The things we love and kill

Almost exactly a year ago I had what is often referred to as a ‘Come to Jesus’ moment by Naval Aviators. Actually, it occurred on 5 November of 2017, a date that will remain as indelibly fresh in my recollections as the day I first got laid.

I was away on a self-imposed writer’s sabbatical along the shores of South Coastal Oregon, perched up on a hillside in a solitary cabin almost custom made for either a literary hermit or a seeker after serene isolation. It was there, tappety-tapping grandly away on a long-anticipated first fiction novel, that my life suddenly changed rather unexpectedly.

The setting viewable through the large front window of this modest cabin was breathtakingly spectacular, the vantage giving no hint of how suddenly things would quickly change in a life that theretofore had been pretty consistently predictable. Out on the pale gray horizon, a thick blanket of fog was forming a scenic backdrop for several strings of pelicans that were skimming the steel gray waters just above the wavetops. The sun had long since disappeared from sight, swallowed up entirely by the thick Pacific mists. It had all the earmarks of a typical Pacific winter day and I was plumbing the depths of my limited creative abilities to craft my novel, a historical romance based in the last bitter stages of the Second World War that admixed desperate human emotions with mechanical passions in a compote of strangely conflicting elements involving the coital attraction between a German pilot and a Japanese woman.

I had completed about 30K of what I anticipated to be a novel of some 130K total words and I recall being perfectly inserted into that difficult-to-retain creative moment wherein thoughts flow from the mind onto paper like honeyed mead down a thirsty throat at a Viking wedding. I was definitely ‘in the moment’.

And suddenly…my brain switched abruptly out of the mind-set I had so assiduously cultivated after rising that morning and plunged back down through all the varying levels of my consciousness to the pure reality of my physicality in the span of a few moments.

I was more bemused than perplexed to reflect on the fact that I felt a bit, well…odd. It was hard to put a finer edge on the feeling than that as I thought about it, but despite rummaging through all my varied recollections and experiences, there was no real equivalent to how I felt that I could put my finger on. I just felt ‘slightly odd’.

Prompted by the strange incongruity of this feeling and how totally out of synch it was with both the setting and with my peak creative resolve, I decided to make the short trip into town and visit the local ER. Perhaps they could find out exactly what was going on? It wasn’t as if I was having any chest pain or other painful physical sensations.

It had just started to drizzle outside as I walked in the door. Rain. Perfect! What artist worth his empty stomach’s growling protests doesn’t value rain as a creative tool to plumb for useful mood setting manipulations?

A short time later, I was lying on my back on a gurney in the town’s hospital ER, listening carefully to what the ER people were saying as they hooked up the EKG leads and ran a routine 12-lead on me. My mood had changed appreciably, I can assure you.

The intense look of the ER doc, a good-looking young fellow in green scrubs with a full chestnut colored beard, spoke volumes as he scanned the EKG print-out.

Turning to me, he announced in an unexpectedly bon homme manner, “Well, I’d say you have a sustained run of SVT.”

For the uninitiated, SVT translates to ‘Supra Ventricular Tachycardia’, an atrial heart arrythmia that results in a higher than normal resting pulse, in my case (so I was told) a rate of about 166. Considering that an erstwhile normal resting heart rate lies somewhere in the 60’s range (depending on age, fitness and a whole host of other factors), that was a most unsettling finding for someone like me, who up until my trip to Oregon had been running three miles daily before breakfast and working out regularly at the local Family Fitness gym. Especially for a person with my professional background as an invasive cardiovascular perfusionist (in heart surgery suites) who had been a religiously dedicated runner for over 40 years.

Being by nature a profoundly pessimistic person, prone to thoughts of disaster at the least of provocations, this totally unexpected news instantly smothered me with a bleak blanket of gloom not unlike the thick fog bank that had been bearing down on my oceanside aerie just an hour earlier.

As always, this particular ER, with its pastel green clinical walls, felt as hospitable as a cold, clammy cavern (why is it that all ERs are as cold as a tomb?). I was shivering at that point, more likely as a result of the growing adverse possibilities that flooded my well-informed imagination than from the actual ambient air temp (which was actually likely in the ‘comfortable’ range).

In actual fact, I know from my own experiences on ‘the other side of the bed rail’ in many ERs of the past that ambient clinical temps are kept on the lower side of ‘normal’ to help keep the staff, who are usually hurriedly running around and burning up copious quantities of adrenalin, from succumbing to accumulations of mild heat fatigue. The unfortunate patients usually suffer (albeit mildly) from the result of that policy, although to the great credit of many well-thought-out ERs, this one did have a blanket warmer stocked with thick toasty linen covers to help compensate for the chill.

After a few minutes of further study, my ER doc called his team over to me and held a brief conversation. Finally, he decided on an approach and told me that they needed to cardiovert me back from SVT to Normal Sinus Rhythm (AKA ‘NSR’). The first step in this would be to encourage me to perform what we call vaso-vagal damping maneuvers; this consists of having a patient bear-down, as if taking a dump (pilots use this same technique to counteract the effects of high-G during aerobatic maneuvers). In some cases, depending on how long the SVT has been running, this stops the SVT. When it doesn’t, the next step would involve chemically challenging the patient’s system with an injectable drug called Adenosine. [In my case, the vagal procedure did not have any effect.]

Since the first thing any ER does on admission is hook up an IV of either saline or D5W, a bolus (small quantity) of short-acting Adenosine would be injected into my IV and this would (in theory) immediately reverse the runaway rhythm. Or so the theory (and practice) has it. Adenosine works, so they will tell you, by fractionally disrupting what is called the AV-(atrioventricular) node conduction pathway. What they usually don’t tell you is that what Adenosine actually does is ‘kill you’ for the brief span of a half second or so. Yes, I said ‘kill’. Think of it as a sort of medically therapeutic execution by fatal injection. Gulp!

That is, for the duration of its half-life (about 0.5 seconds), Adenosine stops your heart utterly in its tracks. Immediately afterwards, the heart resumes (it is hoped) a normal sinus rhythm once again.

Well folks, I can tell you that despite all my many years of work with cardiovascular patients in heart surgery suites, I have never had any personal experience with the drugs and tools we routinely used to treat our patients! I can also tell you that experiencing the effects of Adenosine were therefore quite startlingly unsettling!

The first bolus of Adenosine was injected and immediately I began to feel myself dying (or what I imagined to be dying), as the warmth instantly drained from my arms & legs and I could quite literally feel the sudden absence of cardiovascular circulation that results when your hearts ceases to beat. To say it was both weird and unsetting is a gross understatement, to say the least! Even a half-second of that sort of sensation is too long!

However, that first bolus of Adenosine, other than making me literally feel as if I were dying, had absolutely no effect on my rapid heart rate.

Thus, a second, slightly increased dosage was used. Same unhappy sensations of pending death, still no cardiac response! By this time the doc and his people were all scratching their heads and muttering to themselves. I was long past being seriously worried!

A third bolus with even a greater dosage was tried; still no discernible effect.

Finally, and he shared this most disconcerting information with me (probably because I had revealed my past professional work to him earlier) in the same bon homme manner already described, he quadrupled the usual Adenosine dose. “We’ve never had to do this to anyone before”, he assured me. Gulp again! An instant flash of my name being (posthumously) entered into the Guinness Book of World Records for being least affected by a heart-stopping drug registered in me!

There was again, no discernible effect, as I ‘died’ yet again for a 4th time. By this time I was getting righteously nervous about teasing death in this medically approved manner.

There was no disguising his puzzlement over the fact that I was seemingly so resistant to the ‘usual’ tricks and turns of standard cardiovascular procedure for reversing dangerous arrythmias and I can candidly admit that this fact did nothing to improve my anxieties at all! [Sometimes, a little knowledge is worse than absolute ignorance; this experience was an example of that in spades!]

At last, with a nod towards the electrical (DC current, the first defibrillators used up until the 60s were AC!) zapper lurking over near their crash-cart, he prepared a small bolus of the well-known opioid analgesic Fentanyl (think of any number of celebrity deaths from use of Fentanyl as a recreational drug) and informed me that they’d have to zap me out of my arrhythmia; before doing so, he would first shoot me up with a small amount of the above drug so as to alleviate some of the intense discomfort of having 50 Joules of electrical current doing a lightning-like Bavarian Schuhplattler dance with the conduction pathways of my heart.

You see, in the heart surgery suite, most of the time when rhythms go awry, you’re dealing with aberrant ventricular arrhythmias, in which the heart’s primary pumping chambers (the ventricles) sudden cease operation. This quickly (in the span of a few seconds in most cases) results in the patient becoming unconscious, so that when he is defibrillated, he’s completely insensate and unfeeling of the actual discomfort of the current. Of course, a zap like that quickly results in the patient coming ‘back’ rather suddenly and believe me, all those simulated cardiac emergencies you’ve so often seen on television’s medical soap operas (where the patient bucks and jerks) aren’t all that far from the actual reality.

In my case, I was very much aware and conscious, so he gave me the Fentanyl to help partially counteract the discomfort of such a procedure.

After the de rigueur ‘CLEAR!’ warning (an announcement to all ER personnel present to step away from the patient to prevent unintended collateral zaps), he positioned the electrodes and ‘WHAM!’…I suddenly sat bolt upright on the gurney and declaimed an impassioned ‘S*H*I*T!...admittedly a most unprofessional (but thoroughly understandable) response to a very unpleasant experience!

Much to my great relief, the desired effect had been achieved and I was back in NSR once again. Very shortly thereafter I was also being pushed on my way up to a hospital room for what turned out to be 5 days of wary post-procedural observation.

One of the very first things that followed, was that I was put on a medication called Metaprolol Tartrate, which is in the class of cardiac drugs known as Beta-Blockers. These are anti-hypertensives (blood pressure) and are useful for helping block the effects of adrenaline. Metaprolol is more commonly known to the public by the trade name Lopressor and it is often employed in geriatric heart-failure therapy.

Somewhat later, after returning home to Suckatomato and following this incident up with my Kaiser Permanente docs, I was switched to a time-release version of the drug (known as Metaprolol Succinate) that is taken once a day.

Meanwhile, back in the hospital, I spent the next 5 days hooked up to vital signs monitors while everyone kept a watch out for any other untoward signs of strange cardiac monkey business. Since everyone by now knew they were dealing with what we call a ‘trained patient’ (i.e. someone who is either in the medical biz professionally, or who possesses specialized knowledge of medicine), I received extra-special care. Only once did I seem to have experienced an inexplicable 2AM run of about 36 beats of ventricular tachycardia; otherwise, everything seemed to be fine (within normal limits), excluding what we call ‘diverse morphology ectopics’.

As a light sleeper, however, and still not fully recovered from a case of the nerves, imagining all the worst that could happen (given the utterly unexpected nature of this strange incident), I had inordinate difficulty sleeping and the constant beep-beep-beep of the heart monitor throughout the night didn’t help a whit!

My cardiologist was a rather florid and expansive fellow who, when he learned that I was a published author (and fellow medical person), visited several times a day and we had quite a few engaging conversations on all sorts of things, philosophical and esoteric. It helped keep me amused (by diverting my mind from my situation) and looking back on the range of our intellectual excursions, I’m sure he enjoyed our engagements almost as much as did I.

Of course, being a patient is never any fun whatsoever, especially so when you are hooked up to IVs, EKGs and all the usual modalities employed to keep tabs on cardiac patients. Even getting up to use the bathroom was complicated, since it required an attendant to manage all the accoutrements.

Meanwhile, that timeless admonishment of mothers everywhere to their teens to ‘wear clean underwear, since you never know when you’ll end up in a hospital’ turned out to be absolutely true! The pair of tighty-whities I had been wearing were about a week from their last wash when I went in (hey, I’m an artist…right?!) and by the end of the 5 day observation period, they were ready to crawl off towards a washing machine on their own! [Never question a mother’s wisdom in such matters…even 50 years after puberty!]

By the time 5 days had passed, I was released and told to be sure to follow up my situation with a Kaiser cardiologist, back home. It was also suggested (strongly) that I avoid caffeine and alcohol (among other things), since Metaprolol can interact adversely with those substances (and further, that alcohol itself has been known to increase risk of developing unhealthy arrythmias and therefore should be even more strenuously avoided). [Big shock for me, since I have for most of my life equally enjoyed both strong coffee and a glass of medium-bodied red wine at dinnertime].

Back at my idyllic seaside cabin, I ruefully and not unreluctantly faced the music (it sounded at that moment to my imaginative brain like Mozart’s Requiem), gathered up my things, packed away my laptop (with its 30K words reached thus far) and drove back home via the steep but incredibly beautiful stretches of Highway 101 that hug the cliffs and seacoast of the south Oregon and northern California headlands. It was somewhat of a sad as well as scary journey, by my reckoning, since it marked a transition from my formerly carefree habits to one almost approximating that of a monk. Yuk! (It also had me wondering if something might happen just as I was rounding a particularly tight hairpin curve, perched several thousand feet above all that cold Pacific water!) But I’ve never been a particular brave person, admittedly.

The whole thing was definitely and unquestionably a memorable shock for a person like me, who, having regarded myself still as a healthy (if perhaps a bit long in the tooth) teenager (wrapped up in the skin of an old man), had difficulty coping with this erstwhile ‘reality check’ that arrived completely out of the blue. No more coffee? No more yummy red wine? Whaaaaat?!

All this occurred almost exactly a year ago and since that time I have not done much bicycling, running or body work at the local gym, although I do eat sparingly and try to stay as reasonably trim as I possibly can. Not a day passes that I don’t berate myself for not running half-marathons or continuing to do bicycle centuries. After all, these are habits of a life-time, suddenly and irrevocably dashed to the icy and seaweed-strewn shoals of reality.

All considered, it has indeed been a ‘Come to Jesus’ moment and it very unpleasantly and inignorably reminds me that I am definitely on the downhill slope of the mountain, despite furiously rejecting the fact that I probably have less than 10 years left to live (all other things being equal, of course) after 70 years of healthy, reasonably trouble-free life.

As for the novel, it remains still untouched since November of 2017, at 30K words. I have also refrained from ever before attempting to recount all of these experiences and summarising them on paper as I have here. It’s almost as if the act of trying to put it all down on paper irrationally risks daring the Gods to strike me again with a similar virtual lightning bolt, and I have (unconsciously) been sooo reluctant to do so heretofore for this reason among many.

I haven’t even told my closest friends (with one or two exceptions) about this, since somehow revealing my very mortally naked ‘humanness’ like this seems like a violation of my long-standing Superman self-image.

Now, however, it would appear finally time to reveal it all and accept my mortality with reasonably good grace. I suppose it’s useful as an exercise in writing, but as the Stoic philosopher Seneca the Younger was so well aware, we must all be prepared to meet our mortal end with as much gracefulness and dignity as possible. Life is merely a ‘gift’ that each must do the best we can with in the short time available.

As for the title of this blog installment, it has nothing at all to do with the chosen topic under discussion here, other than to make note of it as a seemingly great title for a poem that remains yet unwritten.

‘The Things We Love and Kill.’ I can’t wait to set the hounds of my poetic urges loose on that rich phrase!

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Postscript: The original 5 Nov 17 diagnosis of Supra Ventricular Tachycardia turned out to be slightly incorrect. A subsequent reading of the 5 Nov 17 data yielded the opinion that what I had experienced was actually Atrial Flutter. A cardiac stress test undertaken half a year after the event revealed nothing out of the ordinary (i.e. ‘normal’, except for occasional ectopic beats) and I remain wine-less, coffee-less and very much discontented about both of those major changes in the quality of my life! Waaaaah! I wanna crawl back in the womb! (Any volunteers out there?).