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Photograph by Cole Garside
?Look, lady, the last time I was in this hospital, I died.?
That was the God?s truth?at least the dying part was. Actually, I?d been back to Toronto General?s emergency unit three times since my heart stopped, the day after I had open-heart surgery in May 2011.
But on this particular morning, three months later, I was lying on a gurney waiting to go into an operating room for yet another heart procedure when the anaesthetist said: ?Mr. Ramsay, we?re going to give you something to relax you.? She unwrapped the needle before inserting it into a vein in my wrist. But she missed the vein, and since I was on blood thinners, my wrist began to bleed all over the sheets. The doctor quickly stepped back and asked a nurse to get my ?line? going. By now, the sedative was having its effect and I began to feel light-headed. But I was ever watchful. That?s when I told her about dying the last time I was here. It was an inauspicious start.
Cardioverting is a little like being tasered. Big wire patches are taped onto your chest and back. Then you?re zapped with 100 joules of electricity in the hope that your heart will be converted back into a normal thub-thub, thub-thub rhythm. Mine was beating all over the place, sometimes fast, sometimes slow, sometimes skipping a beat. This is called atrial fibrillation. You can have it and not feel it, and it can usually be controlled by drugs. But in my case, A-fib made it impossible for me to work, to sleep, to function at all without huge fear that it would send me, as it had many times following my surgery, into what felt like having a heart attack and a stroke at the same time. So by this time I would have done anything to stop the chaos that had taken over my life.
My open-heart surgery three months earlier had lasted for five hours, so I asked my cardiologist, Dr. John Ross, how long this procedure would take.
?A few milliseconds.?
?Will I feel anything??
?I hope not, for your sake.?
He smiled.
Five years before, I?d finished running my 10th marathon and was in the best shape of my life. Indeed, my wife, Jean Marmoreo, and I had founded the women?s marathon group Jean?s Marines that had taken hundreds of women off the couch and trained them to do the Marine Corps Marathon in Washington. Years later, Jean had gone on to be the fastest woman in her age group in the Boston Marathon. We?d trekked to Mount Everest, hiked 1,000 miles of the Appalachian Trail, mushed huskies in the Arctic. I wore my street cred in the world of adventure like a medal.
Then one day in 2005 I asked my family doctor if I could have a stress echocardiogram. I did it more out of cockiness than caution. Sure, it made sense that a 57-year-old man whose mother had died of arteriosclerosis at 59 would have his heart tested to see if anything was amiss. In truth, I just wanted to have proof of how fit my heart was. But as I was to find out, fit doesn?t mean healthy. That test and the events that followed would teach me some painful lessons about what we can and can?t control in our lives.
The cardio imaging revealed that I had a heart murmur caused by my faulty aortic valve. It seems that one in 100 Canadians is born with it and, like fully half the cases, I?d need to come back in 10 to 15 years and get a new aortic valve. My only concern was if I?d be able to run after I got that new valve. ?Of course you can run,? my cardiologist assured me. That was in 2006.
By January 2011, I was barely able to walk up stairs without stopping for breath. I?d ?nap? for an hour in the morning at work, and for another hour in the afternoon. One day I went to a gym to do some spinning on a bike and had to quit after a minute.
My wife, who?s a physician, grew alarmed.
More tests came in fast order. It seemed my aortic valve was wearing out much sooner than expected. Dr. Ross said I needed valve replacement surgery. So on May 3, 2011, my rib cage was cut open and a team of surgeons at the Peter Munk Cardiac Centre at Toronto General Hospital replaced my aging aortic valve with a shiny new titanium one.
All went well. Right after surgery, I was taken to the intensive care unit for 24 hours. I was expected to remain in hospital for another four or five days. Then I?d be sent home, and for the next six weeks or so I?d recuperate and try to walk a little further each day. I could look forward to being back at work in a couple of months. When I was feeling up to it, I could ride my bike or even run.
That day in intensive care I drifted in and out of consciousness. The nurses asked me endlessly if I knew what day it was and could I spell the word ?world? backwards. Jean was by my side. Once when I woke up, she looked teary. I asked her what was wrong. She said: ?I?ll tell you when they take you to your room.?
They did that the next day.
?I think it?s time we told you what happened yesterday,? said Jean.
?Sure, what happened??
?Well, honey, you didn?t have a near-death experience.?
What was she talking about?
?You had a death experience.?
?What do you mean??
She was looking steadily into my eyes. ?Your heart stopped.?
?What??
I first thought it was a bad joke. My next thought was: ?Wow, I?m invincible!? Then, after a few seconds, as I absorbed the impact of what Jean had said, I burst into tears.
Jean told me I?d had sudden ?heart block? (not to be confused with heart blockage). She explained what had happened.
?How long was I dead??
?A little over two minutes.?
?How did they restart my heart??
?Just like on TV.?
So the next day a pacemaker was inserted below my collarbone to kick-start my heart should it ever ?block? again.
F. Scott Fitzgerald once said that in the real dark night of the soul, it is always 3 o?clock in the morning. For me, it was 5 o?clock. At that hour, when everything in the hospital is dark and quiet, I would wake from my drugged sleep and cry.
I know people die on the operating table. For every 100 Canadians who undergo aortic replacement surgery, 2.7 will not make it (although at the Munk Cardiac Centre, the rate is 0.9 per cent). Our parents can die in surgery, maybe. Not us. And certainly not me. Besides, I?d survived the open-heart surgery with flying colours. Mind you, I couldn?t remember a single thing about dying or coming back from the dead. No flashing lights or smiling loved ones. Nothing. In fact, I had to take it entirely on faith that any of this had happened. I told myself that my job right now was to get better physically.
Over the next six weeks, I tried to do precisely that. At home, I read a lot of books, watched a ton of TV and walked further each day.
A couple of times in the months before surgery, I?d felt dizzy and had to sit down, and when my wife would take my pulse, she?d declare I was in A-fib. In other words, I had that occasional irregular heartbeat, with resulting palpitations and shortness of breath.
The doctors had said they couldn?t fix my A-fib until they replaced my valve. It turns out my heart remained in A-fib after surgery. But not to worry, there were drugs that could regulate it. One of them was a beta blocker called Metoprolol. Unfortunately, it also made me tired and lethargic, pretty much how I had felt before surgery.
Two months after surgery, I had a post-operative meeting with my cardiac surgeon who pronounced the valve replacement a total success. So there was a bounce in my step as I headed out of his office and down University Avenue to a client meeting. I had been back at work as a communications consultant for a month. I ducked into the Hilton Hotel to go to the men?s room on the lower floor. Suddenly, my legs buckled. I grabbed ahold of the railing. What the hell was that?
I felt light-headed. My hands and jaw started to tingle. My lips grew numb. I turned around and pulled myself up the stairs to the main floor. I was damned if I was going to die alone in the men?s room in the basement of a hotel.
I walked unsteadily into the lobby and sat down. By this time, I was feeling dizzy, but I had to get out of there. So I got up and walked, one foot slowly in front of the other, outside. The doorman looked at me oddly. I was walking like a drunken sailor. When I walked smack into a building, hitting my arm on the marble wall, I knew I was in trouble. I was having a stroke. I had to get to the hospital. It had to be Toronto General. They had all my records. It was six blocks away.
Somehow, I managed to walk out onto the street and into oncoming traffic. I raised my hand and a taxi stopped right away. I got into the back and said: ?Toronto General Emerg.?
The driver looked at me in his mirror: ?Are you okay, mister??
?I?m not sure.?
Five minutes later, we were at the front door of one of the largest emergency units in Canada. I struggled out of the cab and walked up to the reception. I blurted out: ?I?m having a stroke.? I was pouring sweat and barely able to stand. Within a minute, two triage nurses got me into an examining room. There, they asked me if I could talk, if I was in pain, if I felt numb and where (?My hands, my jaw!?) and even the old standby, if I could spell ?world? backwards. By now the waves of dizziness forced me to prop my head on the top of my chair as I tried to answer their questions. The nurses moved me into an acute-care cardio bed in the ER. They called Jean, who rushed over. Over the next three hours, doctors, nurses and technicians poked, probed and questioned me. I felt better lying down, but the waves of dizziness and rapid heartbeat kept coming every 15 minutes. I was terrified.
After an hour, I was struck by the fact that no one was using the word ?stroke? anymore, so I assumed I wasn?t having one. It seems I had had a particularly virulent A-fib attack that had broken through the Metoprolol and sent my heartbeat racing?irregularly?to 140 beats per minute. All the doctors could do for now was give me more Metoprolol.
Six hours later, feeling exhausted and relieved, I left the ER with Jean. We took a cab home and I crawled into bed. I was well and truly gorked on Metoprolol.
The next morning, Jean told me the new prescription for Metoprolol would double the dose of what I?d been taking. Although it would make me feel even more lethargic, I should stay on the high dosage until they figured out what to do. Clearly, my A-fib was no longer a benign condition. I learned that a third of all strokes are caused by it.
While I?d hoped to be back to work full-time, it became obvious that it would take me longer to recover. Just writing a brief email took enormous energy. My concentration was shot, and my memory, well, it leaked everywhere. Jean said a lot of this was because of the drugs. Talking was tiring; a 10-minute conversation would leave me drained. And though I gradually got my strength and focus back over those weeks, if someone had asked me to write a 30-minute speech, as I?d routinely done before, I no longer had it in me.
After awhile, I knew that I really couldn?t work, so I had to lay off my two staff. This left me alone in the office, where I puttered with paperwork. But frankly, my big daytime activity last June and July was snoozing. I?d bought an air mattress and a blanket and would doze off for an hour each morning and two hours each afternoon.
A week after my first A-fib attack, it struck again. This time, I had a foreboding. Walking along Bay Street in midtown Toronto, I suddenly felt very light-headed. I knew right away I?d have to lie down, so I walked as fast as I could back to my office. I unlocked the door and bolted to the air mattress. My heart raced, my head spun. This time, lying down didn?t help. I was alone on the floor thinking: ?What if this isn?t A-fib, but that stroke I?m at risk of having?? I stood up unsteadily and called Jean, who was at work a block away. I told her I had to come over to her clinic. She told me to go to emerg. I made it downstairs and out onto Bay Street where a friend saw me clinging to a lamppost as I yelled for a cab. I didn?t want to call 911 because the ambulance might take too long. Besides, what if I was taken to the wrong hospital?
At Toronto General, the routine was much like my first visit, and I was discharged that night. Two weeks later, it happened again. Over the course of the month between my first A-fib attack and my third, I went into a profound physical and psychological free fall. When I wasn?t in A-fib, I was in terror of it. I stopped taking the subway for fear I?d be trapped underground during an attack. Each morning, I would map out which streets I would walk on. They couldn?t be side streets. They had to have lots of people, day and night, and most of all, lots of cabs.
By this time, I was avoiding even the few client meetings I needed to attend. Not just because I didn?t want my clients to call 911, but because there were two occasions when I was in the middle of a meeting and I simply burst into tears. So I stopped meeting clients in person as much as I could. But even the phone couldn?t shield me. I took calls from friends, and again I couldn?t stop weeping, and I?d hang up.
The fact is, I rarely went to the office anymore. I?d still do my daily walks. But why do anything that would get my heart rate higher and risk flipping into A-fib? So I stayed at home, slept and ate a lot. I gained 20 lb., filling the holes left by my anxiety.
I gave up reading books because I couldn?t remember what I?d read even as I was reading it. I stuck to magazines and newspapers (I remember getting through the entire front section of the Globe and Mail one day before I realized it was yesterday?s edition). I would lie in bed and watch half a dozen hour-long episodes of MI-5 in a row.
Three or four days would go by and there would be no attacks. I would think, ?Phew, they?re over.? But now, even a mild one brought the same terror as a major attack. Jean thought I should see my cardiologist.
Dr. Ross expressed some surprise that I was on such large doses of Metoprolol. I told him I was always tired. What I didn?t tell him was that I thought the Metoprolol was starting to make me crazy. He suggested I switch to a different kind of beta blocker, one called Sotolol. We talked about what could be done to stop the attacks. It was clear they were not just running my life, they were ruining it.
He said there were three ways out when it came to stopping A-fib. The first was drugs. Well, that clearly wasn?t working. The second was cardioversion, where your heart is shocked back into normal rhythm. But cardioversion only works on a third of patients. The same with drugs and the third option: ablation. They?d open up my heart again and ablate, or destroy, the areas of abnormal heart tissue that were causing the heart?s electrical system to short-circuit. The last thing I wanted was another round of open-heart surgery. Besides, you often had to wait three to six months after ablation for your heart to move back into normal rhythm.
I left Dr. Ross?s office feeling angry and helpless. When I talked to Jean, she admitted that whenever one medical problem had three solutions, generally none of them was really good. I told her that if each of these procedures only worked a third of the time, then the odds were against me ever beating A-fib. She suggested I was getting ahead of myself.
The next morning, a Friday in early August, I went to the drugstore to have my prescription filled for that new beta blocker. The pharmacist explained how often I had to take the pills and suggested I read the product description he had printed off.
I did. It said: ?Sotolol should only be taken in a hospital environment under the direct supervision of a cardiologist.?
What was this? ?Side effects include heart attack, stroke and sudden death.?
What the hell? I read it over and over.
By the time I got home, there was only one conclusion I could logically draw: my doctors were trying to kill me. This wasn?t just some angry fantasy. I truly believed I could no longer trust my cardiologist, my family doctor, or even my wife. So I called a friend who?s a doctor, Elaine Chin, and told her that my new beta blocker would surely kill me.
She suggested I go to the drugstore and buy a bottle of Tylenol and read the product description. ?It will say pretty much the same thing. They all do because they have to mention every conceivable bad outcome. So Bob: take the Sotolol!?
I did, half convinced I was going to drop dead right there.
That same evening, in another desperate effort to exert some control over my life, I told Jean that I was going to check into a hotel, which was just a block from the Toronto General ER. Jean carefully asked me why. I told her?or rather snapped?that I never wanted to be more than 100 yards from the hospital. My barking was one part anger at anyone who was listening, because they couldn?t solve my problem, and one part anger at myself that I was unable to help myself.
Over the last few weeks, my A-fib attacks had occurred more often, with greater force, and lasted longer. My memory had become even worse. I painstakingly entered every appointment in my Outlook calendar, checking to make sure I had the right time and date and place?and three times in a week I turned up for meetings 24 hours ahead of time, or at the wrong place. I tried to cling to my work, but I was way too jumpy to write anything more than a page at most.
Finally, on Aug. 3, I found myself lying on a gurney waiting to be cardioverted. I awoke an hour later to find my heart?thub-thub, thub-thub?beating normally. Days later, it was still fine. Those terrible days of A-fib were in the past. I could pick up where I?d left off in recovering from my valve replacement. I did that; I started to walk to the office. I was even willing to walk down side streets. I took the subway. I noticed that I could walk up more stairs without getting out of breath. I actually started to ride my bike.
But I felt highly anxious. I couldn?t understand why my psyche hadn?t returned to normal when my heart had. A friend called me one night from Chicago. She asked how I was. I burst into tears. I hung up and sent her a text message saying I was fine, really.
Then one evening after dinner, Jean and I went for a walk. Jean idly mentioned that most of the 12 doctors in her office had had a meeting that afternoon. ?Oh, what was that about?? I asked.
?It was about you.?
?Really??
?Yes. It took us 10 seconds to determine you?re depressed and 15 minutes to figure out which antidepressant you should go on.?
I was enraged. I turned to her, practically yelling: ?I?m not depressed. I?m just sad!?
?Right, darling . . . So the antidepressant is safe with all your meds and is called Remeron. Here?s the prescription. You can get it filled in the morning.?
After my flash of anger, I suddenly felt relieved. Someone cared! The cavalry was coming! But could I really be depressed? I?d forgotten the warning before my operation that one in three patients who has open-heart surgery will suffer from depression.
It takes a few weeks for any antidepressant to kick in, and weeks longer to fiddle with the right dosage. But I have to tell you, the next morning, after I picked up my prescription, taking care not to read the product description, I took my first dose of Remeron and felt better within 30 seconds. As Jean said, so great was my need to feel in control that the placebo effect likely sped me on my way.
Today, 16 months after I got a new valve and died, almost a year after my A-fib attacks fell away and a year after I was diagnosed with depression, I marvel at a number of things I?d taken for granted before. I?m amazed that the doctors at the Munk Cardiac Centre were right: I could run after I got my new valve. It?s three times a week at a plodding pace. But I?ll go further tomorrow than I did yesterday, and that counts for something, too.
I marvel at my heart and the new life it has given me. I?m back at work. I rarely cry. My clients have returned and Jean and I have just come home from trekking in the mountains of Bhutan. I marvel that our hearts sit quietly in our chests, beating 100,000 times a day in the seven billion of us who walk the Earth, with only a few of us giving it a second?s thought. Maybe that?s why heart disease doesn?t get the fear and loathing that cancer does, even though it will kill almost as many of us.
But the greatest marvel for me is that I finally realized that for three months last year I?d been living my life as if each day was my last. So now I?m happiest when I?m doing incredibly ordinary things, like having dinner with Jean, or reading a book, or even just going for a walk, one foot consciously in front of the other.
Source: http://www2.macleans.ca/2012/09/24/a-ticking-time-bomb/
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