I just realized that when one is 14 and a goth and writing about mortality, nobody gives a flying fig, because what does a 14-year-old know about mortality, no matter how morbid-minded? But when you’re 44, and have just had two friends your age die within a week, and you have a medical emergency yourself, all of a sudden people take your musings about mortality very seriously.
Herein, the story of my medical emergency, and my musings on mortality, though may I stress I am unlikely to kick off any time soon. For the tl:dr crowd I REPEAT: I’M FINE. For the rest of you, read on.
It happened on New Year’s Day and I hesitate to call it a medical emergency because I wasn’t actually in any danger, though it was hard to be sure at the time. Friends say if one goes to the “Emergency Room” that constitutes an emergency. (Pedants.) Very well. On New Year’s Eve I had imbibed alcohol very sparingly, but I had probably not drunk enough water or tea. On New Year’s Day likewise, I was cooking brunch for a dozen or so friends. We had quite a nice brunch. I make waffles (using the old Usenet Cookbook pancake recipe, the one with the yogurt and beaten egg whites in it) and corwin makes Eggs Corwin (sort of like Eggs Benedict but with a smoked gouda cheese sauce and sauteed spinach).
We had just about finished up the actual brunching part and were just hanging around when I started to feel thirsty. So I drank a few ounces of seltzer. Then I went to pour myself some more and got a sudden spike of light-headedness and nausea. Well, I thought, good thing I’m rehydra…
And then the heart palpitations started. I’ve had this particular palpitation before, and it feels like someone’s knocking on my chest from the inside, my heart beats so hard. It’s a very fast and regular rhythm but it feels like half the beat is missing. The last time it happened was about six years ago, and after it went on for 20 minutes or so, I called my doctor’s office, who called an ambulance, but by the time they arrived my heart had returned to its regular rhythm. I’d gotten the arrhythmia to “break” by doing a vagal maneuver–bearing down.
This time the Valsalva maneuver didn’t work, I tried three times, and after five minutes of light-headedness, I told everyone else. I think my words were, “The bad news is that I may be having a sustained attack of atrial fibrillation.” (It wasn’t a-fib, but it might have been… more on this later.) I announced my plan to give it another five minutes to go away on its own, and if it didn’t, I’d call an ambulance.
Five minutes later nothing had changed other than I’d made my friends quite worried, and I called 9-1-1 and got the paramedics on their way. Then I called my insurance company to make sure I was clear to go to the hospital I wanted (I was on different insurance last time this happened and wanted to make sure I could still go to Mt. Auburn Hospital.) I was still on the phone with them when the paramedics (along with two bright, shiny fire trucks) arrived. They got me into the ambulance right away to put me on the EKG.
Aside: Don’t you wonder why it’s called an EKG and not an ECG (electro-cardio-gram)? According to my father, it’s because ECG and EEG sound too much alike and it could be confusing. No idea if that’s actually why, though.
There are some odd rules around what the paramedics do and what the fire department rescue does. The EKG machine they used was from the fire department; I’m not sure why. A guy from the fire department asked me all the questions, too, about how it started and how I was feeling. But it was a paramedic who said, “Well, you might be dehydrated, so here’s a bag of nice warm sweet saline for you.” And prepped my arm for an IV.
They caught a couple of seconds of the arrhythmia on the paper before it broke, at the moment they put my IV in. “You just dropped from 140 to 90,” one of them said.
“Probably from the pain of the IV,” the other one said. (There were three of them in the back there with me but the third one never said anything, I don’t think.) “Were you actually on the phone with your insurance company when we showed up?”
“You are an outstanding individual. I wish more people would do that.”
Then they showed me the papers that had come out of the machine with the various squiggles on them. “That’s a nice P-wave right there,” the fire department guy said. Then he took his portable EKG machine and said goodbye to the paramedics, and they took me to the hospital.
Over at Mt. Auburn they wheeled me right into the ER. We had to wait a minute or two while they cleared out a room (!) and then in I went. When it’s cardiac stuff, triage sends you to the front of the line. They had to put another EKG on me, which was another dozen electrodes. (I still had the ones from the fire department stuck to me.) I asked the PA if I could peel the old ones off and she said sure.
Recall that the moment the actual arrhythmia stopped, I had gone from being a person having a possible medical emergency (which had lasted 15 minutes tops) to just being a curious participant in an ambulance ride and emergency room trip.
The IV spigot was the two-way kind, so when they had to take blood, they just came and attached to it, then gave me back my saline. No additional needles necessary.
So then it became an evening of waiting for the test results and for the nurse, resident, and attending physician to take their turns with me. Fortunately, they have free Wifi at the ER now, though cell phone use is prohibited. So I could play Words with Friends until my battery ran down, and then I switched to reading the book about Miyamoto Musashi I had brought with me. (Experience of my previous trip for this had taught me to bring a book. The ER is very boring when nothing bad is actually happening to you.) The resident at first was sort of ambivalent about what was going on. Then I pointed out the scraps of paper that had come out of the fire department machine in the ambulance. “Oh, nice,” I heard him say, as he looked them over. “I’m going to show this to the attending, OK?”
Sure thing. Anyway, the verdict was that it was too regular to be atrial fibrillation (which my mother had so severe she had to have heart surgery at the Mayo Clinic) and looked a lot more like supraventricular tachycardia (Wikipedia link). In particular, was most likely PSVT, paroxysmal SVT, aka AV nodal reentrant tachycardia (described on Wikipedia here).
Yep, the description of AVNRT sounds spot on to what happened. It’s not life-threatening except that if the moment of light-headedness that happens at the onset causes one to faint while doing something like driving a car, or results in a fall with a head injury, etc. I didn’t come close to blacking out either time. Unlike with a-fib it doesn’t seem to cause clotting that can lead to stroke, either.
And reading the descriptions of what can stop the palpitations once they start, I know a couple of healing arts tricks to try next time, if there is a next time. I might go another 5-6 years before the next one.
I tweeted from the ER, plus people who had been at brunch at my house went on to other parties, so lots of folks wanted to know more about what happened. There you have it.
I will see a cardiologist this week for follow up, but all my ER blood work looked fine. They’ll give me an event monitor to wear for a week so if it does happen again they can get a good picture of it and know for sure it was PSVT/AVNRT and not a-fib, atrial flutter, or what have you. But it might not happen again at all.
I returned home to many admonitions on my Facebook to not be the “hat trick.” The two friends of mine who passed since Christmas were both 44 years old, but both had suffered with lifelong health problems. I wrote on Facebook on hearing about the second: “I feel like the wolf of mortality just announced itself to my middle-aged herd and is starting to cull the vulnerable. Two friends my age have passed away within the past week, Greg Spira and Alice E. Washburn. Alice was two months older than me, Greg was 2 weeks younger.”
I do, in fact, need to take slightly better care of myself. A few years ago I lost 20 pounds, but I’ve slowly put 10 of it back on, and for the past year my cardio-vascular workouts have been minimal and sporadic while I’ve rehabbed my balky knee. Peri-menopause is playing havoc with my hormones, too. I’ll start ramping up gradually to actual cardio workouts three times a week again, which should help my overall heart health. I’ve got low blood pressure, low cholesterol, and no other big issues, so my prognosis for sticking around a bit longer is good.
Meanwhile, I’m STILL peeling bits of glue off myself from all the many EKG pads and IV tape, etc! Not kidding! Blech!