The Procedure
The operating room is freezing. I lie shivering from cold and shaking from adrenalin. The nurses move quickly around me. I want one of them to stop and reassure me that everything will be all right but they are too busy. The urinary catheter is exerting a painful pressure in my groin. Fear is a heavy lead blanket smothering my stomach, chest and throat. A nurse finally touches my arm in reassurance and smiles but she is carrying a huge, thick silvery tube. I stare. I’m supposed to swallow this?
“You have an arrhythmia called Atrial Fibrillation. Most people with A-fib have a genetic pre-disposition for it. We consider it a benign arrhythmia. It causes no damage to your heart. There is a somewhat increased risk of stroke through blood clots forming inside the heart when the atria are not pumping properly but that can be controlled with blood thinners.” I stare at the beautifully detailed charts of the heart chambers on the office wall. There is no escape. This is my reality. I’m having an attack right now. My heart is thumping extremely rapidly in my chest and it feels wrong, wrong, not a normal beat but a thready, dreadful feeling that makes it hard to focus on anything else. I feel out of breath. I try to concentrate on what the cardiologist is saying. Cardiologist! I am 39 and I have a heart problem. What did I do to deserve this?
“When I push the tube down your throat I want you to swallow,” the nurse says. I nod numbly. I open my mouth and she pushes the tube in gently. “Now. Swallow.” She shoves faster and harder. I swallow but I choke up and eject it. “Try again,” she says patiently. She pushes the tube in. I choke up again. Inside my head I scream. To be anywhere but here! The third time I try so hard I choke completely and go into dry heaves. She pulls the tube out and waits.
“Jeff, we have to get this thermometer tube down your throat so we can monitor the temp. We don’t want to burn your esophagus. If we can’t get this in we won’t proceed.”
I gather some faint speck of determination and nod. I open my mouth again. She pushes it in and I swallow. Success. There is a thick tube all the way down my throat and in my esophagus. It puts an unpleasant pressure and pain in my chest. And I can’t speak.
“Most but not all A-fib cases can be controlled with anti-arrhythmia drugs. Unfortunately you haven’t responded to the drugs. Given the amount of discomfort you are experiencing and the effect it is having on your ability to function in daily life you are a good candidate for the ablation procedure.”Her voice is precise and passionless, lacking any warmth or sympathy. She is a dedicated professional. Sentiment is a distraction. But I am desperate for empathy, for reassurance; a sign that she wants to help me, that she will promise to take care of me and make sure I come through.
“During the ablation we will use five separate catheters.” she points to a chart of the human body on her office wall. My arrhythmia is making my whole body shudder. I can barely concentrate. “Two will enter through each side of the groin and one through the neck. They will carry cameras, temperature sensors and the ultrasound emitters.”
She points to the cross-section chart of the heart and my fear level jumps up by a factor of five as I imagine what one of those upper chambers is doing right now, failing to contract properly. How do they know it is not life threatening? How? What if I drop dead right now?
“We will push the catheters into your heart through the arteries. We enter the right upper chamber then burn a hole through the inner wall separating the left side from the right. We then push through to the left atria to the four vein entrances. Around those entrances are the areas where the electrical circuits have multiplied, causing the misfires in your heart that are responsible for the fibrillation. We will burn them off, cutting the circuits and stopping the arrhythmia.”
I am a blind corpse. They have placed a blanket on my face. There are strange sensations in my chest but the anesthetic has left me confused. I know what is happening but I can’t think clearly about it. But I can sense the pain. Every so often it gets worse as they burn; a sharp, terrifying pain in my heart. Out of the fog of the partial anesthetic I groan. From somewhere out of sight a voice murmurs that they will give me more anesthetic. Later, there is another sharp, sudden pain, and I groan again. Again the voice says something about more anesthetic. I register the words through a fog but I don’t really understand them. Only the pain is easy to comprehend. Every so often I hear a voice by my ear say gently: “Breathe,” and an awareness seeps in that I have stopped breathing. I take a breath. An indeterminate while later the same voice whispers again, “Breathe,” and I start breathing again.
I don’t know how long I have been here, under the blanket on my face. The passage of time only becomes a crystalline sharpness when the waves of pain intensify and the intermittent gentle voice urges me to breathe. It is an endless, swirling, terrifying experience that seems to have been going on all my life.
“There are risks involved. There is a one to two percent chance that a clot will form when the catheters move back and forth inside your heart. The clot could cause a blockage and you will suffer a massive heart attack. They are often fatal. To try and save you we will have to open you up and carry out open heart surgery.” She is relentless. I hate her. “There is a one percent chance that we will burn through the heart wall and breach the esophagus behind it. Within a few days infection will set in the heart as food particles get sucked into the chambers while blood seeps into the esophagus and fills it up. This type of complication is fatal. There are no remedies. Death follows within 10 to 20 days. To reduce the risk we insert a thermometer into your esophagus through your mouth that will warn us if the temperature rises too high, meaning we are getting too close to the esophagus wall. In addition, you will have to be awake through the procedure, so that we can tell by your reactions if anything is wrong.” I stare at the chart as she points dispassionately at the various danger points. I want to hit her. I want to scream at her. My arrhythmia is worse than it has ever been, exacerbated by stress and fear. My heart is hammering so threadily and fast in my chest that my whole torso is vibrating. I can no longer concentrate on anything but the torture in my chest.
“Jeff. Can you hear me?” There is a voice somewhere outside of myself. I realize that I have already heard it several times calling my name in intervals and that I am awake. I try to think of a way to answer but the fog fills my mind and I can’t think of what do next. I am a blank slate.
“Why don’t you try to open your eyes?”
What an idea. It never occurred to me. Open your eyes. I didn’t even realize I had eyes. I think about it for a while and then I realize that I do have eyes and I can open them, and they do. There is a face hovering above me and I can sense something on my arm. I try to move my head but I have no strength. But then I sense her hand moving up and down my arm in a comforting movement. She must be a nurse; and I remember that I am in a hospital.
“It’s over,” she says. “You’re out of surgery. You’re going to be okay.” And she pats my arm again. I become aware of tubes and monitoring instruments hovering all over me. Then I think about what she said. Is it over? The arrhythmia is gone. I realize with a start that my heart is beating normally. Is it over? No, no it isn’t. There are the potential complications and risks to watch for. If the burn went through my esophagus I won’t know for several days, by which time I will already be dying. But it won’t happen. I have to believe that. I am going to be okay. I am going to have my life back. I want it!
I want it!!!
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Alon Josefsberg is a real estate agent with a degree in history, and interests in astronomy, general science, space exploration, politics.
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