I recently sat for a myocardial perfusion SPECT (single-photon emission computed tomography). In less highbrow language, that’s a nuclear cardiac imaging test which, among other things, shows how well blood is flowing through your heart and how well that heart is pumping.
For me, the test was part of a long-term maintenance checkup following a curious incident that happened about five years ago.
The test itself didn’t bother me, although the nuclear part did give me a moment of pause. I understand that nuclear medicine has become a vital and valuable tool in the health care toolbox. But I am also a Cold War baby, and the word “nuclear” ripples many memories, including backyard bomb shelters and school children crawling beneath elementary school desks, both of which are laughably weak defenses against the flash from a world-crushing nuclear strike.
On the medical front, however, nuclear is user friendly. I learned there are various methods that medical folks can use to check your heart, including the myocardial perfusion SPECT, which includes injecting a small amount of radioactive material into the bloodstream. “The nuclear test will give us better results,” Jessica, the cardiac specialist, explained cheerfully.
An appointment was made. I arrived at 6:30 a.m. as requested.
Georgia, the registration clerk, had a few questions.
“Do you have a living will?”
“Do you think I’ll need one?”
She glanced up with the no-nonsense glare that hospital administrative folks have.
“Yes. I have a living will.”
“Are you a smoker?”
“No.”
“If you’re admitted, can they tell family and friends?”
“I don’t expect to be admitted.”
Same look.
“Yes.”
“Would you like to see a pastor?”
“Now?”
“No. If you’re admitted.”
“That would be fine.”
I signed a sheath of papers and was directed to Radiology.
The waiting area was sterile and brightly lit. My wife and I soon were ushered into a small side room by Nicholas, who appeared to be in his early 30s with a trim physique, short dark hair and a no-nonsense demeanor. He introduced himself as the nuclear medicine technician. “We’ll be taking care of you today,” he said.
He got the IV successfully started on the first try, flushed it with a bit of saline solution, then pumped in a small vial of a pale solution that was numbingly cold. A tracer, he explained.
“This the radioactive stuff?” I asked, jokingly.
“Yeah. But just a little.”
I was returned to the waiting area, offered a bottle of water—which I accepted—and told it would be a 45-minute wait while the tracer did its work. Nicholas then reappeared and escorted me to a small room where Stacey, the cardiac sonographer, awaited. She directed me to a machine that resembled an open-ended coffin.
I removed my eyeglasses, wallet and car keys and was instructed to lie on my back, arms overhead. It was a tight fit.
“This will take nine minutes,” she said. The instructions were simple: Try not to move.
The room was cold. A blanket was offered, which I foolishly declined. Stacey appeared at my side, smiling. They were ready to start.
“Are you OK?”
I acknowledged that I was OK.
“Are you sure about the blanket?”
I decided I was not sure about the blanket.
One was immediately deployed, then Stacey and Nicholas disappeared inside an enclosed control panel, and the machine began to hum, occasionally rotating across my chest.
Just when I was beginning to think Stacey and Nicholas had forgotten to check the time, they reappeared and escorted me into the adjoining room, which contained a small bed, a treadmill, an assortment of electronics and a covey of medical folks milling around. This is the stress part of the stress test. You are stripped to the waist, wired with an alarming amount of electronics, and asked to step on the treadmill for a few minutes. The procedure is simple: Pace the treadmill until told to stop, with a continuous warning, “If you have any trouble, let us know.”
At the 5-minute mark, I was told we had “about a minute to go.” This was welcome news. Just before hitting the target heart rate (140 beats per minutes for me), Nicholas, who had been flanking me throughout the test, injected another shot of the ice-cold tracer. There was another minute on the treadmill. I was congratulated on hitting the target rate and told to lie on the bed and rest for 60 seconds. Then, I was told to rest for 60 more seconds before being escorted next door for another 9-minute scan supervised by Stacey.
Nicholas unplugged the IV.
“That’s it,” he said.
“That’s it?”
“Yeah.”
I collected my eyeglasses, wallet and keys.
“What’d you find out?” I asked, knowing no answer was coming.
“We only have the raw data,” Nicholas said, repeating an answer he undoubtedly gives multiple times daily. “They’ll let you know.”
• • •
Test results “looked good,” according to Jessica, which were the results I expected but for which I was also thankful.
Take care of yourself. Be attentive. That twinge you felt while hiking to the trout stream, or pitching a backcountry camp, or when your heart rate jumped to 140 for no apparent reason … it was probably nothing. But don’t bet your life on it.
Readers may contact Gary Garth at editor@kentuckymonthly.com