Seize the day

Sometimes it takes a near disaster to learn some important lessons. Dr. Richard Madow reorganized his priorities after a close brush with death.

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by Richard H. Madow, DDS

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Some people have a perpetual sense of disaster lurking around the corner. Not me! As a 41 year-old, extremely healthy and happy dentist, there was certainly no reason for it. Sometimes it takes a near-disaster to learn some important lessons about dentistry and about life.

About a year ago, as I returned from the 1999 Richards Report Super Fall Seminar, I picked up some kind of flu bug and was knocked out for a few days. I was so beat that getting out of bed was a major event. After awhile, things returned to normal - or so it seemed.

That December, over winter break, we took the kids on a "New Year's Millennium Cruise," which departed from Miami. My in-laws live in South Florida, so we started the trip a few days early and hung out at the grandparents' house for a while.

The same thing happened down there - I totally zonked out. I just couldn't move or do much of anything. (Some people may see this as the ideal way to visit your in-laws.) Strangely, as soon as we left for the cruise, everything was fine. Was I allergic to my in-laws? Were they trying to poison me? Possibly. But as it turned out, that was not the case.

January 2000 - a promising New Year, and things seemed to be back to normal. I finally shook off that nagging flu, and was feeling ready for the new millennium. Everything was great with my family and my career. I had great friends; life truly was good. Then came a Sunday in January I will never forget.

I hate science fairs. I hated them as a kid; now, as a parent, I totally despise them. But it was that time of year, and my son Steven, who had just turned 10, had designated Saturday, January 8, as "The Day Daddy Would Help Him With His Project."

So there we were in our home office, tagboard everywhere, printers and computers humming, glue drying - I'm sure every parent can relate. Around 2:30 p.m., I started feeling a little weird - spacey; almost flushed. I couldn't stand up. I didn't know if it was the science fair project, the lack of fresh air, or maybe my in-law's poison finally kicking in. I sat on the floor for a minute, and everything returned to normal. Steven didn't even notice.

Thirty minutes later, it happened again. This time it lasted longer, and my heart started racing. A couple minutes later it was over - Steven did notice this time - but of course, being the macho guy that I am, I told him everything was fine and we needed to get cooking on that project.

The next episode, again 30 minutes later, wasn't quite as pleasant. I was flushed and sweaty, and lying helpless on the floor. I was disoriented, and my heart was doing a drum roll. Somehow, I managed to take my pulse; it was over 200 beats per minute! My whole body felt disengaged.

Of course, I was perfectly willing to do nothing, but Steven was quite insistent that I call a doctor, or at least 911. I called my internist, but his partner was on call. "Heck if I'm going to see some bozo I don't even know," I thought. "Forget it!"

A few minutes later I was down on the floor again. Steven was scared and started begging me to do something - anything. So I called my wife, Anne, who reminded me that her cousin Miriam was a cardiologist, and quite a renowned one. Of course, it being winter in Baltimore, there was only a 10 percent chance that Miriam was even in town, but I called anyway.

It turned out she was in town, but she wasn't on call that night. Her answering service, hearing the urgency of the situation, hooked me right up with Randy, the cardiologist on call that night. I told Randy the whole story, including the fact that I was lying on the floor, unable to stand, with a pulse of 204. After congratulating me on being such a good historian, he told me, "Well, you know it is a Saturday night during flu season, so the emergency rooms are going to be packed. Why don't you just call my office on Monday morning and come in then?"

Had I followed that doctor's advice, I wouldn't be sitting at my desk right now - I'd be hanging with Hemmingway, Shakespeare, and a lot of other famous dead guys.

A couple of minutes later Anne got home. I was able to stand for a few minutes. Anne, of course, knew her cousin the cardiologist's extra-double-secret special home phone number, so we called her there. She happened to be having a Calgon moment in the tub. Listening to the symptoms, Miriam calmly said, "Meet me immediately at the Union Memorial Hospital emergency room!"

We all sensed it was somewhat serious at this point; Anne's attempts in the car to calm me down were actually having the opposite effect. It was a long, long 20-minute drive.

We got to the emergency room. I told them my name, and it was like an episode of ER had begun. No history form, no Blue Cross card - they just flew me back into the room, laid me down, started shaving things, put EKG pads everywhere, and poked an IV into my arm. At the most dramatic moment, in struts Dr. Miriam, dressed like an Italian fashion model. She started barking out orders and sent the scrubs scurrying around plugging all kinds of things into me.

After about 20 minutes, my pulse (now over 220!) and blood pressure stabilized. They began doing a multitude of tests. The next move was to the coronary intensive care unit, where I was the only nonsmoking vegetarian ever to check in.

I had never spent a night in the hospital in my life - no surgeries, no broken bones, no major illnesses. What the heck was I doing in coronary intensive care, tubed up like a car engine? I wasn't the only one with that question!

After a million tests and the most detailed history ever, my doctor reached a diagnosis: viral myocarditis. Ever heard of it? Me neither - unless maybe you remember it from the movie "Beaches." It's what Bette Midler's friend died of. It is caused by a virus - just like the flu - but for some unknown reason, the virus affects the heart instead of the respiratory system.

The symptoms can be anything from a temporarily abnormal EKG to chest pain, cardiac arrhythmias, loss of consciousness, or even heart failure. In some cases, the disease is self-limiting and disappears completely. In other cases, it can cause permanent heart damage. Nearly 10 percent of the cases are fatal. Yikes! It's pretty creepy to realize I had a 10 percent chance of meeting Jimi Hendrix! At my age, death had never seemed even a remote possibility - but the horror stories I've heard since then made me realize I was damn close!

Getting out of the hospital was great, but it was followed by a month of total bed rest - not that I could do much more anyway! After a week, I managed to get out of bed and check my e-mail, but even this was a major undertaking, leaving me completely exhausted.

The medication I took left me in a mental fog - even watching the Game Show Network was a mental challenge. ("Hey - why are all the panelists on What's My Line wearing blindfolds?")

I paid regular visits to my cardiologist, who took every opportunity to tell me of another patient who came down with viral myocarditis and was now in line for a heart transplant - or in a box. As lousy as I felt, I was also starting to feel pretty lucky.

The recovery period can be anywhere from six months to five years or more (can you imagine telling a patient that a root canal will calm down in six months to five years?) At this point, there was just no way to tell what was going to happen. The best news: it appeared that my heart had no permanent damage. But since the diagnosis was practically all symptom-based, no one was making any promises.

The next few months were pretty much the same - get up and go back to bed, have everyone tell me how bad I looked, check e-mail, go to bed, read a little bit, get chest pains from walking down the steps, have everyone tell me how bad I looked, and go back to bed. I had to give up caffeine, alcohol, and my favorite physical activity. Fortunately, only caffiene is still on that hit list!

By March, things were looking a bit better. I could go to work for a few hours each morning, but it left me totally exhausted. Although I still felt (and looked) horrible, it seemed like a normal existence was right around the corner. And then one morning I was down on the floor again, sweaty, disoriented, and with a pulse in the low 200s.

Fortunately, only two short episodes occurred, but it was certainly something to be concerned about. Back to the hospital - stat.

The cardiologist now suspected I had a funky electrical pathway in my heart. Every once in awhile it went off - a random act of violence inside my ventricle. Time for an electrophysiology study. More fun and games!

Dr. Miriam referred me to another cardiologist - "the electrician" as she called him. Boy, what a comforting name. Glad I didn't have to see "the plumber!"

The next morning, I was sedated, shaved in many places, and brought down to a cold slab in a room resembling NASA ground control. Electrical probes were inserted and gradually eased through my body until they actually entered my heart. I was groggy, but still able to watch the whole thing on the monitor. It's pretty strange to see wires entering your own heart. The whole thing was actually pretty cool until The Electrician started barking out orders:

"1,200 jigawatts!"

Boom! It felt like my heart was exploding out of my chest.

"1,400 jigawatts!"

Boom! Boom! Even worse! This went on for awhile, until my heart had so much electricity pumped through it we could have lit up Yankee Stadium. The result: no electrical abnormalities. After another medication change and three more weeks of bedrest, things seemed to be on the mend again.

And they still are. After spending most of the summer and fall resting and experiencing occasional symptoms, things are going great. It looks like no permanent damage was done, and, fortunately, things are now close to 100 percent.

The good news: this really was a freak incident. I'm no more or less susceptible than anyone else. I'm back to normal (whatever that is!); the odds of this happening again are less than being struck by lightning. And of course, there are always the lessons learned.

There's something symbolic about returning to good health at the beginning of the new millennium. I had time to lean back, relax, and realize that no matter what, you really never know what is around the corner. My experience with a sudden and terrible illness really floored me, just as I'm sure you've been floored several times during your life. One of the strangest things was that when I realized how close to death I actually was, I started visualizing my funeral and my obituary.

I've heard the wise adage that says if you want to follow the right path for your life, envision how your obituary will read. If you slave over the chair for 60 hours per week and then keel over and cash in your chips in the middle of a crown prep, what will others say about you? What if you practiced four or even three days per week, were known throughout the community for your high standards and charitable work, and had lots of time for travel, hobbies, and family?

Will you have done things throughout your life that seemed good at the time, but in retrospect were petty, selfish, and hurtful? Or worse yet, will there be nothing to say about you at all?

We are all slowly dying from the minute we take our first breath. Could there be a better reason to celebrate life, and to create one for yourself that is joyous, fulfilling, and touches many others along the way? I don't think so.

First of all, get your flu shot every year. Viral myocarditis is extremely rare, but as professionals with a high rate of direct patient contact, we are more susceptible to airborne diseases than most. I highly suggest every clinical staff member be vaccinated as well.

Second, check your disability insurance. You never know when you will be laid up for three or six months, or even more. Review the definitions in your policy with your insurance professional to make sure you won't get shortchanged when you are really in need.

But most of all, please realize that you don't need an experience like this to begin these new resolutions. What have you been meaning to do? Make some changes in your practice so you can love your work and spend more time with your family? Sit in a gondola in the Grand Canal in Venice with your love as the sun sets? Write some thank-you notes to people who have helped you become who you are? Do some volunteer or charitable work in your community? Is there something you need to do in your life - someone you need to apologize to or something you need to rectify or remedy? Have you neglected or taken for granted those who have supported you and loved you in good times and bad? Did you give each of your staff members a big hug today? Well, what are you waiting for? Life, wrote John Lennon, is what happens while we're busy making other plans.

I just had a cardiology checkup last week; it looks like I was fortunate enough to have come through with no damage at all. And even though the whole episode sucked, I feel great about having a starting point to spread joy, kindness, and love to all with whom I come in contact. I know that I won't end famine in Africa or stop the horrible fighting in the Middle East. But it's enough to realize that there are those we can touch, and how many they can touch in return. And the best part: it all comes back to you.

Seize the day - the time is now!

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