Schlagwort-Archive: silent infarction

Death of a teacher: Torsten Mick dies

Torsten Mick dies

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Torsten Micks office                                                                                                                                                 Photo: Kunz


The last day in the life of Torsten Mick is warm and nearly too hot. The class of the teacher starts on this Monday very late. He eats lunch with his wife on the porch. The meal tastes good and they talk about how good they are doing and they ask themselves how they have earned all the goodness in their life. Mick exercises a lot, is a nearly militant non smoker, he rarely drinks alcohol. He tries to avoid stress: For several years the teacher for German language and political science works only part-time. He tries to enjoy his life. As often as possible he travels: Amsterdam, Venice, Paris, the Côte d´Azur, the Baltic states or Poland. Over the past several years he is convinced that he will die early. His wife dismisses that, but it seems, that he wants to use the time wisely and wants to make the most of each day. About 2 pm. Mick sets off to school on this late summer day. As often as it is possible, he takes the bicycle for the seven mile trip. As he departed he is serious, other than usual. Does he have physical problems or is he thinking of the invitation for coffee with a close family member this evening? The relationship to it is problematic, that burdens him. Two weeks ago Mick and his wife celebrated their 30th anniversary of knowing each other and she had felt a certain but hardly noticeable distance between him and her. As he leaves the house, she carries the dishes from the porch to the kitchen and wants to ask him, what depresses him, but he is already gone. She thinks for a moment whether she should follow him to clarify the fact, but she does not. She wants to ask him in the evening.
Torsten Mick arrives around 2.30 pm at the school. A Spanish teacher is on her way to class. In front of the main entrance Mick locks his bike on a handrail. That is strange, because the school has a storage room for bicycles. Maybe he was late. Mick looks to her colleague while locking the bike, but his facial expression let her know, that he doesn´t want to talk right now. He is preoccupied with himself. She noticed his red face, but she explains it with the temperature and the sporting activity.
Mick goes to the classroom of the 7th graders. Because it is so hot, they change into a cooler room, near the auditorium. At his last week end on earth he had evaluated a test, which he discusses and gives it back in the first of his two lessons. It is afternoon and the boys and girls are inattentive and restless. Some students say, that his voice sounded different, rougher in a way. He becomes more and more unsettled, walking around in the classroom, he leaves the room for several times and has to throw up. He says to the students, that he feels a pressure on his chest und also arm pains. He walks lonely through the auditorium, raising his arms over his head. Back in the classroom, he goes to the sink several times, holding his hands under cold water. One student sees, that his hands are shaking so much, that he can hardly turn on the valve. The children see, that he doesn´t feel well. They even tell him, that he should go to the doctor. Mick says, that he wants to finish class first. He lets the students go home earlier, they say goodbye and tell him to get well soon. With a pale face und a quite voice he says thank you.
In the auditorium he meets his friend and colleague and they talk together. He admits chest pains and he feels a pain radiating to the face.
The janitor sees, how they talk. A few years ago, the janitor himself had a cardiac arrest. Completely asymptomatic on a Saturday morning he breaks down in school and was without conscience, because his heart stopped beating. He was saved by a worker, who started resuscitation immediately. The janitor wants to talk to both, but they are talking so intensively, that he doesn´t want to disturb.

In his leisure time the animal-loving Torsten Mick takes care of some donkeys of a friend. A jenny is ill and needs daily medication. He wants to visit the animals on his way back from school. He describes the location as remote and if he looses his conscience no one would find him, so he asks his friend for a favour to ride with him. The friend complies, he lives approximately 1/3 mile away from the school but went to school by car. So he drives home with his car and Mick follows him by bike rapidly. His colleague watches him in the rear-view mirror and thinks, he can´t be feeling so bad. He takes the bicycle out of the garage and Mick waits on the street in front of the house. On the way to the donkeys they talk about health issues. That men till their 60th birthday are particularly at risk to have a heart attack and that Mick still belongs to that group. His family physician says that he could become very old. His friend has no cell phone to call for help. Mick needs his phone only occasionally, he has deposit it in his saddlebag. Mick explains his friend how he unlocks his phone, in case that he can´t do it anymore, but he assures his friend, that everything is all right. All the way his friend has never the impression, that Mick feels bad or that he is not in a good shape, on the contrary, he always rides in front of his friend. On the paddock Mick seems fully blessed. He embraces the animals, he looks happy, relaxed and completely healthy. They even talk about the final exams and that Mick still has to create the examination questions. After the animals were provided with food and medication both ride back to the country lane. Mick insists, that his friend rides home. If something happens now, he is easier to find, says Mick. At 5.30 pm at a fork junction the friends go separate ways.
Five minutes later his wife drives to her yoga lesson and passes the place not far from their house, where her husband will struggle for his life half an hour later, afterwards she finds a button of his shirt there.
Finally Torsten Mick is seen from the distance by the owner of the donkeys. Mick waits on a crossroad to pass the street. His face is red and he gasps for breath.
The emergency doctor of the local hospital has been on duty for one hour. At 6.04 pm he receives an alarm call. Four minutes later he arrives with two paramedics to the operation area. A quarter mile away from his house, Torsten Mick hangs with his upper body over the handlebar of his bike leaning against a waist-high stable metallic fence and he is unconscious: “Clinically he was dead”, says the physician. He can´t note any blood circulation activity. On the sidewalk they start with the resuscitation. Torsten Mick is defibrillated five times. After 20 minutes his circulation has stabilised again. On the way to the hospital his condition stays stable. His pupils react and in spite of his intubation he starts breathing spontaneously. His blood pressure is 130/70, heartbeat 90. At 6.35 pm they arrive at the hospital. In the resuscitation room he suffers under ventricular fibrillation. The physicians apply adrenalin and medicine which should stabilize his cardiac rhythm. It comes to a cardiac arrest. At 7.20 pm Torsten Mick is declared dead. It is the 23rd of September and he was 59 years old.

Around 8 pm his wife comes back from exercise to an empty house. It is unusal, that her husband is not at home, but not alarming. Shortly thereafter his two children stand in front of the house, she should dress, the father wouldn´t feel very good. He was already dead for more than half an hour. They drive to the hospital. Torsten Mick lies lifelessly on a bed in the trauma room of the cardiac catheter station. Finally they pull the body in a special room, where the relatives can say good bye. His wife stays the whole night, wrapped in a blanket at the floor. She feels the presence of her husband for a long time, he looks like he is just sleeping.

“Repression, Repression, Repression!”

Dr. Senges, signs of a heart attack are severe pains behind the breastbone, spreading the left arm or both arms, radiating into neck, jawbone, scapulas, upper abdomen or neck. That is nearly the whole upper body. Can´t it be a little bit more specific?
Dr. Senges: No, that are just the symtoms of a heart attack. Every pain, occurring between neck and diaphragm is a potential cardiac infarction pain.

How many patients, who thinks they had a cardiac infarction, actually do not have one?
Dr. Senges: Our register include 12.000 patients from 55 hospitals nationwide. Half of them thought mistakenly that they had a heart attack.

If a coronary vessel becomes suddenly closed by a blood clot it is called a heart attack. How does it come?
Dr. Senges: That is caused because of the fat deposit on the inner vascular wall, caused by hazard factors like smoking, overweight, poor cholesterol values, high blood pressure or diabetes. The plaque can rupture inside of an artery. This causes a blood clot which can mostly or completely block blood flow through a coronary artery.

Torsten Mick hadn´t smoked, had no overweight, exercised a lot and reduced his stress level. His healty living hasen´t paid off!?
Dr. Senges: Ten percent of the patients don´t have this classical risk factors. But I wouln´t say it hasen´t paid off, maybe he had a heart attack much earlier. Probably he was a genetic high risk patient. I would´nt be surprised if in his family cardiovascular disorders occured.

How do we have to interpret his restless walking around in the classroom or that he raises his arms over his head?
Dr. Senges: That had no medical reason. The patient had probably pains and realized, something is wrong. That was the reason of his disturbance.

The students said, that his teacher complained about the pain spreading to the arm. Isn´t this a typical hint for a myocardial infarctation?
Dr. Senges: Absolutely!

And why have the patients this kind of arm pain?!
Dr. Senges: That is a radiation from the heart and it radiates more to the left arm, because the heart is located on the left side.

Finally he throws up. That seems to be a side effect of a heart attack!?
Dr.Senges: It is not typical, but it can happen. The whole vegetative nervous system is uproar!

Did Torsten Mick have possibly a myocardial infarction already in school?
Dr. Senges: Yes!

And he didn´t realize it?
Dr.Senges: He repressed that. An infarctation is a sudden event on the one hand, on the other hand it is possible, that a coronary vessel is not completely blocked. Maybe he had in school Angina pectoris. It is a matter of definition, up to which point it is a myocardial infarction.

Is it possible, that some patients did not notice of their infarction?
Dr. Senges: Yes, but that is rare. In five to ten percent of the cases the patients have a so called “silent infarction”.

For his friend it seemed that on the way back home Micks health condition was improving!
Dr. Senges: In my opinion repression plays here a major role.

Half an hour later, Torsten Mick is dead. He passes away on the street. He was a well educated person with a sharp mind. Why wasn´t it possible for him to read the signs correctly?
Dr. Senges: It is a kind of rebelling against reality, that is similar to other patients. The mechanimus of repression is the leading cause that people don’t go to the hospital or do it too late. If you want to learn something from this story than that: It is a paramount example for repression with all it consequences including death.

Dr. Senges, thank you for the interview!

Interview by DIRK KUNZ

Dr. Jochen Senges

Professor Dr. Jochen Senges (72) is Chairman of the Board of the “Stiftung Institut für Herzinfarktforschung” in Ludwigshafen/Rhein.                                                                                                                                                Photo: KUNZ