The pump

So this morning as I was running, for some reason I was paying more attention than usual to feeling my heart beating faster, feeling my blood pressure higher than usual, that sort of thing. And I got to thinking, tangentially of course, of how after a stress echo last spring, the man who is (in my opinion) one of the world's finest cardiologists told me with wry grin that my blood pressure during the test topped out at 140/90 with a pulse rate of 193, and how most of his patients would be thrilled to have a resting pressure that low. True dat.

Now you may be asking yourself, just exactly what the hell business does a healthy, fit 30-something gal like myself have getting a stress echo, anyway. The quick version (feel free to skip ahead if you've already heard this part, those of you who know me well): In September of oh-four, my dad, a few weeks shy of 55 at the time and with no prior cardiac history, saw fit to have a heart attack and "keel over" (his words) in v-fib arrest.
(For you non-medical types, that's what we call it when the heart decides to quiver like a big ball of jello, not pumping blood to important places like the brain and lungs or anywhere else. It's one of two shockable rhythms. Left unshocked for more than a few minutes, it means *dead*.) Just family history, himself healthy as a whip save for in-remission non-Hodgkins lymphoma...no warning signs like the textbook crushing substernal chest pain radiating to the left arm and left jaw. He said he just felt "a little puny," and like he'd had a bit too much caffeine. And then his heart stopped. Because my dad is one of the most practical people in the world, he had the good sense to do his keeling over in the 5th floor lobby of a hospital where he happened to be visiting my grandma who'd just had back surgery. Mom had just run to the car with Grandpa to show him some home safety equipment they'd bought that morning when it happened. Thankfully an observant pharmacy runner, the only person who'd happened by (I failed to mention that this happened on a Sunday afternoon in Salt Lake City, where anyplace that isn't a Mormon church is a lonely wasteland), noticed the man slumped over in the chair. She was worried about him falling out of the chair and hurting himself, so she tried to wake him and realized he looked a funny color and didn't seem to be breathing. When Mom arrived back on the 5th floor, the elevator doors opened onto chaos, and the hospital's code team shocking "some guy" on the floor. (Mom was looking for Dad, knowing he'd have seen what happened and would be able to tell her the story, and I can't imagine the horror she felt as she recognized the shorts on "some guy.")

Okay, this isn't really a quick version. But at any rate, after a difficult intubation and another round of shocks during that, they got Dad to the cath lab in under an hour, a sudden 100% blockage in the LAD (left anterior descending artery, the big one that supplies the whole heart) roto-rootered and stented, and he's in perfect cardiac health today, they say. Needless to say, with no warning signs and no real history, it was an eye-opener for all of us. It was at that point Brian (my brother) and I decided to make dates with Dr. Joe Lee for baseline cardiac workups. That brings me back, after much ado, to the stress echo.

The worst part, in my opinion, of a stress echocardiogram, comes *after* the 30 minutes of increasingly speedy treadmilling. They quick-quick-quick lay you down on the table, because they have no more than two minutes to get 4 specific ultrasound images of your heart while it's pumping at that maximum capacity. The agony comes in the fact that you have to be holding your breath for each of those 4 images. I have never been on more intimate terms with what death feels like than in those two minutes, my lungs screaming for air and my heart feeling like it was about to explode, literally...my visual field blackening at the edges and my conscious thoughts reduced to "must.breathe.now.or.die" - it was among the most unpleasant experiences I've had.

So I was thinking about all that this morning as I ran. And the feeling our patients must certainly have when we stop their hearts, if only for a couple of seconds. There's a medicine called adenosine, that's given to people whose hearts are beating way too fast in a certain rhythm. Adenosine has a really short half-life, meaning it loses its effect in something like 5 seconds - and it's fun as all hell to give (you have two nurses there, one with a syringe of adenosine jacked into the patient's IV line and one with a flush syringe of saline jacked in at the next port up the line - you be sure the patient's hooked up to the monitor and the defib pads in case something goes bad, and you make damn sure the patient knows the next 10 seconds will be horribly unpleasant - you give a 1,2,3 and bang-bang push fast at the same time).
The monitor shows a flatline until the adenosine wears off and the patient's sinoatrial node clears its throat and resumes its rightful role as pacemaker - but during that 2-3 seconds the patient's facial expression is something to behold. I can only imagine the way it feels when your heart stops dead in your chest and you're conscious and alert the whole time. I'm sure it makes my stress-echo near-death seem like a walk in the park.