Op-Med is a collection of original articles contributed by Doximity members.
“Two thousand dollars!?” I sputtered. “To cut down one tree?”
“Never mind. I’ll do it myself,” I blurted and hung up the phone.
It’s not like I was a rookie with a chainsaw, I could handle one pretty well. Besides YouTube would tell me all I needed to know. We had bought and built our suburban wooded paradise before the commercial building companies hoovered up the surrounding woods and fields, converting our sylvan oasis into a hoary subdivision, with perfect lawns, and winding rows of cul-de-sac. That left our copse of trees out back vulnerable to unfettered winds and freezing rains and other tree-mauling maladies. A large, proximally forking maple tree had split off and one half of an old growth behemoth had separated from the base of the tree. Instead of falling to the ground, it had snagged up the canopy of the pines and maples that surrounded it, creating a “sword of Damocles” in the backyard, threatening my children, my sanity and the American way of life. It had to come down.
And here is the problem for surgeons. We think we can do anything. If I can take out the gangrenous, infernal gallbladder with a hot chopstick and a dip net, surely this (insert unfamiliar but seemingly conquerable obstacle of your choosing) will be a piece of cake. “Nurse, hand me the number 4 chainsaw.”
This snag, like a left main blockage, is called a “widowmaker.” The funny thing is I knew it was a dangerous situation, but I’m a surgeon. I eat deadly problems all day; I got this.
I ordered a Poulan chainsaw from Amazon and it came three days later. I had had another cheap saw in the garage but it was old and wouldn’t reliably start and besides, it was neon green. That is not a respectable color for a chainsaw, just ask any lumberjack on YouTube. I reasoned I would pay $250 for the saw but would save $1,750 in the process and have a new, powerful, properly colored chainsaw to boot.
I oiled and gassed that puppy up and fired it to life the following Saturday. It was perfect tree cutting weather: cold, crisp and clear, ideal for not overheating while undeniably exerting my manhood with the staccato reverberations of the throaty saw and ideal for transmitting 911 calls. I even had on a flannel shirt.
The tree had fractured, green-stick, about five feet above the ground and about three feet above the main fork. I wedged out the sinewing splinters keeping the 40-foot fork attached to the rest of the tree. The saw bit through the cambium and heartwood like a champ and in no time the long stem was liberated from the trunk and crashed earthward, like a gigantic javelin digging its pointed end into the newly frozen, crusty forest floor, but still snagged in the canopy of grappling poison oak vines and bifurcating neighboring limbs, canted away from the direction I wanted it to fall.
I cut a notch in the base of the tree facing the direction I wanted the tree to fall. Now all I had to do was make the back cut, a horizontal cut on the other side of the tree and continue it until the back cut neared the notch on the front of the tree, whereupon the forces of gravity would take over and “Timber!” just like on YouTube, the tree would come crashing earthward. However, the loading forces on a tree leaning away from the direction of felling simply conspire to pinch the saw blade in the newly made kerf, once enough material was removed. And sure enough, my saw got stuck, halfway through the cut.
“How’s it going?” my wife inquired sneaking up on me, the intrepid lumberjack.
“Fine. Just fine,” I lied.
“Is your saw stuck?”
“No, not really. Just resting it there.”
“Maybe we should call someone…”
“Look, I got this. But maybe you’d be safer inside, in case this thing has a mind of its own.”
“Okay. You know what you’re doing,” she mocked relentlessly and went back inside.
A few swings of my old axe and strategic placement of a couple of wedges and the saw was freed. I was sweating from exertion and nervousness and terror. But not nervous enough to give up.
Fearing that my saw would get bound again, I decided to complete the cut by hand, with the old axe. The tree was hard maple but was rotted and dried out making it relatively easy to bite into. But there was a lot of material to remove before I would sniff success.
“This is harder than it looks,” I echoed in my brain as the chips flew from every third or fourth blow. Finally, after an hour or so of working, the thing was ready to go down. I had mapped out my exit strategy; when the thing started to fall I would exit 45 degrees rearward. But I wasn’t sure the tree would fall in the direction I planned. It might slip straight down like it did before, roll free from its entanglements and seek me out like an infrared missile. And besides, that direction led towards the corner of our lot where the fence would hem me in like a caged rat. Better just to run towards the house and open lawn where I could bob and weave in the open and make my escape from the dead falling mechanism.
So, I struck the final blow. The creaking of the cracking timbers was like a gun going off at a track meet. I sprinted off in a panicked run, away from the deadly radius, biding to just get clear. I looked back mid-sprint, and sure enough, it had drawn a bead on me and was hunting me down, pissed that I had interrupted its reclining slumber. I weaved to my right and just as I did the top of the tree came crashing down a few feet from where I had been running. My mind was elated to have solved the problem and avoided calamity. My heart was a different story.
I sat down on the tree to catch my breath and calm down. My heart was thumping in my chest. I was sweaty and uncomfortable. My chest was squeezing and I felt weird. Really weird. I sat down too cool off and drink some water but the discomfort did not go away. I went in the house and tried to take my pulse but it was going too fast. I found my old stethoscope and listened and it was beating like a damned machine gun, easily over 150 to 170 beats per minute.
“Oh shit,” I thought, “you’re in SVT.” I began rubbing my carotids and taking deep breaths. My chest didn’t feel great but there were no stabbing pains like you’re supposed to have. I told my wife I probably should go to the ER and just as I did I popped back into some slower rhythm and felt a whole lot better instantly.
And then the damn thing started again about 30 minutes later.
When we got to the ER, I was in AFib with Rapid Ventricular Response (RVR). I felt weak but did not have chest pain nor shortness of breath. They gave me some diltiazem which rapidly controlled my rate to the 80s. I could feel the fib beats and it was a weird sensation but otherwise I felt OK. The ER doc gave me the scoop. New onset AFib is seen all the time, and my CHAD score was 0 so I was low risk. There were no changes on my EKG other than AFib so likely I could go home with a beta-blocker so long as the rest of the labs were OK.
Then they told me my troponin was elevated. And not just a little elevated. And then it went up again on the second draw. I was being admitted for a NSTEMI. A heparin drip, troponins, echocardiogram and heart monitors were all in my future. Holy Shit.
The following morning, my heart slowed into the 30s and then popped back into sinus rhythm, the beta-blocker ensuring that my sinus node wouldn’t rev much faster than 50 beats a minute. Then I was wheeled down for an echocardiogram by a spry volunteer in her 80s who was bright and conversational until I casually observed that I should be pushing her to the cardiac testing facility, not the other way around. She dropped me off with a less than enthusiastic, “Good luck.”
I knew something was amiss with the echo when the tech wouldn’t tell me anything about what she was seeing and tried to be nonchalant about it. I noticed that the dye seemed to hang around on the screen for an unusually long time, but hey, what did I know about it? The beta-blocker was keeping me non-plussed over the whole situation.
The cardiologist came back to see me later that afternoon, after assuring me earlier that I could go home. But the echo revealed an ejection fraction around 25%, heart failure range. I am 50 years old, no symptoms, no edema, no shortness of breath, no nothing, other than a janky heart rhythm, which by now is back to normal. I can’t be in heart failure.
“You need a cardiac cath,” he insisted, “and maybe even a stent if there’s anything weird. It’s not an emergency; your troponins are finally trending downward. We’ll squirt you first thing tomorrow morning. And we’ll also need to get a cardiac MRI.”
My new onset AFib emergency room visit was turning into a four day ordeal.
To make a long story short, my coronaries were spanking clean. The cardiac cath was super easy thanks to Versed and Fentanyl and the approach via the radial artery rather than the groin. It showed my EF was already back up to 40%, likely from being out of AFib for a little while. The MRI revealed a similar EF and findings consistent with previous viral cardiomyopathy. Blame it on the tree or some damn virus I suppose, but I have to wonder if something else didn’t contribute. The near daily stressors at work have piled on, mostly unnoticed. The post-op bile leak, after a routine lap chole, the drop in hemoglobin after the uneventful right colon, or the post-op fever and prolonged ileus after sigmoidectomy have all hyperplased my adrenal glands to the point where a near death experience could in fact be deadly.
Right now, I feel pretty good. I took the next week off which I had been planning to do anyway and during that week, I managed to go out back and confront the maple nemesis that started this damn thing. It’s still there, mocking me in its length and breadth and muddied presence in my backyard. But damn if it didn’t come down right where I planned for it to.
I’m feeling pretty good now. I could cut this damn thing up right now. Now what did she do with my new saw?
Well, at least I can look forward to the hospital bill getting my heart rate up. I wonder if there’s any plumbing I should tackle.