About ten years ago last November 2nd, I drove home from Jacksonville with smiling eyes and a happy heart. The Florida Gators had once more dispatched those hooligan Georgia Bulldogs in mortal pigskin combat and all was right with the world. Twelve hours later, not so much. The eyes were glazed, the world was confused and the heart was decidedly not happy. At breakfast I face-planted into the grapefruit and my heart rate collapsed to 20 beats a minute.
Let me tell you a bit about 20 beats a minute. Twenty beats will allow you to lie on the couch, maybe sit up every now and then and do virtually nothing else. At twenty beats, you could have a career as a mattress model, a hammock tester, an inert prostitute. Forget about walking. Baby Snooks could toddle rings around you. Couchbound retirees look like Olympic athletes to the 20 beats a minute man.
I did have a little warning something like this might be coming and I did my best to try to penetrate the fog the beast walked in. Months earlier, I had simply fallen off a kitchen chair to the floor, but I never blanked out. When Siobhan came rushing over, I told her I was fine. Siobhan being a licensed professional in these matters, knew right away I was not fine at all. She set me up for a panel of neurological tests, which were mostly no fun. For one of them, the giddy torturers ladled tons of sticky goo all over my head and attached electrodes. Try to get rid of that stuff some day. I think a little bit of it is still there. All to no avail, of course.
Next, we moved on to the cardiac boys. They did ultrasounds, utilized MRIs, performed EKGs and other fancy tricks but found nothing. I even wore a dopey heart monitor around for awhile to no good purpose. Little kids pointed at me and laughed. One day, I was running on the gym treadmill at a mere 7.5 miles per hour, blanked out for a second and fell off. This sort of stunt is always good for a laugh from your workout buddies but the gym trainers tend to get very upset. Since our facility is owned by a hospital, several nurses are always lurking about. They double-timed it over to check me out, mostly concerned whether I had banged my head on the floor and become either (a) a vegetable, or (b) paralyzed, either one grist for a five-alarm law suit. Fortunately for all concerned, I was no more compromised than usual. Back I went to the cardiac docs. This time they brought out the heavy guns, including the brilliant old fellow who founded the place. The BOF smiled and whipped the cover off his newest detective machine. “We’ll get to the bottom of this,” he promised. We didn’t.
I thought okay, maybe 7.5 mph is a little too sprightly for an old gaffer like myself. I reduced my top speed to 6.5. This seemed like the solution and several weeks went by without further catastrophes. Then, one day, KAPOWIE!---same thing. I gave up on finding an answer from the medical world and decided I’d just walk on the treadmill from now on, but I had an uneasy feeling there was more to this than met the eye. A close conversation with a grapefruit convinced me I was right.
On Meeting Jesus
It’s tough to get a man with a heart rate of 20 into a Ford 150 pickup truck but we did it and screeched off to North Florida Regional Hospital in Gainesville where my cardiac team plied their trade. Siobhan is normally a slow, sensible driver but in a crisis she has a Kevin Harvick side to her. It was tough to see much from my post lying in the back seat, but I don’t think anyone passed us for the whole 20+ miles of the trip. When we got there, the hospital personnel seemed at a loss with what to do with someone who could barely sit up. Several opinions were rendered, of which Siobhan’s was the loudest. Somehow, they got me inside.
In the ER, a cast of thousands worked on the problem of elevating my heart rate. Neither basic medicine, magic formulas or secret dust just in from the Orient made a dent in the problem. Sick to my stomach from the medicines and dazed by the flurry of activity, I could swear I saw a little cloud float in with Jesus riding a surfboard. He waved and smiled. I reminded him of all those difficult confessions I made as a youth, all those Friday afternoon Stations of the Cross I tolerated during Lent, about the time I volunteered to coach the St. Agnes Orphanage basketball team. Then I reminded him that I was a good friend of Debra Wynn, an ex Subterranean Circus employee who turned over a new leaf and was now one of his foremost evangelists. You think Jesus is smart? When he has a religious dilemma, he calls Debbie.
Next thing I knew, I heard a faint voice in the distance. It appeared to be coming from a man in a long white coat, perhaps one of the heavenly disciples, but more probably a late-arriving doctor from the Cardiac and Vascular Institute, my home team. “Bill,” the apparition intoned, “we have tried everything to get your heart going but nothing is working. The only way we can keep you alive is with a pacemaker.” Then he asked the easiest question I have ever had to answer. “Do you want us to install one?”
Hmmn, let me think about this. Die? Get a pacemaker? Die? Have a funny-looking bump on your chest? Whatever shall I do? “Are you KIDDING,” I wheezed through the smoke. “Put the damn thing in! Jeez!” So they did. The chief cook and bottle-washer was Dr. Raj Subramanian, who had left India just in time to save a future president. “Jesus brought you here, right?” I asked. He just smiled and pushed harder on the pacemaker. Maybe it was the Hindu version of Jesus.
What’s It All About Alfie?
When I was a mere youth of 55, I went to a new GP, Dr. James DeStephens of Gainesville. After a thorough exam involving arcane practices, he advised me that I had such a thing as a bundle branch blockage, which could rear its ugly head sometime in the future and cause me gobs of unpleasant trouble. I asked him how I got such a thing. He said it could have been from a small undetected heart attack or it could be genetic. Since my sister Alice also has one, I guess we’re going with genetic. Alice, I should report, has not had any of the problems I have had but that might be because she gave up grapefruit long ago or because these things never happen to Republicans.
A bundle branch block is a condition in which there is a delay or blockage along the pathway that electrical impulses travel to make your heart beat. It sometimes makes it harder for your heart to pump blood efficiently through your body. The delay or blockage can occur on the pathway that sends electrical impulses either to the left or right side of the bottom chambers (ventricles) of the heart. Bundle branch might not need treatment or it may need to be dealt with long after discovery. In some people, it can lead to a complete heart block. This is when the shit really hits the fan. My fan actually short-circuited.
Although I have discussed all my other ailments from prostate cancer to a heart attack, feeling that information I can offer in The Flying Pie may be of some value to readers, I have never before mentioned bundle branch blockage or the need for a pacemaker, although many of my friends are aware of it. I think a large portion of the populace has the impression that anyone with a pacemaker is on his last legs, start looking for a shovel, don’t make loud noises around him. Let’s all get over here in the corner and feel sorry for the poor guy. I don’t wish to project that inaccurate image, nor to have anyone pitying me, so I left the issue unannounced. But I would rather give readers the straight story than have them think I am too lazy, addled or unreliable to get the Pie out on time. So I’m bringing this note from my mother. I hope it gets me out of detention.
The Quick And The Dead
People with pacemakers inserted 10 years ago report on the average of twice a year to their cardio pals to have the device “interrogated.” The technicians put a wand over your instrument and an attached machine delivers a printout advising what’s been going on in the months since the last visit. Sometimes, the techs speed up your heart rate, then slow it down just for laughs, though they swear they can obtain useful information via these shenanigans. The pacemaker has a lifespan of 7-10 years, after which it must be replaced. The fly in this ointment is that the insurance companies want your machine to be good to the last drop, like Maxwell House, so things can get a little dicey on occasion. Though you check in for exams more and more often in the late stages of pacemaker life, it’s still possible to cut it a little close. Tuesday, when I went in for my checkup, there was so little juice left in the pacer it was impossible to measure. Nurse practitioner Genny Farnham suggested having the pacemaker replaced in the next few days. I asked her if she could honestly say when it would be kaput. "No," she admitted. Not one to put off important tasks like filing my income tax, washing the windows or avoiding death, I said let’s do it tomorrow.
Michael Rowed The Boat Ashore
Dr. Michael Jansen, one of the legion of trusty doctors at Gainesville’s Cardiac and Vascular Institute and a specialist in medical devices, would do the heavy lifting for my procedure. Replacing a pacemaker is generally a snap, a half-hour job on an average day, but Jansen had other ideas.
“I studied your echocardiogram last night,” he said, “and I’m concerned about your ejection fraction.” So was I. I knew it had fallen from around 40 to 30 in little more than a year, not a happy occurrence. Ejection fraction is a measurement, expressed as a percentage, of how much blood the left ventricle pumps out with each contraction. An ejection fraction of 55, which is what mine was before a heart attack in 2006, means that 55% of the total amount of blood in the left ventricle is pushed out with each heartbeat. After the infarction, my EF plummeted to 25, but I gradually dragged it back up to 50. 40% is considered meager but when you get to 30, you’re floating in the Sargasso Sea of ejection fraction. Alas, I had no idea the pacemaker could play a part in my demise.
“Because your pacemaker was implanted during a crisis,” Jansen continued, “they probably were content to use two lead wires. But over time, the heart can suffer with all the pacing coming from one side.” The heart has a tendency to swing slightly from the pacing so Jansen recommended inserting a third lead wire to balance the pacing and allow the ejection fraction to (hopefully) rise. This is a much trickier undertaking requiring an overnight stay at the hospital. Afterwards, the patient is severely limited with regards to activity for six weeks and the arm on the pacemaker side of the body should not be raised over the shoulder for a week or more. Inconvenient, but hard to argue against when the reward is a jollier ejection fraction. I gave Dr. Mike the thumbs up.
The procedure takes about an hour. The hospital staff polishes you up, wheels you in and runs sleepy juice through your IV. There is no anesthesia so you don’t wake up groggy, stumbling and cursing Morpheus. The pacemaker area is very sore but not painful.
It is now two days past the surgery. The swelling around the site is down and the wound is less sore. I can breathe easier, a result of less stress on the heart (and perhaps an abundance of juice in the pacer). I now have a device next to my bed which records everything the pacemaker does and reports back to CVI, requiring fewer visits to the facility. All in all, a good result, positive signs for the path forward and just in time for Valentine’s Day. With but a single tragic undertone:
The Flying Pie was a day late, a fact that will live in infamy for the rest of our days. Or maybe not.
That’s all, folks….
bill.killeen094@gmail.com
