My hasty heart

I wake in the night feeling a strangeness about my heart, breathless, as if I’ve just climbed a mountain. But how is this possible? I’m young and healthy and the steadiness of the heart is a given, no? Like digestion, like dreaming. So how is it possible I feel this vague but powerful unease?

The heart is a pump that circulates blood. The generator for this pump is a built-in pacemaker that sends out electrical impulses, causing the heart’s four chambers to contract and relax in a coordinated way.

Now the unease becomes a thin band of heaviness that grows wider, thicker, tighter in my chest.

I feel pain and am suddenly dizzy. Perhaps if I sit up this will go away? The problem isn’t the weight of the blanket I’ve wrapped around myself because, a minute ago, I was so cold. No, this is a heaviness I’ve never known. Throwing off all the covers, I sit up straighter, order myself to breathe.

I hoped maybe this was just gas pain, a passing thing. But nothing seems to stop this strange presence, this weight on my chest, this trip hammer pounding of my heart, my once-silent, once-ignored, once-steady heart. My heart has become a mad thing. If this wasn’t my chest suddenly holding a panicked bird, I’d be almost curious. Instead, I’m confused. What is happening?

My partner is out of town so there’s no one to wake, no one to reassure me that I’m fine, really, I’m not alone.

But I am.

I try and stand — a cup of tea, perhaps? — but no, an earthquake has captured me without a single chair sliding or a single pane of glass shattering. My legs now barely hold me and still this wild thing grows. What is happening here?

Arrhythmia or dysrhythmia: from the Greek, arruthmia, lack of rhythm.

Arrhythmias may cause symptoms such as palpitation or lightheadedness, but many have more serious consequences, including sudden death.

Now there is fear. Now I know I must ask for help. Carefully, one digit at a time, I dial 9-1-1 and explain to the calm woman at the end of the line (doesn’t she know?) that I need an ambulance. I wait and I wait and when help comes, when two paramedics — blessed beings — knock at my door, enter, ask my name and hold my hand, then finally I am safe.

But the one holding my hand regrets this is all he can do, hold my wrist, monitor the wild bird that is now my heartbeat as it circles and speeds, looking for a place, perhaps, to land.

“Tachycardia,” he says. A word I’ve never heard before.

There are four types of arrhythmia: bradycardia, tachycardia, atrial fibrillation and atrial flutter, and ventricular fibrillation.

The man asks if I can walk and, yes, I’m alert enough to walk, to avoid the embarrassment of a stretcher. He and his partner guide me, gently, firmly, out the door and into a waiting ambulance where, inside the white van, I’m grateful to lie down on a narrow cot. One paramedic covers me with a blanket and ties me in with two grey straps. I’m surprised I don’t feel trapped or alarmed — I feel safe. His partner shuts the double doors from outside while he stays seated on a small bench beside me. No siren, thank goodness, I wouldn’t want to cause a fuss. The paramedic keeps up a casual line of chatter that doesn’t feel casual at all. Eyes alert, he watches me, takes my blood pressure over and over. We’re surrounded by shelves filled with medical supplies and equipment. This is the inside of all those ambulances I’ve pulled aside for, will always pull aside for, promptly and in gratitude, because now I have been here.

After ten minutes, or is it 30, we arrive at the hospital where the medics open the ambulance doors, pull me out into crisp fall air, and wheel me under a tall red sign into the emergency ward.

There are many causes of arrhythmia. It may develop from other health conditions such as high blood pressure, diabetes, or heart disease. It can be genetic, or involve simply being born with a structural abnormality. Some types aren’t very serious, while others, like ventricular fibrillation, are life-threatening.

I’m transferred to a hospital bed with beige curtains pulled to form a small cubicle around me. Nurses place stickers on my chest, take vials of blood, ask questions using words like “heart attack” and “stroke.” They ask with a question mark in their voices, as if these are only possibilities. So far.

Between tests, I lie on my bed, wondering about the lives around me. The ward is full, each of us brought here by ambulance or by worried family or friends who, because of the pandemic, left their loved ones at the door. We patients share the isolation and the minimal privacy of curtains.

There’s a sudden rustle of curtains and a cheery voice in the cubicle beside mine says to my unseen neighbour-in-emergency, “Hi! My name’s Dr. X. What can I do for you today?” As if we’re all in the corner hardware store, just checking out the selection of hammers or available electrical cords. “May I have a new electrical connection for my heart, please?” I want to ask, and take hope I must be okay if I can still joke to myself.

Risk factors for arrhythmias that can be controlled include high blood pressure, diabetes, being overweight, sedentary lifestyle, smoking, sleep apnea, and drug or alcohol abuse. Risk factors that cannot be controlled include increasing age and family history.

The patient next door answers the doctor in such a weak, old voice that I have to strain to hear. Everything seems important now. “Could you tell me please, why I’m here?” the man politely asks the doctor. “Your wife brought you in, sir,” the doctor replies, “because she thinks you might have had a stroke.” If these were not the days of COVID-19, his wife would be beside him now, reassuring him. We all share this loneliness.

The man will ask the same soft question, “Why am I here?” and get the same answer, “Your wife thinks you’ve had a stroke,” from every medical person who comes near him over the next two hours.

Episodes of arrhythmia can be triggered by exercising too hard, drinking too much alcohol, heavy drug use or smoking, serious life stresses, or stimulants such as coffee, energy drinks, and some cold medications.

Later, I will wonder what the trigger was for me, when none of those issues (except perhaps worse-than-usual stress or getting older) applies. For now, I lie still, grateful to be in care, to feel as safe as anyone can be, listening to the busy doctors and nurses, the health care workers who are keeping us alive. I wonder who would want to do this difficult, vital work? Certainly not me, which makes me even more grateful.

“What can I do for you today?” they ask, as if they are open to any problem, any request.

Tomorrow, I will take action. Tomorrow, I will research this new direction my body has taken. I will talk to doctors, perhaps take pills, focus on the stresses in my life to prevent it happening again. For now, I doze off. I’m tired, so tired, because this morning I climbed Kilimanjaro. This morning I circled the earth, me and my hasty heart, but now I’m back home, I’m safe.