Case Study #3: Unstable Angina (UA)

At Home

Day: 0
Time: 8:30pm
Place: At home

Priya looks out the window to see her husband Harj working on the truck again.

“He’s always out there doing something to that thing. I swear it hasn’t worked well for any of the time we’ve owned it,” she mutters.

Cleaning up the kitchen just before dinner, she glances at the half full bottle of Crown Royal. “He’s drinking way too much again. I know he’ll be grumpy and sad at the dinner table.”

Again Priya looks out the window and sees Harj taking a smoke break from working under the hood of the truck. “He’s also smoking way too much. We probably could make ends meet better if he didn’t smoke and drink so much.”

She moves to the stove and stirs some aloo gobi, then turns the heat off on the stove. “Ok, it’s done. Now it’s time to see if he will come in to eat or if he says he’s too busy.”

She turns around to find Harj staring at her. “You talking to yourself or are the kids here for dinner, too?”

“No, Harj. Just thinking out loud. Are you going to stop and have something to eat?”

“Yes, I think I’m almost done. It’s the fuel pump this time. That’s the last time I’m buying gas from your brother-in-law. The price was right, but I’m thinking the quality wasn’t.”

“It may not have been Gurr’s fault. The truck is old, and have you ever replaced the fuel filter?”

“No.” Harj steps closer to the kitchen island and, lifting his large abdomen on top of the island, reaches for the cupboard with the small glasses. He pours himself a half glass of Crown Royal. “I remember when we only used these glasses for the kids when they were growing up. Now that they’re gone, I use them for my drink. Do you want one, Priya?”

Priya shakes her head. “Maybe you should move to even smaller glasses or drink less.”

“Not again and not today. I’ve been up before dawn, driving all over the bloody county, and now its 7:30 at night. I deserve a drink for how hard I’ve been working.”

“Well, I just looked at the books. All that driving doesn’t mean we are making money. We’re going to have to cut some expenses: maybe your drinking and smoking.”

Harj shakes his head. “This is the only enjoyment and stress reliever I have. I’ll look for more jobs so we’re not driving empty any time this week.”

Harj sits at the head of the table with a view out the patio doors to his beloved truck. Not quite a semi, but not one of those UPS vans, either, he thinks.

“I just have to attach the electrics and I should be done for the night and ready to go tomorrow early,” he tells Priya.

Priya brings dinner to the table and ladles the steamy and fragrant potatoes and vegetables into Harj’s bowl. She gives him one piece of naan but watches in disgust as he reaches and takes hers. He looks at her and shrugs his shoulders. “What? I’m hungry.”

“You haven’t even eaten it and you are taking more. I remember when I could put my arms around your waist.”

Harj looks down at his quite large abdomen and smiles at Priya. “Probably the only thing I own that is fully paid for.”

Priya smiles at his joke and sits at the table.

The two share stories of their day and what the kids have been up to. “It’s really different without the kids here, Priya. The last one moved out over a year ago, but it still seems strange. It’s too quiet.”

Priya nods. “Yes, I know what you mean. They’ll be here on the weekend. You need to take some time off to visit when they come. Last time you worked the whole weekend through and never saw them. That isn’t good for you or the kids.”

Harj stops eating and just looks at his food. Priya hears a quiet, “I know.”

Harj quickly finishes his meal, pushes himself away from the table and begins the motion to bring a cigarette out of his pocket. “No, Harj. We agreed no smoking in the house.”

Harj grimaces at her and walks out the patio doors to the truck, lighting his cigarette as he goes.

Pryia cleans up the kitchen and makes Harj a lunch for tomorrow. She sees him come in. “All done?”

“Not quite. About five minutes more. Got brutal heartburn. Your cooking is killing me. Where are the antacid tablets?”

“By your bedside, like always.”

Harj goes to the bedroom and takes four tablets. Then he walks quickly out to the truck.

Completing the last of the connections, he says to himself, “Finally done. Let’s start this up to double-check.” Slamming the hood down, Harj moves around to the driver side of the cab and lifts himself inside, grunting numerous times. The truck starts up on the first try. Harj revs the engine a couple of times and looks at the dashboard to confirm everything is sound. Turning the key off, he steps out of the cab, locks it, and heads to the house.

After washing up, Harj plops down in the lazy boy chair and lets out a long sigh. Flicking through the channels, he finds the Punjabi Hockey Night in Canada broadcast. Smiling, he says to himself, These guys are hilarious. Much better than the CBC version.

About 20 minutes later, Priya comes out of her sewing room to find Harj leaning forward. “Everything ok?”

“Yeah, yeah, fine.”

Priya moves closer to Harj and sees the top of his bald head glistening with sweat. She notes that he is rubbing his left shoulder and upper arm. “Did you hurt you arm working on the truck?”

“What, what? No, no. I’m fine.”

“You don’t look fine. In fact, you look pale for a brown guy.” Priya leans closer to see if he heard her little joke.

“Ok, ok. Your dinner is killing my guts. It’s just sitting right here.” Harj moves his arm from his left shoulder to indicate his whole chest is sore.

“Not my dinner. You love that meal. Something else is wrong.”

“No, it’s your dinner.”

Priya moves around to look Harj right in the eyes and get a better read on him. Looking closer, she can see he is in a lot of discomfort.

“Ok, Harj, you are not doing well. I think you’re having heart problems.”

“No.”

“Yes. At the mosque, they told us the signs of a heart attack. You must remember that. Chest pain, arm and jaw pain, indigestion that does not go away, shortness of breath.”

“I am not having a heart attack. Leave me alone.”

“No, I’m not leaving you alone. I’m going to call an ambulance.”

“No, you’re not. We can’t afford that.”

“Your life is worth a small bill. Preeti’s dad used an ambulance when he broke his hip. It was about $80.”

“No ambulance. That’s final.”

“Well, then you are going in my car and going to have to put up with me driving. I will take you to the hospital.”

Harj looks down at his feet. “Ok.”

Now Priya knows for certain he is not feeling well. He hates my driving. For him to be willing to go with me really means something is wrong, she thinks.

“I’m going to grab your coat and wallet along with my purse. Meet me at the front door.”

Priya gathers everything up, including her cell phone so she can call the kids to let them know their dad is going to the hospital.

Moving to the front door, Priya notices that Harj is out of breath just getting out of his chair and walking to the front door.

Opening the door, she holds Harj’s right arm and feels him lean on her, thinking, Looks like he can barely walk now, as well. Better not slip or we are both going to have broken hips.

Priya gets him in the front seat of the car and runs back to the house to lock the door.

Sliding into the driver’s seat, she starts her small Corolla and carefully moves out of the driveway and onto the main street.

“Ok, the hospital is about 20 minutes away.”

“The way you drive, woman, it’s about 30 minutes.”

“No, I’m going to drive a little over the speed limit. Might make it there in 15, even.”

Harj leans back in his seat and shakes his head.

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