It was nothing, I told myself, doubled over in pain half a block from my Brooklyn apartment.
Maybe I bruised a rib. Maybe I couldn’t catch my breath because I was panicking about it being more serious.
I couldn’t handle another medical drama. I’d already had emergency gallbladder surgery six months earlier, and spinal surgery to address debilitating neck and arm pain just seven days before this. I still had a neck brace strapped around me like a toilet-paper-roll turtleneck.
This had to be nothing.
I returned home from my aborted stroll, hopeful I’d feel better once I sat back down. I didn’t.
Dr. Google informed me that this new stabbing pain on the right side of my rib cage and near my collarbone, combined with shortness of breath, might not be nothing. It could be deadly.
Ignoring warning signs
People ignore or deny their symptoms for many reasons. A potential hospital bill for treatment can be daunting. Or they don’t want to sit in a waiting room for hours. Or they have been traumatized by unsympathetic doctors or unwelcome diagnoses in the past.
Some of us also think we can just tough it out. Don’t be a burden, we tell ourselves. I had spent most of the prior week at my father and stepmother’s apartment, relying on septuagenarians for my most basic needs. I desperately didn’t want to put them—or my own daughter—through anything else.
I had minimized my symptoms last winter, writing off a violent stomachache to greasy latkes, gas and stress, only to end up with an infected gallbladder and surgery. I did the same a few years earlier with foot pain, ignoring what I thought was a bruise only to learn I’d fractured and permanently damaged a bone.
Caregivers can be bad at caring for themselves in emergency situations, says Dr. Stacey Rosen , president of the American Heart Association and executive director of the Katz Institute for Women’s Health at Northwell Health on Long Island. In her experience, women in particular have an “inability to prioritize their own needs.”
Not every twinge warrants a hospital visit. But certain symptoms are major red flags and require immediate attention.
A sudden-onset headache is one, says Dr. Alison Haddock , president of the American College of Emergency Physicians. It could be a sign of aneurysm or stroke.
Sharp, new chest pain or heaviness that lasts more than a few minutes may indicate cardiac issues or a pulmonary embolism. Intense, localized abdominal pain could reflect a perforated ulcer or issues with the appendix or gallbladder, depending on where it is.
She also says to take seriously weakness or numbness on one side or difficulty speaking, which may be warning signs of a stroke, and to seek care if you’re having trouble stopping a bleed.
When any of these issues arise quickly, haven’t occurred before and are severe rather than mild, “I’m pretty worried about you,” Haddock says.
The bad thing
I sat paralyzed on my couch, trying to convince myself it wasn’t a pulmonary embolism. After 15 minutes I ordered an Uber, headed for the ER. I didn’t take my phone charger or a book, convinced I wouldn’t be gone long enough to need them.
“I feel like…I’m being stabbed in the side…and also my clavicle…and I can’t breathe,” I panted to the intake nurse when I arrived at NYU Langone Health’s emergency department in Cobble Hill, a few miles from my apartment.
I was swept into the ER within minutes. That surprised me. After all, even doctors acknowledge that certain populations, including women and people of color, can be written off as whiny or hysterical when seeking help for legitimate ailments. And I knew cardiac issues can look different for women and men.
A nurse fitted me with stickers for an EKG, monitors for blood pressure (low), oxygen level (low) and heart rate (high), and an IV for blood draws and fluids. A tube was tucked behind my ears and stuffed into my nostrils, forcing oxygen into my body.
My nerves frayed as I waited to be wheeled down the hall for a CT scan of my chest, so I called my father. I followed up with a text. “Didn’t want to worry you. Just came here out of an abundance of caution,” I wrote. “I’ll be OK.”
Soon after I returned to my curtained-off area on the ER floor, the doctor walked over and gave my shins a reassuring squeeze through the blanket draped across my gurney. Her touch settled me, while her face conveyed the gravity of the moment. It was indeed the bad thing—a pulmonary embolism.
I had blood clots throughout both lungs, including a large one right near my heart, limiting the flow of blood. Some tissue in my right lung had died, known as a pulmonary infarction. The official report included the words “extensive,” “acute” and “critical.”
The doctor told me I saved my own life by coming to the hospital. “It’s good you came when you did,” she says.
Dr. Reed Caldwell , who is chief of the emergency department for NYU Langone’s Manhattan hospital and wasn’t involved in my care, told me later if someone who recently had surgery comes in looking winded, complains of chest pain or shortness of breath and has an elevated heart rate, “this is a blood clot until proven otherwise.”
The people’s disease
About 900,000 people are diagnosed with blood clots—deep vein thrombosis or pulmonary embolism—in the U.S. each year, according to the American Lung Association. For many, the first symptom is sudden death.
“I call it the people’s disease. It doesn’t spare anyone—rich, poor, male, female,” says Dr. Parth Rali , director of the pulmonary embolism response team at Temple University Health System in Philadelphia, who wasn’t involved in my care. “You could be the healthiest person in the world and unfortunately it can still happen to you.”
Some lifestyle factors increase your risk of blood clots, such as obesity and smoking. (I’m not obese, though I used to be. And I’ve never smoked a single cigarette.) Dehydration can thicken the blood. And taking hormonal contraceptives, as I did almost uninterrupted since I was a teen, also raises the risk.
Then there’s movement, or lack thereof. When your legs stay still for too long, the blood may begin to form clots, which can then travel through the heart and into the lungs.
I had followed my spine surgeon’s instructions, doing laps in the apartment and walking around the block each day after my operation. But as Dr. Keith McCrae , director of classical hematology at the Cleveland Clinic Taussig Cancer Institute later explained, my body’s clotting mechanism—involving the enzyme thrombin and the protein fibrinogen—apparently went into overdrive as it tried to help my wound heal. My body’s anticoagulants that regulate clotting might not have kicked in the way they are supposed to.
When a clot is so severe as to jam up the blood vessels coming out of a patient’s heart, doctors often prescribe “clot busters,” or thrombolytics like alteplase. They not only prevent future clots, like what blood thinners do , but also actually break up existing clots.
But I’d just had a titanium plate, cadaver bone and six screws inserted into my cervical spine to correct pinched nerves due to disc degeneration. Thrombolytics can cause internal bleeding which, near my spinal cord, could potentially kill or paralyze me. For now, the emergency room doctor explained, I could only get heparin, a blood thinner, as they chased down my surgeon and a pulmonologist for advice late on the Friday afternoon of Memorial Day weekend.
I called my father and told him that I was being transferred to the ICU.
Next I called my ex-husband, who had been watching our 9-year-old daughter while I recovered from the neck surgery.
My own mother died in a car accident when I was 15. I knew too well that we balance on a knife’s edge, potential catastrophe always lurking. That afternoon at the hospital, I worried I’d never see my own little girl again.
Long road to recovery
My father and stepmother cycled through the ICU over the next three days. I dozed occasionally, texted with friends and briefly pulled down my oxygen tube to FaceTime my daughter. I could hear visitors chanting Hebrew prayers over someone in a bed across the hall.
Within 48 hours, the doctors tapered my oxygen machine down toward zero, and an echocardiogram showed my heart was no longer struggling to pump blood. By Monday morning I could walk down the hall, slowly, without oxygen support. The clots weren’t life-threatening anymore, though anything more than a shallow breath was excruciating, even with Percocet.
I was discharged to my father and stepmother’s apartment, and went back to my own home a few days later. I cried when I got my daughter back.
About 85% of patients who are treated for pulmonary embolism recover fully within a year, Rali told me. The rest can have some longer-term impairment, including heart strain or labored breathing.
The usual things that keep you healthy can also minimize your chances of getting a repeat blood clot—exercise, eat a balanced diet, don’t smoke, stay hydrated. Other adjustments, like wearing compression socks during travel, might help as well.
My pulmonologist, hematologist and gynecologist all agreed I will never go back on hormonal birth control pills.
My new daily pill is a blood thinner, in my case Eliquis . That’s standard treatment for blood-clot patients, for anywhere from a few months to the rest of your life. The timeline varies based in part on the type of clot and insights from blood tests.
I don’t yet know what my long-term outcome might look like; this will take time. I will be on blood thinners for at least six months, and still struggle with small exertions like walking up the stairs in the subway station as my lungs continue to recover.
I’m just grateful that I—and the doctors—took my symptoms seriously, and I still have time.
Write to Melissa Korn at Melissa.Korn@wsj.com
