Swimming in the Sink Read online

  I put on the gown but didn’t remove my Christmas socks.

  A nurse wheeled me into the room where they would do the cardioversion.

  Dr. Rawal arrived a few moments later, with three assistants. Dr. Rawal said they were going to give me something to swallow to numb my throat because the tube they used could irritate it. I would be lightly sedated, but he asked me not to resist him putting the tube down my throat.

  One of Dr. Rawal’s assistants put a round ball, the size of a large marble, of the numbing agent on a tongue depressor. It looked like Vaseline.

  He wiped the depressor against my tongue and told me to swallow it.

  I tried, but it was large and cold, and it felt like I was swallowing a huge ball of snot. I gagged. I tried again and gagged harder. It was a good thing I didn’t have any food in my stomach. I was embarrassed and apologized, but I couldn’t get it down.

  One of the assistants warned, “She has a strong gag reflex.”

  I have a strong gag reflex because I’m a swimmer. My body has been trained to keep water out of my lungs so I don’t choke.

  I tried again and thought I was going to throw up. Tears filled my eyes. I tried again.

  Dr. Rawal put his hand on my shoulder. He said it was okay. I didn’t have to swallow the stuff.

  I don’t remember being sedated, and I don’t know what happened during the procedure, or what happened after.

  Laura told me months later that when she saw Dr. Rawal as he came out of the cardioversion room he told her, “We tried to cardiovert her, but it didn’t work. We discovered that she has a severely diminished EF and I want to cath her immediately.”

  Laura thought things were grim; she tried not to burst into tears.

  When I woke up I saw Dr. Rawal and Laura standing near the bed. They looked at me with happy faces, as if they were saying welcome back to the world.

  I couldn’t keep my eyes open. I kept wanting to sleep. I wanted to say, How did it go? But there was something disconnecting my thoughts from my speech. I sounded strange. I couldn’t understand what I was saying. I tried again to say, How did it go? The words sounded like they were being elongated. The medications I had received to sedate me had had an amnesiac effect. All I remember was being wheeled back into the room and trying to clear my mind.

  When I woke up next I asked Dr. Rawal if everything was okay and if I could go back to my workout the next morning.

  He looked at me with disbelief, and he realized that I had missed something. He said I couldn’t go back to working out yet. He told me that he had a friend who was a top-ranked cyclist who was having rapid heartbeats. The cyclist’s EF was down to twenty. He did an angiogram on the cyclist and found that he had cardiovascular disease. They were able to bypass his diseased arteries and improve his EF. It went from twenty to forty-five percent (not quite normal). He wasn’t racing again but was still riding long distances.

  “That’s good,” I said.

  He told me I needed an angiogram.

  I asked if he would be the one to do the procedure.

  He said he would.

  Everything was happening quickly. It seemed as though things were urgent.

  Two nurses rushed into the room, detached the IV, and wheeled me in the bed through the hallway.

  A nurse met us at the room where they did the angiograms. She wrapped me in a heated blanket. Another nurse asked if I had ever had an angiogram before. I said no. She recognized my name and asked if I was the open-water swimmer. She had worked in the same medical group as my dad. The other nurse had read about my swims for years. They told me not to worry. They would take good care of me. They adjusted my pillow and made sure the blanket was warm enough.

  They asked what had happened to me.

  I told them that I had taken care of my parents for many years, and that I was supposed to spread my mom’s and dog’s ashes in a couple of days. I missed them.

  The nurse who knew my dad said to the other nurse, “I bet she has broken heart syndrome.”

  The other nurse agreed.

  Laura and Charlie walked into the room.

  Charlie was a retired internist, but he stayed current. He read medical journals, spoke with colleagues, and read newsletters from prominent medical schools. He had the cheeriest personality of anyone I had ever known and he was so positive that he walked with a bounce in his step.

  He seemed happier than usual. I realized that he was being upbeat to allay my fears and Laura’s.

  They would be in the waiting room during the procedure and they would talk with Dr. Rawal as soon as they could.

  Dr. Rawal was ready.

  My heart beat faster.

  I told myself to relax; all I had to do was breathe and sleep.

  When Dr. Rawal stepped out after the procedure, Laura noticed that he had a grim look on his face.

  Laura told me later that he explained to her that I had a nonischemic cardiomyopathy—heart failure that wasn’t due to coronary artery disease—and that there was a chance that this could be due to a tachycardia-induced cardiomyopathy, a weak heart caused by a chronic elevated heart rate. My ejection fraction, the amount of blood my heart pumped with one beat, was critically low. Normal EF was fifty-five to sixty-five percent. My EF was between fifteen and twenty percent, consistent with someone who is dying. He would need to manage my condition aggressively with medications and consider referring me to a heart transplant center for evaluation. He said I might need to have a defibrillator put in after he had gotten me on the right medications. He thought I was at a high risk for fatal arrhythmias. The defibrillator might prevent that.

  “What’s the prognosis?” Laura asked.

  “It’s poor, but we will have a better idea when we see whether she is responding to medical therapy,” he said. He looked grave.

  Laura went home and burst into tears and told her brother that she thought I was going to die.

  As I woke up Dr. Rawal and his team were talking about the swims I had done. One man said he wished he was a better swimmer. A nurse said she wished she was more comfortable in the water. I said I would be happy to help them swim. We could go into the ocean one day when I got out of the hospital. Their faces went blank and no one knew what to say.

  Wow, I thought, they must think that I will never be able to swim again. I didn’t know that they were thinking that I might die.

  Dr. Rawal said I needed to stay another day in the hospital so they could continue to increase my medications and measure my response. The medications would slow my heart rate and allow my heart to rest with the hope of giving it a chance to recover. We would see how I was doing the following morning, and if things were okay, he would have me start taking the same medications on a daily basis. If I responded favorably, he would continue to increase the doses of the medicines until I reached the optimal therapeutic levels.

  He said there were many different options for heart medications. “If one of those doesn’t work, we can put you on the heart transplant list. I have good friends at UCLA.”

  He had brought that up before, but I hadn’t been able to even think about it then. This time it registered. Oh my God. I don’t want my heart cut out of my body. I don’t want my heart taken away from me. It’s my heart. It’s the heart I was born with. It’s the heart that’s been with me through my life. It’s the heart that I’ve loved with, hoped with, believed with. It’s the heart that’s given me courage. It carried me to distant shores. It’s been strong. It’s kept my body strong. It’s the reason I’ve endured. I don’t want to live without my heart. I don’t want someone else’s heart. I want mine.

  Oh God, why do I have to go through this now? It isn’t fair. I did all the right things. I was the good daughter. I took care of my folks for all of my adult life. I did what was expected and more. I put my desires aside for them. I know they helped me, and I helped them, but now it’s my turn to live. Please let me keep the heart you gave me. Please let me keep the heart I’ve loved with. Please hel
p me heal my heart. I want to live. I want to have a life.

  I still want an evening in Paris, a week in Italy. I want to sail to the North Cape in Norway, swim in Finland, hike in the Himalayas. I still want to see and do things I’ve never done. I want my friends and family to know that I love them, that they have made my life rich, exciting, fascinating, and happy. And I still want to fall in love and be with a man who loves me as I love him. I want more time, more life, more.

  “Do you have any questions?” Dr. Rawal asked. He looked at me. His face was compassionate.

  “Can I go back to my workout tomorrow morning?”

  He looked at me as if I didn’t understand how sick I was. I don’t think I did. He didn’t know that working out was like breathing to me.

  He said I needed to take a few weeks off.

  “Dr. Rawal, I just want to tell you, I appreciate all that you’ve done for me. Thank you,” I said.

  He smiled and said, “You’re welcome.”

  He told me he was going to increase the medications. They would help my heart pump better. He told me that the medications might make me dizzy so I needed to stand up slowly.

  I lay back in the bed and looked at the heart monitor.

  My brother, sister, and sister-in-law walked into the room. They had come to the family home to scatter my mom’s ashes, celebrate her life, and settle the estate. They hadn’t expected to see me in the hospital. I had always been strong and healthy, the one people depended on. They weren’t sure what to say or do. My brother said that I looked good. They didn’t understand. I didn’t look sick.

  I said that I was feeling better. I seemed to be responding to the medications and if everything went well, the doctor said I could leave in the morning.

  My brother offered to give me a ride home and said he hoped I would be out soon.

  I remembered to call Joe the fireman. It was so good to hear his voice. He had been wondering how I was doing. I said I was sorry that it had taken me so long to call, but a lot had happened.

  He was talking to me, but at the same time he was trying to work through my situation. He was explaining about the electrical conductivity of the heart and the cells within the heart and how they regulate the heartbeat. He was trying to figure out what had gone wrong.

  “What’s your ejection fraction?” he asked.

  When I told him, he asked me to repeat it. He was at a loss for words. And when I told him that I might need a heart transplant, he couldn’t believe it.

  He was struggling, trying to reassure me. At the same time, he was trying to absorb the information and make sense of it.

  He asked me a lot of questions I couldn’t answer. He couldn’t figure out why the cardioversion hadn’t worked. He did cardioversions on his EMT patients and they often worked. Why hadn’t it worked for me?

  I didn’t know. And it was better that I didn’t know what Dr. Rawal thought. It would have been too much to deal with.

  9

  DECEMBER 21—WALKING

  Emmy came by in the morning. She looked more like her normal self. She told me that it had been a long time since I was up and moving. I needed to stretch my legs, and she offered to take me on a walk. She told me to take my time.

  It was difficult to keep the wheels of the IV cart in a straight line. My legs felt weak and I wobbled, but Emmy walked beside me ready to stabilize me if I started to fall. I felt strange, but I was breathing at half the rate I had been breathing when I was admitted, and I wasn’t exhausted after walking two hundred meters of the cardiac wing.

  We turned the corner and walked a little faster. She smiled and told me not to do too much too fast.

  In every hospital room were gray-haired men and women lying in beds and connected to IVs and heart monitors. No one was visiting them. I hoped they weren’t alone. I hoped they had people who cared about them. It made all the difference in getting better. I was lucky.

  The farther we walked, the more the stiffness and soreness left my body. For the first time in more than a month, my lungs felt like they were fully inflating. It felt so good to be able to take deep breaths.

  Each time I took a breath oxygen was pulled in and the hemoglobin in my blood carried it throughout my body. It was essential for cell metabolism and for physiological functioning. It felt good to take a deep breath, but it didn’t feel normal. My breathing and heartbeat felt out of sync. Before, my heartbeat and breathing were rapid, but now my breaths were long and deep yet my heart was still beating faster than normal.

  I told myself I just needed to give myself time and everything would be back in sync.

  Emmy walked beside me. We had known each other for nine or ten years and worked out together five days a week at the gym. We motivated, inspired, praised, joked with, and pushed each other during our workouts and in life.

  We increased our pace in the hall.

  “You’re much better than you were a couple of days ago.” Emmy was relieved.

  “Hope I can be back in the gym soon,” I said.

  “So do I. I miss working out with my buddy,” she said.

  Emmy had to leave for work, but Cindy Palin entered the room a few minutes later. The tag team was at work.

  Cindy’s face was more relaxed, and the warmth in her brown eyes had returned. She sat down and asked me for today’s plan.

  If Dr. Rawal cleared me, I would be leaving by noon. I would have to continue taking heart medications probably for the remainder of my life. I wasn’t thrilled about that.

  Cindy was practical. She said the medications would help me recover and taking them was a lot better than any of the alternatives. She had a way of analyzing any situation and amplifying the positive.

  I told her that I didn’t want a lot of people to know that I was ill. Someone had called Greg, a friend, and told him that I was in the hospital. Greg misinterpreted what he was told and thought I had had a heart attack and was going to die.

  We had known each other since we were teenagers and I had always been strong. He couldn’t comprehend that I could be weak. He couldn’t imagine me being in the hospital. He was shocked. No matter what I told him, he was inconsolable.

  I realized that I didn’t have the energy to explain to other friends about my heart. It took too much away from me. I needed to focus that energy on myself so I could get well.

  A moment later, Sandy Field walked into the room. She looked uncomfortable.

  “Hey, looks like it’s time for a party,” I said.

  Sandy smiled.

  We had had years of fun together. She was the friend who encouraged me to join her in Costa Rica at Thanksgiving. She handed me a basket of beautiful blueberries, raspberries, and strawberries.

  They smelled good, and they were plump and sweet, the best berries I had ever tasted.

  When Dr. Rawal entered the room, he looked much happier. He said that the medications were working. My heart was more stable and I was doing better. He was going to release me.

  I was elated. My care had been fantastic, but I couldn’t wait to get home, shower, and get some sleep.

  Dr. Rawal said he wanted me to follow up with him in a week at his office.

  I asked him why I needed to do that. I thought I could go home and I would get better.

  He looked to see if I was joking and realized I wasn’t. He needed to see me in a week to see how I was adjusting to the medications. I still didn’t realize how ill I was.

  He wanted me to monitor my blood pressure, heart rate, and weight daily. He prescribed more Lasix and said it would cause me to drop ten to twelve pounds of fluid that I had retained because of my poor cardiac output.

  I decided to keep a journal like I did when I was training for a channel swim. That would allow me to track my progress. I needed to be consistent, just as I was for my training. To get consistent readings I would measure my blood pressure and heart rate every morning before I climbed out of bed. I would measure my weight every morning before I got dressed. If my weight increased
by three pounds in three days, my cardiac output was not good. I needed to take more Lasix.

  Too much salt in my diet would increase water retention. Dr. Rawal advised me not to eat more than 2,000 milligrams of sodium a day. He said most people found it difficult to reduce their salt intake to that level, but I decided to keep it below 1,000 milligrams. If I could adjust my diet and reduce the salt, I might be able to stop taking the Lasix and that would reduce stress on my kidneys. That would be one less medication I would have to take. I wanted to figure out how I could get to a point where I didn’t need any medications.

  He asked if I had any questions.

  My mother’s ashes were going to be released into the ocean tomorrow by family and friends. Could I swim out and release them?

  Again Dr. Rawal looked at me with disbelief, but he asked me how far I needed to swim and how cold the water would be.

  The swim would only be a mile and a half (2.4 kilometers), and the water temperature would be about 55 degrees Fahrenheit (12.8 degrees centigrade). I hadn’t been in the ocean for a while, but I thought I would be okay.

  “Only a mile and a half?” Dr. Rawal said, and shook his head. He was a runner, and so he couldn’t imagine swimming a mile and a half, but I was a swimmer and couldn’t imagine running a mile and a half.

  He said it was dangerous for me to swim. The penetration site in my femoral artery for the angiogram was not completely healed. It might open and I might bleed out into the ocean.

  Bleeding out wasn’t good. And I thought the blood in the water might attract sharks, and that wouldn’t be safe for me and the rest of the family.

  Dr. Rawal also told me that he didn’t want me to lift anything heavy.

  “Can I carry my swim bag out of the hospital?” I asked.

  “How much does it weigh?” he asked.

  “Not much. Maybe fifteen pounds.”

  He lifted the bag with both hands and said it was too heavy.

  He explained: “Heavy lifting stresses the heart, and in your condition I would like you to refrain from any strenuous activities.”

  I nodded.

  He asked if I had other questions.

  I said I was planning to visit friends in New York City and in upstate New York from December 27 through January 6. Would it be okay to travel?