Mortality

Interesting insight into the death of one of Hollywood’s great stars emerged in a medical journal article I read recently.

The information has to do with a set of heart attacks that killed Clark Gable in November 1960. The article in question has a very long title and summarizes the history of coronary care in America. The article was published in a 2011 issue of Circulation, the journal of the American Heart Association.

I was reading the article for a story I was writing, but the topic of coronary care has personal interest.. In October, I learned that I have a heart condition. I have an irregular heart beat that one Sunday afternoon caused my heart to stop beating several times. I spent the night in John Muir Medical Center’s cardiac care unit before undergoing surgery to receive a pacemaker.

Clark Gable was 59 when he died. The Circulation article focuses on the care he received between two heart attacks he suffered 10 days apart. Gable received the best, top of the line care possible for 1960. The “king” of Hollywood consulted with the most renown cardiologists in Los Angeles. Nonetheless, he suffered his second attack, which was fatal, after he left the hospital and was recovering at home.

 “The recent death of a prominent motion picture performer, whose medical management was of unqualified excellence, precipitated nationwide headlines in the lay press and created a public  awareness that, even with optimum care and smooth convalescence, recovery was not assured.”

This statement came from Morris Wilburne, a Los Angeles cardiologist, who was speaking at the American Medical Association’s annual conference in 1962. Wilburne, who was on the faculty at the University of Southern California, was one of the first doctors to publish articles describing the concept of a special hospital unit designed to treat patients with heart attacks and other heart conditions.

Gable sounds like he was a heart attack waiting to happen. He was always a heavy drinker and smoker, according to the Hollywood history website, Findadeath.com. As he entered his 50s, the one-time MGM box office champion put on weight, ballooning from 190 to 235 pounds. When a movie role came along, he would quickly shed pounds by crash dieting and consuming tons of diet pills.

The film he was making right before his death was the modern-day cowboy drama The Misfits, co-starring two other ill-fated legends, Marilyn Monroe and Montgomery Clift. Much has been written about the stressful, physically demanding shoot. Maybe he-man Gable did his own lassoing stunts, though others doubt that a studio insurance company would allow a 59-year-old star to do such strenuous work. There was also gossip about how Monroe’s  famous insecurities, lateness and “semi-comatose appearances” wore Gable out.

On Friday, November 4, 1960, Gable didn’t feel well as he finished shooting a close-up shot with Monroe at Paramount studios. The next day, he doubled over with severe chest pains while changing a tire on his jeep at his Encino  home.  He and his wife couldn’t call 911 because 911 didn’t exist at the time. Not sufficiently aware that chest pains signaled a life-threatening emergency, they also didn’t think to call a doctor or take Gable to the hospital. Instead, Gable ate an early dinner and went to bed. A bad headache kept him awake much of the night. Finally at 7:15 a.m. Sunday, the chest pains returned, Gable collapsed, and his wife called the local fire department and his doctor.

An ambulance sped him to Hollywood Presbyterian Hospital, where tests confirmed Gable had a heart attack. Bypass surgery was a procedure of the future. Gable’s state-of-the-art treatment consisted of sedatives, anti-coagulants and rest. “The only hint of future treatment was a large machine called a pacemaker brought into his room,” Findadeath.com said.

The Circulation article explains that up until the early 1960s heart patients convalesced in wards or standard hospital rooms with little or no monitoring by staff trained to respond immediately to cardiac arrest.

Gable’s recovery was “uneventful,” the Circulation article said. He stayed in the hospital 10 days. “It was reported that he was looking his old self again, and his color had returned. He was chatting to the nurses and sitting up in bed reading – and probably smoking as well,” Findadeath.com said.

On the evening of Friday, November 16, Gable was back at home. Just before 11 p.m. Gable was in bed looking through a magazine when he lay his head back on a pillow and died.

A remarkable woman introduced me to the Circulation article. This woman, Kathleen Dracup, became a nurse in the mid-1960s and found her calling caring for patients recovering from heart attacks. I was assigned to write a profie on Dracup, the former dean of UC San Francisco’s School of Nursing and one of nursing’s most important pioneers. As I learned during my research, Dracaup has become internationally renowned for her clinical and research work on patients recovering from heart attacks and living with heart disease.

Dracup began caring for heart attack patients at the time hospitals were establishing the first departments dedicated to their treatment. As I wrote in my profile, the invention of ECG machines, external defibrillators and cardiopulmonary resuscitation in the early 1960s gave doctors and nurses the the tools to set up coronary care units where staff could employ life-saving measures within minutes. 

Dracup’s research over the years has focused on the emotional needs of heart patients and their families, She became interested in finding ways to help these patients get well and stay out of the hospital.

Dracup explained to me how medical advances, including diagnostic tools and prevention strategies, have shifted the emphasis of care from people dying of heart attacks to people learning to live with a chronic heart condition. She said that people don’t die from heart attacks with the same frequency as they once did in, say, Clark Gable’s day.  Also, the typical heart patient is no longer a man in his 50s,  like Gable, but someone who 20 years older.

Good follow-up and outpatient, preventive care is key, Dracup’s research shows. The follow-up includes counseling and education for patients and families about life-style changes, managing medications, identifying symptoms and responding to emergencies.

That kind of counseling, education and follow up care was not available to Clark Gable and his wife, who was pregnant with his son. 

In photos, 59-year-old Clark Gable looks, well, old. Today’s top movie idols, upon entering their 50s – Harrison Ford, George Clooney, Brad Pitt, Tom Cruise -- generally look younger and healthier. These guys seem too secure in their fame to rely on plastic surgery – at least in any overt way. They look like they take good care of themselves -- not like they drink heavily and smoke three packs a day.

I think that’s true of men and women in general these days. We know better. We take care of ourselves. We go in for regular physicals where doctors check for heart-problem warning signs such as high cholesterol or high blood pressure. We learn to eat better, exercise more, give up smoking if we haven’t already.

Fifty-nine doesn’t seem so old anymore. That’s only 10 years older than me. Fortunately, my “heart condition” doesn’t constitute a chronic condition for which I must take medication to preserve what healthy heart tissue I have left. Aside from some faulty electrical circuitry, my heart is in good shape. 

So, I don't feel old -- not like Gable looked old in his final decade. But maybe I'm in denial.

When your heart stops

What's happening to me?

I said something like that as I was moving myself from a kitchen stool to the kitchen floor. The ground was disintegrating, while its fragments were rising up to swallow me into a gray-green aura.. I shouldn’t stay here on this stool, I told myself. I should get to the floor because I’m going to pass out.

So, I pulled myself off the stool, moved a few feet and quietly sank to the floor with my body propped against the dishwasher. That’s the last thing I remember until my husband was bending over me, holding up my left shoulder so I wouldn’t topple over.

What’s wrong? What happened? I think he asked. I asked the same thing. I was looking up at his face. Then I heard my mother’ voice next to me. They were coming into focus.

A minute or so earlier, I was sitting at the kitchen table, reading the Sunday newspapers: the latest on the Occupy protests across the country, another scandal in the SF mayoral election, the Venice masters exhibit coming to the De Young.

Before I passed out, I didn’t feel pain or light-headedness. There was just the gray-green awareness of dread and warning.

That was Sunday around noon. Over the next six or seven hours, there would be six more such episodes in John Muir Medical Center’s Emergency Room and then in the cardiac care unit.

Each time, I knew that the loss of consciousness—syncope, as it is known in medical terms—was coming, and I could call out to my husband or to the nurse, “It’s coming.”

A sense of deja vous accompanied the aura. It seemed as if somehow I had been in this situation before, in this gray-green place. Calling out for help. For just a millisecond at most, figures would flash across my brain. They seemed to be familiar people in familiar places. But they were shadowy.

Maybe this is what is meant by one’s life passing before one’s eyes. But for me, I saw no bright welcoming light. Just a glimpse into a place I really didn’t want to go.

During Episode No. 3 in the emergency room, the doctor announced “she’s asystole.” He had the friendly, handsome face of a doctor in TV medical dramas. From TV medical dramas, I knew that “asystole” means something pretty dramatic.

Sudden cardiac arrest that occurs when the heart develops an arrhythmia that causes it to stop beating. ... Cardiac standstill with no cardiac output; it eventually occurs in all dying patients.

My husband says the green number on the black screen of the heart monitor fell from 60something to below 50, and then to zero.

He said it stayed zero for five or 10 seconds; the longest five or 10 seconds in his life. The nurses and technicians with the red crash cart came rushing in.

During each of the episodes, my heart fortunately started up again, though slowly. Twenty. Twenty, Twenty-three. It took about a minute before my heart reached a normal pace -- for me anywhere from the low 60s to the low 70s..

I’m 48 years old and have always been confident of my good, sturdy health. That’s what checkups with doctors or at hospitals always told me: I had a strong heart, strong lungs, healthy weight, no medical problems. I liked to exercise, daily if possible.

And, then on Sunday, just before noon, I started to faint, and it would lead to a new milestone in life and identity. I had become a cardiac patient; I now had a heart condition.

The weekend had started with one of those little miracles. We welcomed a new kitten into our family. My son and a group of his friends arrived home at about 5 p.m. Friday. Five middle school boys walked into the house in a quiet, purposeful way. My immediate thought was, OK, we suddenly have a some mouths to feed.

My son followed me into the kitchen, and I noticed he was holding something against his chest. It was very small and golden.

“Mom,” he said with the most serious face. “We found her in Alma Park. A lady there said she was in a litter of strays.” She was a little tabby kitten, her face burrowing into his shirt.

“Mom,” he said. “I want to keep her.”

And, I knew, yeah, we were going to keep her.

She looked so small. I wondered if we would need to feed her from a bottle. My only worry was how well our 13-year-old cat Fluffy would adjust to having to share some of her realm.

“You’re in love,” I told my son. And he said, “Yeah.”

I had immediately fallen in love, too. My son, his friends and I took her down to Pet Food Express to buy some kitten formula. We learned from the clerk that she was probably 5 to 7 weeks old.

My son wanted to name her something from the Greek myths. After some quick Wikipedia searches, he announced his choice: “Pandora.” The first woman, he said. The one who, according to some interpretations, unleashed evil into the world by opening her “box.” But my son also said the Pandora of mythology was known for her curiosity, and his new little cat seemed curious.

On Sunday morning, I went to the gym and did my hour on the elliptical. I sensed nothing amiss. Then I went to meet a friend for coffee. I felt cheerful and energetic. I thought I’d stop at Trader Joe’s and pick up ingredients for dinner. And I’d go to the famers market.

But all I really wanted to was go home and see Pandora. The kitten was living up to her name. She was curious. She had no hesitancy about approaching people or about sliding down off the couch to explore. She was making herself at home, and our other cat was not freaking out. Pandora also was cuddly and affectionate. She liked to curl up in a ball in our laps and be petted and scratched. She'd open her little mouth and yawn, stretch out her white paws, and look up at us with happy blue eyes.

I saw her bright blue eyes as I lay in my bed in the cardiac unit on Sunday afternoon, in between episodes. I started to cry, because I wanted to get home and protect and love that kitten, and because I was overwhelmed with this rapid turn-around in my reality.

I was in the hospital, with a mysterious heart ailment. My heart was doing this thing in which it suddenly stopped beating. With just a one-or two-second warning, I was losing consciousness, along with the awareness of my surroundings and of myself.

But at least my heart was going haywire while I was in the hospital, where I was hooked up to monitors and a crash cart was just outside my door. For my first episode, I could have been at the famers market and collapsed in the middle of Locust Street.

For the second, third, fourth, fifth, sixth and seventh times, the monitors were recording all the vitals in my cardiac crisis, including heart rate and blood pressure. The eyewitness accounts coupled with the data on my vitals would give the cardiologists valuable information to diagnose my new condition and recommend a course of action.

But the course of action would mean staying overnight or longer.

No going home to Pandora.

.

My $2,374 cut-thumb emergency room bill

A few weeks back, I wrote about the surprisingly speedy service I received at John Muir Medical Center's emergency room. This was on a Sunday evening after I went in for a thumb I sliced with a potato peeler. The bleeding wouldn't stop after several hours, so I figured I had to go to the emergency room to have a doctor look at it. 

I feared that a cut thumb would be very low on the emergency department's priority list, and that I'd end up sitting in the waiting room for hours.  Instead, I was seen right away. My wound was cleaned out, I received a bandage, and I was out of the hospital in an hour. I've since learned that John Muir, yes, has instituted a new system for managing the flow of its patients in its emergency room. It identifies easy to treat patients, like I was that night, and gets them into an exam room as quickly as possible, to be seen, treated, and discharged. This system helps keeps the emergency room from backing up and lets the staff focus on more serious cases.

The bill came, and I was curious, to say the least, that the total bill is for $2,374. For an hour's service. Wow!

I'm not freaking out about it because my private health insurance covers all of that amount, except for the $100 co-pay that I paid at the time of treatment. My initial thought upon receive this bill: My health insurance damn well better cover this ER visit.

That's because for the past year or so, my family and I have been picking up a huge share of my employer-provided Health Net medical coverage--to the tune of $1,400 a month. We chose this somewhat more costly Health Net route because we wanted to maintain continuity of coverage for my husband who has a chronic health condition.

With these kinds of ER costs, I can imagine the person who would be reluctant to go in for something like a cut thumb--or even something more serioius--if they had to pay much higher out-of-pocket costs.
Of course, the health care reform bill was just signed last month. I know I should be more of a health care policy wonk. If I were, I might understand how the health care overhaul might reduce this kind of cost for an emergency room visit--to my insurance company or to me.

According to HealthReform.gov, the health care reform is supposed to make health care "affordable and accessible for everyone." The argument is that by expanding health insurance to all Americans, "and creating caps on the health care expenses that people pay out of pocket, health insurance reform will make health care affordable to everyone.  ... Premiums are high, in part, because of the 'hidden insurance tax' of more than $1,000 for unpaid costs of care of the uninsured."

If any health care policy wonks--pro and con--want to chime in. If you have suggestions of anyone to bug, who might be able to tell me whether health care reform will reduced the costs of a cut-thumb visit, please let me know.

Update on road work and expected lane closures around Ygnacio Valley Road and John Muir Medical Center

Before John Muir can open its new, expanded five-story hospital tower at its campus off Ygnacio Valley Road, the hospital facility needs to finish street improvements on Ygnacio Valley and La Casa Via that will "allow more efficient traffic flow," says a press release.

The road work is expected to begin Thursday and to finish in November. According to Ben Drew, director of corporate communications for John Muir Health, the road work includes the following:

--Widening Ygnacio Valley Road for both a new right turn lane from eastbound Ygnacio Valley Road onto La Casa Via and a second left turn lane from westbound Ygnacio Valley Road onto La Casa Via.

--Widening La Casa Via for a new dedicated right turn lane from La Casa Via onto eastbound Ygnacio Valley Road.

--Repaving eastbound Ygnacio Valley Road from 250 feet west of La Casa Via to John Muir Drive.

--Repaving the intersection at Ygnacio Valley Road, Kinross Drive, and La Casa Via.

--Repaving La Casa Via from Ygnacio Valley Road to Montego.

--Traffic signal improvements at the intersections of Ygnacio Valley Road and John Muir Drive and Ygnacio Valley Road and La Casa Via.

--Relocation and reconstruction of the Ygnacio Valley Road median between La Casa Via and John Muir Drive.

Before I go on, I should mention that a a specially designated webpage on the John Muir website, listing roadwork updates, says that AT&T was supposed to begin work underground on their utilities last week. This work  would require one lane of Ygnacio Valley Road to be closed. The lane closure would take place from 9 a.m. to 3 p.m. Monday through Friday.

And, why is all this road work taking place?

Says the release from John Muir: the campus is completing its five-story, 380,000-square-foot Tom and Billie Long Patient Care Tower, which will double the size of the John Muir-Walnut Creek campus.

"The building has been designed to promote a healing environment for patients with rooms specifically designed to maximize space for technology, staff and family members," the release says.

"In addition to 242 new patient beds, of which 230 will be in private patient rooms, there will also be a new lobby and a separate public elevator and corridor system to ensure patient privacy. Other highlights include three new inpatient surgical suites, a high-speed trauma elevator that will carry patients directly from the helipad on the roof of the tower to the emergency room, 24 new, larger, private critical care rooms and 13 new intensive care neonatal beds."

Surprisingly quick visit to John Muir's ER after my thumb got in the way of a potato peeler

At about 8 p.m. Sunday my husband said I would probably need to go to the emergency room. The bleeding had not stopped from the gash on my left thumb. A steady trickle of blood kept filling up the gauze bandages I kept wrapping around my it. This was about three hours after the skin of my thumb got in the way of my peeling potatoes for dinner.

"Do I really have to?"

I so much did not want to go to the ER.  Not for something stupid like this! I wanted to just get into my pajamas, curl up in bed with some peanut M&Ms and--I don't know--read a Walnut Creek city staff report. (Aren't I fun?)

My thumb didn't hurt, and I figured that, after triage, a cut thumb would wind up pretty low on John Muir Medical Center's emergency room priority list--even if the emergency room wasn't busy. I could be there for hours, sitting up in the waiting room, with that artificial waiting room air and something obnoxious--like Fox News--playing on the TV. Would they even have  trashy magazines to read?

But my husband, the son of a nurse, said the cut looked deep, and it looked like it would keep bleeding, unless I got stitches. He offered to drive me, but I said I could drive myself, and by 8:15, I was in the car on my way to John Muir.

Things didn't look promising when I arrived. Half the waiting room seats were filled, and I was third in line to register. At least, Fox News wasn't playing on the TV. Rather, it was re-run of House. Yes, the TV medical drama--yes, the irony of this show being broadcast in a hospital waiting room. Given that I'm rather fond of House, I decided I could pass the survive this waiting room for a little while.

But it turned out I wouldn't be left out in the waiting room. As soon as I signed in, a triage nurse came to get me and take me back to an exam room, where I was invited to sit on a hospital bed. I thought, well, if I'm here for a while, I can at least lie back and try to zone out.

But right away, a nurse came to check my vitals (blood pressure 121 over 73) and look over my bloody thumb. A few minutes later, the doctor herself appeared, and she looked it over, too. We all had a little laugh over my injury, with both reassuring me that potato peelers are involved in a lot more finger gashes than you would ever realize.

A technician irrigated my thumb, and the doctor saw that stitching it up wouldn't be possible. There was no flap of skin. There was no skin at all, just a deep little hole that the doctor said looked like it reach pretty close the bone. She recommended placing this synthetic material over it, which would act like skin. She would then wrap it up, and she recommended that I wear a splint for a few days, so that I wouldn't be tempted to bend my thumb and re-open the wound. 

And that's what the ER staff did. The nurse also gave me a tetanus shot, because I couldn't remember the date of my last shot. "I've been giving out a lot of these today," she said, adding that a lot of people had come in Sunday with cuts and other injuries that would warrant tetanus shots.

It all went pretty quickly and efficiently, despite the fact that, as he technician mentioned, a trauma case had just come in, and "a lot of people are dealing with that."

An added benefit: in between the visits of the nurse, doctor, and nurse technician, a staff member came and took my insurance information and co-pay.

So, I was out of the emergency room, armed with my discharge papers, in about an hour, despite my presumably low-priority injury. I'll have to go see my primary care doctor in a couple days, to make sure my thumb is heeling and to probably get some antibiotics.

And, now I'm back home, writing this. To my surprise and delight, I'm not having any trouble typing. I'm also OK with the splint. It looks rather dramatic--more dramatic than my so-called crisis was, of course. But as the nurse and I joked, if you're gonna go to the emergency room, you should at least leave with some visible reminder of the "emergency" you went through.

I will soon curl up in bed with my M&Ms and my Walnut Creek city staff report.

But I need to close with some words of advice. You know how your mother tells you to always wear clean underwear in case you get into an accident and have to go to the emergency room? Well, it's probably good to keep up with your manicures, in case you slice a digit with a potato peeler or a bagel knife. Alas, I had to expose my ragged, need-to-be-cut-and-filed-fingernails to strangers.

Oh well, I'm sure they've seen worse.

Walnut Creek "mobility gripe No. 3: Where the sidewalk ends on Ygnacio Valley

I'm sure city planners had good reason at some point, allowing this notable gap in the sidewalk between John Muir Medical Center and San Carlos Drive. And, I'm sure there are readers out there who can explain how this came about and correct my ignorance.

And, yes, there is something nice about the idea of building a "green" sound wall to protect residents along Los Altos Avenue from the heavy traffic noise of Ygnacio Valley Road.

And, I know that you can take what can be a pleasant detour north of John Muir hospital, onto the trail that takes you into San Miguel Park.

And, I know you can cross Ygnacio there from the south side to the north. Yeah, and you can wait and wait for the "walking man" signal that lets you cross...

But still. This gap is just that: a gap, which hinders easy pedestrian and bicycle mobility from one point on Ygnacio to another....

I've come across it frequently my little jogs, like this morning, around town, when I choose to climb up and over Ygnacio Valley Road. And, this sidewalk stop has always mystified me.

Oh, and to the left is peek at the fence on the other side of the soundwall.