Plenty of patients walk out of our hospitals, clinics, and offices
with their diseases under control, and yet they do not feel healed.
Dr. Danielle Ofri
At the registration desk in the Emergency Room of North Ottawa Community Hospital, in Grand Haven, Michigan, the triage nurse asks about my symptoms. Last night, I tell her, I felt pressure against my heart. And sweating. I don’t tell her I feel fine now. Nor, this morning, do I even consider an appointment with my primary care physician because test results, as an out-patient, take days. Being more than a little obsessive, and a hypochondriac to boot, I want answers. I want them now. In the ER, you get instant gratification even if the news is bad: two weeks to live. If last night’s episode is, or was, a heart attack, it’s apparently not life-threatening. So I swoon over the reception desk to at least appear frailer than I feel. This claim must seem legitimate.
The word “heart” bumps me to the head of the line. The wide doors to the treatment rooms swing open.
Enter! This way station will determine your fate: How long to live – or when you will die.
I change into a hospital gown, slide onto the bed, and describe the symptoms to an emergency room nurse. She checks blood pressure, pulse, temperature. All normal. In fact, my blood pressure is low. She attaches electrodes over my upper body for an Electrocardiogram. Cold, gooey patches dot my skin. She explains this shows the electrical activity of my heart. Impulses, recorded as waves, flow along a monitor – if you’re lucky. “The muscle of an injured heart doesn’t show electrical impulses,” she says. I press a finger to my chest. A gentle thrumming. I’m not flat-lining. Yet. However, the overly processed air in the ER, the discordant
noises, the flashing and beeping, the unrelenting fluorescent lights, don’t quite sound like the real world. I almost feel as if I died last night – halfway between awake and asleep – or not knowing the difference. And if it isn’t a heart attack, how to interpret the mystifying message sent to me from my heart?
Last night, December 17, 2012, in my bedroom, I think a flutter in my heart awakens me around midnight – though, from the start, I’m confused by my lack of conviction or hard empirical evidence. Perhaps I haven’t yet fallen asleep. Perhaps I’m in a state of semi-consciousness. Perhaps I’m on the cusp between sleep and wakefulness, a non-state state of being.
Whether awake or not, this is what I feel – unless I hallucinated the entire episode. No: Let me make one definitive statement. This is what happens: My skin sweats, mildly. A thin pressure encapsulates my heart. The pressure deepens, but softly, as if a palm cradles it. Then, for a brief moment, the palm (not mine, whose?) hugs it. This mental image is distinct. No arm is attached to the hand, only a portion of a nondescript wrist. Is the gesture meant to convey a farewell? A greeting? Love? A subtle warning? In this quasi-conscious state, I’m not scared. I passively accept this gesture whether it’s a vision, a dream, or something else.
Then, I fall asleep.
In the morning, I remember the sensation. More alert, I now want to know what it means. It felt good, but was it actually bad? A heart attack?! Was it just a metaphor? (Just?) If so, for what?
Now another nurse, carrying a slotted tray of test tubes, pulls back the curtain surrounding my bed in the ER. She’s here to draw blood. “What’ll that show?” I ask. Apparently, if the heart has been damaged, certain enzymes leak from it into your blood stream. I imagine chartreuse-colored enzymes contaminating my veins. (The word “enzyme” sounds chartreuse. I might be dying, so indulge me.) She slides a needle into the crook of my elbow and fills vial after vial of blood. This does not disturb me. I consider vampires. Vampires, after all, live forever.
Next up is a chest X-ray. I worry about radiation but, at this point, I’m too far into the heart attack scenario to say “never mind.” They maneuver the entire bed, upon which I lie, out the door, the aide soundlessly gliding me down one linoleum corridor, up the next, toward the X-ray department. As we turn down yet another hallway, a breeze gusts my skin. I experience the sensation of floating through space. I feel as if I’m on some picaresque journey. Who knows where I’ll emerge?
I’m still here on earth, however, so I am X-rayed. The technician asks me to stand in front of the machine. “Don’t move. Hold your breath.” When I ask what the X-ray might reveal, he replies “fluid in your lungs. Also, the size of the heart and blood vessels.” But won’t the X-ray appear skeletal, I wonder, a vest of ribs protecting a defenseless heart. I want to ask the technician for a copy of the X-ray – a snapshot to be saved for a photo album. Not that I believe in ghosts or otherworldly creatures, but what if a hand has been dispatched to my heart with a message? I want to see it. I want to know if the message is good news or bad.
I’m wheeled back to my room, a double, which now contains another patient. An ancient man moans, coughs, and sneezes, spewing galaxies of germs into the air. He makes a sound not unlike a cat hacking up a hairball.
I nod my head toward the man and ask the nurse for a face mask, the kind surgeons use to protect themselves from the common cold, Ebola, the plague. She sighs, but gives me one, anyway.
The ER doctor pulls back the curtain, sits on a stool, and scoots close to me. He wants to know my symptoms, what happened last night, what did I feel? For the third or fourth time, I explain the sweat. The pressure on my heart. He waits for me to say more.
“It was gentle,” I whisper, hoping he can hear me through the face mask. “Friendly.”
He puts down his pen. He flips through my chart that might, at this point, contain the results of the blood and X-ray tests. He looks up at me. “I’ve never heard anyone describe a heart attack as gentle,” he says. “Or friendly.”
“Maybe it was a little heart attack,” I say.
“I’m scheduling a stress test for you,” he says. “Just to be on the safe side.”
“Can I do it now?” I ask.
“Three days,” he says. “But the ECG, the blood work, the X-ray, all are normal.”
The way he looks at me is not unfriendly, exactly, but suspicious.
“Sometimes, you know, people imagine things,” he says. “Especially when they’re stressed.”
I want to tell him, of course I’m stressed: about dying. Isn’t he himself terrified by the sheer nothingness of it all?
I also want to ask him if it could have been symbolic. Isn’t it just as important to unravel the meaning of a symbol, a sign, as it is to diagnose a physical symptom? Isn’t there a test for that?
Three days later, I report to the Nuclear Medicine Department for the stress test, which definitely convinces me I’ve not had a heart attack. I want to declare that I am suffering the after-effects of a metaphor. I want to believe that the palm hugging my heart is emblematic of a soft, fleeting shadow – not one ready to stop beating.
But here I am trapped in a high-tech-fluorescent-lit-nuclear-medicine chamber.
In order to undergo a myocardial stress test (to determine whether blood flow to the heart was blocked long enough to have caused damage), I sit on a chair while the nurse ties a thick rubber band around my upper arm. She plunges a needle into a vein, injecting me with Radiopharmaceutical Tc99m Myoview. It takes time for the material to flood my system, though I expect to glow electric-green immediately. With a cheery smile from the nurse, I’m encouraged to go to the hospital cafeteria for breakfast. Return in an hour.
I order an English muffin and a bottle of water. I sit alone at a small round table. A few doctors and nurses, at neighboring tables, laugh and eat. I remove a pencil from my bag, and, on a paper napkin, I write: For breakfast I had an English muffin with a radioactive chaser. Is this a balanced diet? Maybe.
Beneath that I write: Surely I did not have a heart attack. The radiation will kill me instead. It reads like a suicide note. No need for an autopsy. If it weren’t for the radiation coursing through my system – if I didn’t feel like a nuclear bomb about to detonate – I’d sneak out and go home.
Before the stress test, I’m given a Cardiac Computerized Tomography. I lie on a table inside a doughnut-shaped machine while a tube rotates around my body collecting images of my heart and chest. I turn one way. Then another. The machine whirrs. I want a copy of this procedure as well. I want to see inside my skin. Who am I? What was that gentleness? What was that shadow? What do I look like on the inside? Can such a printout convey – if not the actual distance or length of time between me, today, and my eventual (but hope to be avoided) death – a history of my life? What I really want to ask the nurse, but am, at least, wise enough not to, is whether these machines and tests are smart enough to differentiate between heart attack and metaphor?
I’m next brought into a room with a treadmill, as if this is a gym, and I’m here for a workout. If this is a test, I’m sure I’ll flunk. While I walk half an hour every day, let me emphasize the word “walk,” as in “saunter.” I’ve only been on treadmills once or twice and don’t like them. They seemed intimidating. Threatening.
The treadmill starts slowly. No problem. Piece of cake. The nurse turns up the speed. I don’t even break a sweat. My heart doesn’t feel as if it’s about to attack. They speed it up and, again, no problem keeping pace. I feel as if I’m accomplishing something significant, like making it through the Olympic trials. The doctor, studying a printout, smiles. The nurses beam. They crank the machine faster. I feel as if I’m soaring back and forth in time, as if the computer will spew out a complete history of my heart from the moment I was born to now. I’ll understand everything I need to about my heart and my soul – if, if I have one – as if it can be evaluated on a physician’s treadmill.
Finally, the machine slows, before stopping. The doctor tells me I have the heart rate of someone at least fifteen years younger.
But how then to explain that hand holding my heart? I did not dream it. What was it? Whose was it? What did it mean? Was it a warning? A message?
After I return home, I Google symptoms for a “gentle, friendly heart attack,” which the doctors don’t think I had in any event. I find sites that describe a squeezing pain in the center of your chest, pain in your shoulder and arm – even your teeth and jaw. Prolonged pain in the upper abdomen, shortness of breath, sweating, fainting, nausea, clammy skin, fatigue. Besides the sweating (which could be symptomatic of anxiety and stress) none of these descriptions fit me. Nothing about shadows or symbols.
I want to discover what it is.
What other words might pertain to the body to make it more of what it is – or more than what it is – keeping me on the safe side.
The side of life.