My First Heart Attack

For years, I watched heart disease from the safe side of the bedrail. In the wards and the ICU, it arrived in familiar disguises—tightness in the chest, sweat on the forehead, a look of fear patients tried hard to hide. I knew the protocols. I knew the drug doses. I knew the rhythm of urgency. I had taught residents how not to miss the silent infarct. Like most doctors, I carried a private illusion: that this story belonged to other people.

When I looked at myself through risk calculators, the numbers felt reassuring. Cardiologists have several tools to estimate a person’s ten-year risk of cardiovascular disease, and most placed me in a low-risk category. The Framingham Risk Score suggested that only a small proportion of people like me would develop a cardiac event over a decade. The INTERHEART study described nine risk factors that accounted for most heart attacks worldwide. I did not seem to fit that profile. I never felt invincible, but I did feel protected by probability.

Then, one afternoon, the body delivered its own verdict.

I was in the hospital when the pain began. It was not the vague discomfort that allows you to bargain with yourself—perhaps it is gas, perhaps it is fatigue, perhaps it will pass. This pain had a sharp authority. It made me sit up and pay attention. It did not give me the luxury of denial.

I remember a strange split inside me. One part tried to behave like a calm physician. The other part shrank into the frightened simplicity of a patient. I did what I often advise others to do: I sought help quickly.

The response was swift and almost automatic. Aspirin. Clopidogrel. Heparin. Atorvastatin. Drugs I had prescribed hundreds of times were now entering my bloodstream. My ECG showed no infarction. The echocardiogram showed no damage to the heart muscle. These were good signs, but they did not settle me. When you are lying on a bed and the pain is still fresh, “good signs” feel like thin blankets in a cold room.

My ICU colleagues consulted one another and decided I should be shifted to a cardiac hospital about fifty miles away. Their faces were calm, but I could read the seriousness behind the calm. In medicine, urgency often comes wrapped in politeness.

By the time I was wheeled into the cardiac catheterisation laboratory, I had stopped thinking like a professor of medicine. I was thinking like a man who wanted the pain to stop and wanted to go home alive.

Until that day, the cath lab had been a place I visited as an observer—curious, respectful, slightly awed. Now I entered it flat on my back, draped from neck to toes, surrounded by machines that beeped in their own language. The room was bright, sterile, and oddly intimate. You feel exposed and covered at the same time. You are present, and yet you feel as if events are happening to someone else.

The cardiologist chose my radial artery. I felt the sting, the pressure, and the unsettling sensation of something moving inside a vessel. The catheter was threaded towards my coronary arteries. Dye was injected, and on the screen my heart’s private highways appeared—branching lines I had studied for decades.

The cardiologist smiled. “Good, you have no calcium lining the walls of your coronaries,” he said.

A few seconds later he added, “Your left main coronary artery is perfect.”

For a moment, I wanted to believe the story would end there. I wanted to be told it was a false alarm. I wanted to go home and laugh at my own anxiety.

But the dye moved forward and met its obstacle. In the left anterior descending artery, a plaque had grown large enough to bulge into the lumen. It was not a dramatic, total blockage. Perhaps that was the cruel part. It was subtle enough to escape prediction, yet significant enough to cause pain. Like a rock in a stream, it slowed the flow beyond a point. The cause now had a face.

The cardiologist explained the plan to the anxious cluster of family, friends, and colleagues outside. He would do balloon angioplasty and place a stent to keep the artery open. Someone asked, hesitantly, whether medical therapy could be tried first and angioplasty kept as a backup.

It was a reasonable question. I would have respected it instantly if it had come from a patient’s family in my ICU. Hearing it asked on my behalf, I realised how fragile judgement becomes when the body is frightened.

The cardiologist did not dismiss the doubt. He answered gently. The obstruction, he said, was compromising blood flow. He would rather open it now. Then he waited for approval.

Everyone nodded. So did I.

That nod was not an academic decision. It was surrender. In that moment I was not practising evidence-based medicine. I was living the oldest form of medicine: trust. Trust in the person standing at my wrist. Trust in my colleagues who had brought me there. Trust in the collective sense that this was the right thing to do.

The stent was mounted on the balloon and advanced carefully. It was positioned precisely at the narrowed segment and expanded under pressure. The balloon was deflated and withdrawn, leaving behind a mesh that would now become part of my anatomy. When the dye was injected again, it flowed smoothly into the distal bed.

Somewhere in the waiting area, a collective breath was released.

I was wheeled into the ICU with a drug-eluting stent inside my coronary artery. Two days later, I was discharged home. I carried a prescription, a new label, and a quiet disbelief.

During those days, my phone did not stop ringing. Calls. Emails. Messages. Most were affectionate. Some were anxious. A few were teasing in the way only friends can tease after the danger has passed. One message stayed with me because it asked something I had never asked myself so honestly: “What kind of a patient are you? Obedient or full of questions? Compliant or sceptical?”

I understood why my colleague asked. For years, I had urged people to ask questions. I had spoken against unnecessary interventions. I had lectured on balancing evidence with values. I had believed that knowledge protects you from confusion.

The truth was uncomfortable. When I became the patient, my mind did not behave like the mind of a professor. It behaved like the mind of a human being who did not want to die.

The pace of events—rapid triage, quick transport, the urgency of treatment—created an environment where the ideal informed-consent conversation becomes difficult. I was aware of that even as it was happening. Awareness, however, did not translate into control. I found myself accepting decisions that were being made with my body at the centre.

I understood, in a way I had never fully understood before, why patients nod even when they do not grasp everything. It is not ignorance alone. It is fear. It is hope. It is the desperate wish that someone else will carry the burden of uncertainty.

After I returned home, some colleagues suggested further tests. If traditional risk factors had failed, they said, why not look for newer biomarkers? Their concern was genuine, and I was touched by their affection. But I chose not to pursue additional testing.

Part of that decision came from a simple realisation. Medicine, for all its power, is still imprecise. Risk prediction rules are useful, but they are not destiny. Diagnostic certainty is often a polite illusion. The body has its own grammar, and it does not always follow our neat algorithms.

What I carried back from that episode was not only a stent and a set of medicines. I carried back a change in the way I looked at patients. I began to see the trembling inside their calm faces. I began to respect the messiness of decision-making. It is not a clean mathematical act. It is emotional. It is influenced by family. It is shaped by prevailing practice. It is often steered by the tone of the doctor’s voice.

I also saw, with new clarity, the privileges of being a doctor-patient. I did not have to wait in a queue. I did not have to struggle for an appointment. Colleagues cut through delays on my behalf. I received care with speed, respect, and attention. Most patients do not get that. The thought stayed with me long after the chest pain faded.

When people ask me now what my first heart episode taught me, I do not talk about angiograms and stents. I talk about humility. I talk about how quickly a confident physician becomes an anxious patient. I talk about how medicine must remain evidence-based, yes, but also patient-based—rooted in the mind that is trying to make sense of fear.

And I remember Pascal’s line, which feels less like philosophy and more like clinical truth: the heart has its reasons which reason knows nothing of.

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