Jewish World Review March 21, 2003 / 17 Adar II, 5763

HEALTH SENSE: After an interview on heart arrhythmias, the writer undergoes treatment herself


By Judy Foreman

http://www.NewsAndOpinion.com | I was very scared, shivering as much from fear as from the chilly room temperature. I was waiting on a gurney at Brigham and Women's Hospital in Boston to be wheeled in for a catheter ablation, an invasive cardiac "procedure.'' (Ah, the euphemisms.)

In a totally bizarre twist of fate, I had interviewed Dr. Laurence Epstein, chief of the hospital's cardiac arrhythmia service, several weeks earlier in preparation for a story I was working on about new treatments for arrhythmias.

He had shown me his very cool, animated PowerPoint presentations and explained the details of the procedure. As a medical writer, I was fascinated. The process involves inserting catheters through veins in the patient's groin, snaking them up into the heart, then using the wires to record the heart's electrical activity -- from the inside. Once this activity is "mapped,'' the catheters deliver radio frequency waves to ablate (i.e., kill) the clusters of cardiac cells that trigger the abnormal rhythms.

As Epstein showed me his pictures and scholarly articles, I casually mentioned that once a year or so I got tachycardia -- very rapid heart beat. He instantly drew me pictures of what he guessed was wrong -- SVT, or supra-ventricular tachycardia, which affects an estimated 500,000 to a million people with varying severity.

Like many of those people, I probably was born with two electrical pathways through a key switching station in the heart, the atrial-ventricular, or AV, node, instead of just one. Electrical signals from the right atrium (one of the upper chambers of the heart) tell it when to beat. In people like me, the signals sometimes go down the wrong pathway and then back up the normal one, creating an electrical circuit that causes the heart to beat very rapidly.

"We can cure that with catheter ablation, you know,'' he said.

"Great,'' I said nervously. "If it ever gets worse, I'll be back.''

Several weeks later, totally out of the blue, it did get worse, much worse. I'm pretty fit: I either swim a mile or do 10 miles on my exercise bike nearly every day. But suddenly, I couldn't walk a block without sending my heart rate up to 190 beats a minute. Even just washing my hair in the shower triggered it. I was fast becoming a cardiac cripple, afraid of climbing even one set of stairs, lest I become short of breath or pass out.

The whole thing was frightening, even though, rationally at least, I knew that SVT was not life-threatening. I decided to go back to Epstein.

But fear and discomfort weren't the only things I had to cope with. Suddenly I had a brand-new, tricky role -- patient. On the plus side, telling people about my unexpected medical problem meant that I got a huge amount of support from friends.

But becoming a patient also meant that I instantly became the target of masses of unsolicited advice from people. I was a Rorschach ink blot upon which people could now feel free to foist their pet theories.

My close friends did all the right things. They called during the interminable weekend while I waited to have the procedure. They e-mailed. They hugged. They brought flowers and excellent squash soup. But most importantly, they neither pooh-poohed my problem nor rushed in to solve it. They had a way of simply listening, with attention and kindness, taking in what I was going through without trying to take over or tell me what to do.

But other people were truly awful at listening and giving support. Their insensitivity ended up putting the burden of patience and diplomacy on me, as I tried to fend off unsolicited advice diplomatically -- at a time when I had little patience to spare.

Some people couldn't stand to let me finish before interrupting with their own horror stories. Others insisted that my problem must be "stress.'' This was especially annoying, first, because it seemed to imply that my arrhythmia was my own fault and, second, because it seemed to invalidate the reality of my symptoms, which had been confirmed by cardiac testing. As one friend put it, "Telling someone they sound stressed blames them. Saying, `What a stressful situation you're in' doesn't.''

Sure, stress sometimes can boost the chances of getting some diseases, mostly notably, the common cold. But it shouldn't be the explanation of first resort, partly because it blames people and partly because lots of people get very stressed and never get sick.

If some people were too eager to blame the victim, others were almost too kind -- so eager to do something that they trampled a bit on my autonomy, not giving me the open space to decide what concrete help, if any, I really wanted.

Some people, I discovered, also seem programmed to pounce on someone else's illness as an opportunity to promulgate their religious views.

Why are some people such naturally good listeners and others find listening so hard? I wondered aloud about this with my across-the-street neighbor, a psychiatrist, in the countdown days before my procedure. His conclusion makes sense: "When you tell people how helpless you feel,'' he said, "they feel helpless. They can't stand feeling helpless, so they jump in with advice.''

Mercifully, the big day arrived and, scared though I was, the procedure was substantially less awful than I expected. The nice guys with the great drugs conked me out briefly while they inserted the catheters and, when I woke up (the type of anesthesia I had is called "conscious sedation''), the procedure was already under way. I could feel the arrhythmias as Epstein and his team intentionally triggered them. But none of these was anywhere near as disconcerting as the ones I'd been having spontaneously. I also knew that they could stop any arrhythmia at any time, a huge comfort. The actual ablation felt a bit hot from my left hipbone to my left collarbone, but not uncomfortable. In fact, I found I was able to chat with the nurse through much of the procedure. I was also lucky. Sometimes, catheter ablations take three to four hours or longer, but mine was quick -- an hour and a half.

Then it was over! I was ecstatic. I had to lie still for four hours so the puncture wounds in my leg veins could begin to heal, but that was easy.

I went home that same night, feeling terrific. No more tachycardia. No more worries about walking or climbing stairs; not even a hangover from the drugs.

I had trusted Epstein and his team, and they were magnificent. Thanks to them, I could trust my own heart again.

As for the creepiness of researching a medical problem, then actually getting it, that's solved, too. I'm writing about hangnails and pimples from now on.

Judy Foreman is a lecturer at Harvard Medical School. Comment by clicking here.

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