On Tuesday, Amethyst goes in for the This Shouldn’t Have Been Necessary second round of heart surgery intended to eliminate the extra nerve that’s responsible for her PSVT. PSVT being Paroxysmal Supra-Ventricular Tachycardia, which is the fancy way of saying that occasionally, randomly, her heart rate suddenly rises to about 240 beats per minute. It’s a problem she’s had since we were in high school, but it never required and didn’t receive medical attention until about six years ago because it always “self converted”, which is to say that it stopped racing of its own accord. In the past six years, though, it has required medical intervention 54 times. Or is it 55? It’s difficult for me to keep an accurate count. It might be 55, as it happened twice in the span of one week, last week.
The usual drill: She’s just going along having her normal Amethyst kind of day, then she pauses and two fingers go to her carotid artery. “It’s flipped” or “I’m taching”, she’ll say, and then we’re on the way to the emergency room again. The usual response of the trauma staff upon our arrival is, “Again?” or “Not again!”.
Then, of course, they show her to a treatment room and get her situated. Into the gown, onto the bed-like wheeled contraption, and an IV or two are started. She hates it when there are two. For that matter, she hates that there’s one, but the first one is necessary. Quite often it’s A Very Big Thing in the ER, and they drag in everyone who’s involved in the delivery of medical services to observe and learn. Amethyst gives them tips on how to make sure that the first 6cc will work, and so not require the second blast of 12cc, or the third 12cc. When it’s done incorrectly the first 6cc doesn’t work. We’ve seen it done incorrectly several times. Not here in Dinkytown, though.
They always ask if she’s tried the vagal maneuver, the Valsalva maneuver, carotid massage, and so on to self-convert. It used to be that the answer was always yes, but lately it’s always no. Those things don’t work. Apparently they rarely work, but are suggested anyway despite the fact that the carotid massage in particular can be dangerous.
We might have to wait a few minutes for the doc to arrive to give the go-ahead, then it’s 6cc of adenosine followed immediately by some quantity of saline. Seconds later, the display on the heart monitor goes from a rapid pulse train to flat, indicating that her heart has stopped beating — and of course the alarm sounds, because the machine doesn’t know that the stoppage was intentional. My eyes go back and forth from her face to the monitor… About six to 12 second later her heart restarts, usually at around 110 to 120 beats per minute, and another EKG is done. Often, blood is drawn to be sent off to the lab, though sometimes it’s not, and sometimes it’s drawn “just in case” but never goes to the lab. Over the next 45 minutes to an hour her heart rate and blood pressure slowly return to normal. If blood went to the lab, we get the results before we leave and they’re always perfectly normal. Everything is right in the middle of the normal range, and there aren’t any detectable enzymes floating around in there indicating that the heart muscle has been damaged by the marathon that it alone has been running.
Then we go home, and Amethyst lies down for a while because the whole experience takes a lot out of her. She’s a bit weary for the next day or two, then the thing that passes for normal for us resumes again. Normal for us means never knowing when the next round trip through the ER might come. One day it was just as soon as we got home again. Last week it was on Sunday, then again on Saturday.
There’s a magnet on our refrigerator that reads, “Around here normal is just a setting on the dryer”.
Just about a year ago, Amethyst went for the surgery to correct the thing. It involves poking five holes into her femoral artery (because it’s big) and threading cameras, probes, and an electrode that conducts RF energy from her groin up to her heart. The cameras and probes are used to map the heart to figure out which nerve or nerves are involved — the doc does a little zap here and a little zap there until a specific location is identified that triggers the arrythmia. Then the heart is stopped, and with the RF electrode the nerve that’s identified as being at fault is severed with heat, like a miniature microwave oven is being used to cook a piece of it. In theory, anyway. Amethyst was taching again two weeks after the first surgery, so now it’s time for round two.
I try to appear as though I’m just soldiering on through it all, but in truth this stuff just hangs me up something fierce. I can’t get past the fact that doctors’ mistakes kill right around 200,000 Americans each year, and cause untold misery for those who are damaged but not killed. That’s a lot of mayhem. And they don’t even count the bad outcomes that aren’t officially considered mistakes. If a drug or a procedure is officially appropriate for a given condition and it kills you when a different treatment or no treatment at all would not have, it’s not counted in that 200,000 annual deaths. It’s officially a bad outcome, not a medical mistake. This goes through my mind as we drive to the ER, and stays there until we’re safely back home again.
It doesn’t help matters when some medical technologist gets pumped up on adrenaline because tachycardia is A Very Big Thing. There’s one at our local hospital who does that, a newish nurse, who gets Very Important and somewhat frenetic when we arrive. I am not the trusted, respected professional there so I cannot just say to her that she has to leave the room and let someone of cooler head take over. In my former career I was the go-to guy when a crisis went from oh-shit to holy-fucking-shit, and when that escalation was caused by human factors it was that adrenaline response to blame every time. It’s that need to just do something, which is always wrong. When that need arises, the something that needs to be done is to take a step back and a deep breath, and then to calmly assess the situation. If you can’t do that, you should just leave. I can count on one hand the number of times that advice has been taken when I’ve given it, but I’ve stopped counting the times it has gone unheeded and things have blown up because of it.
So next Tuesday my dear Amethyst gets her heart cooked from the inside while I sit in the waiting room trying to keep myself occupied and quietly eating my liver. If it all goes well we’ll spend Tuesday night in a hotel rather than making the long drive back to Dinkytown, and then we’ll spend the next several days hoping those holes in the femoral artery stay closed. Then the next several months will be spent being watchful for signs that the procedure was not successful after all…
Sometimes I think it’s not really science those folks are up to after all. Sometimes it scares hell out of me. Like now.