When I first heard news of James Gandolfini’s death at the age of 51, my first thought was a scene many years ago from — what else? — “The Sopranos.”
Tony Soprano, Gandolfini’s larger-than-life character, had just received news of the death of his mother. His wise guy friends gathered at his moment of grief — or possibly quiet relief, given the bitter relationship between the mob boss and his mother. In a classic portrayal of male communication skills, or lack thereof, the gangsters gather round and fumble for words.
Finally, Tony shrugs his shoulders: “What are you gonna do?” he says in a matter-of-fact tone. Exactly. The wise guys exchange man-hugs with their leader. Time to move on to the next heist, scam, or gangland execution, whatever it was.
And so it is with James Gandolfini, dead of an apparent heart attack. What are you gonna do?
Well, if you are me instead of one of the wise guys, what you are going to do is to once again recall your own near-collision with a devastating heart event and urge people of all ages — and both sexes — to begin paying attention to their bodies.
Gandolfini’s death was just another in a long line of “sudden” deaths by heart attack that I have taken notice of since the day more than 11 years ago when I went into the old Mercer Medical Center for a routine angiogram and ended up at St. Mary Medical Center in Langhorne with a stent installed to clear out a 90 percent blockage in my left anterior descending (LAD) artery — otherwise known as the widow maker.
The deaths are conveniently described as “sudden,” implying that the victims are caught by surprise. But I wonder how true that is. And I have been tempted to follow up with the grieving survivors of classmates and friends of mine who have died of heart attacks to ask if they recall any expressions of aches or pain or discomfort in the immediate hours before the attack. Those might be telltales that the rest of us could keep in mind as we go about our daily grind. If nothing else, the comparison process might make us more aware of what our own body is trying to tell us.
I never get the time or the emotional energy to ask those questions of people I know, but I do take note of some celebrity deaths, and the details of their condition prior to their death:
Darryl Kile, the St. Louis Cardinals pitcher who died at the age of 33 just a few months after my first stent was installed. Kile had complained of shoulder pain and weakness the night before he died. An autopsy revealed an 80 to 90 percent narrowing of two of his three coronary arteries. Kile’s father had died from a heart attack in his mid-40s.
Robert Palmer, the British rock ‘n’ roller who died suddenly at age 54 in 2004. Just a few weeks before his death, his doctors in Switzerland had given him a clean bill of health.
Jim Cantalupo, chairman and CEO of McDonalds, who died suddenly in 2004 at the age of 60.
And one that really caught my attention: Tim Russert, who died in 2008 at age 58 while preparing for the next installment of NBC’s “Meet the Press.” Russert had a heart scan in 1998 (at age 48) that determined that his coronary calcium level was elevated. He also suffered from both low HDL cholesterol and high triglyceride levels. But a stress test two months before his death was normal.
At least some of these “sudden” heart attacks may not have been so sudden after all. In my own case I had a few — very few — signs of discomfort. The impetus for my trip to the doctor came in June, 2001, when the opposing lawyer in my divorce trial framed a question by saying: “So you’re in perfect health, aren’t you, Mr. Rein.”
By that point in our proceeding I was conditioned to answer every question he asked in the negative. My response: “No, I don’t know that I am.”
In fact, as I reported in a lengthy account of my heart problems in the June 19, 2002, Health and Fitness issue of U.S. 1, I had been experiencing some minor and intermittent chest discomfort — similar to heartburn. A few days after the lawyer’s question I called the doctor’s office to schedule an annual physical. The first opening was not until September 10, 2001.
If it had been one day later — 9/11 — my answer to the doctor’s question about any complaints would have been “none at all.” But on that day of innocence 24 hours before the World Trade Center attack I mentioned the chest discomfort in an apologetic tone.
The doctor noted my family history of heart disease, and scheduled a thallium stress test, “the gold standard,” which involves the injection of radioactive dye into the bloodstream, and X-rays taken before and after a cardiologist-supervised session on a treadmill.
The stress was October 24 in Trenton. Two weeks passed, no word. I figured that this one, like most every other medical test I had ever taken, will prove to be negative — another false alarm. On election day, November 6, I took a call from the doctor’s office. “Mr. Rein, your stress test has come back positive. You need to see the cardiologist. We have a referral for you to pick up.” That night I walked the half mile from my house to the polling place at Princeton High School as fast as I could — I was a little out of breath when I got there but felt no discomfort. I walked back home even faster — nothing.
The cardiologist said the stress test showed a “shadow of doubt” in an area of the heart where false positives often occur. The only way now to get a definitive answer was with an angiogram, the procedure that sends a catheter through an artery and into the heart.
I procrastinated and finally scheduled it for January 8, 2002. Even as the nurses wondered out loud why I — with such low cholesterol and low blood pressure — had even been scheduled for the procedure, the doctor pointed up to an image on a display. A vessel as thick as a pencil suddenly turning into one as thin as a string. An ambulance shortly took me over to St. Mary Medical Center for installation of a stent.
That stent was the beginning of me listening — trying to listen — to the faint murmurings of my own body. In 2003 I felt sharp pains in my left arm — must be a heart attack, I told the cardiologist doing the angiogram. Oh sure, he said in mock agreement. It turned out to be nothing.
In 2006 I reported some more of that very faint heartburn feeling to the cardiologist. He sent me in for another angiogram. This time I got another stent to prop open an 85 percent blockage.
Not much more than a year later, I had another bout of that minor heartburn. At the hospital they discovered another blockage — 50 percent. But this time I didn’t get a stent. Instead I was told to stay the course of exercise, low-fat diet, and medication. At that point my already low cholesterol had changed its balance, and my good cholesterol had increased and far exceeded my bad cholesterol, which had decreased. Some cardiologists now believe that good cholesterol can actually diminish the size of blockages. The statistics show that medication and exercise are as effective as stents in this case.
I’m understandably skeptical and I keep listening. Is that subtle heartburn I’m feeling more or less subtle than what I felt when I had that 50 percent blockage? It gets to be a tough call. But if it seems more than the usual, I vow that I will raise my hand and ask for some medical intervention. What else are you gonna do?