Back from the edge: a personal memoir of surviving a heart attack.

• Author: Sauter, Jack

I was dying and, in some grim, unaccountable way, I almost welcomed it. The searing pain in my chest was unbearable and I knew I couldn't go on much longer. If my body's clear message weren't enough, the stricken faces staring down at me left little doubt about my condition. It was a little after 1:00 p.m. on March 2, 1992, and I was in the emergency room of Flushing Hospital in New York City.

The day had started uneventfully, an ordinary Monday. Driving to work that cold winter morning, my thoughts were elsewhere. In four days, my wife Marianne and I would be basking in the tropical sun on the cruise shop Royal Princess. We were booked on a 10-day voyage that would take us through the Panama Canal. I was planning a light work week, intending to clear my desk by that Wednesday.

I was halfway through my mail when I experienced the first odd feeling. It was hard to describe. Not a pain, it seemed to be coming from my lungs, rather than my heart. I'd had a heart attack 12 years earlier and I knew what felt like. That was something I never could forget.

This strange, nearly indescribable sensation was hard to place, however. It vaguely reminded me of that dry taste of bile one felt after running for a bus. Whatever it was, it alerted me. Having once been close to the edge, my antenna was primed to pick up anything unusual.

I related all this to Ted, my office manager, and told him I was going to play it safe by driving over to my cardiologist, 10 miles away. Since his office was close to my home, I was half using this as a pretext to take the rest of the day off. Ted quashed my plans, though, saying, "Why drive all the way out there when the city hospital is less than a mile away? I'll run you over in five minutes and I'm sure the most they'll do is give you an EKG and kick you out." I had to agree with his logic and went for my coat. By the time I'd put away my half-opened mail, Ted was out front in his car.

The first few blocks were routine, and the dull ache in my chest remained the same. Then, on the wings of this first wave came a new sensation, not physical, but mental: one of deep anxiety, the terrible chill of impending doom.

Within seconds, the pain came-full-blown, stabbing, and excruciating. It was like nothing I ever had experienced. Playing softball in the Navy, I'd once been hit in the groin by a sharp ground ball, and that had ranked as a 10" on my personal scale. Compared to my present agony, that ball might have been made of confetti. Seeing me doubled up on the front seat, barely able to talk, Ted swung into action.

Stuck behind a bus, he immediately pulled out of traffic. The left lane offered no path, being packed with oncoming cars. Mounting the curb onto the sidewalk, Ted drove around the bus, his flashers and horn going simultaneously. In less than a minute, we were at the hospital's emergency entrance and I started lurching down the corridor. I could see a group of people waiting at the receptionist's desk and thought, "I'll be dead before she knows I'm here." Fortunately for me, she recognized the telltale symptoms and, as if by magic, a door next to me suddenly opened and I fell into the arms of two nurses.

I was unceremoniously pushed down on a bed, and three pairs of hands moved swiftly over every part of my body. My clothes were removed; IVs inserted; and electrodes from an EKG attached to my chest and legs. Its wires ran into a machine that printed out a message on sheet after sheet of zigs and zags. The pattern reminded me of the Stock Market quotations. Was my stock" going up or down? I couldn't read it, but I knew as long as those lines wiggled I had a chance. "Where there's life...."

An X-ray plate was slid beneath my back and a blood-pressure sleeve placed around my arm. All this was accomplished in less than three minutes. I kept thinking, "This is what it's like to die!"

People have asked me if my life flashed before my eyes or if I thought about the hereafter. In truth, looking up at those three worried faces, my mind didn't have room for memories or philosophical thoughts. The archetypal vise-closing pain had taken center stage over everything, and I felt it soon would ring down the curtain.

Working feverishly, the trauma physician took the X-ray and kept referring to the EKG, which by now was printing out a pattern resembling the seismograph of the San Francisco earthquake! He and the nurses were speaking a language decipherable only by those with medical training, but the urgency in their voices revealed a deep concern. By now, the pain was so bad I lifted my torso to achieve a fetal position, but a nurse gently pushed me down and asked me to hang on for a few more minutes.

I remembered my first heart attack 12 years earlier. Then, I'd been given morphine immediately in the emergency room and the pain receded rapidly. I asked for the same drug, and the nurse replied in an almost tremulous voice, "I wish I could, John, but we're hardly getting a blood-pressure reading, and a shot of morphine would finish you right off."

Since the IV was behind my head, I was unaware that the doctor desperately was trying a series of drugs in an effort to dissolve a large clot completely blocking my main coronary artery. I was drenched in sweat. It ran into my eyes and mouth, and I still recall that salty taste. Twice, an attendant replaced my pillow case, and another nurse kept patting my forehead to keep the moisture out of my eyes. I never imagined I could stand such intense pain without either losing consciousness or dying. My mouth was parched and I couldn't produce any saliva. My breathing came in gasps, and each breath only made the pain worse. I literally was living from one heartbeat to the next. Instinctively, I knew this scene couldn't last much longer -- either the pain would stop or I would die. There was no other ending. I just hoped the two weren't tied together.

Aside from the pain, the only thing I remember was a sweet, confident voice repeating over and over, "Just hang on a little bit longer, John; we're doing everything we can. Just a little longer; you're going to make it." Soon, she even convinced me.

Finally, after what seemed to be an eternity, but probably was 15 minutes, a clot-dissolving drug called TPA worked the needed miracle, and the pain was reduced to something I could bear and I started to breathe normally. At this point, my blood pressure apparently improved enough for me to be given some pain-killers, because I remember falling in and out of consciousness.

During one of these half-awake intervals, I became nauseated from the medication and vomited my breakfast. I was embarrassed. but another nurse just smiled and told me to forget it; it was par for the course. She changed my top sheet and cleaned out my mouth with a sweet-tasting solution. Now, I had a faint sense that I just might make it, and I said a silent prayer to God for getting me this far. I don't know if it was the sedative or my usual optimism, but I felt an inner peace. My destiny was now in other hands.

A little later, Ted and my wife came into the ER to see me. Marianne gave me a look that summed up all the tenderness and devotion of a loving wife, and I regretted having to put her through this ordeal a second time. Subsequently, she confided that Dr. Lee. who had saved my life, said the only good thing was that I had gotten into the emergency room as quickly as I did. One or two minutes more, and I could have been D.O.A. (dead on arrival).

Around 4:00 p.m., I was moved upstairs to the Intensive Care Unit. After that.. the medication kept putting me out for longer and longer periods. When I finally awakened, it was at the urging of a woman whom I first took to be a nurse. I was totally drained and all I wanted to do was sleep, but this white-coated woman with the clipboard wouldn't let me rest. She insisted I answer an interminable number of questions, few of which had anything to do with my condition. All the pertinent medical queries concerning allergies and prescribed medications already had been answered during those first few frantic moments while they were hooking me up, two floors below. This officious woman acted as if any lack of information concerning my occupation and my insurance would have ground the hospital functions to a halt! If I were stronger, I think I would have thrown something at her.

When next I opened my eyes, a young nurse was changing my medication and monitoring all the electronic equipment to which I was connected. She seemed to be with me for a very long period, but I still had no sense of time. They had removed my watch when I arrived, and I was out of the picture for longer and longer periods. It could have been the next day for all I knew. Once, I recall, Marianne reappeared and mumbled something about moving me to St. Francis Heart Center (where my cardiologist was), about 10 miles away. I assumed it was the next day, since I remembered that they never moved CCU (cardiac care unit) patients during the first 24 hours, and rarely within less than two or three days because of the risk. (As I later discovered, there was enough intrigue being enacted a few feet away from my...