A LITTLE HEART RHYTHM THING
"The truth is, the fastest way to get heart disease... is to be screened for it."
- H. Gilbert Welch, The New York Times, Feb. 2011
I gritted my teeth while an emergency room nurse worked to shove an IV needle, comparable in circumference to a garden hose, into a vein along the underbelly of my arm. He forced it right through my soft skin, and rammed it through flesh and muscle and blood vessel walls. I clenched everything—eyes, muscles, fists. I bore down, trying not to cry. The nurse stopped, gave me a short break, then resumed.
"You have deep veins," he said, looking at me, apology implicit in the creases on his forehead.
The ceaseless bleating and buzzing of the heart monitor and the whooshing and hissing of the oxygen as it passed through the thin, clear tubing added to the confusion and pain. The tubes that were draped over my ears curved in front of my face and released pure oxygen directly into my nostrils. My clothes were balled up on the floor next to the gurney. Two nurses and one doctor focused their attention entirely on me. It was as if they were swinging hammers, and I looked a lot like a nail.
They asked me same questions every few minutes. "How's the pain now? Still there? On a scale of one to ten, how would you rate it?" Nurses stood, pens hovering above clipboards, anxiously wanting to write down my answers—to chart the curvature of this event—to identify risk factors. They were ready to rule something out.
I could not answer the question. How did these abstract numbers relate to the pain in my chest? What did a ten feel like? I didn't know, so how could I call this a five? Or a seven? Nothing compared to having that IV needle jammed through my flesh, which might have been an eleven. I consistently answered three, but threw in an occasional four to make it seem like I was good at this, like I was taking it seriously.
Ninety minutes earlier, I had been in my doctor's office. I was only there to get a referral to the chiropractor. My back needed a good cracking, and my insurance company demanded her signature on a form. I had described the back pain, and she had approved the referral. We were done when I said, "Oh, by the way, since I'm here, I should tell you about this weird pain I've been having in my chest for about the last ten days."
She ordered an EKG and a chest X-ray —just to rule out anything cardiac-related. "I'll be flabbergasted," she said, "if you have a heart problem." She scribbled the order with a pen and signed the bottom.
I reported to the hospital, had the tests, and was leaving the radiology department when the EKG tech met me at the door. "I faxed your results to your doctor," she said. She put her hand on my arm and subtly started guiding me forward. "She wants you to go to the emergency room."
"No, you don't understand," I said. She walked with me, herding me. "I just needed a referral to the chiropractor, and..." My voice trailed off, as I realized she wasn't hearing me. She nodded politely and kept us both moving forward.
I was a healthy person when I mentioned chest pain to my doctor in that "oh, by the way" tone. I was still healthy, and knew it, when I entered the hospital. Within thirty minutes and two quick tests, my status as a healthy person changed. The medical system would spend the next couple of days convincing me that I was terribly sick and the next four months trying to determine just how sick. If I had known what was coming as the nurse guided me through the double doors of the emergency room, I would have turned and ran.
But I was a good patient. I wanted to be cooperative. If there was a grade to get, I wanted an A. I did as I was told and lay down on the gurney. I took off my clothes and put on the hospital johnny with its embarrassing gap in the rear.
Showing up in the emergency room with a heart rate of 42, an erratic-looking EKG, and chest pain was a fast ticket to everyone's attention. The ER staff swarmed around me like bees, hooking up monitors, asking me questions, gathering emergency contact information. I learned a dictionary's worth of new vocabulary words. PVC. That's an odd beat of the heart that comes from the wrong place. Bigeminy. That's what they called the particular rhythm that my heart was in. One normal beat, one PVC beat, normal, PVC, normal, PVC. The lines on paper looked like the teeth of a ripsaw blade. Bradycardia. That's what they call an abnormally slow heart rate. Pacemaker. That's a word that entered the scene much too quickly.
I called my partner, Kara, at work. They pulled her out of her classroom to take the call. She came to the phone, breathless. I told her that it might be a good idea for her to leave her students with another teacher for the afternoon, but not to freak out. I was fine. This was the same vague pain I had mentioned to her countless times over the past week and a half. Nothing had changed except the setting. Still determined to turn out healthy in the end, I was sure this was nothing. An overreaction. I would be out of the hospital in a matter of an hour, maybe two.
I hung up and waited, listening to the beeping and pulsing and alarming blaring of the monitor. There were rectangular, adhesive pads stuck to at least seven different places across my chest and belly. Wires snapped onto each pad and ran the data to the monitor. Where it was mounted on the wall, over my head, the monitor knew this pattern wasn't right. It was doing the equivalent of jumping up and down trying to get someone's attention. It flashed little Valentine-shaped symbols and dire acronyms in red. I started to doubt that I would leave the hospital as quickly as I had hoped.
I overheard the doctor out in the hall. "How's my bigeminy in bed four?"
Someone answered. "Her rhythms are all over the place."
I heard the flipping of paper on a clipboard—the scratching of a pen. One asked the other, "Have you had lunch?" Footsteps receded—supportive-soled shoes against smooth tile flooring.
The nurses were still with me, and they focused, at various moments, on my feet. "Press against my hands. Good. Now pull this way. Good. Can you feel this? Good." Their hands pushed and probed against the soles and tops of my feet. Someone's fingers urgently applied pressure against a vein in my foot, checking my pulse. "Have you had any swelling in your ankles recently? No? Good. Your legs? No? Good."
A nurse stood by my bed, adjusting something on the monitor. He shared his opinion. "You'll probably have to have a pacemaker." Seeing my eyes widen at the suggestion, he added, "You're young. You have young kids." He placed a hand on my shoulder—checked to see if I was cool or clammy. "You have a lot to live for."
Thoughts of dying tried to elbow their way into my brain as I considered all that I had to live for. I closed my eyes, pretending to rest so the nurse would go away.
Pacemaker. That word, and all its associated imagery, was to become the theme of my life over the coming months. I was to become an expert in all things pacemaker-related. It's the thing you're not supposed to have in fast food restaurants or airports or anywhere near a microwave. It's the thing your cardiologist (once you have one of your very own) will adjust from time to time with a wireless remote control. It's a high-tech replacement for something that should be a bottom-line requirement for every heart—the natural urge to keep beating.
A young doctor, who was introduced to me as a hospitalist, asked me, "Do you ever feel dizzy?" He seemed to have assumed control of my case.
"I do," I answered. "but I have a little bit of a blood sugar thing sometimes." And that was the truth. At times, when this dizziness set it, I could usually chase it away with a banana or a glass of juice.
"Well," he said with a weirdly wry little smile and a chuckle, "I think you actually have a little heart rhythm thing."
The swarm of ER staff eventually dispersed. When it became clear that I wasn't in any immediate danger, they disappeared, and the waiting began. Over the months to come I would make several such visits to the emergency room, and they would all be like this: a flurry of immediate attention, then a long, anxiety-filled wait. There is nothing in the world that can make a healthy person feel sick any faster than time spent alone on a gurney, listening to a heart monitor. In that first, three-hour ER visit, I became a heart patient. One nurse, as he checked on me, asked if I was hungry, and I said that I was. He brought me a tuna sandwich on wheat from the cafeteria. I accepted it with gratitude disproportionate to the situation, took it as proof that I wasn't dying. If my demise was eminent, I reasoned, they wouldn't bother to feed me.
Just the day before, during a long drive, I had heard poet Dean Young talking about his heart transplant on the radio. He talked about the years of living with a dying heart, and how a thing like that gets into your art. By the time he got the call that a donor was available, his heart was moving only eight percent of the necessary blood volume. He talked about the punishing recovery, and read some poetry. It was about hearts. I had spent miles of that long drive thinking about the dying heart of the poet, removed with saws and blades. "The way to a man's heart," it is said, "is through his sternum." And there in that ER, beneath my own sternum, my own poet's heart was trying to tell these doctors something. Even though they spoke its language, they didn't know what it was trying to say. They were code breakers, and these things take time. "Soon," they told me, hands on my feet, "we'll have some answers." In the end, it would turn out that they didn't speak its language at all. My heart, and I have always known this about myself, doesn't work the normal way. It moves blood around my body, yes, but it does this (as it does all things, such as loving and longing and aching) on its own terms. Our hearts are all different. Now, when I think about Dean Young and his new heart, I wonder if he loves or yearns differently than he used to.
At some point, my own doctor called me on the phone. She didn't sound as flabbergasted as she had predicted during that morning's routine appointment. I found out months later that she had heard the bad rhythm right there in her office and knew full well I wasn't coming out of that EKG easily. I asked her, "Am I headed for a pacemaker?"
A pause. I could hear the busyness of her office—her daily medical practice—in the background. Phones, people, the clattering of clipboards. "You should prepare for that."
. From my gurney in the emergency room, I googled "pacemaker" on my laptop. (Yes. I brought my laptop to the emergency room. I had deadlines.) The images that popped up were of a small box superimposed onto the torso near the heart. In these illustrations, the rest of the body was faded to translucent pinks and reds. The head and shoulders and arms were generic shapes, provided only to orient us. The heart itself and the pacemaker were in full color. Little wires curved out of the box and neatly touched the blue and red chambers and vessels of the heart. Somehow, I was to assume, they attached there and sent impulses to this critical ball of muscle and space. I imagined my heart being gifted with its own brain. Why couldn't the brain I already had handle the job on its own? Who was dropping the ball in there? I closed the laptop and laid back in the bed. I closed my eyes and put a hand over my heart. I could feel the irregularity, as I had for years. BOOM, beat, beat, pause...BOOM, beat, beat, pause...BOOM. If my heart ceded control to this box that needed batteries, what else might be lost? Compassion? Spirit? That emptiness that can only be filled with words?
When the time came for my transfer to the critical care unit, the doctor piled my balled-up clothes, my shoes, and my purse on top of me. He nestled the still-beeping monitor into the blankets by my feet, and wheeled my bed out of the ER. We hung a right, passed through the double doors, and entered the rest of the hospital. There, in a busy corridor, he realized that he had forgotten something, and went back to get it. He left me there, tucked in with my monitor, pants, blankets, and bra, in the busy hallway. Nurses were on urgent missions. Flower-and-greeting-card-carrying visitors looked anxiously at room numbers. Administrators chatted and laughed their way back from a meeting. Doctors scowled at clipboards. Nobody met my eye. I was furniture. I looked no different from the regular hospital hallway scenery. Heart patients blend in to the wallpaper. My hospitalist returned, and with a jolt began pushing me forward again.
I was kept in the hospital overnight and for the entirety of the following day. I was tested, tested, and tested some more. I was denied coffee which resulted in the most devastating headache in the history of headaches. I was denied salt. As perhaps the first vegetarian ever to spend the night in this small, rural hospital, my dinner was a scoop of cottage cheese and a slice of mushy cantaloupe. My heart was explored through ultrasound. Radioactive material was injected into my veins, and I was made to run on a treadmill. My entire body was scanned by a giant machine so charged with radioactivity that the technician watched the whole procedure from an adjoining, lead-lined room. By late afternoon, my caffeine withdrawal headache had reached a level where I thought it might be the thing that killed me, and I started packing up to go home. I had realized that no actual problems had been uncovered, that I was just waiting around for one more test to be read by some radiologist somewhere, and I could just as easily wait at home. My inner healthy person stood tall and said, "Let's get out of here." The floor nurse saw me packing, and paged my hospitalist, who appeared, breathless, in my room. He held his hands up in front of him, making a "stop" gesture. "I can't recommend this," he said. "I really want you to wait until we clear you." He seemed so worried, so convinced that something bad might happen, that I stopped packing and resumed waiting. I watched Oprah. Again, he had me convinced. This new me, this heart-patient-me, put a pillow over the face of my inner healthy person and we acquiesced.
Ultimately, they found nothing. My heart was perfect, except that it was beating to its own erratic rhythm and it was a little slow. And so the doctor allowed me to leave, but he seemed reluctant. "You need to follow up with a cardiologist." He clenched his clipboard tightly as I nodded in obedience.
"The dilemma," wrote reporter Sharon Begley in a Newsweek cover story in August 2011, "is that some of this same health care that helps certain patients can, when offered to everyone else, be useless or even detrimental. Some of the most disturbing examples involve cardiology." She went on to describe the myriad ways that medical technology has advanced to where we can combine treadmills and 3D imaging to see, in miraculous detail, all the best-kept secrets of the human heart. "Our imaging and diagnostic tests are so good, we can see things we couldn't see before," she quoted another expert. "But our ability to understand what we're seeing and to know if we should intervene hasn't kept up."
That article came out after my adventures in cardiology were over, but it wouldn't have mattered if I had read it earlier. When it's your own heart that's been spied on and caught in the act of some misbehavior, you want to get to the bottom of it. When a well-meaning nurse pats your foot and uses the word "pacemaker", you want to know for sure that he's wrong before you go about the rest of your life. And these answers don't come quickly. It can take a long time to get in to see a cardiologist if your life isn't in immediate danger. I made an appointment, but had a two-month wait.
If you give a writer a reason to think about death, it's like giving the hungriest dog the meatiest bone. I spent those early weeks of summer grappling with questions about my mortality. The vague pains in my chest did not go away and I developed dizziness. I became obsessively aware of every irregularity in my heartbeat. I stopped working out. I gained weight. I felt my life get shorter. I convinced myself that I was having frequent dizzy spells and increased chest pain. I was a heart patient. I was sick.
At night I had dreams about heart surgery. In one dream, the surgery center was attached to a store—some sort of mega-store that sold only heart-healthy products. I was on a gurney, under a blanket, being wheeled through the store by my surgeon. All around me, people shopped for vegetables, medications, and exercise equipment as I wheeled past. At the back of the store, my surgeon and I waited for the elevator that would take me up to an operating room. He chatted easily with some people who were shopping for ankle weights. "This is Penny. We're all worried about her. She's had this problem for over a year." He stepped further away and lowered his voice, so I could no longer hear. He then returned to my bedside, and as we entered the elevator, he described the procedure. The plan was to put in two stents to increase my heart's ability to fill with blood, and then to install a pacemaker.
"Doesn't that seem like a lot to do all at once?" I asked, feeling surprised by the magnitude of his treatment plan. "Are you sure I need stents and a pacemaker? Couldn't we just do one or the other?"
He grimly shook his head, and pressed a button. "I'm afraid not." With a jerk, the elevator rumbled and began to climb.
The dream took a turn that dreams take sometimes, and the elevator turned into glass. I could see the vast store sprawled out under our feet. Exercise balls, walking shoes, vitamins, low-fat dairy products—all bathed in the bent sunlight coming in through the glass walls. I pushed back the blanket, sat up, and let my feet dangle towards the glass floor. It was a long way down. My heart wanted to fight its way out of that bowl. But I found that I had no fight left, and I sank back down onto the gurney. We rumbled upward.
"A lot is going to happen in the next five minutes," said the nurse, thrusting a hospital gown in my direction. "Take off your shirt and bra and put this on."
. I had again reported to the E.R., again at my doctor's urging. New, and probably imaginary, symptoms had arrived on that summer afternoon: an unfamiliar, sharp pain between my breasts accompanied by numbness and tingling in my left arm. Sitting at my desk, working on some emails, still maintaining the long holding pattern I had been in for weeks while I waited for the appointment with the cardiologist, I had endured these fleeting, impossible-to-miss pains for a couple of hours. On the pain scale, they were a six or seven, but short, only lasting a few seconds. Then nothing. My arm felt like it was half asleep, like I had fallen asleep lying on it, like the blood vessels were slowly refilling and the feeling slowly returning. But I hadn't fallen asleep on it, and the feeling had been returning for a long time, when I finally called my doctor to report what has happening. She told me to go. I went.
This was, of course, just more crazy, just more evidence of how strong the power of suggestion really can be. But I didn't know that, and it's better to be safe. I drove myself the thirty miles to the hospital. Heart patients, I told myself, go the ER a lot. This was my third trip—and each time, they found nothing. But I was worried, while I waited for my pacemaker, that my heart might just decide to stop. And I was young. I had a lot to live for.
The emergency room has a triage system that works like this: the nurses' station is behind a thick piece of mirrored glass. Patients can't see the staff back there unless they peer through a small hole. On a green piece of paper, you write your name, date of birth, time of arrival, and chief complaint. You then slide the green paper through a slot into a plexiglass box on the other side, and press a buzzer to alert someone to its arrival. I did these things—wrote my name, the date, and the words "chest pain," slid it through, and pressed the buzzer. Nothing happened. Through the conversation hole, I could see two nurses at their station. Nothing about the way they were looking at each other, laughing easily, or fidgeting with their simple jewelry was indicative of treating medical emergencies. I felt like they both had time to come read my green slip of paper, to notice the words "chest pain" that I had written there. Neither of them made a move. I considered ringing the buzzer again, but I didn't want to be too pushy.
Instead, I slid open the door to the registration area, a small room attached to the nurses' station. Behind a desk, a young woman was moving papers around, and she looked up.
"I wasn't sure if I was supposed to let myself in here, or if someone was supposed to come get me," I lied, trying to be her friend, to have her on my side.
She said, "Oh, I heard you ring the buzzer." She put some folders down. "I guess the nurses didn't hear it. Come on in."
She did an intake. My name. My address. Same insurance? Good. Still working at the same place? Great. We chatted about the community center where I work. She had questions about what we do there. She wanted to come see it sometime. She had a question about clam-digging licenses. I told her that we don't issue those, but I was pretty sure the state park did. She asked what brought me to the E.R. that day. I said the words "chest pain," and "numbness and tingling," and her eyes widened. Across the room, I could see the green slip of paper upon which I had written those same words still resting in the plexiglass inbox, still being ignored by everyone at the nurses' station. The registration clerk rose from her seat. "Wait here," she said.
That began the expected, rapid succession of events—questions, clipboards, "how long has this been happening?" "On a scale of one to ten...?" A swarthy, young doctor passed through the registration area and, upon hearing the words "chest pain," he said, "That will get you an EKG around here." He winked at me.
I was gowned up and again subjected to a dozen or more adhesive pads stuck all over my body. Predictably, my heart did some thrilling tricks—bigeminy, trigeminy, sinus rhythm, in and back out of various patterns of PVCs and regular beats. My heart rate started out at 32, then rose to 64, then settled in at its usual 42. Clipboards were scratched on.
I had to answer the same questions no fewer than four times. "When did this start? How long has it been happening? Has this ever happened to you before?"
Once the EKG and chest X-ray had been completed and my cardiac enzymes had been checked and showed no signs of damage, everyone went back to the serious work of ignoring me. In the E.R., they call that "waiting for test results." It went on for hours.
I lay there, in my gown, my clothes and belongings once again gathered up and shoved under the bed, and tried to relax. It wasn't so bad. The monitor was blaring and buzzing every time my heart threw a PVC or my rate fell below 50, but I found it strangely soothing to know what was going on in there. I could feel all the usual sensations—things that had become, over the summer, familiar mysteries—but there in the E.R. I was allowed to look inside. It was not unlike the small hole in the mirrored glass at the triage desk. I had to stand in exactly the right place and look it at just the right angle to see anything. Otherwise, I saw only myself; the usual outside view. This technology let me peek inside. The insistent blaring of the monitor confirmed what I had been told: something was wrong. My brain and my heart were in agreement. I found this soothing.
After a couple of hours, and another tuna fish sandwich, they let me go home.
Cardiologist number one didn't listen to my heart.
Two months had gone by since my first visit to the emergency room. In the cardiology office, eager to be a good heart patient, I had done as I was told and put on a hospital gown, was subjected to another thirty-second EKG and answered all the usual questions from the cardiologist's assistant. What brought me to the office? How long had this been going on? What was the story? After these tasks, I waited politely for cardiologist number one.
He entered the room and shook my hand. Glancing at the EKG results, he asked why I was there. I gave him the story, and he nodded. He did not leave his chair once. He did not put a stethoscope to his ears.
"You have a variety of heart rhythm disorders," he intoned. He barely moved as he said this, choosing to sit in his chair, across from me, the folders containing my charts and test results gripped in his fist. His arms were crossed. The folder took on a sharp crease in the middle where his thumb pressed into it. "And the treatment is medication."
He went on to explain that these pills, called beta blockers, might solve the problem by bringing the errant rhythms under control. They might take away the pain and the dizziness. "Or they might make you feel worse," he explained. "The side effects are dizziness and fatigue. They probably won't work, but they're the least invasive thing, so we start with that."
I let this in. The next obvious question eventually floated forward through the falling debris that had become my brain. "And so what happens if they don't work? Or if I just feel worse?"
He explained that the next step would be an electrical study of my heart in which the misbehaving cells were identified. After that, he would perform a surgical procedure in which these cells are zapped out of existence with a laser. "That will fix it."
I pictured what I knew of lasers: the blue and green glowing stick-like weapons from Star Wars. I imagined one zapping individual cells in my heart. "How will we know if the beta blocker isn't working? Will I wear some kind of monitor?"
In my memory, the conversation ended right about there. In my memory, he stood up, snapped my file shut, and said, "Nope. We'll base it entirely on how you feel. If you feel better, the medicine worked. If you don't," he turned to leave, "we do the procedure." Truthfully, that's probably not how it happened. He may have waited patiently there in the exam room until I ran out of stammering questions to ask. He probably hung in there until there was no more to say. But my memory has latched onto the moment that it felt like the conversation was over. When he told me that all future decisions would be based on my self-reporting of symptoms, it felt like there wasn't much else that I could say. To point out the obvious flaws in that plan felt uncooperative. To point out that I was already half-crazy with this thing and should not be trusted to determine my own need for surgery felt too self-effacing. To point out that I might be imagining this whole problem—even this whole cardiac visit—felt like maybe I was, in fact, all the way to crazy. Whenever the conversation ended, I watched him leave with my charts tucked under his arm. I felt like my pockets had just been filled with rocks. This doctor had not listened to my heart, and my heart was done talking to me. Communication was getting tight.
When I got home, I called my family doctor. "Get a second opinion," she said.
That took another two months.
"Screening the apparently healthy saves a few lives...but it definitely drags many others into the system needlessly—into needless appointments, needless tests, needless drugs and needless operations," writes H. Gilbert Welch in a February 2012 OpEd in the New York Times. "This process doesn't promote health: it promotes disease. People suffer from more anxiety about their health, from drug side effects, from complications of surgery. A few die. And remember: these people felt fine when they entered the health care system."
I shared that article with my dad, whose life had been saved a decade earlier by triple bypass surgery. He shrugged it off, seeming vaguely offended. "How are doctors supposed to know, in those first hours, who really has a problem and who doesn't?" His story started in a similar way: pain and a trip to the ER. The same tests and imaging that had started my story also started his, but his led to the operating table. He was the patient whose pain warranted intervention.
How do we know? Isn't it better to be safe?
My friend Laurie thought so, when she reported to the same cardiology practice in which I saw cardiologist number one with symptoms very similar to mine. She was assigned a different doctor, but got the same advice: try medication, then have an ablation. During the ablation, the cardiologist was just a little too aggressive with the laser, and killed a portion of Laurie's heart muscle that was previously healthy. Now, Laurie lives with a pacemaker implanted deep in her chest. She has since realized that she probably didn't have a life-threatening problem until she sought help.
"The truth is, the fastest way to get heart disease," writes Welch, "...is to be screened for it."
My appointment with cardiologist number two was scheduled for late afternoon, and I spent the day growing increasingly nervous and obsessed. Another two months had gone by, as I waited for this second opinion. There were two worst-case scenarios that unfolded cinematically in my head over and over. In one, my new cardiologist took one look at my test results and ordered me to report to the emergency room immediately. He was shocked to learn that I had been out in the world, walking around in this near-death condition. In the other scenario, he looked at my test results, scratched his head and shrugged. "You're imagining the whole thing. I don't know why you're wasting my time."
Some part of me still doubted that I was sick. I know my own propensity for drama. I am aware that I have the ability to inflate symptoms, to dwell on death. But there was so much hard evidence—EKG results, an overnight stay in the hospital, one cardiologist already insisting that I needed serious medication or even surgery. I couldn't find my way through my doubt and around all the data to reach my own conclusion. Some part of me was sure that the nurse who used the word "pacemaker" would be right. My inner healthy person had been bound and gagged and was in some dark corner, waiting to be freed.
Worse than all that was the truth that some part of me wanted that nurse to be right. I had come to want a pacemaker. All the months of obsessing about it, the multiple trips to the ER, the myriad of tests and needle sticks and the terrifying bruises they left on my forearms—it all had convinced me that something was terribly wrong and I needed intervention. I don't know if it's my need for a clear narrative arc or my darkness-seeking personality, but the "on" switch on my crises-meter had been triggered, and I had become hooked on intervention. Hearts aren't trustworthy, and mine obviously needed help. The ER staff and the hospitalist (whatever that is) had done their job of convincing me that I was a serious case.
What I would learn next is that the system has no patience for the very hypochondria it creates.
When he arrived in the exam room, cardiologist number two told me three things. He told me that I wasn't dying. He told me that cardiologist number one was guilty of hunting a mouse with an elephant gun—there was no way I needed surgery. And he told me to knock it off. "Stop taking your own pulse. Stop being crazy." He told me that figuring out what needed to happen next was his job: not mine. He asked me to let him do his job and told me to focus on mine. I was given a device that would monitor my heart rate when I was having symptoms. He sent me home. I appreciated his candor and believed that, together, we would figure out what level of intervention I needed.
I came home with the monitoring device. Roughly the size of the Walkman I owned in the nineties, it came with a supply of adhesive pads and a set of wire leads. I was to stick the pads onto the left side of my chest (one above and one just to the side of my breast), run the leads under my clothes and plug them into the monitor. I was to carry the monitor clipped to my belt or hung from a strap like a purse, and press a button marked "event" every time I felt something. The somethings included pain, palpitations, or dizziness. Each time I pressed the button, I was then to write down the date, time, and nature of the event in a log book that came with the whole kit. After five events, I was to call in the data by dialing a phone number and hitting a button marked "transmit" on the device. It would then squeal like a fax machine and send signals from my heart across the phone lines to the office of cardiologist number two.
There is nothing that can make a sick person feel sicker than wearing a visible apparatus that clearly belongs in a hospital. The sight of an adhesive pad with a wire peeking out from underneath my shirts made me not only feel like a full-fledged cardiac patient, it made me look like one too. I worked at my desk, sat in staff meetings, went to other meetings, and had to answer questions about the visible adhesive pad and its wire there just below my collarbone. Part of me wanted to hide it under crew neck shirts or scarfs, and part of me did not. Part of me wanted validation, acknowledgement from other people that this was happening. I wanted their stories, "Oh, I had to wear one of those once." or "My boss went through that too." But part of me didn't, because the stories all seemed to end with the lack of an ending. "They never found anything." Or "It was just anxiety." I knew that would not be my ending. I had a heart problem. A pacemaker or a procedure would fix it. Doctors had confirmed this.
I lived those two weeks with a steady focus on every beat of my heart. I was a diligent monitor-wearer and event-button-presser. Any time my heart was fully engaged in flip-flopping or skipping beats, I pressed the button. It's like I was waiting in a closet with a camera, already focused, and then jumping out and catching my heart in the act of something illicit. Sometimes there were pains, sharp at times, dull at others, and I recorded a healthy a range of them, and then tried to describe them in my log book. "Sharp pain, quick." Or "Sharp pain, lasting." Or "Dull ache, all morning."
Writer Thomas Larson, who struggled with serious heart disease—one that felled his father and older brother, and tried to take him out as well—wrote in 2012, "The health we are told we desire, we seldom get to, in part because staying hooked on palliative medicine stops us from trusting ourselves or, when necessary, challenging authorities. Medical dependency is really institutional addiction." Over those fourteen days with the event monitor, I was haltered and led by this device, and I gladly ceded control of all decision-making to its electronic innards and to the people who could interpret its data. My heart was like a leggy colt that I could not control. I let it run laps, show its stuff to people who understood it.
Two weeks later, I drove back to Portland for my follow up visit. I was subjected to a variety of tests. I was wired up, put on a treadmill, and told to walk and run my way through a physical routine and then quickly made to lie down so the team could perform an ultrasound while my heart was still revved up. Stand, run, lay still. I was a pro now and could see for myself the valleys of the PVCs on my EKG as my heart jumped into and then back out of bigeminy. Like the rest of this saga, the process confused my heart, but it responded the best way it knew how: it kept beating blood through my veins, delivering oxygen to my brain, doing its work. The heart, as the song says, goes on.
With the tests behind me, and all the events from the monitor phoned in, cardiologist number two had reached a verdict. This whole, four month saga came down to this simple diagnosis.
"You're fine," he said.
I sat, dressed in my regular clothes, and tried to find a way to parse apart his words, but there weren't very many of them. There were no shades of meaning to dissect. So convinced that I would need a pacemaker, I waited for him to go on, waited for the "but."
"There is no correlation between your pain and anything going on with your heart. You have some extra beats, but I see people here with ten times that number of extra beats, and they're fine too. If it's really bothering you, we could try medication, but honestly if you walked out of here today with no meds, I wouldn't spend another moment worrying about you."
This possibility had not occurred to me, and I sat silent for a moment. Back in May, when the double doors of the ER had whooshed open in front of me, I would have agreed with him. I was fine. Not anymore, though.
I asked, "So what's making my chest hurt?"
He pressed his lips together for a moment before speaking. "I have no idea," he said. "It could be a thousand other things, but I'm a cardiologist. It's not your heart."
It was like someone slammed on the brakes, leaving black skid marks the entire length of my newly-developed sense of self. It wasn't my heart. It had all been a farce. There was to be no pacemaker. I was not a heart patient anymore. This story was ending. My reaction is hard to explain now. I was disappointed. I was relieved. I felt, mostly, stupid and embarrassed. I hazarded one last question, "So I don't need a pacemaker?"
He actually laughed. "A pacemaker? Who ever said you needed a pacemaker?"
I mumbled something vague about it being someone in the hospital, tried to sound like I too thought it to be a ridiculous idea. A pacemaker. Indeed. As if.
He seemed to sense the complexity of the moment and asked me one last question. "If you could get rid of one symptom, would it be the pain or the palpitations?"
I stared at him. He sat there, looking directly at me, flanked by two young, female PAs. All three of them suddenly looked smugly healthy. They were lean and in shape, wearing running shoes. The young women wore sleek ponytails and carried clipboards. I wanted to tell them that I used to run too, that I was healthy once too. They all three waited for my answer to this pointless question.
"I don't even know how to answer that." These two symptoms—pain and palpitations—had, for me, become so tied together that to imagine choosing my favorite felt like one last act of uselessness in this whole useless process.
And then I was free to go.
The two young female PAs walked me down the hallway. "Don't feel bad," one of them said. "We see cases like this all the time."
As I walked away, I knew they were watching me, in their snug-fitting, body-showing-off lab coats.
And with that, I was released into the rest of my life. I stood in the parking lot, blinking in the sun, feeling like I had been shot out of a cannon and just landed in this spot.
I am left, to this day, with questions about my health. I am experiencing all of the mystifying body-changes that come with my fifth decade: altered skin, increased waistline, inexplicable pains in joints. Changes that make my doctor shrug and say, "Welcome to your forties." I try to file the whole ugly episode in a box labeled: "mystifying, age-related crap to wonder about." It's almost two years later now, and the pain, dizziness, and arm-tingling have all gone away. I still take my pulse once in a while when I feel my heart doing its high-wire act, looping around like a trapeze artist, but I have stopped being a heart patient. Sometimes I think back to cardiologist number one, and the ways in which his diagnosis differed so dramatically from cardiologist number two. One of them is wrong. Am I just choosing the opinion that I like better? Will I regret it if my left ventricle says "Okay, that's enough."? On my way to the floor, my knees buckling, will I think back to the clipboard scratching and wish I had played it safer? My friend Laurie would say no. My dad would say yes.
"A heart is true, pure, achy/breaky; a heart is San Francisco where you left it, Christmas within, the going on after the Titanic sinks," writes Larson, "a heart is worn on your sleeve, is a lonely hunter, is made of stone; it's where one is sick at, where one's home is, where you know he's right, the thing you gotta have, miles and miles of it, and that which, above all, the hero has in spades." Sometimes, as I'm falling asleep, I feel my heart skip a beat, feel the BOOMs and the pauses, and I know that the worst thing I could do is mention it to my doctor. This is how my heart works.
I still have not been to the chiropractor.
Penny Guisinger lives and writes on the easternmost tip of the United States. Her work has appeared in Fourth Genre, River Teeth, The Rumpus, Guernica, the Brevity blog, Solstice Literary Magazine, Under the Gum Tree, multiple anthologies, and other places. She is the author of Postcards from Here, which will be released by Vine Leaves Press in May 2016. She is the founding organizer of Iota: The Conference of Short Prose, and a graduate of the Stonecoast MFA Program at the University of Southern Maine.