Saturday, February 12, 2011

Conversion

I sit here, this evening, a convert.

I converted.

But not how you might think.

Yesterday, seeking a break in my daily grind I proceeded to the gym for a workout.  It looked like a pretty hard core workout and I was looking forward to it, as it had two of my favorite exercises - power cleans and kettlebell swings.  So, like a good cross-fitter I scaled it to my ability - dropped the swing weight to 35 lbs (about 1 pood) and the clean weight to about 80 lbs and reduced the jump height to about 15" and only planned 5 rounds instead of 7.  Cuz I'm older, still fairly new to cross-fit and knew I'd be working up a good sweat but didn't want to hurt myself.  You know, throw out my back, blow a knee, that sort of thing.

I never thought I'd throw my ticker out of whack.

I got into a good groove - I was pushing myself hard, and getting enough rest between sets, so I thought.  Going into my last circuit, I decide "Fuck it - I'm going to push it HARD".  So I finish up my last round of swings and all of a sudden my sternum feels like someone firmly tapped it with a rubber mallet.  I can feel my heart beating hard and a weird reverberation at the bottom of my esophagus.  I get a little dizzy, and I know that that's it.  I am done with this workout.  So I calmly put everything away, ignoring how wobbly I am because I know that if I just cease activity and rest my heart will calm down.

After I put the gear away I go sit on a bench and try to take my pulse.  It's freakin' funny.  Not getting a very strong one, but fast.  I'm getting several fast beats, a pause, and then two or three quick, arrhythmic beats.  Here's where the tiny voice says, "Dude, this isn't right.  Maybe you should go to the front desk and see if they can call someone from the clinic to come down and check you out." But the big, stupid voice said, "Look, you're breathing okay, you're not in pain, just clean up, go back to your cubicle, hydrate, and you'll be good."  So I listen to the stupid voice.

Indicator #1 that I might be wrong is when I step in the shower and get dizzy again.  I ignore it.

So I get back to the office and the Executive Assistant for my group reminds me that one of my wonderful "staff tasks" is "pre-due" today.  Pre-due means the boss needs to look at it two days before it is due so that when it is coming up for approval when it is due then the approval will be expedited.  We all know what that is.  An artificial due date before the due date that adds pressure to you to get the job done faster, and makes you give less time to those who you need to delegate parts of the task to.  In all fairness our office handles it pretty well; the product is not expected to be polished, just a "show me what it looks like as is" that can be reviewed at leisure in the two days before formal approval starts.  And in this case the job was almost done anyway so it was fairly easy to gather everything together and get it ready.  Indicator #2 came when I got up to go to the printer and got dizzy again.  That's when I said as soon as I finish this I'm going down a floor and walking in to acute care.

Indicator #3 came when I had to get to the printer again.  FUCK. THIS.  I stapled everything together, handed it to the person in the cubicle next to me and said "I really feel like shit.  I need to get to the clinic.  When you hear about such-and-such being due today, this is it.  Could you please give it to so-and-so?" She said yes; we are assigned as back-ups to each other on most of our work, so it's common place.

Let the fun begin.  I walk down to the clinic, walk in, take my number, think "screw filling out the form" and walk right up to the civilian receptionist.  She's doing something besides looking at me so I lean over and say "I took a number but I don't care.  My heart is racing and beating funny and I almost passed out twice. I need to see someone now."

She looks at me and says, "I'm sorry, do you need to see someone?"

"Yes.  My heart is in arrhythmia and I have almost fainted."

"Sir, did you say you feel like you are going to pass out?"

"Yes, ma'am. I need to see someone please." (My inner monologue: "I FUCKING TOLD YOU TWICE! CALL FUCKING TRIAGE YOU DUMB FUCK!!!") In all fairness, they are quite an overwhelmed staff most of the times.  20,000+ people working in the building, too small a staff to handle it all...but I was in no mood.  Things seemed screwed up and I was getting scared.

So the nice nurse comes out, I explain to her what is happening and she asks "Do you want a wheel chair?"

"No"

"Sir, look at you, look at me.  If you fall, how am I going to get you where I need to get you?"

"I ain't going to fall.  I walked down here from the second floor, I can make it another 50 feet."  Stupid, but I made it.

So they hook me up to the EKG, take my vitals and yeah, things are screwy.  Heart rate is 170, in a-fib, BP 150/113, talking amongst themselves.  Doctor comes in, looks at it.

"Are you feeling any pain?"

"Nope.  No pain in my left shoulder area, no numbness in my left arm, I can breathe fine."  And believe me, I'm constantly thinking about this..."Hey I'm 42, I work out, okay I haven't been eating as well as I could be in the last month or so, but come on! This can't be happening."

Cardiologist confirms I'm a-fib, I get a couple of doses of beta blockers, and that gets my HR down to about 85-100 within 90 minutes. The staff starts looking more relieved around me, and talking like things are going to be okay. "Sir, you're heart rate is down, which is good. That's the primary danger.  But you're still in arrhythmia, and we need your heart rate to 'convert' back to a normal, sinus rhythm. Now we can keep you here until that happens on its own, but with the weekend coming up we want to make sure you aren't in any danger, so we're sending you to the ER."

Great, that's encouraging.


An hour or so later I've been in the ER, they've taken blood for all sorts of lab work, done a chest X-Ray and everything is clean.  No heart damage, no thyroid issues, no blockages.  A seemingly perfectly healthy heart in a-fib. Hey that's great, except it's fucking uncomfortable and what the heck are you going to do about that?

Doc informs me that they'll keep me overnight and see if I convert by morning. If not, they'll stick an endoscope down my esophagus to ensure there is no blockage, and then they'll perform a conversion by sedating me and giving a low-level shock to my heart to unfuck the rhythm.  Kind of like a defibrillator but without the huge jolt.

Great, that's encouraging.

I think the doc notices this on my face and assures me that my current condition is not life-threatening and neither is the procedure.  By now I've talked with my wife a couple of times and the big question is should she come down from Rhode Island?  After many discussions involving dozens of variables we decide to wait until early morning to decide.  If I haven't converted and want her to be here, she'd hop a flight. Until then, the best place was for her to be with the kids.

Why? Because this is not a big problem. I'm not in the ICU, the doc was very thorough in explaining what was going on (and believe me, I make them explain everything - the mechanisms at work in the body, the risks, everything.  If they charge every time they talk to me as a consult, then I am going to get my fucking information!).  I wasn't in any danger and I had come to trust the doctor so that I didn't believe he'd do anything risky to rid me of a low-risk condition, the reason part of my brain said "Hey, this is going to be an annoying 12-16 hours and then I'll go back to my room." Also, I could feel that the a-fib was slowing down.  The events were fewer and farther between.  I was pretty confident I was trending toward normal on my own and I'd convert before morning.

However, that wasn't guaranteed.  And even though the risk in the "procedure" is miniscule it is still there.  And it doesn't depend on how much good luck you've had in your life, or you being due to catch a break, or some being who may be looking out for you or deciding to turn a blind eye at that moment.  It is sheer, unadulterated probability based on a number of factors.  And if you fall within that small probability, then that risk gets bigger.  Much bigger. So the question in my mind as I went to sleep - and it was really bugging me - was:

"Even though it is a very, very small risk, am I willing to accept that the last conversation or contact I have with my wife may be over the phone?" Really.  I think when the lights go out, they go out.  No afterlife, no nothing.  The last contact with anyone I truly valued possibly being a phone call.  In hindsight it seems silly, but in the moment it was a point to ponder.  If I have the option to be with someone I loved in the moments before I could lose everything - even if the risk of doing so was so small - should I take it?

I wake up at 3 am, because I can't sleep and I need to "go" and can still feel the occasional fibrillation.  Great.

At 5 am I was awakened by a knock and the nurse coming in to check my vitals. "Good news, our monitor shows your heart rate has converted to a normal sinus rhythm.  As soon as our EKG techs can confirm that, you'll be able to leave."

Relief. Text my wife. Relief.

Realization that working here in DC while the wife and kids live 500 miles away SUCKS ASS. Things like this that don't entail serious risk but still benefit greatly from being able to be together suddenly become huge problems.  Being a "geographic bachelor" could be the dumbest thing I've done in my 20+ year career.

Realization that damned near everything in life is a risk-decision.  The decision to bump the intensity up just a little harder.  The decision that something is happening but I'll "wait awhile and see what happens". The decision that it's too close to the weekend to just let you go without being sure. The decision that based on science and reason I'm going to be okay and I'm willing to accept that this is almost certainly not going to be the last time we talk, so just stay put.

And, strangely, I'm good with that.  The only things I'm going to do differently are not "wait and see what happens" when I know something is really not right and, as part of that, not wait to tell my family when shit does happen, just in case it does happen to be serious.

Postscript: It turns out that, as I mentioned, I am fine.  Of all the reasons a-fib could happen, this was "it just happened".  I'm clear to resume my life.  The doc recommended that, even though I'm healthy now, I get a stress test given that my family has a history of heart disease.  Every indication is that it will be fine, but I should do it.  So that is the next step.

Oh, and there is a third thing I'm going to do differently - make them shave the spots where they attach the electrodes.

5 comments:

MRMacrum said...

Glad you are okay. You just started blogging again.........See, it's really all about me and what I want. ;)

That's some scary stuff. But a "real" man would have just grabbed some more weights and toughed it out with more reps......and then keeled over and died.

Seriously though, out of the blue medical emergencies with no real explanation of why or how can scare the shit right out of a person. And yeah, if there is a next time, have them shave your apeman chest. That picture is just gross and I winced when I saw it.

Beach Bum said...

...no thyroid issues...

I have hypothyroidism, which freaked my wife out when heart failure was mentioned at the diagnoses.

The only things I'm going to do differently are not "wait and see what happens"...

That's my issue as well, I have often went to the doctor feeling "bad" only to feel "not as bad" when I get there and feel more like a fool for wasting their time and mine.

Glad you are okay, and yeah, I demand the medics shave me before they attach the freaking EKG electrodes to my chest.

Randal Graves said...

I have to second the gentleman from Maine. The Old Ones care not for puny mortal excuses. Max the envelope and push the zone to the extreme, Ia, Ia, etc.

Don't be a tough guy and make sure you keep an eye on your ticker, dude.

okjimm said...

whoa... I think you need to leave DC....bad for health. Take care.

Julie said...

Too scary! Glad it turned out okay, but I hope it doesn't happen again.

(Something similar happened to me, which appears to have been an unacknowledged side effect of triptan drugs for migraine. Once the doctors determined that I wasn't having a heart attack, they let me go. Nobody was interested in following up to find out the cause.)