Craig Wisner

Archive for August, 2014

Strange Rhythms. (Part 2)

Dr. V. skips me passed the admitting areas and straight into the hands of a paramedic for another EKG and processing for a room in Emergency Care.  At this point everything speeds up; people do what they are trained to do and inertia builds.  I’m wheeled to the front of the line, top priority.  Our hospitals don’t know how to go slow; everything is immediately geared towards expecting the worst, doctors and nurses and techs charging full steam ahead.  I soon find myself on a gurney in a room with an IV drip, injections going into my IV line, an unknown injection in my stomach, pills, an oxygen mask, oximeter, and a wiring harness connecting me to monitors.  The rapid, irregular beating of my heart beeping on the monitor is driving me insane.  I’m told I have to try my best to calm down, that my heart rate is too high, that I have to do anything I can to relax.  I tell them to turn off the beeping if they expect me to relax.  They can’t.

My heart rate isn’t responding to drugs, at one point pushing 180 BPM laying prone.  It’s as if my heart is running a sprint.  I’m told in a matter-of-fact way that I can have a heart attack if I have a sustained high rate for too long.  They’re giving me more medications to lower my pulse, hoping to also make it more regular.

Three different doctors come through within the hour, each asking the same questions.  I retell my story over and over.  I’m told that due to the irregular rhythm, blood can pool in the atria and form clots, putting me at a very high risk of passing a blood clot and having a stroke.  Until now, I have never envisioned having a stroke.

I’m utterly powerless, laying there and staring at the clock, vividly aware of the wild sensations in my chest, trying to get myself to stay calm.  They’re making it sound as if I could die any minute and I haven’t even had time to call my wife.  Dr. V.’s words echo somewhere in my mind.  At around midnight a doctor enters with an advanced directive form, asking if I’d like to be resuscitated should my heart fail.  I stare at her blankly, trying to process.  She answers for me, saying I’m young, that she assumes I’d like to be resuscitated.  I say yes.  I’m asked if I’d like to be kept alive via feeding tube should I lose my ability to swallow.  I answer no, but she instructs me that I should check the “let’s temporarily give it a try” box.  I’m baffled to be in this situation given I was eating Thai food with my wife eight hours earlier.  Nothing is making sense.

That feeling of resignation I experienced as a teenager begins to take hold.  I start thinking that I should unhook myself from these machines and just go sit outside.  The smells, the sounds, the lighting; I hate this place.  I understand that one of the greatest fears all of us civilized humans share is dying in a hospital…and yet that fear is based on reality as that is how most of us will die.  I want to tell them to let me go outside and get some fresh air, to just unhook me.  If I am to die, I’d almost rather it be out on Sunset Blvd. under the stars instead of under these fluorescent lights surrounded by strangers doing their respective jobs on me.  “You’re so young…” the nurses keep telling me.

Medications taking effect, things finally begin to slow down.  I’m left alone longer, the blood tests slowly become less frequent.  Troponin I is a protein released if the heart is in failure; I was being tested every 15 minutes for it.  I’m afraid to call Lusi but eventually find the down time to do so; I lose it when she picks up the phone, I swallow back tears trying to explain the situation in a rational and collected way as my throat keeps seizing.  I want nothing more than to be with her and the kids.  Then I could get through this.

Sometime in the middle of the night I’m transferred to a new room for a longer stay.  A crash cart and heart monitor ride at the foot of the gurney; I catch a few concerned glances as I’m being wheeled down the hall and my heartbeat is audibly wild, heard beeping through the machine.  Yet everything appears relatively stable now.  I do not show any of the protein markers for heart failure.  The problem begins to present itself, slowly becoming more clear to the doctors as they piece my symptoms and tests together.  Paroxysmal Atrial Fibrillation with no underlying disease.  They order an echocardiogram to see if there are any physical abnormalities.  The night becomes a blur of medications and blood drawings, my heart monitor alarm going off every time I shift my body in the bed.  And the waiting.   I’m terrified that the scan will reveal some terrible gift from my ancestors; a faulty valve, a heart enlargement, some unexpected deformity.

The nurses are afraid I’m losing it, sitting in the room with the lights off, no TV, door closed.  Admittedly, I don’t deal with illness well, retreating into a depression.  They want to cheer me up, coming in every 15 minutes asking if I want to watch something, do something.  Fluorescent lights and bad television are not the answer though.  Lusi arrives early the next day; having her at the bedside immediately makes this more bearable.  Again, I am choked up, confused, emotional. She’s in the room and listens to my heart valves during the echocardiogram, a high pitched swishing coupled with an abstract image pulsing on the screen in black and white.

I’m eventually cleared to go home, heart rate wild and erratic but deemed stable enough for discharge.  I’m given prescriptions and instructions.   I’m assured that I will not drop dead, though I’m reminded that I’m at high risk for stroke while in this unnatural rhythm.  I’m told to rest, to take the week off of work.  I ride home with my head out the window, savoring air and natural light, optimistic that whatever happens next, at least it will happen outside of that hospital.  I get home, eat, and sleep for 16 hours.

I’m afraid of my heart and its strange rhythm.  I squirm on the couch, taking repeated deep breathes, hoping to somehow calm it down.  I’m winded by light exertion, my heart immediately jumping into fits of hard beats, premature ventricular contractions.  I play video games with my son, just as I played games with my father when he was ill.  After fives or six days of movies and laying around the house, I feel well enough to return to work, light headed from medications, yet determined to try and act normal.  Again, the resignation sets in.  Being scared becomes too tiring.  I try to forget, to ignore the strange beats drumming from my chest as I’m teaching.  My students are very supportive, coming forward to volunteer and keep me from doing anything strenuous.  Some ask what it feels like.  I describe it as a fish out of water flopping around in my chest.  A student suggests that perhaps the problem is that I have a goldfish instead of a heart.  I hadn’t considered it.  “How’s the old goldfish today, Wisner?” becomes the norm.  This is why I like teenagers.

Ten days later I have my first appointment with a new cardiologist and my options are presented, most involving a life on medications, all of which will have their own range of mild to serious lifestyle-altering side effects.  I am informed that in the majority of cases this condition only gets worse with time.  The fact that I have been in sustained AFib for 10 days is already a bad omen, making it less likely I will come out of it naturally.  If I’m in the rhythm much longer, the diagnosis changes to “chronic” and treatment options change.  The cardiologist eventually informs me about catheter ablation, a process in which wires and a camera will be fed into my heart through the femoral vein, pierce the septum between the atria, and get guided into the left atrium.  They will detect and burn out the bad electrical signals originating from around the pulmonary veins in my left atrium, the cause of the fibrillation. The risks are relatively low, though serious, such as stroke or nerve damage or bleeding, but estimated at less than 4% on the whole.  However, it is believed I have a 60-70% chance that this procedure will end the problem for good.  The longer the condition is left untreated, the more permanent it typically becomes, thus limiting treatment options, as the heart begins to actually make the bad electrical pathways permanent.  The cardiologist flat-out says if he were in my position, at my age and health, he’d choose the ablation procedure.  Sitting there with my heart beating wildly, I immediately agree.  Anything to make it go away.  In my naivete I was hoping I’d be scheduled for the next day and I’d be on my merry way.  Not so.  Instead I was informed it would take over two months, with many tests, procedures, and medications to be used along the way.  I’m now scheduled for September 5th.

I was cleared for “light” exercise, assured that despite how weird I feel, I wouldn’t drop dead, that my problem is electrical.  I was encouraged to listen to my body and take it easy.  Which I of course interpreted to mean I could go surfing.    Nearly two weeks without much activity, let alone being in the ocean, I’m ecstatic to get out.  The following morning I paddle out alone at 5:30 AM, rhythm still irregular, thankful the waves are relatively small.  Getting outside the breakers leaves me winded, my heart rate high, and I’m not sure if this is going to work.  But being back in the water alone is sheer ecstasy, washing away so much of the stress and fear almost immediately.  I catch a few small waves, simply enjoying the morning.  John soon meets me there and somewhere during the joy of riding waves and tumbling underwater I forget about my heart.  I’m just surfing, everything else has vanished.  I try to scare John a few times, stiffening and falling off waves while clutching my chest in agony.  Despite the comedy, I’m certainly more at ease out there knowing that he was an ocean lifeguard; I’d bet on John more than anyone else I know to haul a limp body out of the ocean.  About 45 minutes into our morning I’m greeted by a dolphin pod.  Dolphins always cheer me up, the closer, the better, and I take this as a gift, a fleeting moment that sparks an immediate appreciation for being part of this world.   One comes straight at me in a wave as I paddle out, another swimming beside me.  I wonder if they can hear or feel my heart, if their echolocation clicks are penetrating my chest, if they feel my weird electricity.

I feel surprisingly good and take my pulse when I get out of the water.  My heart rate has converted back to a regular rhythm, the first time in over 12 days.  It feels so good to feel normal.  That I have been cured by dolphins is the only rational explanation I will accept.

With the exception of a few flutters and spells lasting only seconds, I’ve been in a normal rhythm ever since.

I get to go back to life and pretend everything is fine- until I find myself alone in quiet spaces and the silence amplifies my thoughts.  I cannot help but imagine a thousand different lives, a thousand outcomes, a thousand deaths.


Strange Rhythms. (Part 1)

Strange rhythms and palpitations.  Lying in the darkness feeling like a fish was flopping around inside my chest, I was at times convinced I was going to die, cold fear and anxiety washing over me in floods.  The episodes were typically short lived, though eternal in my mind, but I was able to endure them and eventually fall asleep or forget.  Though it happened as far back as my late teenage years, I don’t know why I never went to a doctor.  It’s strange the sort of denial we foster about our bodies and our fears.  Perhaps that denial is simply the dread of having those fears affirmed by a professional, being told that we are in fact sick, as opposed to pretending it might be something else.  Until that confirmation, we can shrug off strange sensations and pains and call them stress or anxiety or not enough rest.  I have dealt with the heart episodes long enough that I actually grew so tired of being afraid that I simply accepted whatever was to come.  I specifically remember a night in which I lay in bed, heart racing and sputtering, resolved that if I was going to die then I would die, but I was not going to be afraid anymore.  In this resignation I was free, temporarily, from the panic surrounding the sensations I would feel.  In letting go there is peace, coupled with avoidance.

I was told my father spent an entire night suffering while sitting upright in a dark living room, fighting chest pain and heart failure, refusing to go to a hospital.  I have to wonder if the motivations for his stubbornness were the same as mine, if he too resigned himself to possibly die right there on the spot rather than face questions and hospitals and confirmations that yes, Mr. Wisner, you are very sick.  At least in uncertainty we can lie to ourselves.

His death from heart failure when I was eighteen years old has caused me to forge a complicated relationship with my heart.  I imagine that a normal person doesn’t think about their heart very much, as it should be.  The silent engine, faithfully pounding away, governed on its own accord; there is nothing to think about.  A healthy person has no reason to fear it will simply stop, that there will be some great and sudden malfunction, a misfiring of electricity or a muscle starved of oxygen and withering.  My heart has been a constant source of anxiety, but especially since his death; I had become convinced that besides some books and a watch, my father left me a defective heart.  I am possessed by a hyper-awareness of what my heart is doing; the rate, the strength of each beat, every twitch and ache, the pulsing in my temples most often being the last thing I think about before drifting to sleep.

I have managed to silently cope with all the strange behavior of my heart, having developed a dubious assortment of my own strategies to try and mitigate the physical sensations and the anxiety they produce.  Breathing, meditation, imagery.  Or when those failed, simply squirming on the couch with nervousness while watching a movie with my wife, trying not to let on how uncomfortable I was. I became very good at calling the fits of strange beats “anxiety”.  2004 finally found me at the doctor’s office reporting my experiences.  I was given an EKG, which came out normal, followed by a pat on the back, and assurances that somebody so young and healthy wouldn’t be having heart issues.  But I knew the results before they even did the test.  I knew they wouldn’t find anything as I felt the sensations stop about thirty minutes before arriving.  Yet I chose to believe them, because I desperately wanted to.  I was told to see someone about managing anxiety and stress.  I did.  I was given my choice of 3 or 4 different prescriptions to help and I passed.

On a Friday evening at the end of May of this year I had a particularly bad episode, preceded by a week of more frequent episodes than normal.  In addition to the rate being very high and erratic, there was a sensation of pressure I had never experienced, a tightness extending up into my throat. My heart was working far harder than it ever had before.  I tried to ignore it but couldn’t; I found myself out of breath and getting slightly dizzy while trying to work.  I went to the bedroom to relax and close my eyes, attempting to counter it with calm, but lying in the dark stillness only heightened my awareness of everything my heart was doing, causing even more panic.  I got in the shower and started breathing exercises, doing all I could to will everything back under my control.

But I am not in control of my heart.

After three hours I decided that now was likely the best opportunity yet to get to the doctor and have them catch it.  Suddenly my thinking shifts from wanting it to stop to hoping that it won’t, hoping the sensations last until I get get to a doctor and an EKG.  It is a strange thing to want a problem to continue.

Events quickly turned disorienting in urgent care, a feeling of detachment and distance taking over, as if I were watching the events from somewhere up above, spectating an episode in my own life.  Dr. V., a thin, long haired Indian man with wire rimmed glasses and strange calm about him called me into his office after the nurse finished my EKG and I returned from giving blood at the lab.

“My friend, you are in atrial fibrillation, and you have a potentially serious heart condition.  Are you in pain, having any shortness of breath?”

I remember a ringing in my ears as I began to process what he was saying.  On his desk sat a small Chinatown gift shop Buddha and I was suddenly intensely aware of the temperature of the light in the room.

“So this has nothing to do with anxiety or stress?”

“No, not at all.  This is a physical problem with your heart.”

My stomach sank.  Twenty years of lying to myself was instantly dispelled.

“We do not know what causes this.  There’s a lot of speculation, but nobody really knows.  Is there heart disease in your family?”

I explain about my father, both of my grandfathers.  All male blood relatives except one have died of heart disease of one form or another, most when relatively young.

“What ethnicity is your family?”

“German and Danish, primarily.”

“Ah.  Germans have bad hearts.  Unfortunately, we cannot control what is in our genes.  What is written in them determines far more than we know.”

My head spins as I try and comprehend where he’s going with this.   I’m almost angry, wanting to challenge him and ask what the hell he’s trying to say, but I can see in his eyes and his calm that he actually speaks with care.

“I’m immediately checking you into Emergency Care and personally escorting you there.”

I’m overwhelmed by the feeling that this is not supposed to be happening and I realize that nothing is supposed to happen, that this feeling is me not wanting this to happen.  I’m confused by the fact that I was fine this morning and now I’m sitting here, with this.

He gets a wheelchair and we’re soon out in the night air, crossing the street and down a back alley to the Emergency entrance, the sounds of Hollywood and traffic filling the night.  It’s a long walk, or feels long, and we talk, the conversation helping ease my anxiety.  Until he informs me that medicine is like art, that he has seen people walk in the doors on their own and die within hours due to poor decisions made by doctors.

I’m not sure if this man is the Reaper or some sort of monk-like Savior, but I know that I have no choice but to go with him.

Leonardo da Vinci, from his sketchbook.

Leonardo da Vinci, from his sketchbook.