I was rolled on a gurney into a chilly OR. Doctors shaved my groin and gave me a shot of local anesthetic down there. They ran a catheter up my thigh, through the abdominal aorta and down into my heart. They induced the arrhythmia, and my body began to shake. Dr. Danforth Zhee (I’ll call him), my young electrophysiologist, stared at a computer screen. Dr. Zhee called out sectors of my heart by letter and number. I felt a buzz each time the catheter burned the interior of my heart muscle.
The ablation seemed to work, for a little while. I went biking. I went hiking. I was back in the kingdom of the healthy. But in the fall of 2015, the V-tach started to hit me more frequently, started to hit me at night. BOOM, BOOM, BOOM. The bed shook with the crazy pulse of my ventricles. My doctors prescribed new drugs, Sotalol instead of Atenolol, but no medicine seemed to work. Every night, I was up pacing the kitchen, staring at the monitor on my wrist, 147, 148, 149.
For Christmas vacation, we went to visit my older brother, Daniel, in California, and he set us up in his neighbors’ place, a big, stucco, ranch-style house in the pretty border between Oakland and Berkeley. I don’t know if jetlag exacerbated the symptoms of my arrhythmia, but in that week my V-tach was awful. I was up three and four times a night with my heart pounding. My brother’s neighbors’ house had a big, squared-off staircase between its first and second floors, and all through the night, I found myself going up and down, up and down, hoping and praying that the whacking in my chest would stop.
“This is torture,” said Marcia, about getting awakened three times a night. “This is how they drove Oscar Wilde out of his mind.”
In February, I had another ablation: again my chest was shaved, again the cold adhesives were applied to my skin, and again I was rolled into the catheter lab. The cold, clean room, the massive banks of instruments, the big screens and big white plastic cameras, and the technicians at their monitors behind the window. Nurses put on their sterile gear and set up the IV and the instruments. They played soft 1970s rock from someone’s iPod, Billy Joel, Elton John, Carole King. The Vercid numbed my brain. The catheter slid into my thigh. The equipment beeped each time my heart beat. Dr. Zhee and his assistant stood anxiously by their computers, calling out numbers and watching the screen, their crazy game of Battleship.
I really like Dr. Dan Zhee. He reminds me of my smartest friends from the Bronx High School of Science. His hair is always neatly parted, his shirt is always pressed, and his white doctor’s coat is always clean, but somehow he manages to look casual. He slumps a little. He never moves fast. Early on, Dan gave me his cell phone number and encouraged me to call him by his first name. A Harvard grad with a degree in public health as well as medicine, he seemed to me like the kind of super-bright guy who had ruled the foosball table at college, who would only talk about something if he were an expert, who always competed to win. But in the OR that day in February 2016, Dan could not get through the first step of the ablation. He could not stimulate my arrhythmia.
It was absurd. I was going into V-tach three times a night, two times a day, every day, but somehow, while I lay there on the operating table, given every kind of electrophysiological lure, my heart wouldn’t budge. Dan Zhee kept trying, again and again, to get my heart to do its whacky dance. Again and again, my heart refrained. My sinus node, so willing every other day of the year to cede control, now stayed jealously at the helm: steady at sixty beats per minute she went. Dan Zhee knew my heart well from the first ablation, and following what he knew, he burned the hell out of its insides, working the spots where the pattern had been last charted. I began to feel his frustration. I began to feel the burning in my chest.
“Sorry,” said Dan, and I was given more Versed.
This went on for a couple hours, until finally he gave up and rolled me into the recovery room, where, promptly and unbidden, my heart went into its familiar arrhythmia.
I asked Dan if he could roll me back into the OR once more and give it another whirl. He told me that was impossible. These things were tricky and complex, he told me. I shouldn’t lose hope.
“Sometimes, there’s a settling in period,” he said.
Dan, with all his brilliance, confidence, expertise, and degrees, all his drugs, computers, monitors, cameras, radio waves, and catheters, suddenly seemed like a building superintendent with a monkey wrench taking a few whacks at a boiler and hoping the heat would rise to a third-floor apartment.
At work, I stared at ceilings and waited for meetings to end. I dragged myself through my classes. Still I had not experienced any defibrillator shocks. Still I was driving to Queens. But I could feel that an end was coming, that I would be incompetent soon enough. The drugs prescribed were more powerfully tranquilizing, but the symptoms persisted. I had the slow pounding attacks every night. I was up in the kitchen at 2 a.m., hopping up and down and hoping my heart would beat right, sometimes even hoping for a shock to put the arrhythmia to an end. In the day, my attacks were more acute. I got up from the couch, watching TV with my family, and listed suddenly to the right and had to lean against a wall. My knees buckled, but I didn’t fall. The next morning, I sat down in the driver’s seat, pulled the belt across my chest, and imagined the jolt to the heart, the sliding car, the crash, the dead pedestrian.
At dinner one night, Lucy said, “So we’re not going hiking this summer, right, Dad?” And I said I didn’t know. I said the doctors might be able to fix my heart.
“They’re not going to be able to fix it, Dad,” she said, thirteen years old and wise to me.
I had fooled myself into thinking she didn’t know what was going on, that she was unaware of my weakness, that she didn’t know that I was up every night, that she had believed me when I said my hospitalizations were no big deal. But she maybe had a better grasp of it all than I did. I gripped her hand. She looked at me, big eyed and soulful.
“Let’s try to be optimistic,” Dan told me the day he adjusted my device and scheduled my third ablation. But I wasn’t optimistic anymore. I was sure my run of good luck had finally ended.
I left Dan’s office, got to the street outside the hospital, and checked my phone. There was an email from my literary agent, David McCormick. I had never mentioned my heart problems to David—or to anyone in the publishing world—and had only told my closest friends in my department. David had been sending around my novel about three marriages in one family, and a fifth editor had rejected it. David had been very enthusiastic about the book at first but now thought that I should consider revising it. I knew he was right. The book needed revision. But I also knew no matter what happened, I could not rework it. I wasn’t the person I had been when I’d started the book.
A dozen years before, mine had been named the best first book of fiction by an American writer, but the award had always seemed somewhat fluky to me. As I stood in the street outside the hospital, my career as a writer now seemed done. Was I a has-been or a never-was? The Buster Douglas of the literary world, I figured, a palooka who one time got lucky and knocked out the champ.
Who had I been kidding anyway?
All I had to read on the way home from the hospital was Toni Morrison’s Beloved, which I was supposed to teach the following week in my contemporary novel class. But I couldn’t read it. The train got more crowded as we moved through Manhattan, and all of it seemed so depressing to me. There was a pretty nurse riding home from the hospital across from me, and I watched a man try to flirt with her. He had aviator glasses, and his thick tawny hair was combed back 1970s style. His eyebrows rose on his expressive face, and his hands made broad gestures. She nodded demurely. She looked away. Both of them had hearts, and both their hearts were going to fail, and they were both busy pretending that this was not inevitable. I climbed back up the steps of the subway as the sun was setting in Brooklyn.
I decided to buy salmon for dinner. Then I went to the friendly fruit and vegetable market and bought my daughters the kind of mandarin oranges they love. At the wine shop, I got a bottle of vino verde, then an
other. I bought cut flowers, something I never do. I thought of a friend and neighbor, Tom, who had died earlier that year. He was a handsome man with a sympathetic face. He had two boys and a beautiful wife, and the family owned a shaggy dog. Throat cancer ate at him for a long time, through onset, treatment, remission, and then a wicked demise. I had seen Tom through his illness climbing up the subway steps, headed home after work, at the end of his day as an art director in Midtown, and I’d always felt sorry for him, and he’d always smiled. We exchanged pleasantries, and sometimes, “How are you?” came out of my mouth, and he would always say, “Fine,” even when his throat didn’t work anymore. His voice turned to a croak, then a high-pitched whisper, and then it was gone. As I made my way home with my flowers and fish and wine and oranges, I thought I understood a little better what his smile had meant, how much maybe he enjoyed those last months of life, savoring a stupid, ordinary thing like coming home from work.
Marcia was on her way back from a job in New Jersey. I made dinner—that was my happiness—I got to make dinner while my children did their homework and joked and complained. But after dinner my sense of happiness was gone. I had at the time an old rocking chair in my office, an orange-pleather faux-modernist thing that once belonged to my in-laws, and I was sitting in the rocking chair with my feet up, going through Facebook, clicking “Like” every time a picture of a baby appeared, when I drifted off, and I was neither awake nor asleep when suddenly the ICD fired. The computer flew up and down on my lap. I must have screamed.
“Are you all right?” called Marcia from the kitchen.
“I’m fine, I’m fine,” I said, partly because that’s what I always say and partly to hide my terror from my kids.
I went to the bedroom. Nothing like that had ever happened in all the time I had had my ICD—the shock out of nowhere. I lay down on my bed to clear my mind and think things out. My heartbeat slowed. I felt it in my chest, like a tickle, like a seed planted there, the beginnings of arrhythmia. I tried to stand. I knew my heart was about to speed up. I had the idea that if I got up and moved, I’d stop the V-tach from happening. I put one foot on the ground and had the other one in the air when the shock came again. This time it sent me sprawling. I lay on the floor. I pounded the carpet.
“What do I do?” I asked Marcia.
“You call your doctor,” she said.
Dan Zhee was quick to call back when I paged him. He knew right away what was wrong. He had reset the device so it would respond to arrhythmias slower than 150 bpm, but in doing so he’d somehow shrunk the time between the ICD sensing my arrhythmia and the machine giving me a shock. When the V-tach started, there wouldn’t be any gentle pacing beats tonight. Right away, as soon as the V-tach commenced, the thing would slam me. And the V-tach seemed to happen every time I relaxed.
He recommended against a visit to an emergency room. It was past 9 p.m. I’d be there all night, he said. I’d never get any sleep. If I went to the ER, they’d probably admit me to the hospital. He knew that I would be more comfortable at home and asked what drugs I had in my medicine cabinet. I told him. He prescribed more than twice the dose of beta blockers I’d ever taken—both kinds that I had in the cabinet, Atenolol and Sotalol; we added a one-milligram pill of Ativan, and I’d already had three glasses of wine.
“That should do it,” he said. “Get some sleep.” He told me to meet him in his office first thing in the morning, and he would reprogram the device.
“You’re not in any danger,” he assured me.
I took the pills and went for a walk, figuring that it would take some time for the drugs to take effect. When I came home, the kids were in bed. I talked to Marcia. We tried to reassure each other that the night would go okay. I decided, as kind of test, to slow my heartbeat gradually. I sat on the living room floor and tried to meditate. It’s something I normally don’t do, but I am a reader of Buddhist self-help books, and I borrowed a mantra from Thich Nhat Hanh: “present moment,” on the in breath, “beautiful moment,” on the out. I said that three times, then the device shocked me.
I got up. I went to the kitchen. When the shock hit, the pain was total; when the shock was gone, it left no trace. I felt like I was being tortured, but there were no torturers, just our cat in the dark kitchen with me.
I went to the bedroom. Marcia told me to just follow the doctor’s advice. I was in no danger, he had said. I should try to get some rest. I changed into my pajamas. I flossed my teeth and brushed them. I lay down, and the sheets were cool, and Marcia’s body was warm, and I picked up my book and turned on my reading lamp, but I couldn’t read.
The memory of pain exists more in the body than it does in the mind. Even if there’s no bruise, no mark, or no tenderness, the flesh seems to hold the ghost of the feeling. We had this idea, Marcia and I—the kind of idea people invent when their hopefulness makes them stupid—that I could lie back and relax, that even if I got shocked once more, maybe if I stayed quiet, maybe then I’d be able to sleep. Maybe after one shock, the V-tach might leave me alone.
But lying in bed that night, I flinched each time I felt my heart slow. I kept sitting up, lying down, and then sitting up again. I left the bedroom. It was not yet midnight. I looked at the couch. I thought maybe I could lie down there, relax, have tachycardia, get shocked, and then stay still, and then maybe I could sleep. But when the shock came, I was on my feet again, pacing the kitchen. I took out a sponge and some spray bottles, and I began to clean.
I sprayed down and wiped up the countertops, the table, and the cabinets. I swept the floor. I straightened up the living room, putting all of Lucy’s schoolwork in one pile and Eliza’s in another. I looked at the couch again. I was so tired. I decided to try it one more time: to lie down and see if I could get some sleep. As I lay there, I tried to unclench my muscles. I tried deep breathing. My mind would not be tricked into sleepiness, but my body got warm and heavy.
I felt waves of cold and warmth, pins and needles, the accumulated exhaustion of a winter without sleep. Don’t move, I told myself. Don’t move when the shock comes. And it was the repetition of those words, “don’t move, don’t move,” and the fantasy that I would relax, that I would get shocked and somehow get quiet and sleep—it was the fantasy of sleep that set my mind adrift, and as soon as it did, as my mind departed consciousness, I felt the thunderclap in my chest, and it bounced me off the couch, onto my feet.
The philosopher Elaine Scarry writes, “Physical pain—unlike any other state of consciousness—has no referential content.” Pain belongs only to the sufferer; it can’t be communicated. As Scarry puts it, “To have great pain is to have certainty; to hear that another person has pain is to have doubt.” Another person’s pain exists beyond the human senses—something like ultraviolet light or high-frequency sound or dark matter, something you simply cannot perceive—and pain also exists beyond words. As Scarry has it, we can describe a “burning” pain, a “hammering” pain, a “stabbing” pain—we can use metaphors for the instruments that cause pain, but to express the actual pain itself, the best we can do are curses, screams, and ululation.
I made myself a cup of tea. I tried writing in my journal. I began to try to recount the whole day, the minutia of the day before I had seen the doctor, working at my desk in the morning, washing dishes, and listening to A Tribe Called Quest. Each time I finished a paragraph, I looked up at the clock. Each time I looked at the clock, the minute hand crawled. I regarded the couch the way a whipped dog looks at an electric cattle prod.
I’m telling this story as carefully as I can. I’ve tried to get it right—the times of night and each instance of shock. I wrote it all down in my journal the day after it happened. But I only wrote down six shocks, not the nine that my ICD recorded. These three missing shocks are maybe more eloquent than all my high-flown references or language. When the shocks hit, I was not myself.
I sipped my tea. I picked up my teacup and walked circles around the table. By 2 a.m. it felt hard to stand. I imag
ined myself in a puddle on the floor, getting shocked and shocked and shocked again, too whipped by the ICD even to be able to scream and wake up Marcia. I made a second cup of tea. I stood out on the stoop in bare feet and let the cold air wake me. I went back inside, and with nothing better to do, I tried to get some work done, which in this case meant reading Beloved. I sat up straight, pencil in hand for underlining. In my focus and my posture and fidgety note taking, I kept my pulse above sixty beats per minute.
In the book, Sethe had been raped and whipped, and the white rapists had sucked the milk from her breasts. She was making her way from slavery and the plantation through the Kentucky grass to the Ohio River, where freedom lay. Her feet were so swollen she could not walk, and her back was flayed and bleeding. The book didn’t exactly cheer me up or distract me, but it did remind me where a balky defibrillator lay in the hierarchy of life’s miseries.
I made a third cup of tea. Again, I stood outside on the stoop in the cold. I had the idea that I would get dressed and walk from home in Brooklyn to the hospital. If I took my time, I’d get there at 6 or 7 a.m. I’d pass through Times Square. I could stop in the East Village for coffee and breakfast. I could get to Washington Heights for another meal, and then wait for the ICD clinic to open. But what if I got V-tach as I walked, I worried, and the device started to shock me? I’d be lying on a deserted corner screaming, alone, in pain. How quickly my mind invented its pictures—strong me crossing the Brooklyn Bridge at night, vulnerable me on the sidewalk, shocked and spastic—like there was a fluttering switch in the back of the brain, running from fear to denial and back again.
The Open Heart Club Page 29
