Sunday, July 3, 2016

Slower Than a Dog, Faster Than a Whale

Dear George,
After fiddling around for eons, Katja and I finally saw a lawyer to make up our will.  Actually we did have a will 45 years ago when J was an infant.  All I can remember is that the will specified, at Katja’s insistence, that she will donate all her organs to science and she will have an open casket funeral.  The lawyer strongly advised against this.  He said they gouge huge holes in your head and torso for organ donation so an open casket funeral would be horrifying for the mourners.  Katja was adamant, insisting on an open casket, large holes or not, and that’s how our will wound up.  It doesn't matter because that will disappeared somewhere in the attic.  It was easier to hire a new lawyer than to search for the old document.  

There’s nothing like doing a will to make you aware of your mortality.  Right in the midst of these legal matters, something unsettling happened at the fitness center.  I routinely take my blood pressure and pulse before my workout.  A normal pulse rate is between 60 and 100 beats a minute, and my pulse is always about 75 or 80.  On this occasion, however, the machine said my heart was only beating 40 times a minute.  That seemed impossible.  How could my heart rate drop by 50%?  I informed one of the trainers that the blood pressure machine was malfunctioning.  Just to be sure, I rechecked my pulse on our neighborhood drugstore machine later in the day.  Much to my dismay, it was 42.  What was this about?  Was my heart in the process of quitting altogether?  

I googled “low heart rate” and learned that large dogs’ hearts beat 75 times a minute, blue whales only 6, and the lowest human pulse rate in recorded history is 28.  At forty beats per minute, I was a lot closer to 28 than I was to 75.  I was six months overdue for a cardiologist appointment anyway, and this news spurred me to action.  When I called the office, they said Doctor Weinberg didn't have an opening for a month, but I could see nurse-practitioner Carrie Jenquist the next day.*  I opted for the nurse-practitioner.  

Carrie Jenquist took my pulse manually, and it was 60 (better than 40 but still much lower than it’s ever been).  Then she did an EKG, and my heart rate zoomed up to 90.  Explaining that the EKG was correct, she said that the fitness center and drugstore machines were inaccurate because they aren’t sensitive enough to pick up irregular heart beats.  She asked if I’ve always had irregular heart beats.  I had no idea.  Carrie Jenquist said they might be harmless or they might not be (i.e., most likely they are fatal).  She scheduled me for a treadmill stress test and prescribed a heart monitor which I was to wear on my chest for a month (to determine whether my heart rate dips below 40 in the middle of the night).

I get excited about doing stress tests because they are one of my few areas of achievement nowadays.  I’ve reached an age where the hospital staff think I’ll barely be able to climb onto the treadmill, but, in fact, I do the treadmill all the time.  Mikhail, the technician who administered the test, said my target heart rate goal, based on my age, would be 120 beats a minute.  I said that was good but I would like to go higher than that.  Mikhail asked every 60 seconds if  I were having chest pains, and each time I said that I’d like to go faster.  After 10 minutes I'd reached 136 beats per minute.  Mikhail suddenly said "Oops, I pushed the wrong button.  Such a mistake.  I’m sorry, but the test is over."  He said he'd gotten all the information they needed, and I wouldn't have to repeat the test.  I don’t really think Mikhail hit a wrong button by mistake, and I was disappointed not to keep going.  I think he decided that stopping the test would probably save my life.  Unlike my past stress test visits, Mikhail didn’t say anything about my doing well.  I had been watching the printed output on the roll of paper, and the ups and downs of my heartbeats looked like something Jackson Pollock might have drawn.  I told Mikhail it seemed very erratic, and he said it was because my heart was going fast.  When I thought about it after leaving the medical center, I decided he didn’t tell me I’d done well because, in fact, I’d done terribly. 

A few days later the office called and said that Dr. Weinberg wanted me to come back and do a nuclear stress test.  That made me exceedingly nervous.  What had they discovered from my treadmill stress test that now called for a nuclear stress test?  It was a good thing that the lawyer was close to completing our will. There's something about getting your will done that makes the end of life much more acceptable.  A young woman named Marlee did the nuclear stress test. After injecting radioactive fluid into my veins, she invited me back onto the treadmill.  Marlee was friendlier than Mikhail and didn't hit the wrong button by mistake.  When I reached 140 beats a minute, she said "that's awesome!"  I was watching the x-ray of my heart on the computer screen, and it stilled looked sort of crazy though.  There was a big fuzzy undulating area on the upper left side of my heart that looked to me like a large, impenetrable blockage.  Marlee was not allowed to tell me anything.  I started mentally preparing for the worst.    

Carrie Jenquist went on vacation, and so I saw Dr. Weinberg the next week.  I asked Katja to come along for moral support.  Dr. Weinberg came in the room, shook my hand, and opened by saying that my heart was doing just fine.  I have a lot of irregular heart beats but they are harmless and nothing to worry about.  I asked about the heart monitor that I'd worn for thirty days, and he said that was also fine (though I suspected he hadn’t actually looked at it).  I asked why my heart rate on the machines had dropped down to the 40’s, and Dr. Weinberg said maybe I hadn't been drinking enough water.  The upshot is that I’ve stared Death in the face and have returned to the land of the living.  I’m trying to remember to drink more water, though old habits are hard to break.  I have lost all interest in keeping a written record of my pulse rate.  Since the machine is wrong, why bother?   On the other hand, I will definitely feel better when the lawyer completes our will. 

*Pseudonyms are used in this story. 

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