A Cardiac Adventure

I’m Jim Comeau, aka jimcooncat and similar names on the internet for a long time. The events shown date from Thursday, March 8, 2018 to Friday, March 16. I’m a Gulf War and NATO vet, at one time I was highly disciplined and in excellent shape for a smaller guy. I’ve had so many varied life experiences that few people really relate to me, and I really haven’t cared. Now I’m 56 years old, in a slow process of shifting careers, and have moved beyond the pain and fear of a heart attack I had seven years ago. This is a medical story, but I don’t think you’ll find it boring; it exposes my flaws, which I hate, but important for your understanding; it shows my strength, of which I’m not proud, yet I hope it inspires you.


I sat in my small office in Maine’s capital city, finally relaxed from a busy morning of stacking firewood and a long commute, and feel a dull ache under my armpit. I probably wrenched it a bit hurrying this morning. It’s still there when I get home, so I mention it to my wife. The next morning, a Friday that I don’t have to travel to work, my stomach doesn’t feel well. I take our new snowblower out for a spin, making a nice swath through the five inches of fluff that got deposited overnight. Though I’m just getting used to this machine, it doesn’t seem that I should be winded from just that bit of effort. We call the doctor’s office — closed because of the storm — and call his home number he had left on the machine. “Go in and get checked out.”

We live on one of the busiest highways in town, a US route that is well maintained by both the town and state road crews. Yet strangely, the road hadn’t been plowed this morning, giving my wife a real challenge driving the short two mile trip to the hospital. We make it in our little car with her skill and goading from me not to slow down before climbing a small hill. Blood work and some preliminary tests, they wish to have me take some medication. I call the doctor’s house with my cell as I’m wary of any new drugs that these people-I-don’t-know want to spring on me. The ER physician’s assistant can’t understand why I would question, almost seems personally affronted. I ask if he could contact the VA to see if this visit would be covered, and that bought a few minutes. My good doctor doesn’t answer but soon I get a message from him through the nurse, “You just do what they tell you.”

The tests progress through any external ones they can find for me to do. The blood work came back and luckily I haven’t had a heart attack. I get on the treadmill for a stress test, but I get winded before I reach my target heart rate. I knew I haven’t kept up with aerobic workouts, but I was surprised that I didn’t do much better on this test. Now the talk shifted, and the doctor suggested that I go through a heart catheterization in Lewiston, and was amenable to our suggestion of Bangor instead. Soon, there is a change of plans. The VA wants to do the procedure in East Roxbury, Mass., and I leave in one hour by ambulance. With no time to have my wife go home to gather any of my small comforts, we kiss and I get strapped to the gurney.

The driver gives me a choice as to which way to get out of town. I was quite surprised and happy that he would take the flatter river route than the shorter hilly one. They put some classic rock on the stereo and except for the occasional bump the ride didn’t seem too bad. After a while I grew a bit tired of entertaining myself with phone texting and trying to read the book I’d brought while it jostled in my hand. I tried to relax and guess where we might be on the map by the curves and bumps in the road, time elapsed, and lights coming through the back window. Once in a while the EMT would come back to check on me, and I’d be far off in my estimation. It didn’t matter, it was occupying my mind, and I became aware that I was slipping back into an old feeling of confident mental self-reliance that had proved so important in surviving my military and earlier life.

It’s getting to be a very long ride back here when I feel us going up an incline. Hey, I DO know where we are now, and lift my butt off the gurney a bit as we bounce over the Kittery bridge like a stagecoach on a Corduroy road. A good while later we arrive and I get checked into hospital, saying goodbye to my new great EMT friends that delivered me safely. It’s late Friday night and my procedure isn’t going to happen until Monday, so I’m set in my mind for a long boring weekend. I lie down in the bed and find out it has a mind of it’s own. It deflates under my upper back until it’s lower than the rest of my torso, then pumps back up halfway. Then it deflates under my butt, then pumps back up. It makes several more small adjustments then the air pump stops making noise. That’s strange.

I get a private room all weekend. I busy myself with every activity I can think off, and make good progress in reading my book, “Growing a Business” by Paul Hawken. This must be the fifth time I’ve read it and it gives fresh inspiration every time. “No, the WiFi connection is just for hospital staff, not patients.” I try make a few arrangements to tie up loose ends in my work life over a 1G connection and the too-small Android keyboard. A couple of my well-meaning friends message me that I should be resting and not thinking about work, but the alternative was to worry about my situation. Not an option. Late at night people wander in and out of my room for no apparent reason. I’m used to locked doors and warning, so I keep an eye open. A janitor enters to grab my trash. The main trash, the bathroom trash, and he starts to creep up the side of my bed to get the wastebasket I’d moved it there for tissues. He’s too close, too sneaky, I’m too vulnerable. I raise my hand up and command him to halt, point to the door and order him to leave. A look of horror goes over his face, and he avoids me for the rest of my stay.

I meet the cardiologist team, three quirky guys I nickname to myself, ‘Larry, Darryl, and Darryl‘. It amazes me how they work together, all three approach me at the same time with their expensive stethoscopes out. Like a choreographed dance, they each pick one quadrant of my torso to listen to, then move to another in rhythm with each other. Happy with what they don’t find they move to my back while I take deep breaths, and then all nod their head in agreement that my lungs are good and clear.

The time comes to be wheeled to surgery, where if find myself not in a traditional white operating room, but a huge industrial bay with big robotic cameras, very high ceilings and a strange slab for a bed that has one armrest. The idea is for them to put a catheter in my arm to look at my heart, and I make sure to ask them that if they find anything they would be able to fix it right then. They assured me that they would be ready to make whatever corrections are needed at the time, such as installing a stent. They do some busy work with IV’s and such and finally the large camera moves down to block my view. I really didn’t want to watch the procedure anyway, so I close my eyes.

I’m still on the greater side of consciousness though most of this procedure and listen to their progress. They are able to view an 85% blockage through the catheter, but aren’t able to place the stint that way. They retract it and puncture the top of my leg and put a larger diameter one in that way. Remarkably, I had no discomfort, unlike when I’d had this procedure seven years earlier.

Sounds like they’re doing all right, it’s getting to be a strain to hear what they’re saying and trying to put it in a context I can relate to. Guess what, you’re not in control of the situation right now anyway, buddy. And they’re supposed to tell you about what happens later. So you might as well think about a song while they do their stuff …. “in the year 2525” … Oh no, that’s the LAST song you need to be thinking about right now! Maybe something by Creedence

BAMPH!

Bam Bam Bam big fist on my chest, sounds of people scurrying and barking orders … someone’s on top of me pushing me down bam bam bam… can’t see … lights flashing every time bam this guy must be big I can smell his sweat bam bam bam OK I think he’s stopped … oh I’m tired … what was I thinking about?

“You had us worried in there.” Look Mister, I didn’t do a DAMN thing to cause that. I look at the burn mark on my chest left from the paddles. Not bad, oh well, looks like French Toast. Really, you’re not supposed to find that funny, Mr. Comeau. I can’t help but smirk as they wheel me down the hall. They tell me they were able to install the stent then moved to the other side of the heart to view that, but when they were getting ready to retract the probe touched the muscular wall — and the heart stopped beating. I appreciate their honesty, but I’m less than impressed.

They wheel me to the cardiac care nurse. He looks just like Lennie Briscoe. Happy in his work, joking, we develop a rapport once I come around enough to talk sensibly. He plays with the leads and IV’s and defib pads that are stuck all over me and in me. A notice that one of my meds is being discontinued, and you could see a light of inspiration come over his face. He starts punching away at his computer and rattles off a tirade of jargon to himself, oblivious for a moment to his surroundings. “There!” He comes over and disconnects all my IV drips and rearranges them all to feed only one arm instead of two. “Now you can use your left hand!” Wow, man, thank you.

The echocardiogram man came to check me out. I had a difficult time with this normally mundane procedure, as he had to press the microphone deeply into my bruised chest. But he was able to get a good set of pictures, and later let me know that my heart function was fine.

So ‘Lenny’ is nervous about tonight’s storm. He’d had a bad accident during another recent storm and is not happy about his position of being forced to travel into work tomorrow. So he makes a huge deal out of it, joking with all the staff on the floor, eventually getting roars of laughter in response. He asks me what kind of pizza I like and orders enough delivery for the whole floor. I’m really impressed by this nut, I’ve already had supper but could still eat a horse. In very little time Alfredo and spinach and garlic tops a nice chewy crust, tastes like heaven.

Shift changes, the storm is just beginning to start. CRACK! We have Thunder Snow! For the next hour the lights blip on and off as it keeps switching from the grid to generator and back again. Every time the lights change over the staff goes, “OH!”. Really, does that jump you? I go back to sleep.

No one’s surprised the next morning when ‘Lenny’ doesn’t show up for his next shift. He calls in, living right on the coast line he had gone outside, and got met with a 60 mph blizzard. The whole place was short staffed and unhappy to double-shift, though all surgery had been postponed. I have them close the window shade. All I could see was the roof of the next building and the window building up with snow. It wasn’t doing anything positive for my outlook.

Later someone comes up from downstairs and says they have a bed available. They wheel me down and I climb into bed. The bed goes through it’s gyrations, but the motor doesn’t shut off, it continues to hum. I try staying still for about 20 minutes. I give up for the moment and rest in the recliner, and text my wife that the curtain halfway in the room is closed, and though I said “hi” to my coughing roommate I had got no reply. “He’s the Wizard,” she writes back.

Three more attempts to get the bed to work, and I report the malfunction to the nurse. Apparently these beds have been a sore spot for the staff, and she’s beside herself on how to handle the situation. I wrap myself in a blanket on the recliner and spend a couple hours napping. I start feeling a little cheated, that bed upstairs was really just fine, and if anyone needed some good rest — well, I felt entitled. Not really my style, but I’m trying to accomplish my mission to survive this trip with some self-respect intact.

Two young nurses finally show up with a replacement bed, expecting some extreme gratitude as they had been put out so very much by having to wheel it across the hospital. Yeah, thanks, I really need some sleep. Over the course of the next day, Mr. Wizard entertains me by exhibiting some strange behavior. Never acknowledging my presence, he goes from incomprehensible muttering and grunts when the staff addresses him, to eloquent paternal advice when his son calls on the phone, as well as a few other character manifestations. He does not sleep the next night, as he is full of mucus, and the cough syrup they’re giving isn’t helping. I mention to the nurse that he could use some lemon to cut through the phlegm, but he’s powerless to even make a suggestion. I just feel bad for Mr. Wizard, and I’m still exhausted.

So the doctors (Larry, Darryl, and a replacement, so Moe I guess) would be willing to have me on the way. Though the storm’s over in Massachusetts, it’s still a raging blizzard in Maine. No shuttle service so I will have to stay another night. I have a logistics problem in using the shuttle anyway, according to the schedule it will arrive late at Togus VA so my wife would have to travel in the dark. I’ve been commuting the road all winter, and have come close to driving off the road several evenings from misjudging the pot holes and frost heaves with the small car.

If I could just get to South Station by 1 pm tomorrow, I’d be able to get on a bus and arrive in Maine at a great place for my wife to pick my up by 4:30. I made a plan of action and told them I wouldn’t need the shuttle. All I would need to do is to jump in a cab for a one-mile trip to the Metro station, and ride a train into the city. It was going to cost me about $40 total, give me a shorter, comfortable ride, and I was going to be free of this place. What a smart move! Or was it…

Waiting this morning, IV tap is out of my arm, and once more I’m stripped of all the monitoring pads. I think I’m ready to go when I’m told to wait for the doctors. So I wait, it drags on another hour. Then they show up, all of Larry and his brothers and a couple of sister cardiologists. They pat me on the back and tell me not to come back soon. I check the time, and I don’t have much to spare. Out the door I go — the wrong door. There are no cabs around, and I can’t believe it. I check back with the front desk to be sure. I walk down the street for a few blocks and the street names don’t match up with the map on my phone. I stop in a gas station and ask, they have no idea where this train station is, and don’t even know the neighborhood they work in so I can get back over to the street. I go back to the hospital. By this time, I’m ready to hit the bathroom. I go back to the front desk and ask for the Spring street exit, and am taken completely through the complex to the other side. I look at the time and it’s not looking good. Oh, well, if I miss the train I just walk back, right?

One mile to the station and I take off in a brisk walk. I keep walking but ask people as I go by if the station is up ahead. I’m sensing that I’m going up a little incline, and that’s not helping much. This one mile is much farther than one mile used to be. I get up to the station which is nothing more than a full parking lot, overhang, and a bench. I sit on the bench to take stock of the situation, and see an LED clock. I’m five minutes late. I look around and there isn’t a soul in sight. I feel tired, but exposed and vulnerable. I get up an make my way back down to the main road, girding myself with the last of my determination. A little farther I get to a bus stop, and exhaustion overtakes me. After sitting on the bench for a bit with no relief (and the cold breeze is biting a bit), I ask an old man who to call for a cab. He tells me and the voice on the other end says, “we can’t come.” I google another cab company that answers, and they say, “we can’t get over there.” I’m more than discouraged, I’m desperate, and call 911. They pick me up, give me oxygen, and take me back to the hospital where I go through another battery of tests. I get my wind back in about an hour, and some of the cardiologists visit me to deliver a well deserved dressing-down. I’ve suffered no real injury, but am back in the shackles of an IV needle in my arm and monitor leads sprouting from my body once again.

I call my wife to tell her the bad news that I’m not on my way. I make plans to leave the next day on the official shuttle, with an option to stay overnight at Togus if I can’t get a ride. I get a nice roommate with drastic medical problems who falls asleep on his blaring TV remote, so I’m not resting well for another night. We take off in a small 9-seater van the next morning, and stop at the other VA medical facility to take on more riders. This van has no accessibility features, and a 300+ pound man shuffles up, weak from whatever’s ailing him. With a push and shove and teeter and recovery, he collapses into the back seat. One of the scariest part of this whole journey, the rest of the passengers are angry like I am at the situation. We ask the driver if this was the regular van and he said yes, he wishes that one or more of us would complain about not having a ramp, lift, or something more than a stepstool. We assured him we would.

I’m not a good traveler anymore, though I used to be. My depth perception has always been skewed from the Coke-bottle glasses I wear, and sometimes a particular view will make me nervous as I imagine myself dangling from the top of a structure up ahead. So I asked to move to a rear seat and kept my head down, texting and playing with my phone as the driver navigated our way through outer Boston. Sensing a lull in the traffic and a straight road, I look out at the coastline with some joy. I know the city is coming soon, so it’s back down to my position before too long. Some days I like to push through my silly projective fears. Today I don’t feel obligated to in the least.

Diagonal flashes of light played at the corner of my eye. I think I might know where I am even though I don’t think I’ve ever been here before. From the front, “Did you know the same firm that built that Florida bridge built this one?” I’m going to keep my head down for a while more. Lights go dark, the traffic noise changes. I sit up and am amused as we course our way through a tunnel. Wow, this is a long one! Feels good to sit upright, and chat some more with the other passengers. The dot of daylight up ahead forms into a rectangle and slowly gets larger. We must have passed through here when we came down in the ambulance. No wonder why things happened the way they did. Our van must be emerging from Bizzaro World.

We have a blissfully uneventful trip back to Togus. With a bummed ride across town from one of the vet passengers, I hang out at a donut shop while my wife navigates the bumpy road down to pick me up with plenty of daylight to make our way home safely. A joyous reunion, an uneventful ride home. A light supper and we’re all ready for bed on time.

We lie there and she says comfortingly, “Things are going to get back to normal.” I reply, “No, things are going to get better.” And finally, in a locked home outside of town on the main drag, I let the tight hold on my thoughts go.

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Skirting the addition

Skirting the addition is not the same as skirting the issue. I’m using pre-painted roofing, cutting it with a Dual Saw and burying it 5 to 7 inches deep in the ground.

Some things that’s helped me do this project:
2×4 strongtie metal ledge hangers, 1 per three feet
Pressure treated 2×4 “stud”, mounted widthwise, 2 ” above ground level
Roofing screws with rubber washers, 1 1/2″ and 2″
Screened loam, John Deere tractor
sharp square loam spade, rake
8p short galvanized nails, palm nailer, compressor, hose

skirting

Installing Skirting

lots of clamps, sawhorse, extra 2×4’s to clamp to
tape, level, tri-square, sheet-stock square, pencil, marker
hammer, punch, drill, 1/4 ” hex driver bit

Learn Technology with Monit

Over the past few days I’ve been playing with software called Monit.

Monit is a utility for managing and monitoring, processes, files, directories and filesystems on a UNIX system. Monit conducts automatic maintenance and repair and can execute meaningful causal actions in error situations.

Translated to a simpler phrasing, Monit sits in the background and runs tests that you tell it to on your computer, and sends you an email about the results of those tests. Optionally, it can restart programs that stop working, or do any kind of trick you can dream up based on the results of the tests.

Monit comes with it’s own email sender, so you don’t have to set up anything extra to get it to send you an alert. You will need to specify an email server, though.

Getting Monit to run is very simple. Thanks to no-names.biz, I’ve modified their howto posting to show you how to just get it running on Ubuntu 8.04 (Hardy), and I’ve used nano instead of vim as an easy-to-use editor for the configuration files. Before using this, get familiar with nano. I’ve highlighted any portion where you need to substitute anything unique to you, like your email address:

#sudo aptitude install monit

#sudo cp /etc/monit/monitrc /etc/monit/monitrc_orginal

#sudo nano -w /etc/default/monit

startup=1
CHECK_INTERVALS=60

Ctrl-O to save the file, Ctrl-X to exit nano.

#sudo nano -w /etc/monit/monitrc

set daemon 60
set logfile syslog facility log_daemon

# If you run your own mailserver (use this or the next entry):
set mailserver mail.mycompany.com

#For gmail instead of your own mailserver (all on one line):
set mailserver smtp.gmail.com port 587 username “you@gmail.com” password “password” using tlsv1 with timeout 30 seconds

set mail-format { from: monit@$HOST.mycompany.com }
set alert you@mycompany.com
set httpd port 2812
use address localhost
allow localhost
allow you:password
## Services
## You put your tests here.

Ctrl-O to save the file, Ctrl-X to exit nano.

#sudo invoke-rc.d monit start

———–
If all goes right, you should get an email shortly with the subject “monit alert — Monit instance changed localhost”. Because we used the $HOST variable in the mail-format section, you can tell which computer sent you this by looking at the from: address of the email. If you don’t get an email within a few minutes, well, the aggravation can start now while you fix the /etc/monit/monitrc file, probably by monkeying with the mailserver line.

# tail /var/log/daemon.log

The above command will give you some clues if it’s not working right, as monit will log the errors.

Now the fun begins, as we add tests to the end of the /etc/monit/monitrc file.

#sudo nano -w /etc/monit/monitrc
Scroll down to the end of the file, you can just mash the down-arrow button until you get there.
## Services
## You put your tests here.
check host mycompany.com with address mycompany.com
if failed port 80 proto http for 3 times within 5 cycles then alert
#
check host example.com with address example.com
if failed port 80 proto http for 3 times within 5 cycles then alert

Ctrl-O to save the file, Ctrl-X to exit nano.

#sudo invoke-rc.d monit restart
——
What this will do is check your remotely-hosted website, as well as the little website at example.com. If your website isn’t up in three out of five minutes, monit will email you an alert. I’m also including a check against example.com, because there’s the possibility that your computer might not be connecting to the internet properly. So if you get an email that both are failing, then it’s a good chance your website is still up, but your internal network’s got a boo-boo.

A huge amount of tests are available, and many different technologies have tests written for them. By playing these tests and researching what they do, you will get a huge dose of technology learning across many different topics. Guaranteed.

Configuration examples from the monit wiki
Service test documentation

I’m currently running this one and trying to figure out how best to tweak it to my in-house server:

## Check the general system resources such as load average,
## cpu and memory usage. Each rule specifies the tested resource,
## the limit and the action which will be performed in the case
## that the test failed.
#
check system localhost
if loadavg (1min) > 4 then alert
if loadavg (5min) > 2 then alert
if memory usage > 75% then alert
if cpu usage (user) > 70% then alert
if cpu usage (system) > 30% then alert
if cpu usage (wait) > 20% then alert