How late is late, before it blows into a medical emergency

J.V. Yakhmi

During a short trip to Japan, I noticed that I was sweating profusely when I got off at Nagatsuta, a small train station in Tokyo. In addition, I had a bloating sensation. Feeling uneasy, I sat on a bench. After the few alighting passengers exited, I was left alone on the platform. I felt I needed to seek help because my body was giving me signals of a heart condition at my vulnerable age of 53. But, help from whom, to what extent, and how soon? I was in a quandary, especially because I was due to fly back to Mumbai next day.

It was the morning of June 8, 1999 in Tokyo, a day before I was to board my return flight back home to Mumbai, after my 10-day trip to Japan. I was to spend the last day of my trip in the labs of Prof. H. Yamauchi at the Nagatsuta campus of Tokyo Institute of Technology (TITech). I was travelling light, with just a strolley and a small carrybag as my luggage. Accompanied by an Indian post-doc to help me board the train I arrived at Futako-Tamagawa station to catch the train to Nagatsuta. It was to be a 30 minutes journey, with 15 stops in between, as shown by the route map displayed at the platform. As soon as the train came, I boarded it and the post-doc bid me good-bye, and left but not before I reminded him to call up the secretary of Professor Yamauchi on phone, after my train left, telling her the estimated time of my arrival, since she was to pick me up at Nagatsuta station.

The train was not crowded. I sat not far from the door of my coach for convenience of handling my bags, and watched the doors fling open at each stop to let passengers alight or board before the doors shut. That also brought a whiff of fresh cold air at each stop. Despite that, I noticed that I had started sweating. The route-map pasted in my coach indicated that Nagatsuta was still 5–6 stops away. Sweating increased every minute and my vest and shirt were nearly soaked in sweat when I alighted at Nagatsuta, a small station. Uneasy, I sat on a bench, watching the alighting passengers leave the platform to go downstairs to exit the station.

I felt bloated, and had a strong urge to go to the toilet, but it was located downstairs, as shown by the indicator. I was tense, and by then was nearly sure that I have had a heart attack. I took some sips of water from a bottle I had, but decided not to exert by lugging my baggage about 15 steps downstairs to the arrival hall, because my platform had no lift.

It was not the age of smartphones, and I was not carrying a mobile phone either. I had only a calling card, but there was no phone booth on the platform where I was. I needed to, somehow, inform the secretary from TITech that I had arrived at Nagatsuta station. I was sure that she was waiting for me in her car outside the arrival gates. But how do I tell her?

In order that I could seek help, I approached a young man, about 20, from among the passengers alighting from the next train on my platform and asked him if he could speak English. He said, ‘Yes. Do you need help?’. I said YES and told him that I had arrived by the previous train, was unwell, and he could help me by locating the secretary from TITech, waiting for me in a car outside the arrival hall, and request her to stay there. He quickly ran downstairs and was back in 2–3 minutes to tell me that he had located her and had told her to wait. He picked up my bags and asked me to walk behind him, and took me to the secretary sitting in her car, after which he, the young angel, waved me good bye and went his way!

We reached Nagatsuta campus at about 11 am. Upon entering the building, however, the secretary told me that my host’s room was on the first floor, and there was no lift. I was 53 then, and knowing my condition, I decided to wait before walking upstairs. Leaving me to rest in a room at the ground floor, she carried my bags upstairs.

After resting for fifteen minutes, I used the attached toilet. I didn’t pass any stools, but the feeling of bloating was persisting, nonetheless. I gradually walked upstairs, and entered Prof. Yamauchi’s room. He knew me because we had been in a conference together in USA. Since his secretary had briefed him about my sickness, he told me to relax on the sofa in his room, and cancelled the lecture which I was to deliver at 12 Noon. He and his colleagues invited me to go for lunch, but I politely declined and took a cup of tea, instead. Prof. Yamauchi asked me to feel easy, and offered to get me medical help, or even take me to a hospital, if I wanted. I said no, and kept resting.

All this while, there was a minor, very mild pain at a spot on the left of my chest, which came like a small throb every 2–3 minutes. It must have been angina, though I wishfully thought it arose from indigestion. Did I make a correct decision in skipping the offer of medical attention? I didn’t wish to debate this thought with myself, lest it added to my stress.

While lying down, another thought came to me, an obvious one, if I should call up and disclose my condition to my family, primarily my wife, or my son who was 26 then and employed. But, sitting 7000 kms away, what could they do for me, except worrying, getting tense and feeling helpless?

Lying on the sofa, I was relaxing only physically because my mind kept engaged with several thoughts, some of them weird, such as:

1. Did I acquire something unlucky recently, which brought this misery to me? I recalled that I had picked up a phone calling card, lying at a telephone booth, the day before. Apparently, its user had forgotten to pick it up after use. I had pocketed it after checking that it had some calls left in credit yet. I quickly threw that card away, dispossessing myself of the unearned stuff.
2. Would I be able to travel the next day to Mumbai from Tokyo airport? If I couldn’t, then would another ticket have to be bought, if I got hospitalized?

Eventually, I told myself to stop worrying about things that had not happened yet, and I tried to stay calm, instead, by praying to God. By 3 pm, I declared that I was better, and held a scientific discussion of about 45 minutes with the group members of my host. After another tea, I took leave of Prof. Yamauchi, who asked his colleague to drive me to my hotel, the location of which had been chosen to suit the convenience of my travel to Tokyo airport next morning.

While checking in, I informed the reception desk at the hotel that I won’t be taking dinner. My room was at 5th floor and I watched from my window that there was a 7-Eleven store, just across the road. At about 8 pm, I walked to it and bought some fruits for myself. I also called the Indian post-doc to tell him that I was in my hotel, resting because I had a mild chest-pain. He tried to convince me that I would be alright, and not to worry too much.

All through the night, the bloating and flatulence persisted, with that small ‘throb’ occurring in my chest, every now and then. I must have gone to the toilet every hour, and chewed several cardamoms to ease digestion, but to no relief, obviously because the problem didn’t relate to indigestion.

Finally, it was daybreak, I took bath, got ready, and packed my bags. Before leaving, I went to the hotel cafeteria for breakfast — just some orange juice and a slice of bread with a speck of butter. Then I went to the front desk and asked them to call a taxi for me to go to Tokyo City Air Terminal (T-cat), the in-city check-in counter of Tokyo airport. The receptionist told me that it was a distance of about 15 km, for which a taxi would cost me the equivalent of about USD 150, and suggested that I do, instead, what all other hotel guests do — take an elevator from the floor of my hotel-room, and press the button marked ‘train platform’ to arrive there directly. Once there, buy a ticket costing about USD 10, to go to Suitengume station, where an elevator at the arrival platform would take me upstairs directly to T-cat. I replied, “Look please, it is my money, and I wish to go by taxi”.

Frankly, I didn’t wish to carry my bags even for a few steps, lest it made my heart overwork. So, a taxi came and my bags were placed in it by the hotel staff. I reached T-cat in 20 minutes, where I checked in, booking my bags to Mumbai, retaining just a small hand-bag. All checked-in passengers like me were put in a bus, with our checked-in bags kept in its luggage storage space, and driven to the airport, about 90 minutes’ ride. On way, the ‘throb’ kept visiting my chest, at regular intervals of 2–3 minutes. I closed my eyes to relax, and tried to bolster my spirits by thinking positively.

After arriving at airport, I went through the security check and emigration. I bought a can of apricot juice, sipped it off and on for sustenance, as I walked slowly towards my boarding gate. To my relief, I noticed that the ‘throbbing’ had just stopped. I had reason to be happy, and called my wife from a phone booth to tell that my flight will arrive at Mumbai in time, without mentioning a word of what I had gone through.

I was fine through the long flight, and got off at Mumbai. While being driven home, I narrated to my wife and son, in brief, that I had gone through profuse sweating and angina at Tokyo. They were stunned to hear all that, but we did not discuss if I did the right thing by not seeking medical assistance in Tokyo, or by not making a phone call to them, when I had a medical emergency.

Next day, I joined my office at BARC (Bhabha Atomic Research Centre). To check, if that eerie ‘throbbing’ would recur, I started stretching my daily walks on longer routes with gentle slopes. I did feel a bit of very mild pain during walks, though not every day. I called up our hospital for an appointment with a cardiologist, and was told to come after about four weeks. They didn’t treat it as urgent since I was attending my regular work at office.

On June 30, I reached my office as usual and was writing something urgent, when some contractual workers came at about 11 am to do some drilling job in my room. I said NO, but they kept arguing with me to let them do it. Exasperated, I lost my temper and shouted at them to go away, which they did. Barely a few seconds later, I felt as if the ceiling of my room and the walls were going in circles. Sensing that it was the onset of a serious heart problem, I thumped on a wooden partition between my room and the adjacent one. In response, a colleague rushed into my room, whom I asked to get me a wheel chair to go urgently to our dispensary, which was located in the same building. In the meantime, I lied down to give my heart the least work to do. After a few minutes, I was sitting in a wheel-chair, and taken to dispensary. An on-duty doctor recorded my ECG, and sent me in an ambulance to our hospital, about 3 km away. I was admitted to its ICCU, where my vital parameters, like ECG, were monitored continuously for help in diagnostics.

After spending two nights at ICCU, I got the impression that since there were no tell-tale symptoms observed in my case, I might be discharged. However, it needed a review by our senior cardiologist, Dr. P.T.V. Nair, who was then Head of Medical Division and In-charge of BARC Hospital. He came for his round, and watched my online (real-time) cardiac health on the monitor repeatedly and concluded that there was a small abnormality, a ‘blip’, in the ECG, which only his keen eye could discern. He came to my bed to tell me that he planned to keep me at ICCU for observation for another two days. I was discharged on Monday, July 5, with an instruction to go for a stress test after two weeks of bed-rest at home, mandatory after discharge of a patient from ICCU.

During this intervening period, I tried to stay calm, and not exert physically, but my mind was analyzing the risk factors that might have caused the stress in my life, and heart problems. These factors included my insecure and deprived childhood and adolescence, having lost my father to tuberculosis when I was just 15. I also was the only survivor among my siblings, four of whom had died, none having lived beyond a few months due to malnutrition and lack of medical attention. I also recalled that when I was 32, I had a bout of hypertension when two friends, both below 40, died due to various reasons, triggering a sense of insecurity in me. And, my daughter was diagnosed to have Type I (juvenile) diabetes, in 1994, when she was a college student. It was devastating for my family to accept that she would be on insulin injections all her life.

I went through a stress test two weeks later, but it had to be discontinued mid-way because the diastolic beat was not returning to normal, under conditions of stress. In view of angina and my strongly positive stress test, Dr. Nair referred me for angiography which was conducted on Aug. 29, 1999 by Dr. S.C. Munshi, at Jaslok Hospital, Mumbai. Dr. Munshi found multiple blockages in my arteries, namely 100% in LCX (left circumference artery), and 75% in both LAD (left anterior descending) and OM (obtuse marginal). Since my case was not fit for angioplasty, I was advised to undergo CABG (coronary artery bypass graft) surgery. An appointment was taken for this from the cardio-surgeon Dr. Kaushal Pandey, who scheduled it for Sep. 16, 1999 at Hinduja Hospital, Mumbai. Dr. Pandey gave me a small 20-page booklet which answered all the FAQs that come to the mind of patients due for CABG, and their family members.

CABG being an open-heart surgery, my family was under considerable strain before it was done. My wife’s sister came from hometown, to live with us, for support. Many among my friends’ circle, who learnt about my heart condition rallied round. Managing my appointments at Jaslok and Hinduja Hospitals was done by a Ph.D. student in my lab. Organizing a group of volunteers for donating blood at Hinduja, a day before my surgery, was actively coordinated by a senior office colleague, etc.

After admission to Hinduja Hospital on Sep. 14, all necessary pathological and other tests were conducted for me next day. After an early bath on Sep. 16, I was wheeled into the surgical operation theatre at 8 am. Two doctors, alongwith assisting nurses and technicians took over. One of the doctors, I guess an anesthetist, kept me engaged by chatting, apparently to distract me, and I didn’t know when I was under the spell of anesthesia.

In an operation lasting 6–7 hours, Dr. Pandey conducted the bypass surgery for my above-mentioned three arteries which had blockages. When I came to, at about 6 pm, I found myself lying in the ICCU of Hinduja. I learnt from my wife that three of my senior colleagues, stayed put at the Hospital that day, for hours together, until news came that my CABG surgery was successful.

I was kept in the ward for another six days to monitor my health and to help me recover under Dr. Pandey’s supervision. I was discharged on Sep. 23 to go home, before which I went to BARC Hospital to meet Dr. Nair. There is no gainsaying the fact that it was his keen observation and expertise that had discovered the subtle ‘blip’ in my ECG during my stay at ICCU of BARC Hospital, which saved my life.

Dr. Nair advised me to go on medical leave and recuperate at home for another two months, which I did. I joined office in early December, and was in reasonably good health for the wedding ceremony of my son on Dec. 26, 1999. A very close friend was rightfully upset as to why he was not informed about my surgery, but he excused me even before I could explain.

Ever since my heart surgery, I have been going for periodic check-ups to doctors at BARC Hospital and at my dispensary, and have been taking statins, slow-acting aspirin and diltiazem, regularly. Additionally, I have been under the care of Dr. Nair, all through. Heart patients like me adopt a regulated, disciplined life, watching each step, so to say. I do walk at least 3 km every day. One can stay healthy, even under challenging conditions by taking due precautions, medical help, and staying relaxed.

Staying physically very fit would be tough at my age, now 75. However, staying mentally engaged, and useful to the society does contribute, positively. It is also beneficial to stay connected with close friends, recalling good old shared happy memories with them and indulging in light-hearted comments and laughter. This can be done, even during Covid-19 times, on audio or video calls, without moving out of the safety of one’s home. Above all, a great caution needs to be exercised to manage and control anger. Sudden anger can lead to a heightened blood pressure, and even a lethal heart attack in the case of chronic heart patients, in particular.

Despite all precautions taken, things do not always stay smooth, as years go by. This is because a human body is a complex thing driven by so many parameters. But it does give us cautionary signals, provided we are alert to take note and comply. One should respect these signals, even if they turn out to be not of serious consequences. I recall discontinuing my evening walk on one day, just after walking 200 meters, because I felt uncomfortable. On another occasion, after completion of my 4 km walk, I felt uneasy and sat down at a place, calling up my wife on phone to bring a taxi, riding which only I returned home.

Looking back at my own case, all my actions including not using stairs with my bags, travelling by taxi to T-cat and seeking the help of a young Japanese man at the platform were wise except that I took a grave risk in shying away from accepting a medical check-up being offered by my host a day before boarding my flight to India.

It is true that a few people get disturbed so easily at even minor health upsets that they press the warning bells and rush to a hospital’s emergency unit. That apart, in case of a sudden health problem, particularly a heart attack or stroke, one should seek medical help immediately, even if it is a false call. There is no justification for biding time in making non-expert judgments and slow-pedaling the emergency, letting golden minutes fly away ignoring, wishfully, the signals given by the human body. Delaying can be deadly. I was lucky that I survived. Seeking professional medical help makes the most sense and should not be treated as a stigma or a sign of weakness.