The conference room where we meet Priya Mehta-Kowalski feels deliberately chosen. Neutral territory, neither medical office nor coffee shop. She's the kind of person who thinks about these things. At 44, she carries herself with the contained energy of someone who's learned to channel anxiety into action, a software project manager who treats life's uncertainties like sprint planning sessions that just need better data.
Eighteen months ago, she had a heart attack. Not the dramatic clutch-your-chest-and-collapse variety, but the sneakier kind. A non-ST-elevation myocardial infarction that arrived during a product launch as what she initially dismissed as indigestion. What happened in the hours after her emergency catheterization offers a masterclass in advocating for evidence-based treatment when you have neither time nor medical expertise on your side.
Full disclosure: Priya is a composite character, an amalgamation of patient experiences and advocacy patterns. But her story—the specific tactics, the emotional arc, the systemic barriers—reflects real dynamics playing out in catheterization labs right now.
You had a heart attack during one of the worst possible times professionally. Walk me through those first hours.
Priya: The timing. God. We were three days from launching a major feature update, and I'm in this pre-deployment meeting feeling like someone parked a truck on my chest. I kept thinking, "This is just stress, I'll take some Tums, we'll hit our release date." My team lead actually drove me to the ER because I was too stubborn to call an ambulance.
The ER moves fast once they see your EKG. Suddenly I'm on a gurney, they're saying "cardiac catheterization," and I'm texting my husband one-handed while they're wheeling me down hallways. The cardiologist—nice guy, very efficient—explains they're going to look at my arteries, see what's blocked, probably put in a stent. He's already walking away when something clicks.
I call out: "Wait. What kind of stent?"
He turns back, a little surprised. "Drug-eluting stent, standard protocol."
"Can we talk about that after you see what you find?"
He pauses. Then nods. "Sure, we'll talk."
That pause, that tiny moment of surprise? I knew I'd just bought myself a conversation.
What made you think to ask that question in that moment?
Priya: Pure project manager instinct. When someone says "standard protocol," my brain immediately goes: Standard for what use case? What are the tradeoffs? Who defined these requirements?
I had maybe fifteen minutes before they sedated me. I'm lying there with my phone, searching "drug-eluting stent vs bare metal emergency." Found this systematic review—one of those papers that compares outcomes across multiple studies.1 I'm skimming abstracts, looking for anything I can actually understand.
And I see it: drug-eluting stents need longer dual antiplatelet therapy. Twelve months of blood thinners versus one month for bare metal.
My dad had a bleeding ulcer on blood thinners two years ago. Nearly died. That's in my chart somewhere, but in an emergency, who's reading family history carefully? I screenshot the paper, text it to my husband with "SHOW THEM THIS IF I CAN'T TALK," and then they're wheeling me in.
So you're preparing to advocate while they're prepping you for the procedure?
Priya: I know how insane that sounds. But I've spent fifteen years managing product releases. You learn to make high-stakes decisions with incomplete information under time pressure. This was just higher stakes than usual.
During the catheterization, I'm conscious but loopy. I can see the monitor, these grainy black-and-white images of my arteries. The doctor's pointing, explaining: "See this? Mid-LAD lesion, about 70% stenosis. We can stent this today."
And I ask—I actually manage to ask through the sedation fog—"Can you use that ultrasound thing? The one that goes inside?"
The cath lab goes quiet.
The doctor looks at me. "You mean IVUS? Intravascular ultrasound?"
"Yeah. That." I'm slurring a bit. "The guidelines say it helps with complex lesions."
Where did you learn about IVUS in fifteen minutes of phone research?
Priya: laughs I didn't! Not really. I saw it mentioned in a table comparing imaging techniques. I had no idea if my lesion was "complex" or if this was even the right question. But I figured worst case, he says no and explains why. Best case, we get better information.
He actually seemed... I don't want to say pleased, but maybe relieved? Like, here's a patient who's trying to engage. He explains that yes, they can do IVUS, it'll add maybe twenty minutes, help them size the stent properly and make sure it's fully expanded.
Then I ask the big one: "If you do that, and the stent looks good, can we talk about which type before you pick?"
Long pause. I can feel the nurses looking at each other.
Finally he says, "That's not how we usually do this, but... okay. Let's see what we find first."
What happened during that conversation after the imaging?
Priya: They pulled me into this recovery bay. Still woozy but functional. My husband's there now, looking terrified. The doctor sits down, and I can tell he's mentally recalculating his afternoon schedule.
He explains: the lesion's significant but not terrible. IVUS showed good vessel size, no heavy calcification. He's recommending a drug-eluting stent, explains the restenosis rates—about 15% with bare metal versus 8% with drug-eluting over two years.2
I ask: "What about bleeding risk with the longer blood thinner course?"
He acknowledges it's real but says for most patients, the restenosis benefit outweighs bleeding risk.
Then I play my card: "My father nearly died from a GI bleed on dual antiplatelet therapy. That genetic predisposition... does that change the calculation?"
He stops. Pulls up my chart. "I didn't know that."
We talk for maybe ten minutes about family history, my personal bleeding risk factors, the fact that I'm relatively young and might need other procedures down the line. He's actually thinking out loud now, not just executing protocol.
"Look, both options are reasonable here. If you're worried about bleeding and willing to accept slightly higher restenosis risk, bare metal is defensible. But if we go that route, I want you on aggressive medical management—high-dose statins, perfect blood pressure control."
That's a significant shift from "standard protocol."
Priya: Right? And what I learned: he wasn't trying to railroad me initially. He was just being efficient. Emergency cases, you develop protocols. But when I demonstrated I could handle a nuanced conversation, he shifted into collaborative mode.
I asked one more question: "If this was your wife, what would you recommend?"
He smiled. I think he appreciated the directness. "Honestly? With your family history and age, I'd probably go bare metal and be religious about the medical therapy. But I'd want a follow-up angiogram in six months to make sure everything looks good."
We went with bare metal. The whole conversation, start to finish, maybe fifteen minutes.
It changed everything.
What was the recovery like? Any regrets about the decision?
Priya: pauses The first month was terrifying, not gonna lie. Every twinge, I'm thinking "Is this restenosis? Did I make the wrong call?" I was checking my blood pressure three times a day, obsessing over my statin dose. Very healthy coping mechanisms.
But six-month follow-up? Clean angiogram. No restenosis, vessel looks great. And I didn't have a single bleeding episode, which—given my dad's history—feels like dodging a bullet.
The doctor actually used my case in a teaching conference. Not by name, but he told me about it. "Patient-initiated shared decision-making in acute setting." I was weirdly proud.
What would you tell someone facing a similar emergency decision?
Priya: You have more time than you think. Even in "emergencies," there's usually a window. After they do the catheterization, before they intervene. That's your moment.
Ask the imaging question. "Can we use IVUS or OCT to get better information?" The 2024 European guidelines actually recommend it for complex lesions.3 You don't need to know if yours qualifies. Just asking shows you're informed.
Frame it as collaboration, not confrontation. I never said "I don't trust your judgment." I said "Can we talk through the options given my specific situation?" Huge difference.
Have one person who can advocate if you can't. My husband had those screenshots, knew the questions to ask. That backup plan gave me confidence.
And maybe most important: bring your family history into the conversation explicitly. They're looking at your arteries, not your chart. You know things about your body they don't.
What about the emotional side? You're describing this very rationally, but you had a heart attack at 44.
Priya: voice softens Yeah. The rational framework is how I cope, honestly. But there were moments in that prep area, phone in hand, where I just... broke. I'm texting my husband about stent types while thinking "I might not see my kids grow up."
The advocacy part—the questions, the research—that gave me something to control when everything felt out of control. I couldn't control my arteries, but I could control whether I asked for better imaging.
And afterwards, the doubt was crushing. Every article I read about drug-eluting stents being superior, I'd spiral. "Did I let my family history fear cloud my judgment?" It took months and that clean six-month angiogram before I could really believe I'd made the right call.
Any final advice for patients facing urgent cardiac decisions?
Priya: Remember that "standard protocol" is optimized for population averages, not your specific situation. You're allowed to ask: "Is this standard because it's best for me, or because it's best for most people?"
And laughs maybe don't try to do medical research while having a heart attack. But if you do, focus on one or two key questions. Mine were: "What imaging can give us better information?" and "How does my family history change the risk-benefit calculation?"
You don't need to become a cardiologist in fifteen minutes. You just need to demonstrate you're a thinking person who wants to understand the tradeoffs.
Most doctors, in my experience, will meet you there.