A Non-Medical View Of The Heart: Angiography & Angioplasty
2023 closed with a family member needing an unexpected heart procedure. My family & I found ourselves in the chaotic world of emergency healthcare. In a short span, we had to make sense of information from unknown sources as we grappled with difficult decisions. I’m only starting to make sense of it – overnight trust in strangers, blind assumptions, conflicting information and many, many emotions.
A Change Of Heart
Heart care has not been on our worry list. This goes to what we know to look for – diet, exercise and blood pressure. We follow a healthy diet – less oil, minimal spice, few processed foods, plenty of vegetables & fruits, and no meat. This person is a singer. Western medicine doesn’t account for the impact of singing on health but this person has the best oxygen levels in our family.
Yet, they woke up one morning needing emergency care. Four days would pass through a heart procedure and time in ICU. The shock has been as stressful as other factors. The doctors say we were lucky to catch it early and ‘before an event’ (their words).
We’re speaking to others in our circle and it seems like stents are more frequent than we realised. Everyone says things get better; one person even congratulated us. But I want to pause for a minute to register how tenuous our sense of being okay is. 2023 was a year of healing and this incident brings home how bloody that can get.
Demystifying the ‘Angio’ thing
As Indians, we carry both blind faith and innate mistrust of what we believe in. So we put doctors up on pedestals and also beat them. We take very little personal responsibility for our finances, diet, health and emotional regulation. We either pay people to do this for us or we lean on gender, familial roles and class privileges to cover this for us. It is a capitalist, feudal, patriarchal and so exploitative world. And too many of us go through life, not attempting to rise above this conditioning.
I knew the prefix ‘angio’ referred to the heart in the same way the prefix ‘onco’ has to do with cancer. I didn’t think about it beyond that. We blindly fear the word ‘operation’. Everything to do with the heart is scary. Culturally, we’re not even used to communicating from the heart. Here is what I have understood from this experience:
Angiography (angio: heart; graphy: recording) is a procedure to look at what is going on with the heart. Bone specialists do this with X-ray. For the heart, a special dye is injected to trace the journey through the arteries & veins. Blood must flow in a certain way through the body with the heart as its control center. This procedure assesses blockages in this flow. In a sense, this is a lot like a plumber’s job.
Angioplasty (angio: heart; plasty: shaping) describes procedures that help to clear blockages in the heart. This is where it stops being like regular plumbing because this is inside the human body. Clearing a blockage isn’t just about scraping it off or poking a hole through a choke-up. Of the things that cause heart blockages, no residue must enter the bloodstream. It’s not a bathroom pipe where the unwanted can be allowed to flow out as dirty water.
There are different kinds of blockages, which need different devices and techniques. And finally, it appears that the doctors can’t entirely tell what they’ll be facing until they start the procedure. Each device and technique comes with major costs. This is why it is so tricky.
Mechanics, Healers & Saviours
Time has brought us the realisation that this procedure was performed by highly skilled hands, the precision of their work bringing acclaim from others who knew how to assess. But that time, after the procedure, was a gruelling period because we, the non-medical public did not understand. We were not given any information, let alone reassurance. Questions were discouraged, even punished, which made it harder for us to trust. This ordeal made me reflect on who we place our faith in and how they treat us.
Western medicine defines a doctor’s professionalism by how objectively they treat their domain. How far should a doctor go in withholding emotion, to do a good job? When a doctor sees a patient as a diseased body, it is similar to a mechanic assessing a faulty vehicle. It’s dehumanising. This is probably why most doctors will not enjoy being equated with mechanics.
But we see doctors as healers, not mechanics. And how can you expect to be healed by someone who doesn’t respect you?
Health ailments bring our meanest, most fear-driven impulses to the fore. As my family gets older, I feel more and more helpless. The health issues stack up. I’m running on a treadmill that keeps getting faster as my burdens get heavier.
Every month erodes another layer of my ego. And as I look back, I marvel at how deep my saviour complex runs. There is a kind of arrogance in assuming that we can ever protect or rescue another person from pain. It stems from love only in that all human emotions stem from a need to connect. But unexamined, it becomes a weakening of the spirit. A bitter refusal to accept the truth that we are powerless.
Is that what doctors face? Maybe they need to be cold to their patients to survive the emotional toil of their work. In turn, the news is full of stories of patients’ relatives threatening and violating doctors. On a noticeboard, I found a statement of solidarity with medical professionals who had faced violence in the line of their work. That’s a statement I’ve only ever heard describe firefighters and the military.
The pandemic made all medical people into warriors, humanity’s last defence against the deadly virus. The PTSD of that war remains. Both patient and doctor are navigating a journey that they must make collaboratively but do so expecting betrayal. Every aspect of health is personal. The heart feels most so.
I’m reminded of a poster in the waiting room of our family doctor with the words,
“I treat but HE heals”
I have many problems with organised religion. But this – humbleness and the surrender to a world bigger than one’s ego – is the part that completes something as enormous as healthcare.
The Class System of Waiting Rooms
The months have flown by. But each minute ticked on longer than eternity. The most painful time for me was not during the procedure itself but the dreaded ICU waiting room. The people in there looked distinctly different from the ones in the other sitting areas of the hospital. All humans look tense and brittle in healthcare spaces (including staff). But the clothes and appearance of the ones in the ICU waiting rooms looked distinctly poorer. It is a glaring statement about how expensive healthcare is. And the untold reasons Indians shiver at the word ‘ICU’.
Years ago, I worked on a healthcare app for underserved communities. It made me think about how economics affects our sense of being okay. I’m used to rushing to get medical advice the minute I start sniffling. I have a stock of pills and syrups for inconveniences ranging from stomach trouble to respiratory issues. But our building security guard, for instance, would not think to spend on a doctor for ‘a mere headache’ or ‘slight fever’.
There is a notion that over-diagnosing makes for weaker immunity. However, health isn’t always a finite trajectory of infection. The scariest of ailments come with underlying implications of catching it early enough. This means a lot of people who cannot afford what I can, only see the doctor as a last resort – when what ails them (or their loved ones) is at the worst, most hopeless point. How horrible then, that this is the stage that’s most financially and emotionally draining.
An air of defeated despair hangs over ICU waiting rooms. Even the air conditioning doesn’t seem to work as well. The electricity is on 24/7 and for environmental conservation, the power is motion-activated. This means the large room looks dark & desolate unless there’s a stir somewhere as someone turns restlessly. The others don’t even move. They’ve been there longer and the energy to be restless just seems drained out of them.
Occasionally when the attendant comes to call for somebody, other eyes look up. They don’t all carry hope. Many are dreading being called. Perhaps they are not expecting to hear anything good; only an ending or worse. What is worse than that? A prolonged suffering. ICUs are where you watch the last thread of human spirit fray itself after it has drained of all colour; nerves becoming coir and then just dust. The heart can handle dramatic pain but the poison needles of watching a life drip away into indignities and meaninglessness – that’s beyond most of us.
Can you hope for a reprieve from discomfort when all around you, people have lost the will to pray for life?
Language Classes
I sometimes joke that in any hospital in the world, if you yell, “I am hurt!”, a nurse will call out, “Yevadai?” Malayalam after all, is the language of healthcare. Thanks to the tireless efforts of thousands of young women from the coastal state who study nursing and go out to care for people and support themselves.
Amidst the chaos, I found a nurturing comfort in the smiles and faces of nurses. They were tireless and ever-smiling, lean arms lifting sick people, wiping fevered brows, soothing as they shot injections and mounted drips. I asked, “Malayalam-aa?”. If I had thought that smile couldn’t get sunnier, I was wrong. Each time, I asked, I was rewarded with joyful reactions ranging from shy smiles to more exuberant questions about whether I was from Cochin or Kottayam. Only slightly apologetic, I’d explain that I was from Mumbai. “But,” I’d add, “I’m Tamilian.” As Nirmal Pillai and his friends would say,
So many of the nurses were very young and fresh from Kerala, even the familiar twang of their neighbour state must have been comfort in their homesickness. On their breaks, I’d ask where they grew up, and where they studied – in Tamil. And they’d share little scraps of their lives in happy Malayalam. What a delightful confluence of hearts happens when two people speak different languages and still communicate with each other!
During a particularly busy time, two of them were huddled over a gigantic register, one explaining complicated records to another in Malayalam. Their senior passed by and snapped, “Speak in Hindi!”. It surprised me because the senior’s name tag showed her to be Malayalee as well. Perhaps her intentions were more benevolent than her tone suggested. Maybe she had been harangued too many times by patients with demands to clean bedpans in their language only. Human beings are uncomfortable with being tended to like we are babies. But in colonial-hungover India, we prefer to believe that we’re being served and waited on. Language is currency with its own complex power hierarchy.
I discovered that almost all the housekeeping staff were Marathi-speakers. The security personnel, ranging from the guards at the gate to the ones posted outside operation theatres and at the entrance to waiting areas, were all Hindi speakers: UPites or Biharis. In stark contrast, the doctors and clerical staff came from diverse linguistic backgrounds. A quick look at all their name tags and nameplates on doors would show. But everyone whose name didn’t appear spelt out anywhere seemed to come from a linguistic background homogenous with everyone else in that role. It was an odd observation in a country where your name slots you into a box of class and community.
But it was as if the roles echoed the stereotypes where the names (upper-class only and signalling diversity) couldn’t. The aggressive security staff who made me wait for an hour in the sun, then wouldn’t let me enter; the snarling guard outside the OT who was the only one to not stand when the almighty doctors walked past – were all the male aggression of UP & Bihar. The indifferent robotic sweepers and lift operators – Maharashtra muttered present. The shining efficiency at billing counters smiled like Gujarat. The canteen smelled and sounded like Karnataka (Nāvu Uḍupiyavaru sar!). I’ve mentioned the dulcet Malayalam tones of nursing but it also had the sweet voices of Meghalaya.
This person watching all the dramas of life and death from outside the glass window, in the heat? I don’t know. I couldn’t help it.
Healing Hearts
What a role it must be, to be a pleasant-faced caregiver to the sick and hateful who also discriminate against you for things that have nothing to do with health! From nurses and lab technicians to ward boys, housekeeping staff, cleaners, and hospital cooks, these unsung heroes embody the true spirit of healthcare—making it about healing rather than merely treating ailments.
Healthcare also takes us all – patients, caregivers, medical staff and others – back to the fundamental essence of this thing we’re all doing together. In the same place, daily, babies are born, organs are removed, wounds are treated and goodbyes are said. It is a bloody business, after all. You can’t leave a hospital without it touching your heart.
* Read my other posts on health.
- These are some resources that I use to keep informed about healthcare:
- Mayo Clinic
- Heart.org
- 1mg
Thanks for sharing so candidly, Ramya.
My family also saw a fair bit of health drama in the last couple of years, and while things are alright presently, I have now become very sensitive to the slightest health-related disturbance… even if the individual affected isn’t me, AND even if that particular individual is totally comfortable/relaxed with the situation. I know there isn’t a real solution to this, and perhaps, it isn’t even anything to solve but more a over-sensitive dynamic (within me) that I need to get comfortable with without attempting to change or judge, etc.
Was chatting with a beloved friend who was worried about her spouse’s erratic health habits, and I had to remind her, “He may be in pain but you are the one suffering.” That reminder was a note to my own self as well.
Wishing your family and you the best!