First of all, we’ve been using the wrong word all these years. It means without rhythm. The only arrhythmia is asystole, I tell my students. That’s the flat line accompanied by the clang of alarms in all the television dramas. There’s not much you can do about it; the patient is dead and usually stays dead. The correct word to describe all the ways a heart can dance and die is dysrhythmia, which means a disordered rhythm. There’s the soldiered march of ventricular tachycardia or the pirouette twirl of Torsades. Ventricular fibrillation simply quivers on the monitor. When these rhythms occur, the patient is pulseless and sometimes you give magnesium, usually shock, and always pump their chest to the beat of whatever song lives in your head. Once I was speaking with a man who stopped in the middle of a word, and I watched the rhythm on the monitor change. When I didn’t feel a pulse, I started CPR, and then we placed the paddles on his chest and shouted, Clear, just like in the movies. And it worked. He opened his eyes and looked at me and said, I don’t feel good. And I said, It’s okay, I’m going to get you better and smoothed the fair from his forehead, but then the alarms blared and the V tach returned, and we did it all over again—the drugs and compressions and shocks, and his eyes opened one more time and he mouthed I’m scared around the tube I’d placed in his throat, and I said, I’m here with you. But that was the last time he said anything. We didn’t stop for thirty minutes or more. He’d waved to his family when the medics loaded him into the ambulance with just a little chest pain, so they were shocked when I entered the small consult room to tell them he had died. His teenage son collapsed and landed on his knees and punched the ground and said, But we were fighting, and I think the last thing I said was I hate you.
All I’m trying to say is that it’s really important to use the right words.
~Rachel Mallalieu “A Brief History of Arrhythmia” from the journal PEMBROKE MAGAZINE
If you break
break going out not in.
How you live your life I don’t care
but I’ll sell my arms for you,
hold your secrets for ever.
If I speak of death
which you fear now, greatly,
it is without answers,
except that each
one we know is
in our blood.
Don’t recall graves.
Memory is permanent.
~Michael Ondaatje from “To a Sad Daughter”
I was still a kid
interning at State
he reminisces late in the meal—
It was a young red-headed woman
looked like my sister
when the lines went flat
I fell apart
shook
like a car with a broken axle
Went to the head surgeon
a fatherly man
Boy, he said, you got to fill a graveyard
before you know this business
and you just did row one, plot one.
~Alicia Suskin Ostriker, “The Surgeon” from The Book of Seventy
Like many other medical professionals who have worked in the trenches of frontline healthcare, I too am fascinated by the emergency room streaming drama “The Pitt.”
At first, I couldn’t watch without feeling I too should be working at the bedside alongside the ER team, trying my best to do the task assigned to me, responding to each new instruction, grateful when things go as hoped, crushed when nothing helps and the patient is lost.
The Pitt is the newest addition to the canon of medical dramas and feels like the real thing. All the technology is there, the medical terminology and procedures are real, in addition to the fraught interaction of professionals under stress. Most of all, it feels real because it shows patients and their families trying to cope with the worst day of their lives.
And medical miracles do happen, on TV and in real life.
Recently, a church friend was rescued in a drowning event, was unconscious on a ventilator for nearly a week, with much uncertainty about how much damage his brain had endured while under water. Several weeks later, he is now home, dealing with some memory gaps and muscle weakness, but improving strength daily.
Last week, I had the privilege of meeting a middle-aged pastor who was saved a few weeks ago when his heart stopped in his sleep. His wife started CPR, paramedics shocked his heart in the field more than once, he was stabilized in the ER, unconscious on a ventilator, cooled down to a lower body temperature to preserve his brain function.
His care team, along with family and friends, watched and waited and prayed, uncertain what would be the rest of his story.
When he was warmed up 24 hours later, he woke up, able to breathe on his own. Other than no memory for those brief hours of unconsciousness, he is still himself – living with a new awareness of his vulnerability and an immense gratitude, now with an implanted defibrillator in his chest.
The right words after being brought back from the dead?
The right words when we never know if they will be the last words we utter or the last we will ever hear?
I know what they would be for me. I carry them in my heart…
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