Friday, June 19, 2015

911. Twice.

I try not to call them for myself. I was raised not to bother people. I'll call them for Steve when he indicates a breathing issue, and I called them for Daddy back when. I did call them for myself after the school bus rear-ended my car, though that was much more to report an accident than to freak out over a neck injury: I could still move, after all. But I'd rather drive myself to the ER if at all possible. I took my cardiologist's advice to heart when he said I could just sit quietly and wait out an A-fib attack, unless I passed out. I have done that now, several times. The waiting, not the passing out part. I've even gone to bed for the night during an A-fib episode, fairly confident that I would 1: wake up the next morning 2: with the A-fib having run its course.

Wednesday night was different. It did start in the usual way around 6 PM, a little something bringing my attention to what was going on in my chest before the maddened sparrow started trying to beat its way out. I even was dealing with a phone conversation through the early stages. But then it changed.

When I was a young teenager, I fainted twice. There is a distinct feeling ahead of the blackout where all the blood seems to be draining out of your head. If you recognize it, it's your 1.5 second warning to get your head down between your knees or find something soft to land on. That, or you wake up with the consequences. Wednesday I ended the conversation early after getting that feeling about three times.

It continued happening, enough that I actually mentioned to Steve that I was having A-fib. I usually try not to, at least not at the time, to keep him from worrying. After all, if I could just sit through it, why fuss? I hadn't said anything just Tuesday night when the last "regular" A-fib event occurred. But this was new, and just a tad scary. Just a tad, that is, until it kept happening. Rich got home, and by then I'd mentioned that I kept feeling like I was going to pass out. In fact, I added, I was about 4 minutes from calling 911. And maybe they could kinda keep an eye on me in case I actually did pass out.

Steve wasn't about to wait my 4 minutes after hearing that. Before those 4 minutes were up, the first of what seemed at least a dozen first responders, paramedics, and deputies were filling the living room and half the driveway.

We have excellent response time here.

I was hooked up to their EKG, allowed an escorted trip to the bathroom (A-fib always does a bang-up job of stimulating my kidneys, mandating that trip about every 15 minutes!), strapped onto the gurney, wheeled down the driveway and loaded into the waiting ambulance. I'm not sure who answered all their questions. I fielded some, but there were too many simultaneous conversations going on at once to follow. Nobody even asked about insurance! But off we went.

Allison, the paramedic in the back of the ambulance with me, noted that I leaned my head back every time I got that blood-draining feeling. After establishing that connection verbally, and noting what was happening on the EKG at those times, she asked me to let her know as it happened so she could hit the button to make printouts to document them. As they were now happening about every 30 seconds, and the EKG showed they were long pauses in the ventricular beats, she told the driver to hit the lights so we could avoid any traffic build-up in downtown Taylors Falls, or the rest of the way to the hospital in St. Croix Falls across the river.

She also commented to me that my feeling like the blood was draining from my head was likely exactly what was happening. During those pauses, nothing was pushing it back up.

OK, now I was scared. I had kinda been wondering how much of an over-reaction this whole ambulance thing was, up to this point. Now I was thinking it was a damn good thing we were closing in on the end of my ride. Oh yeah, and it had been about another 15 minutes since that bathroom break, and I was even more worried that my bladder wasn't going to hold out that long! Allison and I spent those last few minutes discussing adult diapers - yes, they had them - and bedpans - they had one - as options, but neither was feasible with all the straps pinning me in place. She finally decided to quit trying to solve that problem, reassuring me that if it happened, oh well.

Yeah, tell my Mom that! Even from the grave, she'd be mortified! Me too, of course.

I was quickly wheeled into a private room in the ER, not just a curtained cubicle, and a commode brought in before transferring me to the ER's bed. WHEW!

Somewhere in the process of my getting in the bed and the new set of leads being attached, I converted. No, not religiously. I converted to normal sinus rhythm. Blessed normal heartbeat. No more nearly passing out, no more mad sparrow. While that was in process, the doctor was informing Allison that if she saw the same thing on an EKG again, "a little electricity is never a bad thing."

Oh. I couldda gotten the paddles. Good to know. For next time. I'll be sure to mention it.

Meanwhile they noted the conversion, but decided justifiably I needed observation for a while. And just because, and neverminding my allergic reaction to the medical adhesive holding them in place, they taped the huge patches on me that they use when they do have to shock the heart, one in front, one in back. They wheeled in the machine to do the job too, just in case. Saving time, you know. (Yes, the marks are still there and still itch, in case you wondered.)

After a couple more hours and some discussion, I was OK'd to go home. The last thing to wait for was removal of the IV in the back of my hand. About half an hour earlier they'd had me up and walking, to be sure I was able to do so safely: bad PR if the patient passes out just before discharge. The bag was disconnected from my IV pole for the walk and the line was clamped to prevent bleeding.

Nobody unclamped it.

A half hour later I was thinking it might be a pretty bad idea now to do so. Some blood had backed up into the line, enough that it looked black for about 4 inches, gradually changing to red, then pale red. Even on Warfarin, surely a half hour was enough time to form a blood clot? Seemed to me I was dealing with enough issues that a blood clot wasn't on the list of what to add to the mix. So when the nurse finally arrived to take out the line, I had pinched it off tightly with my thumbnail in order to slow her down enough to ask a question. Meanwhile she was squeezing the IV bag to try to empty the remainder into me. It wasn't getting past that thumbnail, by gum. She insisted that there couldn't possibly be a clot formed even after half an hour, and I wasn't buying it or anything except that she was not going to listen to me. Especially so after her "because I'm the nurse, that's why!" She finally quit trying after letting me know that nothing was flowing through the line anyway, never admitting the possibility of something having clotted as the reason, and never noticing my stubborn thumbnail.

Close to midnight Paul picked me up, Steve being reluctant to drive after dark, especially over lesser-known streets. I arrived wired, not ready for sleep, so Steve and I watched a little TV to unwind. Around 2 AM we finally hit the sack, still talking about the events of the evening.

Oh oh. Just after laying down, the A-fib returned. That too is something it's never done so shortly after converting back to normal sinus. Of course it already had occurred two days in a row, by far another first. We were both still so unnerved from the previous experience that I promptly mentioned it to Steve, and he grabbed his phone for another 911 call. I wasn't feeling the ventricular pauses this time, but neither of us had the fortitude to wait for them.

The deputy was the first one in the door this time, and he came carrying the defibrillator unit, with the disclaimer that he would only use it if I became unconscious. Which I wasn't. There were other new faces this shift, and a few familiar ones. One of the repeats was apparently a neighbor across the street.

Ain't it reassuring to know your neighbor has seen you without your shirt or bra on? Twice?

This time by the time the initial questions were asked and the leads attached, I converted again. (If only I'd known!) I can hereby attest to the fact that it is possible to feel both silly and scared simultaneously! I refused their offer of another ride, since now having converted without the threat of falling unconscious I wanted more than anything to spend the night in my own bed with an actual possibility of getting some sleep. I was rather sternly informed that should I call them again, I would not be given that choice, and would in fact be taken all the way to St. Paul Regions Hospital for a real cardiac workup and treatment.

I had orders to contact my regular doctor for an appointment the next day. Having lived here for over 20 years before moving to Arizona, I had medical contacts with history with me. My former primary was full for the day, but they found me an appointment with a PA, luckily one down the hall from my former cardiologist if a consult was needed. Of course, I couldn't have gotten in to the cardiologist on shorter notice than a month but the PA could consult for whatever was needed on the spot. She wound up also calling my Arizona cardiologist, having actually gotten acquainted with him a few years before! Small world.

The three of them worked together and wound up with a plan that will hopefully keep me healthy long enough to spend the rest of the summer up here with only the intervention of a change in medication. I already made a set of September appointments before heading north with the cardiologist, and best case scenario is we can wait until then for any more drastic interventions, including possible surgery, either to remove the cells which are sending the wrong timing signals to my heart, or possibly, now with ventricular arhythmia, get a pacemaker, or both. None of which come with guarantees.

Neither does the new medicine. Just the warnings that come with it are enough to make me think that surgery may well be the preferred option. You can explore that further in my next post. Meanwhile, I'm just hoping for time enough to be able to make my choices down there, where my insurance gives much better coverage.

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