the honker guns it, chirping her tires, and peels into an adjacent lot reserved for hospital employees.
It’s 8:00 a.m. and I’ve arrived 30 minutes early for my appointment with the cardiologist.
I park on an upper level of the patient’s lot because higher up it’s easier to back my truck in. In all my visits to the VA hospital, I’ve noticed the prevalence of back-in parkers. Did we all learn to do this during our time in service? Something about needing to be ready to GTFO ASAP in case shit suddenly hits the fan?
Another similar detail of this VA hospital and every other one I’ve ever been to is the exchange of pleasant acknowledgments amongst veterans. Nowhere else in my life do I witness such an abundance of good mornings and hellos between strangers. There’s also a lot of door holding and other evidence of basic good manners. It’s as if when we’re here we suddenly remember our soldierly fellowship. We may no longer wear uniforms, but the camaraderie is strong. Here, we see each other.
I do all my medical dealings with this VA hospital on Fulton Street. Its proximity to Duke makes it an extension of the university’s top notch medical facilities. It keeps the VA hospital staffed with world-renowned doctors and staff. When I lived in Sacramento and Spokane I also used VA facilities, but there I experienced what it’s notorious for—long waits, tired doctors, and general institutional malaise.
My destination is usually Clinic 1D, where my GP Dr. McCrory and Nurse Theresa consistently deploy genuine curiosity and patience during my annual checkups. But today I’m going to an unknown wing. So I inquire at the help desk for directions to DUR CARD ECHO BETA C3012, as noted on the reminder card I received in the mail. “Third floor,” a lady says as she smiles and fidgets with a patriotic lanyard. “I can show you to the elevator,” she says. “I’m good,” I say, “I’m going to take the stairs anyhow.”
The stairwell echoes my footsteps, and the third level is absent of the first floor’s bustle. A sign points to nuclear medicine, radiology, oncology, and my destination. I walk slowly down the hall and into a solemn waiting room where two men sit messing with their phones while another in a wheelchair stares at a muted wall-mounted TV. They each note my arrival with head nods. After I tell reception my birthday and the last four digits of my social security number, they instruct me to take a seat. I do as I am told.
The three men waiting are older than me, or so it seems. They all have a similar look—their cheeks are puffy, their fingers and waists are thick. And yet, here we all are, together in the queue to see a heart expert. All of us, evidently, with concerns about the most important muscle in our bodies. But how can this be? I look at these men and unfairly assume there’s no way they take as good of care of themselves as I do. I run a lot, I walk a lot. I mean, just yesterday I did ten training miles with a full backpack in nearly triple-digit heat and stifling humidity. I also refrain from processed sugars and read nutritional labels. I get at least 8 hours of sleep per night, do yoga every day, meditate every day. Why the hell am I even here?
But I know exactly why. The chest monitor I wore for two weeks showed evidence, albeit very occasional, of supraventicular tachycardia (a fast and erratic arrhythmic heart rate), ventricular tachycardia runs (abnormal heart rates), and one instance of sinus bradycardia (extra low beats per minute—36). McCrory told me he’s not really concerned. “Sometimes a super active heart like yours does things that otherwise look like red flags,” he said. “If it wasn’t for the low heart rate reading I’d just put you on beta blockers.” He ordered more tests, an echocardiogram and stress test just to be sure.
Still, I am in denial about the possibly of having issues I don’t commonly associate with healthy people. I am actively managing a mild freak out because my condition, whatever it is, is yet unknown and out of my control. They men around me are non better or worse than I am, yet I project my resentment on them and begrudge the fact that we have something in common besides a DD-214. I want my heart to be healthy. And as I think this, I also think, Shit, what I don’t want is a heart like my dad’s, or my grandpas’. Their hearts, quite literally, were the death of them.
Since my dad died in 2023, I’ve been sorting through a lifetime of various ephemera (his generation saved everything). While doing so I learned that in 2014 during a routine checkup his doctor noted a significant decrease in his heart function. A journal entry in my dad’s cursive says, “Dr. Vince asked if I would consider a heart transplant…this is all pretty overwhelming…I think I will need to set some priorities for future activities.” He never mentioned this to anyone, not even my mom. Hope, often times, creates our identity.
My maternal grandfather also had a problematic ticker. I am unsure if he had two or three heart attacks, but one of them left him flatlined. I was a teenager when he told me the story of his death. We were driving in his truck down a country dirt road looking for osprey nests when he said, “Tommy, I’ve never really talked about this with anyone, but when I died I saw a light.” He pulled the truck to the shoulder and kept it idling as he finished the story. “The light told me—not with a voice, more in a thought—that it wasn’t my time yet. So here I am.” It was the first and only time I saw my grandfather cry.
For the rest of his life, my grandpa had a pacemaker. Every time I saw him he’d grab my hand and force it onto his chest to feel the metal instrument situated just under his skin. “If it wasn’t for this little sucker I’d be a dead man,” he’d say with a laugh as I’d yank my hand away. His words carried immense weight. They were a punchline to a joke only he found funny.
My other grandpa had multiple bypass surgeries, and my great grandfather suffered a fatal heart attack in his early 50s. Surely there are more stories about my ancestors’ compromised hearts that have been lost over time. But I know enough to know what I’ve inherited.
So no, I do not want any of their hearts.
A specialist enters the waiting room and calls my name. She’s Stephanie, and she leads me to the exam room. Stephanie explains that the procedure is similar to an ultrasound. I follow her instructions and remove my shirt, lay down on my left side, and get comfortable. The she lubes up a metal wand and places it between my upper rib bones. It’s surprisingly warm. She explains what she’s doing, and I find her voice soothing.
My body position keeps Stephanie’s torso in my direct line of sight. I can’t help but glare up at her as she takes an image of my heart. I don’t want to stare, so I crane my neck a bit to avert my eyes to a framed pastoral print that hangs behind her. A rickety grey barn and a field of lonely haystacks.
Stephanie maneuvers the wand to capture the sounds emitting from my heart’s four chambers. She increases a speaker’s volume, which gives sound to my heartbeat, then quickly turns it down to zero. I ask if there’s a right or wrong sound, and she is careful with her answer. “The right side of the heart often sounds lazy compared to the harder working left side,” she says. I want her to tell me that mine sounds marvelous, but she doesn’t. She brings her focus back to the screen and deftly taps the keyboard to note her findings.
I tell Stephanie the one heart story my dad did tell us—that he was declined entry into West Point Military Academy after a physical determined he had an enlarged heart. The concerning size of his heart, turns out, was the result of his life as a cross country runner. Its exacerbated size was actually a marker of his athleticism. I tell Stephanie this even though I’ve since found a 1964 letter from California Representative Don Edwards delivering my dad the bad news. He was denied entry, yes, but not because of an enlarged heart. He was denied based on “the unsatisfactory results of [his] academic examination.”
All those years he used his heart as an excuse.
Stephanie assures me that even folks who take the best care of themselves often end up with heart issues. “Genetics play a big role,” she says as she re-lubes the wand. “Are you also having a stress test, Mr. Griffen?” she asks. “Yes, next week,” I say. She nods, and keeps her attention on the screen as the regular tempo of my heart gets loud before she mutes it again. It sounded like an aggressive squish.
Stephanie finishes a few minutes later. She hands me a towel to wipe off the excess lube and steps behind a fabric screen to give me privacy. The dry rag mostly just smears the remaining gel around my chest. When I’ve cleaned off all I can, I let her know I’m done.
Stephanie reenters the room and asks how I’m doing. “All good, considering,” I say. She then tells me that the results of the echocardiogram look normal. I exhale deeply. Her ensuing pause is well-practiced. “Tom, if there were any concerns, I’d have you speak with the cardiologist before you left,” she says. “But there are none, so this is a good first step.” She then tells me where I’ll go for next week’s stress test. I listen, but mostly I just want to hug her and thank her for the relieving news.
I leave the office, then stop in the nearest bathroom and lock the door behind me. I wet a wad of paper towel and give my chest another wipe. I lean towards the mirror to see the hazel green glow of my irises and the bumpy freckles around my nose—reminders of what I love and hate about my body. I then cover my face with my hands and cry quietly, allowing my body a reprieve. I then dab my eyes with the paper towel and take the stairs back down to the first floor.
As I walk the pedestrian bridge between the VA hospital and the parking garage, I make eye contact with each of the entering veterans as we cross paths. Their reciprocated greetings assure me that I am here. And even though my heart may, very well, be in fine shape now, it probably won’t always be. This moment in time however, this scare, has me motivated to rethink things. My diet, my profession, my relationships, my everything.
Near the end of the hallway and just before the garage, I say good morning to a tall old guy. He’s wearing a trucker cap paneled with the Vietnam service medal and a flurry of pins. He slows his walker to respond to me. “Hey there!” he says, clearing his throat. “Take good care of yourself!” There’s a twinkle in his eye. Which may just be a glare from the tall window and late morning sun, but it also may be something else. Something that I can take with me and pass along.
Isn’t it crazy how those of us who take good care of our bodies can still end up with serious health issues? So glad your ticker is in good shape! 😊
Love this one Tom! Thanks for sharing! “Take good care of yourself!”