Authors: Tilda Shalof
Cezar tears the printout off the machine and attaches it to my chart with a paper clip. For the echo, I flip to my left side so that he can obtain the best view. He glides the probe around my chest, digging it in at certain landmarks for a closer look, pausing, peering at the screen, then moving on. While Cezar works, I take a look around the small room, dimly lit as a nightclub to enhance the clarity of the picture onscreen. In the corner there’s a treadmill for stress tests and a red “crash cart,” equipped with defibrillator, pacemaker, and emergency drugs.
“Ever had to use that?” I point at it.
For a patient like me?
“Yup.” Cezar’s brow creases, his eyes widen then narrow, but he keeps them trained on the screen in front of him. The sound of the amplified beats of my heart fills the room.
“See anything?” I inquire, well aware that he’s not supposed to divulge anything, but I’m quite sure Cezar knows a thing or two. “Don’t worry,” I assure him. “You can tell me. I’m a nurse – an
ICU
nurse.” He stays focused while I chatter on. “There’s a problem with the valve, isn’t there?”
Cezar pauses his probe and looks at me. “Big-time.”
But I feel fine! Well, maybe not my best …
“How bad is it?”
“I’ll let Dr. Drobac speak with you about it.”
I get dressed and graduate to the office of Dr. Drobac, who greets me warmly. As he reviews my
ECG
and echo report, I check him out. He’s a tall, thin, elegant man who looks like he may have run a few marathons himself.
“You’ll never see a fat cardiologist,” my old nurse buddy Laura says. “Yet, there are many neurotic psychiatrists,” she points out. Laura has developed extensive character profiles of every medical specialty. According to her, neurologists are precise and nerdy, gastroenterologists are messy and swear a lot – “think of what they do!” – and all ophthalmologists have small, legible handwriting. Her theories have yet to be tested.
Dr. Drobac introduces himself and we sit down opposite each other for the “functional inquiry,” also known as the “patient interview.”
“How have you been feeling?” he starts off.
“Great! No problem!” I say.
“Asymptomatic,”
I feel compelled to add.
“Any history of family illnesses?”
“My mother had early onset Parkinson’s disease and manic depression. My father had type 2 diabetes and coronary artery disease.” Died from it, too, but I keep that detail to myself so as not to prejudice my case.
“Do you smoke?”
“Never!”
How virtuous am I?
“Take any prescription drugs on a regular basis?
“No.”
My body is a temple!
“How about recreational drugs?”
“No …”
Well, not lately …
“What about alcohol?”
“Clearly, not enough.” Now that gets a laugh out of him.
“Are you a Muslim?” he asks, breaking from the script of a standard cardiac history to figure out who I am. He hasn’t quite got me pegged.
“No,” I say. “Jewish. We like to eat. But I plan to start drinking more red wine as soon as possible. In moderation, of course. Strictly for the cardio-protective properties.”
Broccoli and dark chocolate, too. From now on, I’m going to do everything right
. My mouth is dry, my hands are beginning to shake. “I have a feeling you’re about to give me bad news.”
“No, I’m not.” He smiles. “Not at all.”
Maybe it’s nothing. What am I worried about? I feel perfectly fine.
“Any shortness of breath?” he continues.
“No … Not really.”
Well … maybe, a little, now that you mention it
.
“Chest pain …”
“No, never!”
“What about chest discomfort or tightness, or racing heartbeats? Have you had any dizziness, light -headedness, coughing, or fainting spells?”
Now that you mention it …
I swallow the lump in my throat and stifle the harsh, dry cough I’ve had for a few months. Suddenly, I realize it is a
cardiac
cough. I’d have recognized it in a patient!
“How do you feel after you walk up a flight of stairs?”
“Not great,” I admit. The truth is I haven’t been able to walk up stairs for a few months now. I’ve been avoiding them when possible, and when not, I take them slowly, pushing against the heaviness in my chest, out of breath within moments. Ditto for hills and any inclines, for that matter.
“Do you have much stress at work?”
“Not at all.” My patients do, but not me! But dare I mention that lately I can barely make it to the end of my shifts at the hospital? I
am exhausted by lunchtime. “What’s wrong with Tilda lately? She’s always lying down,” I heard a nurse say in the staff lounge the other day. “I’m taking a power nap,” I said, popping up. At the end of my shifts, I’ve been dragging myself home and crashing into bed, not a drop of energy to spare.
“Are you able to do your daily activities at home?”
“Yes,” I say but don’t tell him that I couldn’t rake leaves or shovel snow this past winter and the house is a mess. I move the vacuum cleaner two sweeps and have to sit down to rest. A laundry basket full of folded clothes sits at the bottom of the stairs, too heavy for me to lift and carry to the top.
“How about sexual activity?”
“Absolutely!”
“Sex is very beneficial for heart health,” he explains.
In that case, I’ll have sex every day – twice a day – if necessary! (Note to self: Notify Ivan of this new treatment protocol.)
“What about exercise?”
“I have a gym membership. I’ve done a few aerobics classes …”
Yes, I’ve showed up at all those classes with the improbable names like Guts and Butts, Cardio Funk, and Jazzercise. But my workouts have become lame and “half-hearted.” I can’t get my heart rate up above 100 and it takes a long time to recover and return to my resting rate. Oh, and I’ll never bring a water bottle so I can have an excuse to keep stopping for a drink at the fountain to catch my breath.
“Are you keeping up with your peers?”
I haven’t heard that phrase since I was fourteen when I begged my parents for the real Adidas running shoes with three stripes that the cool kids wore, not the cheap North Stars with only two. Of course it was only a fashion statement and status symbol, since I wasn’t doing any running anyway.
Then there is my recent attempt to keep up – literally. It was on a vacation to Nelson, British Columbia, to visit my friend Robyn, during a group hike up a trail on Pulpit Rock, in the foothills of the Kootenay Range, near the Rockies – listed as a “gentle climb” in the guidebook. As I struggled to keep up with the pack, other friends easily strolling along faster, farther, and higher were casting back sympathetic gazes. Robyn stayed behind with me, looking worried.
“I’m taking it slow … so I can … enjoy … the view,” I said as I huffed and puffed, shaky and breathless.
I need to make it to the top of this hill
, was all I could think as I kept stopping every few feet to clutch my chest, praying I wouldn’t collapse on the way.
I’m a wounded buffalo, trying to keep up with the herd. Shoot the beast! Put it out of its misery!
We both knew something was wrong but didn’t discuss it. Now I allow myself to know the truth: I could have dropped dead up there on that mountaintop.
Suddenly I realize the
real
reason that I quit the amateur parent-teacher talent show a few months ago. For my audition, I chose “A Cockeyed Optimist” from
South Pacific
, and mercifully they cut me off after a few bars since I sucked, but I was also too out of breath to finish. Nonetheless, they gave me a one-line solo in a song-and-dance number from
CATS
that required me to leap onto a platform wearing a skin-tight catsuit (what
was
I thinking?) and belt out, “Can you ride on your broomstick to places far distant?” I couldn’t make it to
broomstick
. I bowed out, claiming to be too busy for rehearsals.
“So, no symptoms?” Dr. Drobac presses on.
“No.” Only a premonition of doom, which I’m having right about now.
He makes notes in my chart – I now have a
chart!
– probably jotting down
unreliable historian
, the damning term for patients who
aren’t to be trusted. He’s recorded my
symptoms
– what the patient reports – and now moves on to the physical examination, the
signs
– what he, the physician, observes and can measure.
We look at the
ECG
together. “Mild ventricular hypertrophy,” he notes and points out the deep amplitude spikes in the chest leads and explains that my left ventricle is dangerously enlarged as a result of having to work extra hard to pump blood against the resistance of a constricted aortic valve. Any
ICU
nurse would grasp what he’s talking about, but my thinking is so jumbled I can’t follow his train of thought.
He stands up for the physical examination, ready to discover his own findings. Okay, let the objective tests be the judge. I may lie, but they won’t.
Back in my patient “uniform,” I lie down on the examining table. Dr. Drobac palpates my pulses, the carotid in my neck, brachial in my arm, radial at my wrist, femoral in my groin, popliteal at the back of my knees, and dorsalis in my feet. My pulses have always been weak and he notes that. He examines my jugular neck veins, which reflect the pressures in my heart. He places the bell of his stethoscope on my chest, closes his eyes, and listens. As I await my verdict I recall that according to Laura’s profile, in addition to being slim and fit, cardiologists are the most musical of doctors. It does make sense: they spend their days listening to the melodies of the heart and have to be exquisitely attuned to pitch, volume, rhythm, tempo, crescendos, and diminuendos.
As Dr. Drobac moves his stethoscope around my chest, I know exactly what he hears: a slushy, mushy whooshing. My heart doesn’t have the distinct sounds of a healthy cardiac cycle of contracting and relaxing; not the vigorous
lub-dub
of strong ventricles pumping effectively with valves opening and closing efficiently. My heart is the
swish, swish
of a lazy, burbling stream.
As a child, I was invited by medical schools as an interesting case study for doctors-in-training to learn abnormal heart sounds. Any first-year med student who could not correctly diagnose my obvious, loud systolic murmur would surely fail. But, when I grew up and became a nursing student myself, I stayed home from class the day they taught cardiac auscultation. We were supposed to listen to each other’s hearts and my cover would have been blown.
Back in my civvies, I sit down with Dr. Drobac, who looks me squarely in the eyes. “It’s clear why you’ve come to me now. You’re not feeling well, not keeping up. The echo shows that your valve is tight. You have severe aortic stenosis.” He gives me a moment to take that in, then says what I’ve waited all my life not to hear. “There is no doubt in my mind that you need open-heart surgery to replace your valve and to repair part of your aorta, too.”
Valve plus aorta. Cut and blow-dry. Shave and a haircut, two bits
.
The bottom drops out. I can’t breathe. His words catapult me to the
other side
. I’ve crash-landed on Planet Patient, a destination where no one – but especially no nurse – wants to go.
Hey, don’t I get any immunity from these things happening to me?
Way over there is the doctor, talking to me from the safe side, waving and smiling from the far shore. He still seems to be thinking he’s giving me good news.
“You’ll need a cardiac angiogram first,” he continues, eager to get this party started, “to rule out coronary artery disease before surgery.…”
Of course. The cardiac surgeon doesn’t want to open me up and get in there only to find blocked arteries and that I need a coronary artery bypass as well as a valve replacement.
“Can this wait awhile?” I ask.
“Better to face it now, when you’re feeling relatively well, with no other co-morbidities.”
He means high blood pressure, peripheral vascular disease, coronary artery disease, hardening of the arteries, diabetes, kidney failure, a little of this, a touch of that, things waiting in the wings for most of us, one day, eventually.
“Your aorta is enlarged … the valve severely constricted … blood flow is reduced … ejection fraction is less than 30 per cent … you’re not getting adequate blood supply.”
“Could it be repaired? A minimally invasive procedure?”
Could this have been avoided if I’d dealt with it earlier?
That question, I wonder, but don’t dare ask since I don’t want to know the answer.
“No, your valve is too diseased. Extensive work needs to be done. It has to be replaced along with part of the aorta. It can only be fixed by opening the chest.”
But these things happen to patients!
“I need time to think about it.”
“Don’t take too long.”
“When should it be done?”
“Soon. Within the next few weeks …”
Open-heart surgery – how inconvenient!
I had lots of other, much more fun plans for the summer! Taking a break from my work in the
ICU
, spending time with Ivan and the kids, working as a camp nurse, spending time at my brother Tex’s cottage on Georgian Bay. And this was the summer we were finally going to adopt a puppy, a year after the death of our elderly dog, Rambo.
Dr. Drobac asks if I have any questions. None and many, but first I have something to tell him that’s way more urgent than any questions I might have.
“I want you to know that if I get a serious complication and don’t wake up afterward, or if I become severely brain-damaged
or have to be on prolonged life support, please let me go. If it’s my time, let me go.”
I do not want to be kept around beyond my useful shelf life
.
I blurt out these dire directives, not bothering to explain why catastrophe is uppermost on my mind.
He’s incredulous, at a loss as to how to react to my at-the-ready disaster plan. “Have you thought this through?”
Have I ever!
I think but can only nod yes to his question.