Swimming in the Sink Page 7

  Oh great, he has to convert my heart, and I’m going to have to go on blood thinners, and go into the laboratory every week or two to have my blood levels checked to make sure my blood isn’t too thin. That’s what my mom and dad had to do. I don’t want to do this. I just want to go home.

  Oh God, I wish Laura was here. I wish Charlie was here. I wish Joe was here. But it will be better if I just deal with this, then they won’t worry.

  “AFib begets AFib—the longer you are in it, the harder it is to get you out. I’d really like to try and convert you as soon as possible. We need to get you into the hospital today to get your heart rate under control.”

  He had a plan and he was confident. That was good. “How do you do this?” I asked.

  “First we need to make sure your heart is safe for cardioversion; by this I mean making sure there aren’t any clots present in the heart prior to shocking it. We will do this with a transesophageal echocardiogram (TEE). The control chamber of your heart happens to lie adjacent to your esophagus, and this is where we are most likely to find clots if there are any. I’m going to take an ultrasound probe, about the diameter of my finger, and pass it down your esophagus so that I can get a good look. Of course, you will be well sedated. As soon as I confirm the absence of any clots we will shock your heart with hopes of putting it back into the normal rhythm. We’ll reset your heart,” he said.

  It was amazing that he could reset the human heart.

  “Do you do a lot of these conversions?”

  “Yes, I do,” he said, sounding confident.

  “Okay,” I said.

  “We will try you on rate-control medications first, and if they don’t work we will try the cardioversion tomorrow morning.”

  “Okay,” I said.

  “All right, then, let’s make it happen. I’m going to put in a call and get you a bed,” he said.

  The hospital was across the parking lot from his office. I thought I could walk that far.

  He asked what medications I was taking, if I was allergic to any medications, and if I had had any surgeries.

  This information was on the health history form I had filled out before I saw him, but I realized he was confirming what he had read. He was thorough. That was good.

  The only time I had been in the hospital was when I was five years old—when I had my tonsils and adenoids taken out.

  “You haven’t been hospitalized for anything?” he asked, astonished.

  “I’ve been lucky. I’ve been healthy,” I said.

  He asked me if I was okay waiting for Laura in the hallway and said that she could come and see him if she had any questions. He needed to make the calls to see if he could find a room for me.

  I walked into the hall and held back tears. This wasn’t the way I was supposed to spend the next part of my life. I was supposed to be able to have my own life now. I was supposed to be able to do what I wanted to do. I decided to e-mail Ed Schlenk, the doctor in Iowa. He would have some suggestions.

  I wrote to him and said my heart was in AFib. Dr. Rawal was going to try to control the AFib with medications and to start me on blood thinners. If the medications didn’t work he was going to shock my heart and start amiodarone to keep me in the normal rhythm.

  Ed sent me an e-mail.

  He wrote:

  You are your own best medical advocate. Always read (wiki and/or e medicine) about your diagnoses and medications. The more you know, the better your decisions. Don’t be afraid to take notes and/or bring a friend to your medical appointments.

  Atrial fibrillation has several related conditions that you might read about and want to rule out. Hyperthyroidism is an associated condition, but there are many others. The anticoagulants (heparin short term, Coumadin/warfarin long term) are to prevent clots from forming in the atrium since it is contracting erratically. They can travel downstream and do damage.

  Your foot swelling is probably due to low cardiac output from the inefficient contractions. The med you mentioned, amiodarone—look it up for side effects so you know what to monitor.

  Keep yourself medically informed, and keep me posted. Glad it is (and you are) getting taken care of. We have to be our own “Mom” now. Cheers, Ed.

  I remembered that the side effects of long-term usage of amiodarone were peripheral nerve damage, lung damage, and blindness. My mom was on amiodarone when all the other medications no longer worked. She couldn’t feel her feet, and she was losing her vision. She kept telling her internist her symptoms, but the internist never told her that it might be caused by the amiodarone. It was because this was her last option.

  I was frightened. I didn’t think I was that sick.

  Just then Laura arrived. She hugged me, asked me how I was doing, and if I had seen Dr. Rawal.

  I summarized what had happened and said I was sure I missed some details. She disappeared into his office. I leaned against the wall in the hall.

  “Are you okay?” she said when she opened the door.

  “I’m okay, but I don’t want to be here,” I said.

  “I know,” she said, and she explained that while Dr. Rawal was trying to find a room for me, she would walk with me to the hospital and to admitting. By the time I finished filling out the papers, they might have a room; the sooner I got in and took the meds, the sooner I could leave.

  We walked across the parking lot, and she asked me how I was doing.

  Much better because she was here.

  She led the way to the admitting area of the hospital. She used to work there, and the woman in admitting recognized her. Laura introduced me and explained why I was there.

  The woman handed me an admitting form and I read through the pages and signed the release. I had done this so many times for my parents. I never thought I would have to do it for myself.

  Two physicians recognized Laura and walked over to say hello, as did a radiologist’s wife. It seemed as if she knew everyone in the hospital, and everyone she knew liked her.

  Dr. Rawal entered the lobby and walked over to us.

  The hospital had a shared room ready and he didn’t want to wait for a private room. He wanted to get me going on the medications.

  Laura led the way into the room and told me to sit down and get comfortable.

  I told her I’d rather stand.

  “I don’t like to be a patient either,” she confessed, smiling.

  The nurse arrived in the room and introduced herself.

  Laura needed to go and said, “You’re going to be fine.”

  The nurse asked if I had ever had an IV.

  I hadn’t.

  She explained the procedure and asked if I wanted to put on a hospital gown.

  “I have the option to wear my own clothes?” I asked.

  She nodded.

  “That’s great,” I said.

  I could get up and walk the hallway without having to try to hold the gown closed. I could keep my muscles moving and keep them strong.

  The nurse started the IV, made sure I knew where to find the call button, and showed me the television remote.

  I realized I needed to contact Cindy Palin to let her know I couldn’t make dinner, and I needed to tell my friend I wouldn’t be at our workout the next morning.

  Cindy was heading home from work and said she would stop by on the way.

  The nurse came back and said that Dr. Rawal wanted me to move to a private room where it would be quieter and I would be able to get some rest.

  The nurse guided me through the hallway. It felt good to get up and move. And for a moment I fantasized about pulling the IV out of my hand and running into the elevator and out of the hospital.

  I settled into the new bed. It was a lot quieter. Cindy walked into the room. She had had difficulty finding me. She looked distressed.

  I remembered going to my parents’ hospital rooms and seeing an empty bed, and suddenly feeling panicked, wondering if they had been moved or if they had died.

  “I’m glad you found m
e. I’m glad you’re here,” I said.

  Cindy’s dark brown eyes were opened wide. She was shocked to see me in a hospital bed. She glanced down to regain her composure, sat in a chair across from me, and smiled.

  She had been in court and was wearing a dark blue jacket and skirt and a pearl-colored silk blouse. She was an attorney and defended doctors and hospitals.

  She hugged me and started talking fast. She said after she read my text message she called her assistant and asked her to run a check on my doctor to make sure I was in good hands. She said Dr. Rawal’s record was pristine. He was thirty-eight years old, so he wasn’t just out of med school; he was experienced. She spoke with him when she saw him at the nurses’ station and was impressed.

  “Cindy, only you would run a background check on my doctor.”

  A few minutes later Dr. Rawal walked into the room. He stood close to the bed, glanced at my feet, and smiled.

  I was wearing my bright green Christmas socks with leaping reindeer. Everyone who walked into the room saw them and smiled. Dr. Rawal pulled one sock down and looked at my foot and leg. He pressed his finger into my shin. It left a dimple, but the dimple disappeared faster than it had in the office.

  “Looks like the fluid is starting to move out,” he said.

  He didn’t anticipate that I would have any problems during the night, but if I did, he instructed the nurses to call him. If I didn’t feel right, I needed to ask them to call him.

  The last thing I wanted to do was to wake him up in the middle of the night, especially if he needed to do a procedure on me in the morning.

  He must have read my mind. He said he needed me to let him know if I was feeling worse.

  I assured him that I would.

  He reached out and held my shoulder for a moment and said, “Good.”

  After he left the room, Martha Kaplan, my book agent and friend, phoned me. She tried to sound calm, but her voice was stressed.

  I reassured her that I would be okay and that I could go on the book tour scheduled for August, but said I was worried about getting back in touch with the people who were helping me coordinate the tour.

  Martha told me not to worry about the tour now. I just needed to concentrate on getting well.

  She asked if it was okay if she updated my editor, Vicky Wilson, and others at Knopf, my publisher. I didn’t want them to worry, but Martha said they would want to know, so I said it was okay. I didn’t want a lot of people knowing what was happening with me. I was trying to deal with it myself.

  I remembered that I hadn’t called Emmy, my workout buddy. I felt bad that I hadn’t gotten in touch with her sooner. I called her. There was just too much happening. I was having a hard time thinking straight.

  Emmy said she would come to the hospital as soon as possible. It wasn’t an emergency; I told her to take her time.

  She told her husband that I was in congestive heart failure. She thought I was going to die.

  When she arrived, Emmy’s long brown hair was tousled, her blue eyes were wide open like Cindy’s, and she was out of breath.

  “I’m glad you called me,” she said. She sat beside my bed. She was all wound up.

  “I knew something was wrong with you this morning. I called you and when I couldn’t reach you, I texted you, and when you didn’t respond, I called every emergency room in the area, but this is a little out of the area. I never would have thought of calling here,” she said.

  She calmed down and settled into the chair.

  “I’m glad I came to see you. You look a lot better than I thought you would,” she said.

  “I’m already getting better. You need a workout partner, and if I’m not there, you won’t get to the gym on your own,” I teased.

  She grinned and wiped tears from her eyes. She told me about what was happening with her family, and I realized that she was trying to give me a sense of normalcy at a time when things were not normal.

  She stayed until 9:00 p.m.

  I wanted to call Joe, but it was past midnight on the East Coast. I wished it wasn’t so late. He said I could call anytime. I wanted to tell him what was happening, but I felt it was too late.

  As I lay back in the bed, I realized that each of my friends had given me gifts that day—the gifts of their time, knowledge, positive energy, and love. I was so lucky to have such good friends.

  It was almost ten.

  Laura called. She had spoken with Dr. Rawal. He said I was responding well to the medications. She wished me good night.

  The heart monitor was beeping and displaying the number of times my heart was beating.

  My heart rate was fluctuating between 98 and 122 beats per minute. It needed to be lower. I wondered if I could lower it. I wondered if I could do yoga breaths. Breathe in deeply, hold my breath for ten seconds and exhale slowly. I repeated this process three times. That slowed my heart and mind and allowed my body to relax.

  I decided to use the heart monitor as a biofeedback tool.

  I did the yoga breaths and my heart rate dropped three to five beats per minute. That wasn’t good enough.

  I needed to escape. I closed my eyes and imagined that I was in the swimming pool, hanging on to the wall. I took a deep breath and pushed off, and I exhaled slowly as I glided through the water. I took three strokes, turned my head and inhaled. I continued swimming until I reached the wall. Took a deep breath and opened my eyes to look at the heart monitor like I would look at the pace clock. My heart rate had dropped by three beats. I pushed off the wall and swam four laps of the pool and checked the heart monitor. My heart was beating three or four beats slower. That wasn’t enough. I needed to keep swimming. I kept trying, but I couldn’t get it below ninety-five for any significant amount of time.

  I closed my eyes and thought about my life—what I had done and what I wanted to do. I thought about the things I had planned and the things I hoped to do. I thought about the people I loved and how much I wanted to spend more time with them. I wondered if I would get well or if it was my fate to decline and die. I wondered if the medications were working.

  8

  DECEMBER 19—HOSPITAL

  It was about 8:00 a.m. when Dr. Rawal walked into the room. He asked me how I was feeling. I was feeling better. My heart was beating slower and I was breathing easier. He said the Lasix was working. It was helping to remove the extra fluid out of my body. My feet and legs were less swollen. The medications they gave me had slowed my heart, but not enough. It was still in AFib and it needed to be converted. He wanted to do the cardioversion as soon as he could get the room and staff.

  “If you are able to convert my heart, what is the next step, and if you aren’t able to convert it, what will we do?” I asked.

  “If we are able to convert your heart to sinus rhythm, the next step will be to optimize medical therapy—giving you medications. If your heart responds and your ejection fraction, or EF, improves, your problem was likely due to tachycardia-induced cardiomyopathy, a persistently elevated heart rate. The condition can ultimately produce significant cardiac structural changes that can result in heart failure (inefficient or insufficient pumping). If not, then we will need to consider a pacemaker and a defibrillator and placement on the heart transplant list,” he said.

  Cindy Palin walked into the room. She looked like she had been crying. Her eyes and cheeks were bright red, but she smiled and asked me what was happening.

  I told her I was better and explained what Dr. Rawal had told me. I was worried about the possibility of having a pacemaker and defibrillator. I didn’t want to walk around with appliances in my heart. I wanted to be normal.

  “Lynne, I have to tell you, as your good friend, you’ve never been normal,” she said.

  She made me laugh hard.

  “Take a deep breath. Slow down. You’re getting ahead of yourself. Take one step at a time, don’t get ahead of yourself,” she coached. She was so reasonable.

  I took a deep breath, but I hadn’t told her the
worst part.

  “If the defibrillator and pacemaker don’t work, Dr. Rawal wants to put me on the heart transplant list at UCLA,” I said, and my voice became high-pitched. I didn’t want to tell her like that, but I was emotional.

  An indecipherable expression crossed her face. I think it was horror, fear, and shock mixed together.

  She looked down for a moment, put on her confident face, and repeated, “You are getting ahead of yourself. Take one step at a time.”

  In my mind, I repeated “one step at a time” over and over. Take this one step at a time. This would be my mantra whenever I was overwhelmed. I knew I was sick, but I never thought I might die.

  “Look at what’s already happened. You are responding to the meds. Your feet and legs are less swollen. You’re breathing easier. Your heart rate is a little slower. You’re feeling better. The meds are working. They have already taken a lot of stress off your heart.”

  She was so positive, strong, and capable, and she was telling me what I needed to hear.

  She stepped out into the hall and made some calls. She decided to work remotely today so she could be with me at the hospital.

  Cindy must have established a tag team, because the moment she stepped out of the room, Emmy walked in.

  She looked so serious that I joked with her and said she didn’t have a good reason for skipping workout. She reminded me that I was skipping workout too. She said she’d give me a pass for today, but not for much longer.

  Emmy leaned forward in the chair and said, “Don’t worry, you will get your strength back. You have achieved incredible goals. This is just another one of those big goals.”

  A nurse walked into the room and handed me a hospital gown and told me I needed to change. They would be coming to get me soon.

  Emmy said she would wait in the waiting room and see me after the procedure.