“Hey Frank, lookie here. We’ve got some new meat!” Herb sported a gray sponge of hair on both sides of his bald head, connected by two desperate strands of hair that he immediately smoothed with his forefinger.
What are you talking about Herb? Too early in the morning to think about that stuff.”
“Look over at the door by the sign – in girls.”
Frank looked in the direction of Herb’s gaze and I could see them watch me intently at the vital signs station. Then they made their move. Frank’s belly jiggled when he walked and his black knee socks actually did encircle his knees, cutting off what blood flow was left of his pencil thin legs.
“This dude looks a little young for this place but he’s got some nice exercise pants,” said Herb.
“Nike. I can see the swoosh on the side.”
Then they stared.
The medical assistant took my vitals, gave me detailed instructions on the daily protocol that required strict attention, and then instructed me on how to properly attach the ECG electrodes and wires to the telemetry box.
“Each day you weigh yourself, put on your telemetry, making sure to sanitize it after you work out, then write down your weight on this chart by your number, which is, 4563. Remember that. Any questions?”
“Got it down so far dear. You doin ok today?”
“Yeah, thanks for asking. Actually was hard to get out of bed this morning, but you know, patient care always comes first.”
“I see.” Interesting concept – wonder where I heard that knee – jerk mantra before.
Frank and Herb relished their opportunity and pounced, one on each side of me, escorting me away from the MA.
“Always good to see fresh meat in our club,” said Herb
Frank scolded him with a smirk. “You said that before Herb, maybe a twenty times this month.”
“Yeah, but not with him.”
They reached out their hands and I shook hands with the obviously seasoned regulars.
“Ok, Bob, nice to meet you and welcome to our little fun house. By the way, your wires are hanging out of your shirt – better tuck your shirt in.”
I liked the name I gave them. Basic and boring. I looked down at the dangling wires that were dangling midway down my shorts and I smiled. “You guys clearly don’t have an eye for fashion.”
“And a little more advice though. Always use the color – coded chart on the stick figure taped to the wall, that way, you’ll never crew up your ECG leads. And trust me, if you screw up your leads, nurse Ratched – he pointed to the dark – haired nurse with a red stethoscope in the middle of the room where the telemetry monitors lived, will surely let all of us know about your royal screw up.”
She looked up briefly and gave Herb a friendly scowl.
“Herb, your heart rate’s up too high and you haven’t even started exercising! You need to tone it down a few notches a little with the new guy.”
“Julie, you’re no fun.” Then he looked at me. “Bob, if you survive the first day, you’re golden.”
I told Mutt and Jeff, clearly the class clowns, to have a great day.
As they walked to their exercise stations, I said, “Don’t hurt yourself ladies, and Herb, your hairs are out of place.”
I met the class clowns. Always the most insecure and therefore the first to fall. I would have to watch them.
Julie, otherwise known as nurse Ratched now took over the remainder of my orientation to the kingdom she ruled with an all – knowing stethoscope: Cardiac Rehabilitation.
I didn’t belong here. Never thought I would be in Cardiac Rehab, hell, I was low risk and strong as an ox. Or so I thought. A little unsettling to watch this motley crew of people, mostly older, but not all, do their warm – up exercises, in unison, watching each other to make sure they were in step and on the right count, kinda like wheezing robots, but the crackles of the arthritic joints made me want to take can of WD40 and inject it into their knees and hips. I desperately looked for a syringe. This must be a mistake right?
“We meet three times per week and you can pick a morning session or afternoon session to fit your schedule, especially if you work. You must complete all six weeks of the program and any absence must be excused by a doctor.”
“I am a doctor, so that means I’m permanently excused right?”
“Funny Dr. Carson. That tactic won’t work with me.” She continued unfazed. “Every session you’ll join the group for mandatory warm –ups, then weights. After that, you choose a cardio machine, either stationary bikes, recumbent bikes, elliptical or treadmills etc. while we watch your heart rate and rhythm for safety. The MA’s will come by your exercise station and ask you to rate your exertion on a scale of 1 to 15, and also whether you are having any chest pain. Understand Dr. Carson?”
I was still stuck on the “excused absence.” I wondered if I needed a hall pass to go the can, but decided not to ask her that. She was no nonsense and I kinda liked that in a draconian kind of way. But I was worried she would ask me to bend over for a shot in the butt cheeks to tranquilize me into Cardiac Rehab lock step.
“Got it Julie.”
“By the way, since you are a physician here in the community and active in the hospital, we need to give you some personal privacy, so what would you like us to call you, Dr. Carson?”
I thought maybe Supreme Allied Commander would work ok. Instead, I told her to call me Bob.
“Ok, Bob it is.”
“Now, education is important for our patients but I know it will be elementary for you, Bob, I mean Dr. Carson. We ask patients to take a pre – test on diet, cardiac anatomy and cholesterol, then ask you to read the materials in the library so you can take the posttest and learn from your mistakes. In your case I want you to take the pre test but we’ll waive the post test.”
That’s a relief. I looked at my watch, office starting in 40 minutes. Is she going to let me start exercising or not? Reminds me of my running races when the race starter lectured us and discussed the cross – country course, disqualification rules, the weather and his grandkids before he gave us the commands to start.
“So Bob, take this little pre – test then go on the machines and get your 20 minute workout in.”
“You mean I can skip the group warm up?”
“You missed it.”
I scanned the first few questions:
1) Is bacon a good food? T/F
2) If you smoke, your risks for heart disease fall to zero if you cut from one pack per day to half pack? T/F
3) Exercising ten minutes 4 times per month is recommended for cardiovascular fitness.
I started laughing so hard after reviewing the rest of the test; I couldn’t complete it in good faith. So I answered the first three: T, T and T then put the test down incomplete and started on the treadmill.
It had been three weeks since my MI, the one that nearly cost me my life, had it not been for the grace of God and the perfection of the medical staff surrounding me and I already had taken it upon myself to gradually increase my exercise capacity, mostly by hiking with a friend and lifting weights. I wanted to advance to swimming laps with interval sprints, but I thought better of it until I received the ok from my cardiologist…, which of course, leads me to Rehab. I had a few post – stent symptoms that are apparently expected, but I remained hyper vigilant, and my confidence with more intense exercise needed a boost. Not only that, I needed to show Rached and her minions as well as Frank and Herb what my capabilities were, and that I was far from being washed up.
I entered the exercise floor and perhaps 20 rehab patients were already exercising on the equipment then suddenly, a therapist who worked with me at the hospital yelled across the gym loudly, “Hey Dr. Carson, What are you doing here? Making rounds?”
Heads turned and stared. So much for my “cloak of secrecy”. It was blown before I even started. But I don’t think Frank and Herb heard.
I smiled at her, walked over and said, “I’m here just to see what my patients go through when I send them here Cathy. That way I can commiserate with them.”
“Oh I see, that’s nice of you Dr. Carson.”
I did a 12 minute walk test for Rached and reached the maximum score on that, passing everyone on the little walk track, most of them were 15 to 20 years older but who cares?
“May I run?” I felt out of place, cramped in a cage, and wanted to let my stride stretch like days of old.
“No running Bob,” said Julie
I did my 20 minutes on the treadmill and then the bike at a heart rate of 130 to 140 then packed up and left for a day at the office. My partners wouldn’t let me do hospital procedures and on call duty yet. Well, actually it was my cardiologist, because my partners wanted me to be on call as soon as physically possible. Turns out I wasn’t on call for a whole month after my MI, but I was back to work part time 2 weeks later, probably because I pushed my cardiologist so hard he just wanted me to shut up.
“Need to keep you on a short leash Carson”, he said. “Most people who are lucky enough to survive what you did, if they do go back to work, it’s after about 6 weeks.”
The next few sessions, my confidence soared and I started to run on the treadmill, full stride, kinda like the old days on the track in high school and college and it felt damn good! I thought I was flying down the hill to the finish line, kicking past the world record holder who was sucking wind, then…
“Bob, your heart rate is 160! Slow down!” Nobody does that here!”
So? I thought. I felt good. “Ok, I just felt so…”
“I don’t care,” said Rached. “Slow it down.”
Session no. 4 out of a prescribed 18 started with a warm up with the others and the silly exercises that didn’t seem to fit me, and the five pound weights going over head didn’t do it for me, so I left the gang and went to a corner and did my runners stretches I learned in high school, followed by sit – ups on an inclined board.
Herb walked by. “Show –off.”
“Your hair’s out of place again Herb,” I grunted
I finally attended an educational lecture, to make it look good I guess, but more out of curiosity. I regretted that decision. It was given not by a nurse or a dietician but my medical assistant. It was a two-part lecture: smoking and salt in your diet.
She started by handing us out sample food labels to read about sodium content, cholesterol and saturated fat. It caused deep within me, the gurgling urge to pull out a bag of Lays potato chips from my pants pocket, but thankfully I didn’t find any. I’m sure they would’ve kicked me out of class and nurse Rached’s kingdom, with a dishonorable discharge
“And I want you to know that smoking is bad for you and also it smells bad.”
I choked on my saliva. Really? I thought.
“There are things produced by the combustion of cigarettes called carcinogens and other toxins that can cause cancer and also accelerate heart disease and lung disease.”
Interesting. Was this educational? What planet did they think we were on?
I had enough, so before I ran for the exits, I raised my hand. “So, I’ll assume that an occasional stogie is ok, right?”
Her glare nearly ripped my lips off, and I walked away smiling. I was conquering this problem, in my own way and that’s how I coped.
Session five came and I knew I could exercise harder in the lap pool then here, but I dutifully came back because I’m sure Rached would tell my cardiologist what a bad patient I was. But my confidence was increasing each time. I asked the physiologist if I could leave the program early without having my right arm cut off.
“I’ll call Dr. Leonard. He has to give permission.”
After 10 minutes on the treadmill at about a 6.5 minute mile pace she came back. “He said if you do 15 mets for 30 minutes without arrhythmias, you have validated the course.”
Ah ha! My chance to skip to the head of the class and then the exits. So, I did 15 mets for 30 minutes and left rehab after 5 sessions. What a great feeling!
I never said goodbye to Herb and Frank, or to Nurse Rached, I mean Julie because I wasn’t there to socialize. I was there to accomplish my goals, increase my confidence with high intensity exercise, and I must say, mission accomplished.
Who knows if anyone in the Cardiac Rehab class understood who I was. It doesn’t matter. Yeah, my knees hurt horribly for about a month after, because you see, my heart was in better shape than my knees and the freedom to fly airborne like days of old was an uncontrollable feeling.
But life is good, and I remain a thankful, and lucky man, bad knees or not.
Thanks to the Cardiac Rehab staff, for putting up with me.
SRC