heart attack

When a Cardiologist Becomes a Heart Patient: Dr. Paul C. Ho

/ Jordyn Redwood / Leave a comment

Today, Redwood’s Fans, I have a special guest blogger for you. Dr. Paul C. Ho is a cardiologist who suffered a heart attack which led him on a journey of self discovery. Today, he shares his thoughts here and I hope you’ll check out his book, Art on the Human Heart.

Welcome, Paul!

I’m a board-certified cardiologist and a cardiac arrest survivor—a heart doctor who became a heart patient. I believe these experiences make me somewhat of an expert storyteller from both a doctor’s and a patient’s point of view. As I reflected on playing these dichotomous roles in the health-care arena, the story of my autobiographical novel, Art on the Human Heart, came to be.

Aside from its anatomy and physiology, are there other functions or meanings to the human heart? The ancient Egyptians and the ancient Greeks considered it to be the seat of emotions. The Bible says, “In the heart dwells feelings and emotions, desires and passions. . . . The heart is the seat of the will and understanding.” For millennia, this centrally located organ has been implicated in our perception of the outside world and capable of generating a behavioral response to our feelings—the very essence of our presence, our being.

But which is the chicken or the egg? The age-old question applies here to the “emotional” aspect of the heart. When we are happy, the heart feels a sense of openness and a certain lightness. Conversely, anger can bring troubling heart palpitations and chest tightness. There is no doubt that “heart emotions” can be influenced by outside stimuli—whatever makes us happy or angry. But could the heart itself be the originator of feelings that may alter behavior and outcome? Is there then a true nature of the human heart?

As a cardiologist, my professional focus is on the physical nature of the human heart. As we all know, unhealthy life habits, such as cigarette smoking, eating fatty foods, and lack of exercise, can lead to the development of acquired heart diseases. Parallel to outside forces influencing heart emotions, external factors can also affect physical changes in the heart. What if the intrinsic nature of the heart can lead to the development of heart disease? For example, in an innately angry or unhappy heart, could the negative emotional tone trigger early heart ailments? Surely in medical literature, we are seeing an increase in reports of such associations.

When I suffered my own heart attack, I was only thirty-nine years old. I was young, living a healthy lifestyle, and did not have a predisposing genetic factor for heart disease—there was no obvious medical cause for my near-fatal condition. Why then did I almost die at thirty-nine? I questioned if the nature of my heart had something to do with it. At the time, I was extremely hard-working and had an angry, perfectionist, and type A personality. Was I subconsciously dissatisfied with my life? Was I unaware of deep-seated unhappiness? Could that have been the cause?

To better understand what happened to me, I wrote my novel to explore the true nature of the human heart through the eyes of a high-powered, high-stress cardiologist. When I became sick, my compassion turned inward toward myself for the first time in my life. Recognizing that well-being goes beyond conventional medical treatment, I dug deeper into the meaning and nature of our hearts. What truly makes us happy? What truly makes a healthy heart? To save ourselves, as I tried to do in the aftermath of my heart attack, we must understand the true nature and desires of our own hearts— nobody else can do this work for us.

I hope you will enjoy my book and learn as much as I did about our true hearts.

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Dr. Paul C. Ho is a cardiologist and a heart attack survivor. He has published numerous medical papers and is a reviewer for several medical journals. Art on the Human Heart is inspired by his love for creativity, exploration, and self-discovery. Dr. Ho studied engineering and medicine at the University of Pennsylvania, Temple, Dartmouth, and Harvard. He was the chief of cardiology in a hospital system and was awarded several patents for his medical device inventions. Dr. Ho enjoys traveling to remote places and has worked in native communities including locations in Alaska. He lives in Hawaii with his pooch, Bear-Bear.

Author Question: Medical Condition for Elderly Man to become Comatose

/ Jordyn Redwood / 2 Comments

Amanda Asks:

I have an elderly character who is about 90-years-old. As things stand, he is very sharp mentally and physically and fairly strong for his age. The story needs are for him to be in a coma, whether natural or medically induced, for several weeks.

My question is, is there a cause or condition that would make this plausible at his age, that he could still awake from when it’s time for him to re-enter the story? I did some preliminary poking around and it seems like medically-induced comas are less common in the elderly. What might happen to him to put him in such a state (naturally or medically), that he could still awake from?

It could be anything at all for the story. I just don’t know what’s feasible and what’s not. And how long can he be in the unconscious state before it becomes too unrealistic?

Jordyn Says:

Lots of things can cause someone to be in a coma caused by direct injury to the brain or something that would cause lack of oxygen to the brain.

One thing that is quite common in the elderly is a subdural hemotoma. Sometimes, if the clot is big enough, it will cause pressure and swelling on the brain enough to induce a coma. Usually, surgery would be used to drain a blood collection like this. One of the most common causes of a subdural hematoma in the elderly is a fall where they strike their head. As we age, our blood vessels become more fragile. If your character was also on a blood thinner for any reason— this would increase his risk for bleeding and potentially the size of the blood clot.

Any significant, direct injury to the brain can cause coma. A serious car accident. Falling off a ladder onto your head. Etc.

More medical causes, particularly in his age group, could be a stroke or a heart attack. A stroke causing a coma might be hard to write. In real life, it has a high mortality rate. Not to say it’s impossible but any direct injury in the brain (either through blood bleeding where it shouldn’t or the brain dying because of lack of oxygen causing death of brain tissue) is going to be hard to overcome with a mentally intact patient on the other end.

A heart attack, where he was deprived of oxygen for a period of time, could cause coma. Generally, over four minutes of down time without resusitative efforts is getting into the brain death arena. Even patients who are revived after four minutes will typically have brain death or proceed there. Of course, there are always outliers.

However, even a patient who gets immediate resuscitation (CPR at the least) can still proceed to coma once a pulse and good blood pressure are reestablished.

If I were you, I would pick either a subdural hematoma or a heart attack. I think this will be more likely to preserve the mental state of your character. If the heart attack, I would have it be a very short down time before he is treated and gets his pulse back.

Comas are very hard to write into stories. The length of time is up to you— that happens in real life. A coma of 1-2 weeks for these situations might be a little on the outside but possible.

The problem with a character in a coma for a lengthy period is that normal bodily functions must be tended to. We have to maintain the body functioning as close to how it does when we’re awake. So, the patient must be fed (either through a nasal, oral, or surgically implanted feeding tube). The character will still need to pee and poop— so a catheter can be placed to drain urine. We generally don’t like catheters to stay in long term because it increases the risk of infection for the patient and the elderly are more at risk for this.

Also, a patient in a coma is likely going to need ventilatory assistance and if they are on a vent over 7-10 days then generally there will be talk of putting in a trach.

The longer the coma, the more rehab a person will need. Even if in a coma for 1-2 weeks, the amount of generalized muscle atrophy will be significant. A character who is a 90 y/o who awakens from a coma after being bedridden for 1-2 weeks would probably go to inpatient rehab for several weeks/months and then outpatient rehab for a couple of months– and that might be underestimating. It’s just hard to recover from these types of injures as we age.

Hope this helps and best of luck with your story!

This Is US: Jack’s Needless Death

/ Jordyn Redwood / 4 Comments

This television episode caused more people to reach out to me over any other. This Is Us has been building up to Jack’s death for eighteen months. It needed to be big. It needed to be dramatic. Can you tell I’ve been watching the show? It was really none of those and medically— well, just weird to be honest.

If you haven’t watched the episode then don’t read this post because it will reveal his cause of death . . . like right now.

Jack’s ultimate demise? A heart attack called the widow maker caused by the stress of the fire.

Jack is in intense smoke and heat for several minutes. He emerges and is first checked by EMS. He is being given oxygen and a dressing to his arm for “2nd degree burns”. The EMS person says she can’t treat the burn and he is seemingly refusing transport, but she does encourage him to be seen. Also, giving oxygen is correct, but it is not the right type of mask. A note on burns. Burns will evolve over the next several days so you don’t really know how severe a burn will be for a while.

Jack does eventually go to the hospital to get his burns checked. The doctor is initially giving him instructions on burn care.  The doctor says, “I’d like your heart rate to come down.” and glances at the monitor— which doesn’t have any readings on it. No waveforms. No numbers. He then says, “There’s soot in your airway so we’ll have to run some tests. The swelling is minor.”

That’s about it. The doctor tells Jack he basically dodged a bullet and seems none too concerned about his potential airway damage.

Just as I mentioned above, airway burns from smoke inhalation are similar to skin burns in that they evolve over time. Smoke inhalation and the potential for upper airway swelling is taken very seriously. There is a nice overview here. At the very least, there should be discussion of admitting Jack to the hospital. As quoted from the article, “Studies have shown that initial evaluation is not a good predictor of the airway obstruction that may ensue later secondary to rapidly progressing edema.” If there is concern about significant injury to the airway then the patient is electively intubated until the airway injury heals. It’s VERY difficult to intubate someone with a lot of airway swelling.

Shortly after this consultation, Rebecca decides to make a phone call and get a candy bar from the vending machine. In that, perhaps under two-three minutes passage of time, Jack codes and dies. Even though she is just outside the ER nurses station, she never hears a code being called. Doesn’t see the commotion.

The doctor approaches her and says, “One of complications of smoke inhalation is that it puts a terrible stress on the lungs and therefore the heart. Your husband went into cardiac arrest. It was catastrophic and I’m afraid we lost him . . . Mrs. Pearson, your husband has died.”

After a few exchanges she goes to Jack’s room where there is a spotlight shining on his chest with a cursory ambu bag at the head of his bead . . . but no other equipment. I’m telling you in two minutes, a code has barely just begun and is never called so hastily . . . like ever. Later, explaining the event to Miguel, Rebecca says he had a widow maker’s heart attack.

The widow maker is a real term for a heart attack. It generally refers to occlusion of the left main coronary artery that feeds the left side of the heart. It is the same heart attack celebrity trainer Bob Harper had and survived. The reason the widow maker can be so devastating is that the left ventricle is the largest, strongest pumping chamber. If it dies . . . well, you’re hosed.

There would be no realistic way the doctors would know it was specifically this kind of heart attack as shown in the episode without an autopsy. Presumably, Jack went into one of the lethal heart rhythms, v-tach or v-fib, at the time of his code. In the time frame given on the show, the medical team would have barely started CPR and given the first line treatment which is electricity. A 12-lead ECG can be a strong diagnostic tool for this type of heart attack, but they never did one. Had they done that early on, they probably would have seen the changes.

Also, he would likely have some signs and symptoms. Chest pain. Nausea. Left arm pain. Sweating. Demonstrating these might make the scenario seem more believable. Having Rebecca witness the code would have been more dramatic.

Also, it would make more sense that he would suffer this cardiac event while he is actually under duress— such as during the rescue of the children and the dog.

The only way to truly know that this is the type of heart attack Jack suffered as presented in the show would be to conduct an autopsy.

This Is Us— thanks for killing off a beloved character in a totally lame way— at least from a medical standpoint.