Sunday, August 30, 2009

60 posts in 60 days, day 2: going viral

So, Joe's heart. What happened was this.

About three weeks ago, Joe had a cold. All of us, of course, ignored it, because the fact of it is that Joe always has a cold. I'm not sure why, whether or not this is a testament to his delicate constitution or to my insurmountable immune defenses, but while we both work at hospitals and both live with two preschool-aged kids, he catches everything, and I catch nothing. So Joe had a cold, sniffling and coughing and what have you, and there was nothing much more to say about it than that.

Though, apparently, there was.

Three days into his cold, Joe started noticing some palpitations. He describes them as feeling weird, occurring first at night as he was trying to fall asleep, like strange jolts to his body that shook the bed. He tried to ignore them, but they were getting more frequent and he was feeling shitty, and after his surgical cases one Wednesday afternoon, he asked one of the anesthesiologists to run an EKG on him and hook him up to some monitors, just to see what was going on. This was in a series of cryptic and alarming texts I got from him while at work:

Getting an EKG.

Pulse ox reading 95% on nasal cannula.

Having lots of PVCs, P waves look funny.*

(* If those letters and words mean nothing to you, don't worry about it, the long and the short of it is that all indications pointed to the fact that something with his heart was fucked up.)

I texted him back, basically telling him that he needed to go to the ER postehaste and force them to get an echocardiogram, because it sounded like he might have a viral myocarditis. So he did, and they did, and...he did. ("I knew it!" I crowed triumphantly over the phone when Joe confirmed the diagnosis, after telling me how others in the ER were pooh-poohing his concern, with some sentiment that an echo might be overkill. But then I kind of realized that this wasn't an academic discussion and this wasn't "guess the diagnosis" on rounds, this was my husband, and the ridiculous knee-jerk triumph of being right kind of gave way to dread.) So anyway, they admitted him to the cardiac "progressive care unit," put him on telemetry, and that is how Joe ended up in the worst place in the entire universe: an ICU in an academic hospital at the beginning of August.

I know I'm going to get such shit for saying this, since I was a resident, like, yesterday, but the intern who rounded on us? Was probably fourteen years old. She was lovely though, and adorably flustered. I remember that feeling so vividly, how much as a medical student or a junior resident we would all just hate having a patient was was a doctor. There was that dread, that sense of embarrassment that I was never quite able to hide. I might be able to fool my other patients into thinking that I knew what I was doing, but the patients who were medical professionals? They knew how inexperienced I was. They knew that I was an impostor.

This is probably also a good point to make note of the fact that as patients, we were exceptionally privileged in terms of the kind of care that we received. As a two MD household, one of whom actually worked at the hospital where he was admitted as a patient, we know that people treated us a little nicer, checked in on us a little more often. We had a little more access to information. When it came to the issue of visiting hours, people looked the other way. When it was time for us to go home, the discharge protocol was accomplished with probably the most expediency I've seen in an academic hospital. But the fact of it is that regardless, being a patient is just a terrible, terrible experience. No matter how much you know, you will feel helpless. No matter how much you can do, you will feel powerless. And no matter how much you try to reassure yourself, there is that lurking dread in the back of your mind that the worse case scenario could and may occur. In this sense, being an overly knowledgeable patient may actually be worse. And as much as being a doctor helped to understand what was going on, there were moments when I would have gladly put out of my head the patients I'd had with a history of myocarditis who were on the UNOS list for a heart transplant. Ignorance can be bliss.

Joe, luckily, was never that bad off, and our hopes are that the odds are on his side and that in the next few months he will get better and better, his myocardium remodeling and his cardiac function returning close to his baseline. But until then, he's taking a handful of meds--some of which aren't a terrible idea for him to be taking anyway (hard to find a thirty-something year-old cardiologist these days who isn't already on a statin) and some others which we hope he can wean off eventually. And not to be hopelessly glass-half-full about things, but this may be something of a blessing in disguise, forcing us to take a good hard look at ourselves and make some lifestyle changes that have been long overdue anyway. We're trying to cook more, eat healthier, and while Joe is still restricted from any major physical exertion (I've been doing most of the heavy lifting around here, which is even more hilarious than it even sounds), I'm sure at the end of the six month convalescence period, he will be more than happy to step it up on that front too. Sometimes it can take something like this--frightening and vivid, but hopefully with no long-term implications--to scare you straight.

But that aside, what I learned from this experience is that the line between ourselves and our patients is a very, very thin one. Curiously, being exposed to sick people day in and day out has something of a distancing effect. I take care of patients in some degree of heart failure every day, but I never think of it in terms of my own life. The more I take care of patients with myriad medical problems, the more it can seem like heart disease and lung disease and freak accidents are things that happen to other people. But they're not. It can happen to us. It can happen to our spouses, our parents, our friends, our kids. We like to think there is a line dividing us and our patients, but one day when you wake up and find that you are the patient, you realize that line is just wishful thinking, a protective measure that exists only in your own mind.

It's true that doctors make the worst patients, but in another way, we also make the best patients. Having seen the good, the bad and the ugly, and having more of a sense now how fine the divisions are between, we will do what it takes to get things right. Having walked through the trenches for years among those who have not been so lucky, we appreciate what we have, and we temper our attitude towards the sick people in our care accordingly, from those days and weeks and months that the word "patient" were not a them, but an us.


  1. Michelle, I only check in on you now and then because you get busy, or I get busy and don't think about it. But I hate hearing this not-fun-at-all news about your hubby. I feel like I have watched you guys grow up!

    I think it's a shock for all of us when something serious pops up and shows us that we don't have a magical pass of some kind. That does often seem to happen in the thirties. It's true, you probably do know too much at a time like this and don't have the comfort of putting yourself in the hands of some all-knowing physician. But Joe is going to be OK, this is just one of those things that helps us keep perspective in life and will makes you both (even) better doctors and parents and friends.

    Best wishes for Joe's complete and speedy recovery, and remember that worrying is a waste of energy. In fact, since the incident was nearly a month ago, I trust that things are looking much better by now!