The Family Heart, Part I
Things Fall Apart
By Steve Watkins
ADVANCE EDITOR
This is the first in a three-part series.
FIRST PERSON
One day in the early fall of 2009, I went in for what was supposed to be a routine colonoscopy. I chugged all the nasty purgatives the night before, did the proper business that followed, then showed up for the procedure first thing in the morning. For the past 19 years, I’d taught Journalism, Creative Writing, Modern American Lit, and Literature of the Vietnam War at a small, provincial liberal arts college in Virginia. I may have had one of those MWF schedules that semester giving me the odd day off, or maybe I canceled a couple of classes. My wife Janet took a few hours leave from her job as a newspaper reporter and health editor to drive me over for the appointment. I was 55 and had a history of diverticulitis, but had been polyp-free the last time I did a colonoscopy, five years earlier. With no family history of colon cancer, there was no reason to expect anything different this time around. I left Janet in the waiting room, changed into an open-back gown, laid on the examination table, and conked out under the anesthesia.
Halfway through the exam my heart rate dropped into the 20s. The gastroenterologist and his staff freaked out. They administered a shot of epinephrine to stop the descent into bradycardia, then held their collective breath until my resting pulse returned to normal, somewhere in the 40s—normal for me, anyway, a lifelong distance runner, masters swimmer, and power yoga teacher. Weirdly, they continued with the procedure. I awoke a short time later with a nurse shouting down at me in the recovery room, demanding to know why I hadn’t warned them that I had a bad heart. “You could have died!” she kept saying. “You could have died!”
I had no idea what she was talking about.
The gastroenterologist, meanwhile, was out in the waiting room talking to Janet—nonchalantly, as she remembers it. “Your husband did great,” he said. “No polyps. No need for another colonoscopy for another five years. He should be ready to go home in just a few more minutes.”
He started to leave but then turned back as if he’d just remembered something. “Oh yeah,” he said. “His heart rate fell dangerously low during the procedure and we had to give him something. I recommend you make an appointment right away to follow up with a cardiologist.”
Janet was beside herself with worry, but I tried to shrug the whole thing off when she told me about it. A blip on the radar screen, I assured her. An aberration. It’s possible I was still under the effects of anesthesia, and nothing was registering: the nurse yelling at me, the gastroenterologist’s disclosure, the dead certainty that Janet wasn’t about to put up with patronizing bullshit—mine or anybody else’s. It’s also possible that I didn’t want to consider the possibility that I had inherited what my brother and I had already been referring to as the family heart.
Janet made some calls and managed to line up a cardiologist appointment for the following afternoon—somebody’s late cancellation. I taught my morning college classes, led an Ashtanga-adjacent power yoga class at the YMCA, then hurried over to meet Jan at a second-floor office complex in a brick and steel medical building next to the hospital. The wide picture windows in the waiting room atrium gave us a great view of the parking lot and our Honda Civics—hers eggplant, mine a shiny white. The heart doctor, a trim older man who may or may not have just returned from a cloth-napkin lunch at the country club, wore a sport coat and bow tie and spoke with a patrician Virginia drawl. He asked the requisite background questions, and when he found out what I did for a living told me he’d done his undergraduate studies at Sewanee—the University of the South—and had a deep interest in Southern literature himself. He then held forth for the next five minutes on the New Critical canon: Faulkner, Welty, Glasgow, Penn Warren, O’Connor, Woolf, Caldwell, Porter, Percy. I nodded along with feigned interest. Janet, who still had deadlines to meet back at the newspaper, crossed her arms and tapped her foot. Finally, perhaps suspecting he was much better read than me with my second-rate Ph.D. from a southern state university, he got down to business: ordered an EKG, frowned at the results, then had his technicians hook me up to monitors and put me on a treadmill where I ran nine-minute miles for half an hour on an incline until they told me to stop.
“Arrhythmia,” he announced after a quick scan of the data. “Atrial fibrillation. That combined with the anesthesia brought on the low heart rate you experienced yesterday.”
He turned to Janet. “If your husband could just exercise like this all the time, his body producing enough adrenaline to keep his heart rate elevated, it wouldn’t be a problem. But that’s obviously not possible. He’s likely been in atrial fibrillation on and off for years, largely controlled and masked by all the aerobic activity.”
He said I was at risk for a stroke, or something worse, and needed a cardioversion to shock me back into proper rhythm. Either that or a cardiac ablation, a more invasive surgical intervention that was more effective at controlling irregular heart rhythms long term. It involved something called a Cox Maze Procedure to identify and essentially cauterize problem areas in the atrial wall and block the abnormal electrical signals that triggered the arrhythmia. First, though, he wanted me to go on an old-school blood thinner, Warfarin, just to be on the safe side, to reduce any chance of the A-fib throwing loose a blood clot and causing a stroke, something that had happened 20 years earlier to my mother, and again three years ago, in 2006, not long before she died.
My uncle—my mother’s brother—also had an irregular heartbeat, and none of the several cardioversions they’d done on him had worked for more than a few months before he fell back into A-fib. And like my mom, he ended up with a pacemaker anyway. So, we opted for the ablation. Once they had the Warfarin regulated—a process of trial and error that could take an anxious few months, and did—they would schedule me for surgery.
Janet and I went home, trying to get our heads around this new, worrisome reality that had suddenly entered our lives—seemingly from out of nowhere, though in retrospect, not really. I just hadn’t been paying attention to the mountain of evidence that was all around me and had been for years. It would be December before the stars and the Warfarin aligned for the ablation.
***
Janet had noticed the irregular heartbeat before—in quiet moments when we lay in bed together, my arm around her shoulders, her head on my chest, drifting off to sleep in our small upstairs bedroom across the hall from our two youngest daughters. We had a wobbly ceiling fan that my dad and I had incorrectly installed the summer when Jan was pregnant with our daughter Claire. We mostly ran it now for white noise to block out the street traffic. It didn’t drown out all that much—certainly not the odd beat of my heart that I had always been so quick to dismiss whenever Janet brought it up. But as vigilant parents who wanted to hear the girls if they got up during the night, we didn’t mind if the ceiling fan wasn’t much good at its secondary job.
We took turns putting the girls to bed—Claire then six, Lili four. Jan read them piles of books: Runaway Bunny, Goodnight Moon, Bread and Jam for Frances, Caps for Sale. On my nights, I told them stories about Regular Bob and Pee-Pee Mary, made-up friends from my childhood. I also sang songs that my mom had sung to me when I was little, and that I had spent years singing to the girls’ older sisters, Maggie and Eva, now grown and gone. “I Gave My Love a Cherry,” “Hush Little Baby,” Brahms’s “Lullaby.” The girls begged me to lie next to them in their twin beds on opposite sides of their bedroom. I wasn’t sure how Janet handled it when the girls wheedled her, but I split the difference by briefly cuddling with one, then the other, then stretching out on the thin floor rug equidistant from both of their beds and doing supine yoga until their breathing deepened and softened and slowed and they settled into sleep.
We clung to our routines:
Claire skipping off for school each day to the tidy pink and blue classroom of her beloved teacher Mrs. Hannik, who lived in an equally tidy Cape Cod with flower boxes and a white picket fence a block away from us. We passed it every afternoon on our way to the swings and climbing apparatuses at the Lutheran Church playground where we met up for play dates with Claire’s pal Tovah and her little brother Tescher who also lived in our neighborhood.
Lili and me on a tandem bike pedaling across town to her Montessori pre-school next to the city dock where she started her days by organizing all the children’s name tags in a box just inside the front door. At night, when she insisted on taking showers instead of baths, she also insisted that I sit on the closed toilet seat and play my guitar, which was how she grew up knowing all the lyrics for “Friend of the Devil” and “Ripple” and “Sam Stone.”
Jan power-walking a mile from our house to the newspaper office every morning, and a mile back home to me and the girls at the end of the day, and then me and her splitting duties on the weekends as co-directors of religious education at our Unitarian Universalist fellowship. She was also mentor for half a dozen teenage girls at the fellowship, meeting with them once a month for a couple of hours where they licked the salt and vinegar off salt & vinegar potato chips and poured out their secrets and souls to her and to one another.
My oldest daughter Maggie planning an autumn wedding to her fiancé Marty at a forest venue by a wide sweeping bend in the Rappahannock River. Her sister Eva in Texas working for a nonprofit with AmeriCorps.
Me trying to keep my head down at the college where I was the trouble-making adviser to the school newspaper and a faculty member in a pathologically dysfunctional department—trying and largely failing, as evidenced by the downward spiral that dragged me further and further out of favor with the powers that be until I took a buy-out and left two and a half years later.
***
The December ablation was a bust. A younger cardiologist, new to the practice and possibly new to catheter ablation and the Cox Maze Procedure, did the operation, which took a couple of hours—threading a tube through a groin incision and up into the left atria via my femoral artery. I don’t remember much about it. Actually I don’t remember anything about it, except that they made me lie flat on my back for five hours afterwards so the incision would have adequate time to heal. As soon as they had me stand, though, the sutures failed to hold and blood poured down my leg and puddled on the floor.
The cardiologist came in to assure us that everything else had gone OK. That is, there had been no complications from the ablation per se. That was the good news. The only problem, he said, was that during the procedure they discovered that in addition to the A-fib, I also had a complete block in my A-V Node. The electrical signal from the upper chamber of my heart (A for atria) couldn’t always reach the lower chamber (V for ventricle)—hardly ever, in fact—so the two chambers were beating at completely independent rates, another cause of my slow heart rate.
“Meaning what now?” I asked.
“Meaning you need a pacemaker.”
As far as what had caused the A-V Node block in the first place, the cardiologist said he had no idea. We wouldn’t learn the answer to that medical mystery until 12 years later, when my brother’s wife and daughter made a desperation appointment for him at the Cleveland Clinic for an exhaustive, weeklong cardiopulmonary study—including genetic testing, something we’d never considered despite all our talk over the years about the family heart.
Janet and I were thrown once again by the news—and by the sudden urgency. How could this be happening? I kept to a mostly heart-healthy diet. Had been a vegetarian in a past life, and rarely ate red meat or processed foods. I didn’t smoke. Didn’t drink. Hadn’t done illegal drugs since my 20s. I exercised nearly every day: Running. Swimming. Power yoga. I even meditated. Sort of. Sometimes.
The pacemaker insertion was scheduled for a week later, enough time for me to recover from the ablation, turn in final grades, and wait for a massive winter storm system to blow into the Mid-Atlantic and bury us under a historic snowfall.
I remember Christmas music playing in the background as they put me under anesthesia—right after a brief conversation with one of the OR nurses, who seemed bothered when I mentioned I was a Unitarian Universalist, and that we celebrated not only Christmas in December, but also Hanukkah, Diwali, Kwanzaa, Bodhi Day, and a pagan holiday or two, the names of which I couldn’t recall. Christmas carols were still playing in the recovery room a few hours later as I woke up after the procedure. Mostly what I was aware of, though, besides the distant strains of “O Come, O Come Emmanuel,” was the sensation of something slamming into my chest, a mule kicking the shit out me over and over from inside with every beat of my now pacemaker-assisted heart. When I finally I managed to say something—it took a while to get the words out; I wasn’t very intelligible—the attendants summoned the junior cardiologist and whisked me back into the OR. Just before they put me back under, the same nurse from before whispered to me, as if my heretical UU soul had just been saved, “What do you think about Jesus now?”
***
“A micro-perf,” the young cardiologist explained later to Janet. She thought he sounded nervous. After so many hours under anesthesia, and back-to-back pacemaker and lead insertions, it would be hours before I’d be able to make sense of anything. “A slight perforation of the heart wall,” he added. “We’ll keep him overnight for observation, and do an echocardiogram in the morning to make sure everything’s OK. Which I’m sure it is.”
The snow kept coming down hard all night—two feet in all—not that I was aware of much of anything in my lingering stupor. The cardiologist, clearly more concerned than he’d let on, dug his own way out of his long, rural driveway to a half-cleared road so he could drive himself in to the hospital first thing the next morning and do the echo himself—not wanting to wait for a technician, or perhaps worried that the technician wouldn’t be able to make it in to work through all that snow. (A friendly nurse on the cardiac ward told us this later.) I was clear-headed enough by then to hear the relief in his voice when he told us all indications from the echo were that I was in the clear—the “micro-perf” having closed on its own; the pacemaker and leads functioning well, all in their proper places; no further complications.
People took care of us, god bless them. And shit kept happening. Janet’s parents came over that morning to stay with Claire and Lili so Jan could be with me at the hospital. Maggie and her new husband Marty dug their stuck car out of a snow drift across town so they could drive to our house with snow shovels and clear a parking space out front for when I made it home later in the day. Another friend with a four-wheel drive fetched us from the hospital that afternoon. A snow plow threw a rock through the side window of one of our cars we’d left on the street. Other friends took it to a body shop and had it fixed. After a second snowmageddon two weeks later, the drywall ceiling in an addition we’d had put on the back of house started bulging with snow-melt from a leak in the flat roof. I reached up with my good arm to touch it and a couple of gallons of water immediately poured out onto the carpeted floor. We all stood around and watched in disbelief until somebody finally ran for a bucket. We managed to dry everything up—running fans all night aimed at the pond-sized wet spot, though it was still snowy and freezing outside. Not knowing what else to do—the insurance company said our homeowner’s policy didn’t cover a “natural disaster” like too much melting snow—I stuck a literal band-aid over the hole. There must not have been any more water leaking in by that point, because it miraculously held until we could hire a guy to come in and fix the roof. Not long after that, the Christmas tree we’d decorated but had forgotten to water lost its precarious balance and fell over in the middle of the night, waking Janet and me and the girls with the loud crash and destroying most of the ornaments and lights. We threw it into the backyard, planning to leave it there until spring, or until the snow melted, whichever came first.
I never saw the junior cardiologist again. The senior cardiologist either. Junior left town not long after, and Senior retired before I could come in for my follow-up appointment and the first of what would be countless device checks and remote monitoring transmissions of the pacemaker over the next 15 years to make sure it was still working properly and keeping me alive.
Next Sunday: The Family Heart, Part II: O, Brother
***
Steve Watkins is editor of The FXBG Advance. You can find Steve Watkins Books, his author Substack page, HERE. You can find Pie & Chai Magazine, which Steve also edits, HERE. And you can contact him HERE. An earlier version of this essay was published in Pie & Chai.