I lifted my three-year-old daughter, Willa onto my shoulders, and then we continued up the hill to take in the view of the Georgia pines and perhaps spot a deer, or the great-horned owl that had swooped skyward there a few days before. I was enthused by the leisurely morning, but soon my chest tightened, my heart beating far too fast. Something’s wrong, I said to my friend, Sean Hill who was hiking with us. I described the quickening of my heart, and Sean asked if he needed to carry Willa, but I lowered her to the ground, saying, I think I’ll be all right.
We walked gently. By the time we reached the Bartram Forest parking lot, my heart rate slowed. Sean departed to visit with relatives while I took Willa to lunch. Upon driving home, as Willa ran up the walk I waited in the driveway for the mailman. Lingering there, I felt uncharacteristically impatient; the mailman was taking forever to find a package. Why was he so slow? Finally, with the Christmas gift in hand, I trudged towards the house.
As I stood in the front doorway, the large open living room felt unusually small. I said to my wife, Renee, I need to sit down. My heartbeat felt rapid, yet it shouldn’t have since Willa and I had sat for almost an hour at lunch, and the walk into the house measured less than ten yards. My goal suddenly became trying to reach a brown-cushioned chair.
Easing my body down, I said to Renee, Feel my heart.
She placed her hand upon my chest.
Listen to my heart.
She pressed her ear against my shirt, and then said, Your heart is racing.
Something, I said, is very wrong.
I lay on a couch and felt my heart slow but feared the unknown, the gray area of whatever could be the matter. Letting myself fall asleep, I believed we could wait until morning to see the doctor since nothing physically hurt now, and since my heart rate remained steady. Still, I worried about what the doctor would find.
In the morning I drove myself in, and the nurse promptly administered an EKG.
Then as I sat anxiously in the exam room, the doctor strode in, remained standing, and asked, Allen, how long have you been feeling like this?
You’re making me nervous, I said.
Your heart is in A-Fib right now, the doctor revealed. It’s beating out of rhythm. You need to be driven to the Macon Heart Center immediately to be treated by a cardiologist.
I telephoned my wife and told her that she needed to drive over with her mother, Margie, and take my truck back to our house before bringing me to Macon, which was forty-five minutes away.
The doctor’s receptionist printed out directions and told me I would be Dr. X’s patient at the heart center. Renee, Willa, and Margie arrived and then brought me home. Since my pulse wasn’t skyrocketing, I entered the house and packed an overnight bag. I walked slowly, moving carefully like any sudden move could set my heart off.
The sky was as gray as an anvil and rain fell everywhere as we parked at the Macon Heart Center. When I told the front desk clerk that my heart was in A-Fib, she picked up the telephone.
An orderly transported me by wheelchair to room #501. There was one bed, two chairs, a sofa, the walls were light blue, and the louvered shades were drawn. I felt relieved to have my own room, but thought that the isolation created a particular solemnity, yet whatever a doctor might tell me about my heart shouldn’t be overhead by a stranger.
Renee, Willa, and Margie stayed in the room as a youthful female nurse told me to change into a standard backless gown. After the nurse attached electrodes to my chest, a tech started an IV. Wires from the electrodes ran to a small transmitter that fit in the front pocket of the gown, and the transmitter connected to an IntelliVue heart monitor. Within seconds beeps sounded, and like a condemnation the words Irregular Heartbeat flashed on the heart monitor screen, along with my heart rate, measuring one hundred and twenty-five beats per minute, not nearly as fast as when I’d walked into the house the day before. The nurse told me: I had to remain connected to the heart monitor; if I urinated it had to be in a plastic pitcher; an IV drip would be started soon; and my blood pressure would be recorded at regular intervals. I felt like a laboratory specimen, the scrutiny stifling, claustrophobic.
Now the nurse questioned me to work up my medical history. I told her my mother’s father had died of an aortic aneurism. My father had a heart murmur, a right bundle branch block, and thirteen years ago he’d been fitted with a pacemaker because of fibrillation. I told her my age was fifty, and then recited a plethora of surgeries. I’d had my tonsils removed, a broken nose packed and splinted, wisdom teeth taken out, a hernia repaired, and I’d had shoulder surgery for bone spurs and a torn labrum. On December 3rd, three weeks earlier, I’d undergone sinus surgery. What the history meant to me, most of all, was that after any medical treatment my body had always healed or allowed me to resume life freely. I’d suffered no dire consequences. Even after the two months of physical therapy to rehabilitate my shoulder, my doctor had pronounced it functional. In other words, life had been, for half a century, quite benevolent.
The nurse told me, Well, you don’t look fifty. I’m surprised that your irregular heartbeat didn’t show up during the sinus surgery.
So am I.
I wanted to ask her some questions, but she said, I have to leave now because it’s the end of my shift.
Sifting through my memory, I recalled dragging logs out of the woods a year before. My heart had beat fast, but I had believed it was simply because of my approaching fifty, growing old and being out of shape. In March one afternoon I had felt like something unknown was slowing my body down while I ran because it had felt difficult to keep below a twelve minute mile pace, but in June and July I had progressed to five and six mile runs at a sub-seven minute pace, prior to injuring an Achilles tendon. Then in November I’d felt winded hauling gravel with a wheelbarrow, resting more than I ever needed to, and now here we were. Apprehension unfurled within me, the realization dawning inside my thoughts, as if a puzzle had finally been solved, that my heart had probably been malfunctioning for over a year.
The next nurse was a talkative young man who started rattling off worst-case scenarios: I might require surgery; I might need a pacemaker; tests might show I had suffered a heart attack and damaged my heart muscle; or there could be blood clots in my veins or in my heart.
Do tell, I thought, with pseudo bravado, like a novelist imagining plotlines for characters. But I also felt wary, as if I’d suddenly peered over a cliff’s edge and confronted a perilous drop.
Renee’s face had become grave, and I thought that Willa shouldn’t have been hearing any serious talk about my health. Margie’s face revealed infinite concern.
Soon a third nurse, a middle-aged woman, entered and informed me that in the morning I would have a transesophageal echocardiography, a sonogram of the heart, the images recorded by a probe inserted down my esophagus. If my heart was free of blood clots, then I would likely undergo a cardioversion: electrodes would be attached to my chest and back, so my heart could be shocked back into its normal rhythm.
The mood felt ominous; it was as if every molecule in the air had suddenly been altered beyond any state I’d previously known.
Dr. X, the cardiologist, failed to appear by that evening. I told Renee to drive Willa and Margie home because they—or at least she—would need to return in the morning. As my wife kissed me goodbye, I stayed strong to ease the departure, reassuring her that I would be all right. But once everyone left, the transmitter attached to my heart stopped working, and the talkative male nurse attached the cables directly to the heart monitor, tethering me to the bed, requiring me to buzz out and notify the nursing staff each time I had to get up to use the bathroom. Suddenly I felt shackled, trapped, and loathed being alone.
Soon the edges around the window louvers dimmed. The room lights were darkened. I tried to sleep, but the heart monitor beeped loudly, reading Irregular Heartbeat, my pulse over 130, and then an urgent voice called out repeatedly over loudspeakers: Code Blue, followed by a room number and a doctor’s name. The sound of hurrying footfalls filled the hallway, and as if I were amongst wild animals in the wilderness, death seemed palpable in the air. Yes, many people entered the heart center and failed to walk out, because the heart was such a fragile organ. What, I wondered, was wrong with mine?
When I tried to relax, my heart slowed down to forty beats per minute; the monitor beeped, and Low Heartbeat flashed on the screen. I remembered, of all things, being sixteen, running high school cross-country, and having recorded a similar low heart rate for a physical. My heart shouldn’t have still been able to beat so slowly. At that rate, what was to keep my heart from stopping now altogether?
After midnight my thoughts dragged me down into the most maudlin self-pitying realm. I felt tired from being stuck in the room, and soon became anxious from watching the monitor, knowing that my heart was beating only far below and far above the normal limits. I thought of how it was Friday and Monday would be Christmas Eve. From thereon the night devolved into further sleeplessness; I was just lying in the dark for hours, considering too many worst-case scenarios, the solitude interrupted by a tech needing to record my vital signs. Soon a nurse asked if I’d been taking any kinds of medication, looking for causes for the significant fluctuations of my heart rate. I answered, No, and struggled to sleep feeling trapped in a limbo between this world and the next. I couldn’t help thinking of four friends who had died, three from suicide, the other from a heart attack. Janet, Rob, Dave, and Dave, I thought. How are things on the other side?
The morning nurse was Filipino, and she outdid the other nurses by finding a transmitter that worked, restoring my mobility. Before Renee arrived, an orderly delivered me by wheelchair downstairs where I was placed on a movable hospital bed for the echocardiography and cardioversion.
A bespectacled nurse prepped me, explaining how I would be given anesthesia, and then the cardiologist, Dr. X finally appeared. He was pudgy, balding, affable, like a mellowed out former hippie. If the first test goes right, we’ll shock your heart back into rhythm. Since you’ll be asleep, you won’t feel a thing. If all goes well, afterwards you’ll feel fine.
If, I thought.
The room felt cold. They anesthetized me; I went under while being wheeled into another room. When I awoke Renee stood by my bed, asking how I felt. The echocardiography didn’t reveal anything more, so they shocked your heart, she said. The doctor said it worked.
For how long? I thought.
Late that afternoon, Dr. X entered my room and told me that Doctor O would be covering for him for the weekend. He explained that since my heart had been beating out of rhythm it had gotten out of shape; the condition of my heart on a 1 to 10 scale was now an 8. I worried that my weakened heart might be permanent. Renee commented later that Dr. X hadn’t explained what had caused my irregular heartbeat or offered a prognosis. He did mention, however, that I should ask Dr. O a lot questions claiming it would be good for her. When the evening nurse told me that Dr. X was going on vacation like many doctors do during the Christmas week, I realized that for my primary care I had drawn the cardiologist who was halfway out the door.
When the Filipino nurse showed up with pills and informed me that my new medications were to be taken twelve hours apart, in the morning and evening, I intuited with a sharp pang that this wasn’t temporary or just for my hospital stay, but it was a permanent regimen, for the rest of my life. What had I done to cause this? Early each day I had to ingest an aspirin, a blood thinner, Pradaxa, and two beta-blockers, Coreg and Sotalol. The beta-blockers would keep my heart beating in rhythm, not letting the rate drop too low or soar too high. We need to monitor you here for a few days, the nurse said, to make sure the medications are working.
A few days? Renee remarked she was glad it was only for that long, but I felt frustrated, and was struggling to not be depressed. Seven pills a day seemed implausible, and I thought my heart had betrayed me. To distract my thoughts, I stood up, padded over to the window and opened the louvers hoping to see green grass or a dramatic cityscape. But my eyes were met by a gigantic ventilation unit. And I had to crane my neck, straining to see upward, to catch only a glimpse of what seemed like the smallest rectangle, the grayest patch, of dark gloomy sky.
The afternoon meandered by, and left alone that evening I contemplated calling friends who lived in Macon. Wouldn’t it be great to have a party? To eat barbecue or pizza and attempt to ward off all my dismal emotions? I didn’t want to be pitied, though, so I couldn’t bring myself to contact anyone.
That night no more heart monitor alarms sounded for a low or high heart rate. Still I found it difficult to close my eyes—what if the medication failed and I died in my sleep? By morning I had rested very little and wanted to be anywhere else. A middle-aged African-American nurse told me I could shower, so I lingered under hot water, washing away two days worth of grease and sweat from my hair and pores.
When Dr. O, the second cardiologist, walked in, she stood at the foot of the bed and briefly seemed fixated upon my features. She was a brunette, slightly younger than me, and when I met her eyes she glanced nervously downward. I didn’t have my wedding ring on and inferred that, of all things, she was attracted to me. I supposed that my being much younger than the typical patient made me seem rare or more intriguing. Despite the awkwardness she told me I might need to stay beyond Tuesday.
The idea of being stranded there through Christmas startled me. I thought of Willa and started to cry; embarrassing tears streamed down from my eyes. Trying to compose myself, I apologized, explaining that I knew my wife was having a difficult time driving back and forth and keeping our house together, and my daughter would be acting out in any number of unknown ways the longer I wasn’t at home. I’m sorry. None of this has been easy, I said. What little optimism I had left was dwindling away; all I wanted now was to go home. Disappointment about my being married had only appeared on Dr. O’s face for a moment, and still trying to gather myself I told her that there were some questions I needed to ask her about my heart. She acted professionally, telling me, I’ll be back later, granting me more time to regain my composure.
That afternoon when Renee and Willa arrived, my daughter climbed onto the bed, and I read to her. I became emotional, not wanting to disappoint her, not wanting to tell her that I might not be home for Christmas. Please, go find something to eat or drink, or ride the escalators, I said, and by then I was crying. The future had become much too uncertain; psychologically, I felt asunder. And I thought of how I had always been able to pull on a pair of running shoes, step out the door, and accrue four to six miles without a second thought, simply trusting my limbs and body, but now that confidence had suddenly vanished, as if my freedom had been stolen.
How much of an illusion do most of us have to live with, I thought, never recognizing the fragility of our health?
By the time Renee and Willa returned, I had composed myself. Dr. O entered the room, and Renee and I asked questions. We learned that I would still be able to exercise, but the doctor didn’t recommend my running sub-seven minute miles. Coffee and Coke or Pepsi were out because caffeine was a stimulant that would contradict the beta-blockers. My irregular heartbeat and atrial-fibulation stemmed from an electrical problem, meaning the bundles around my heart weren’t transmitting the proper signals, which was a condition, not a disease, that I couldn’t have done anything to prevent, and my needing a pacemaker someday couldn’t be ruled out.
Still waiting to see if the medication would regulate my heart properly, I felt glum, sorrowful, stuck in the doldrums of mid-life. When Renee and Willa left that evening, I nearly cried again, and my eyes focused upon the heart monitor, tracking the ups and downs, making sure the range didn’t dip too low or rise too high, like I was visually tightrope walking. Sleep eluded me, and when an orderly served me eggs and bacon that Sunday morning, I wondered if I was really in a heart center or if it was all a strange mystifying dream. But Dr. O appeared, and to my astonishment she said that I would be discharged that evening. She explained that as long as I kept up with my medication, I’d be better off not doing any extensive reading about my heart and just living my life for a while. Lastly, she smiled and told me that she was a single parent, as if to say she more than understood raising a child and my reasons for having become so upset.
I telephoned Renee, letting her know about my imminent release, suggesting she drive over in the late afternoon. It was the day before Christmas Eve, so I behaved all morning and afternoon, not wanting to endanger my release. Renee and Willa arrived at four o’clock, and after an hour a nurse told me I had officially been discharged. I felt ecstatic, but on the way home when we stopped at a CVS to have my new prescriptions filled, I found myself buying a long plastic pillbox with letters for each day of the week on top of seven compartments. My parents, who were in their mid-seventies, used similar boxes, so I felt discouraged and resented my fate. My concerns about whether my heart would stay in rhythm left me feeling guarded about how happy or content I could truly be. How much was my life my own now? The fact that my own living tissue, the most important muscle in my chest, had rebelled against me, not behaving any more as it should, felt unfair, like the cruelest decision possible.
On Christmas Eve day, I shopped to cook a roast for my family and stayed up late wrapping Renee’s and Willa’s presents. Christmas was splendid simply because I was at home with my family, and in those initial days I didn’t try to run or exercise. The worst-case new scenario would have been triggering a rapid heart beat and having to return to the heart center. Instead late at night while Renee and Willa slept, I brooded, watching a slew of b-grade movies, the Robert B. Parker series, which features Tom Selleck as police chief, Jesse Stone. I felt comforted by how predictable each of the movies was. Stone always solved his cases, and whenever an attractive actress was listed in the opening credits, she would always make an overt pass at Stone—it was laughable because of how blunt the actresses were. Most of all, Stone’s masculinity always prevailed over criminal attempts on his own life, and he persevered for justice despite his failed marriage or the demons of his own alcoholism.
My medications now kept my heart rate within acceptable parameters, but I could feel the beta-blockers working; it was as if an unnatural wave would pass through my chest, slowing and holding back my heart, as if an artificial force or presence were maintaining my life, rather than my own body. I recalled Dr. O saying I’d be better off just living my life, and I knew I needed to attempt to restore my heart’s efficiency, so availing myself to exercise, I returned to Bartram Forest two weeks after I had left it.
I jogged ever so slowly for the first quarter mile, passing through the rows of pines, and my heart beat steadily, but it was as if a governor had been inserted into my chest, as if my body wouldn’t allow me to gasp or breathe too deeply; brakes seemed to have been applied, firmly restricting my level of exertion. So my heart, which had always been strong and pure, was now questionable and hindering me. As I ran further, as much as I wished otherwise, I knew my body had not escaped unscathed, and therefore the experience of being alive, of living itself, was no longer the same. Yes, my heart now depended upon a daily dosage of seven pills, so my life wasn’t my own, my body not continuing on freely without consequences. I felt it with the lessened capacity of each breath, with each diminished stride; there could have been a giant hand controlling me, like I was just a marionette attached to strings. Then, before I was even halfway through the three mile loop that I had run countless times before, fate became all too present, telling me that I would never run as fast as I used to, and so my own death now felt closer instead of far off or unimaginable, as if there was no escaping mortality. How many years did I have left? Would I be able to accomplish everything I wanted to? Indeed, at some point my heart will stop beating entirely, my life span not my own to determine but bound now to the realm of echocardiography. And whenever I have glanced at my watch since, seeing my slower mile times, no longer naïve, I have been reminded of that previously unknown fact.
“Echocardiography” is part of an essay collection called My Chinese-America. The collection was named runner up in the 2013 Santa Fe Writers Project Literary Awards Program judged by Lee Gutkind. It will be published by SFWP.