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Friday, 25 January 2019

Not quite at death’s door

The episode started on Saturday 19 January after I went to see ‘Mary, Queen of Scots’ in Leichhardt. I had a long bout of heart palpitations while getting off the train and it kept going after I had walked up the five flights of stairs at the station. (I don’t use the lifts at the station unless compelled by circumstance as I got stuck in one of them in November 2017.)

The heart arrhythmia was still going after I got home so I called an ambulance. There were two paramedics in the vehicle when it arrived in the street, one of whom (a woman) was driving and one of whom (a man) was in the back doing tests on me. After asking what I did, he mentioned ‘Vice’ (which I reviewed here on 16 January) and said helpfully that “if your heart’s fucked, you’re fucked”. He mentioned that I ticked a lot of the boxes: the right age, overweight, living alone.

At the Royal Prince Alfred Hospital there were around twenty people to greet me in the resuscitation ward - the arrhythmia had stopped after the ambulance had arrived but had restarted as we were driving, but then had stopped again - and they all stood around watching the heart monitor to see what the signal would look like when it started again. A cardiologist came up and connected me to another electrocardiogram (ECG) machine and looked at the printouts the paramedics had made while we were in the ambulance. These he called “gold”. He was dark-skinned and looked like his ancestors were from the subcontinent and he said usually with this kind of condition you can take medication to control the heart but that they would keep me in the coronary care unit (CCU) for a while to monitor me.

They gave me a pill which stopped the ventricular tachycardia (VT), called Metoprolol. While I was having the bed changed on Sunday morning in the CCU I took a photo (below) of the connector that brings electrical signals from contacts (they call them “dots”) stuck to your torso to the ECG monitor in the room. Each connector is colour coded, with each colour clip having a designated location on your chest, shoulders and stomach. The monitor has different coloured lights that illuminate depending on the type of event. The orange light seemed to be the most common but there was also a blue one and a red one. The monitor also made sounds and was linked to a central monitor at the nurse’s station. Not all the alarms that happened on the ECG monitor in your room relate to you however. All of the ward’s patients’ hearts are monitored by all of its monitors (and also from a central monitor at the nurse’s station) so that staff can see if there are any significant alarms happening even if they are in someone else’s room.


They had me prepare early on Monday for an electrophysiology study, which is invasive, and an elderly man came at 6am and shaved my groin. Breakfast was a slice of bread just before that. Then I waited and later one of the young cardiologists asked me questions about a magnetic resonance imaging (MRI) scan they wanted to do. Then another cardiologist came and told me the EP study would be done after the MRI scan, which was scheduled for Wednesday. But no-one told the nurses of the new plan, so when I buzzed to ask for something to drink the nurse stood there in the door with his hands on his hips and told me I was “nil by mouth”. He seemed quite shocked by the change of plan and went away to find that no paperwork had been made for it. Then he brought me juice and yoghurt. I learned something about information and power.

They had put cannulas in both of my arms when I presented to RPAH resusc on Saturday. The one in the left arm became painful and on Monday a nurse took it out and put on a bandage. The one in the right arm remained and it hurt too. I posted on Facebook that I would need anaesthetic soon, probably on Thursday, but that I didn’t see much need to keep it in just then. I asked a nurse if she could take it out but she didn’t want to do it. She said that for people with my condition they like to keep a cannula in “in case they need to give medication”. So protocol trumped comfort.

Being alone in a room in bed day after day you start to notice different things. I saw the ethnicities of the various staff (orderlies, nurses, registrars, specialists, paramedics, student doctors) and listened to their different ways of talking. From my room I heard men and women talking behind the curtain across my door and tried to imagine where they were born, and what level of education they had attained. I saw so many different people and hear their voices and it strikes me that there is no “typical” Australian. It is an entrepot, Sydney, and a world city.

One of the nurses, a woman named Kelly, told me that RPAH was looking into developing leadless contacts for the heart monitor. She said that a woman who had been a patient here was developing the technology. Kelly and I talked about how wifi had been developed by the CSIRO. Sometimes governments need to step in to make big changes.

I was reading the great Inga Clendinnen’s study of the Aztecs that a friend had bought me and I was reminded me of how reality can elude the grasp of the careless spectator. To understand the truth you have to follow where the facts take you, and stick to original sources where available. This is the scientific method as first expounded by Bacon in the early 17th century. If Clendinnen teaches us anything, I thought, it is to avoid familiar narratives as far as possible and to remain true to the evidence. Even Petrarch as far back as the 14th century shared a message about empiricism.

Every time that first cardiologist came to see me – usually it was in the mornings – I asked him about the prognosis. Even with the medication there were two episodes of atrial tachycardia (which is less serious than VT) on Monday morning but each was only about 10 beats long and they had captured a record of both. This cardiologist told me that VT does not shorten life. But one day when a different staffer came to do a 12-point ECG on me he said that VT was serious. So I was getting mixed messages.

I intrinsically trusted the senior cardiologist, however. His name turned out to be apposite, but I won't include it here, and one day he came to see me and asked me if it was ok to move me to the Mater Hospital to do the EP study. They would have an anaesthetist there, he said, and the equipment they used in their operating room is also more modern. I said it was ok, as I had private health insurance that would cover such a procedure at that kind of hospital, and he got me to sign another consent form. There are various forms to sign when you are in hospital. The admin person had already come around to ask if it was ok to bill my healthcare provider for the stay in the RPAH and I had agreed. Then a man in light-blue scrubs with a light-blue cloth cap in his head had come around to get my consent for the EP study. He told me about the risks (which included puncturing part of the heart and infection in the invasion points in the groin) and I had agreed to going ahead.

The anaesthetist’s receptionist called me and organised for me to pay the excess (the part of the cost above the covered amount) using my credit card, which was in my wallet as usual. She sent me an email which I responded to as instructed. Then I called her back to see if the email had arrived. My phone said it had gone but I wanted to check and I had plenty of time. She said that my email would have gone to a general practice email address, not her private one, so she could not currently check to find out.

On Wednesday morning I had no breakfast and did the MRI scan. The orderly who took me there was named John and he was about my age, if not older, and had very long, white hair and a thick, long beard. He didn’t wear glasses and had twinkly eyes. He was kind and joked with me as we made our way along the halls of the building. I wondered at the fact that I had learned so much about heart function in my few days in the institution, but had no idea where my ward was physically located inside it. The walls of one of the lifts we used during the trip had a pressed metal cladding that looked, John said, like the body of a Dalek. He asked the nurse, who was young and second generation Asian-Australian, if she knew ‘Dr Who’. She said she didn’t. 

I had worried about whether I would be able to tolerate the confined space of the MRI machine but it turned out to be ok. It was sort of hypnotic being in a narrow plastic sheath for 45 minutes following instructions on how to breathe from a recorded voice speaking in a sort of American accent. The device operator also talks to you through the headphones. The machine worked in short, noisy bursts each time I held my breath. The sounds were abstract and informal, as if they had come from some 20th-century 12-tone orchestral work. It was a bit like being in Kubrick’s 1968 masterpiece, ‘A Space Odyssey’. The feelings you get when you’re listening to the voice are complex and I can imagine how a prisoner would develop a relationship with his captor because of the need to follow orders. There was a grey, painted band down the length of the tube to help you orient yourself in space and at eye level there was a dark mark in the band shaped much like the Macquarie Bank logo. The operator told me the machines are expensive to buy.

I stayed in the CCU after the MRI scan but they were preparing to send me to the Mater. The transport was due to arrive at midday but eventually they came after 2pm. There was a young man and a young woman and they put me on a high gurney to take me downstairs to the vehicle. On the road, as we were sitting at the lights on Fig Street just before the entrance to the Western Distributor, the woman driving, my heart started to palpitate a bit. I told the crew and the man said that nothing was coming up on the ECG monitor but that they would stop when it was possible. We got onto the bridge and went up the Pacific Highway (still no place to stop) and the heart calmed down a bit so they just carried on to the Mater, which is just near Crows Nest. 

As soon as we arrived we went to my room in the ward and the anaesthetist (a woman who might have been of Indian heritage) came to ask me some questions. Then we moved to the operating room, where the senior cardiologist came up to me. We had a quick chat. I mentioned to him that his stopping the Metoprolol on Tuesday had turned out to be good timing because it would allow him to do the procedure when the heart would be labile. I said he was very clever and he smiled and went away. Then I met one of the team who would work on me who had the same surname as me. I asked him if he was second or third generation and he said he had been born in Brazil and had then had worked in South Africa. He had visited Mozambique (my paternal grandfather had grown up there when it was known as Portuguese East Africa) many times for business. When he walked away I could see he had a small, black yarmulke on the top of his head, held in place by tiny clips that were almost invisible.

Once in the operating room, a woman who was a bit older than me came and stood in front of me with her hands on the hospital gown, part of which rested on my thighs, to help me stay modest, she said. She introduced herself as one of the operating theatre staff and she was very kind, asking me if it was very boring staying in hospital. I wanted to say that a friend had bought me a good book but I couldn’t get the words out as emotion overwhelmed me. 

She just stood there with me until it was time for me to put my legs up on the table. The anaesthetist put some chemical in the cannula in my right arm and talked to me but I was soon out cold. When I awoke she told me that during the procedure I had kept asking where my glasses were; I had worn them into the theatre and they had taken them away from me before the procedure started and had put them aside. When we had been in my room I had mentioned to her Kate Cole-Adams’ wonderful book to her (titled ‘Anaesthesia’, which was reviewed here on 21 November last year) and had asked her if it is true that people sometimes wake up during procedures. 

She had said that practitioners don’t really know how anaesthesia works. Cole-Adams had said to me in a tweet that the book raises questions about consciousness. I find that what she wrote is true: people are frequently aware of what’s happening during operations but mostly don’t have any memory of it after it is over. After the procedure, which took three hours, was over, I was taken to the recovery ward where a nurse who had migrated from an Arabic country, and who wore a hijab, looked after me as I regained my senses completely. I was shivering at first. There was a stereo playing softly in the ward. One song was by the Eurythmics and one was by Madness, both 80s bands. When we got back to my room in the ward the nurse told me not to raise my feet. Before the procedure a male nurse, who was about my age and who was Asian, had put tight stockings on my lower legs with a hole where the toe section is located. Now, the recovery nurse pointed to my feet and energetically told me to keep my legs flat, but called me “darling”.

After a ham, cheese and tomato sandwich that night in my room in the ward the nurse, whose name was Jo and who had a Scots accent, gave me the wafers I take for my mental health underneath a crucifix above the door to my room. Just up the road was my accountant, I thought wryly, as I prepared to sleep. 

Then I had the most appalling stomach pain on Thursday and I posted about it at 4am. It felt like something was moving around inside me, I thought it might be gas, but the result was what felt like terrible cramps. I felt like Executive Officer Kane (John Hurt) had done just before, in Ridley Scott’s 1979 film ‘Alien’, the creature emerges from his stomach, and on top of the pain I was desperately tired, having had two procedures that day. The nurse gave me two doses of emetic through the cannula (they had taken out the one in the right elbow and put in a new one on the back of the right hand) and two Panadols. The nausea waned slightly, although I did throw up a little a bit later, but the cramps remained. It felt like they were creeping up my body to my diaphragm. I think the nurse got a bit tired of answering my calls but the dry retching and the pain were unbearable. I wondered idly in my distress what childbirth was like for women.

But the EP study had been a success. When the senior cardiologist came to talk with me later in the morning he said that they had found a part of the heart that had been sending incorrect electrical signals to the organ and that they had ablated the area with a catheter and heat, to prevent the VT from happening again. The Metoprolol would continue indefinitely, however.

Later the same day I told the nurse, whose name was Sophie and who was Asian and also first generation, that I would stay in the ward but then after a while I told her that I wanted to go home and recover from the procedure there. She had given me two Panadeine Forte earlier in the day. Now she gave me other things, including medication to take for a few days, and also a card with an appointment date and time written on it when I could visit the senior cardiologist at his offices in Camperdown. She told me to go to my GP and get a referral to see the cardiologist. I told her I would do that.

I put on my pungent clothes and gathered all my belongings in their places – keys and wallet and phone in pockets, the rest in a bag they had given me at RPAH – and walked down to the hospital’s front desk. In a small office area behind it, I paid the excess with my credit card and signed some more forms, and called a cab using the phone that had been placed for that purpose on the front desk.

When he arrived I apologised to the driver about the smell and he said it was alright. I told him not to go fast, and he didn’t. In 15 minutes I was home. No more cannulas, no more ECG monitor with its endless contacts connected to your skin. No more pissing into a bottle and bathing with a small basin of water. No more injections and no more blood pressure tests. No more nurses to call when you want every small thing done. Now, all I need is time to get better. The procedure left me with sore insides. I have aches in strange places that make it impossible to lie down on my right side. Even lying down on the left side is hard. Mostly, on that first afternoon at home I just stayed in bed on my back and daydreamed and snoozed. The dreams I had that night were about melons and pumpkins and which was better, and about whether irrigation was better or if getting water just from precipitation was better. I kept trying to make the story work but it kept failing, as though the narrative was too weak.

The next morning I went out to buy milk and a chocolate muffin at the convenience store. The man who runs the store, who migrated from an Arabic-speaking country, called me “my friend” when I told him I had just come out of hospital and told me to stay well.

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