“You are one lucky fellow to be alive!”

Bob Johnstone
February 04, 2021
Rev. Mary and Bob Johnstone
Rev. Mary and Bob Johnstone

Just last February, between Hilton Head and Charleston, coming back from a wonderful mid-winter month living aboard in Florida, we were cruising our MJM Yachts 43z BREEZE on a windless, calm open stretch of the Intracoastal Waterway just east of Coosaw Island.

Here was a chance for some fun. Push the throttles down on her triple Mercury Verado 400 HP racing engines. Let’s see if BREEZE can hit her WOT (wide open throttle) speed of 50+ mph. Didn’t quite get there. There was a problem. The port engine only got up to 4,300 rpm, 1,000 rpm less than either center or starboard engine.

People are like boats: There’s always something! The heart is the engine, blood is the fuel.

Six months later, on a sweltering 95-degree August Sunday on Folly Beach, Mary and I had just finished our picnic under the shade of a beach umbrella. Time for a stroll up the beach. After 100 yards, I  sensed some pressure under my jaw. Mmmm…that again. 

A similar tightening occurred seven months earlier, in late January on the Naples Yacht Club dock. Went to a walk-in clinic for an EKG... normal. Must have been acid reflux or something. Had a similar episode at age 68 in 2002, when previously residing in Charleston. My primary physician at the time prescribed a transfemoral CT angiography scan... normal. So, this latest episode was probably another false alarm. Maybe it will go away. Rationalizations, rationalizations!

On that Folly Beach walk, I had to rest a moment, then continue on. Not normal! Time to take action…again!  Called our primary MUSC/MDVIP affiliated physician, Dr. Sarah Stapleton, who advised, “Come on in, let’s do an EKG.”  Did so on Aug. 14. Same story: “Normal!”  

“OK, Doc, something’s not right, related to exertion, just like my boat. I can’t get up to full rpm. The engine seems starved for fuel. What’s the next level of investigation?”

Her answer was, “A stress test down at MUSC Ashley River Tower. I’ll get it scheduled.” At 10 a.m., Monday, Aug. 24, I was slid into the MRI-like nuclear imaging tunnel with dye injected into the bloodstream for the first round of images, then onto an inclined treadmill, hooked up to EKG, pulse and oxygen monitors to raise heart rate up to 120 over five minutes. Then back to the CT scan tunnel.

Upon seeing the resulting images, Dr. Stapleton called. “Bob, your heart’s the right size, seems strong and healthy, taking in lots of oxygen. But there’s an indication of some blockage in one of the arteries. It doesn’t appear major. Best a cardiologist review the images and take it from here.” 

On Thursday, three days later, MUSC’s Dr. Anbukarasi “Arasi” Maran got the nod. She was gracious enough to suggest a FaceTime session rather than my having to drive nearly an hour to her office. 

Dr. Maran’s read of the images was, rather than trying to treat the matter with drugs and not fully knowing what the extent of the issue might be, it would be best to undergo a relatively new procedure called transradial cardiac catherization (CT angiography scan). A long thin tube is inserted through the radial artery in the wrist and fed into the heart. Or, if necessary, the transfemoral version through the groin. Dye is injected through a catheter tube into heart, which is lit up to create a movie revealing how valves and arteries are all functioning and the extent of any blockage. 

Leading up to the procedure, Dr. Maran, being the great teacher she must be, was most helpful and patient in answering all my questions and those of my grandson, Hunter Johnstone, an employee of Athena Health Care who had previously focused on such procedures. 

Dr. Maran further explained the process. “If it’s just the one artery with minor blockage, while you are still out on the operating table, we’ll insert a stent, or maybe two if not major. You stay overnight and are out the next day. If we discover worse, I will meet with the MUSC cardiac surgeon team to decide on the next step.” 

The CT angiography scan was set up right after the weekend, on Monday, Aug. 31, in Ashley River Tower. I went under at 4 p.m., regaining consciousness in the SW corner room of the fourth-floor ICU, hooked up with numerous tubes and sensors.

A doctor from my cardiac surgery team looked in to say, “You are one lucky fellow to be alive! You won’t be going home tonight. There’s a balloon in your main ‘widow maker’ artery. It was 99% blocked. The left artery also had significant blockage. You will be going into the operating room ASAP for double bypass surgery. Meanwhile, we are going to keep you under 24-hour observation and care here in the ICU.”

WHOA!  Offsetting that shock was the corner room’s nice view of sailboat masts in the Ashley River Marina; a cheery sense of light in the ICU suite; and the smiling care of a wonderful group of nurses, making me feel right at home, addressing me as “Hon,” “Dear,” “Sweetie,” or “Love” rather than “Mr. Johnstone.”  

At this hyper-sensitive moment, my fears were allayed and my confidence in MUSC couldn’t. have been higher. The operating surgeon would be Dr. Lucas Witer, a highly regarded cardiothoracic surgeon recruited by MUSC 30 days earlier from New York’s Columbia Presbyterian Hospital, who reassured me I’d live longer with his bypass solution than with stents. I’d heard MUSC had one of the leading cardiac surgery teams in the country with a 96% survival rate (vs. 90% national) and with Emory University Hospital in Atlanta was one of the top two in the Southeast.  MUSC was currently operating at a rate of 50 heart transplants and 200 bypasses per year. Was nice to know I’d benefit from all that practice on others at Columbia Presbyterian and MUSC. Then there was the comforting presence of another pair of expert eyes on my fate: I’d built, then helped one of MUSC’s senior cardiac surgeons, Dr. John Kratz, acquire his MJM Yachts 34z, GRUMPY.

I went into surgery on Thursday and didn’t wake up until Friday on a vent, oxygen, intravenous drip, etc.  It went well. My stay was two weeks in two different rooms on the fourth floor of MUSC’s Ashley River Tower. At the end there was a weekend delay for antibiotic treatment of a urinary tract infection and high white blood count, due to concern about a contaminated blood sample. A careful team!

Post-op care was excellent by Dr. Witer, nurse Carrie Wahl, in-home care nurse Rachel Forbes-Harvin, and PT care nurse Marianne Cromwell. Due to a four-week pandemic back-up for cardiac rehab openings at MUSC, as well as my reluctance to travel thrice weekly to a higher risk COVID exercise environment when Bishop Gadsden Episcopal Retirement Community (BG) had all the equipment on campus and portable heart monitoring devices were now available, MUSC’s Director of Cardiac Rehabilitation Mark Clair thoughtfully helped coordinate a modified rehab (aka physical therapy) program here at BG with PHC Home Health Care’s  English Suggs and BG’s Dr. Bill Wilson.

Tragically, a week after I’d left the hospital, a young sailor and friend, died suddenly from heart failure under eerily similar circumstances: to mine: a family history of heart disease; several instances of tightening in his upper chest/neck, thought maybe indigestion; normal EKG when checked; and a normal follow-up stress test. Ten days later, he was gone from heart failure, reportedly, with a 100% blockage of the main artery. How was this possible?

I went online to get the answer.  Studies have shown that  of those with coronary disease, a stress test can be normal right up until sudden death or a heart attack strikes. A nuclear stress test, such as administered to me by MUSC, is reported to be the most accurate with sensitivity of about 81%. That means it will miss 19% of high-grade blockages. Even then, as in the case of simple treadmill and echo tests, it is likely to miss almost all blockages that narrow an artery to less than about 65%.

Thank goodness, and God, for (1) the superb quality of MUSC affiliated medical support here in Charleston; (2) living 10 minutes away from MUSC over the James Island connector; (3) Ashley River Tower’s handy $10 entry door valet service so Mary could visit me for a couple of hours each day and not have to spend two weeks sleeping in my hospital room;  and (4) the expertise of the MUSC cardiac team in recognizing what could have been glossed over as a minor issue, or missed.