New beginning. My heart's business (short story)

Harald Renner

When I met Professor Paul for the first time, I was surprised by the youthful appearance and the vivid, gentle voice of the cardiologist. I would have thought he was more likely to be a politician than a doctor. He was surrounded by a neat ambience that conveyed the impression of solidity and seriousness. I was also impressed by the amount of time he took for our first interview. I was allowed to tell him about my tale of suffering in detail. He listened attentively and only occasionally interrupted me with specific questions and took notes.

For about ten years my "heart's business" has been bothering me. At first I believed in a single event in my rhythm disturbances, then in avoidable triggers of the seizures. I developed strategies to avoid alcohol, coffee and extreme stress and reduce stress as well as possible. I learned autogenic training, moved regularly and persistently and changed my diet. In the following years, however, the incidence and duration of seizures increased. The end of each seizure was like a redemption: sudden palpitations, discomfort and anxiety disappeared in the chest. Three years ago, the diagnosis was "atrial fibrillation" and a drug therapy was initiated, but nothing could effectively stop the course of the disease. Three months ago, my heart went completely out of rhythm, and only rarely did the stumbling phases change to a normal heartbeat. I felt miserable, exhausted and depressed. Luckily, I had retired four years ago and no longer had to prove myself in my job.

Suddenly the chief physician rose from his chair and hurried to the bookcase behind the desk. He quickly found what he was looking for: an atlas of cardiac arrhythmias. He opened the book where the bookmark was sticking out over the edge.

"Do you know what catheter ablation is?"

"Not much," I admitted.

"Then I want to explain it with these pictures. Look, this is a picture of the left atrium. You see the four junctions of the pulmonary vein. It is now known that atrial fibrillation can be triggered by additional electrical impulses from the pulmonary veins. Catheter ablation should therefore electrically isolate the pulmonary veins so that these impulses cannot spread further. It's that simple."

"And how does it work technically?" I asked anxiously.

"In the case of narcotized or centrally subdued patients, catheters are guided via the inguinal veins into the right atrium of the heart. A puncture of the atrial septum leads to the left atrium. There, the critical tissue is warmed up with high-frequency current and destroyed in its structure."

"How risky is that?"

"In principle, catheter ablation is a gentle procedure. Complications are rare but occur. A stroke or heart attack is expected to occur in two percent of the cases, a lung vein occlusion in another two percent, which would require postoperative treatment, and the cardiac muscle may very rarely be injured with pericardial effusion. Positively, in 96 percent of cases, the procedure is uncomplicated."

"Do you advise me to have the surgery?"

"I'm afraid I can't make that decision for you. You'll have to meet it yourself. When we talk about the risks of surgery, we must not overlook the opportunities. If all goes well, you will get a completely normal heartbeat again, without any medication with the sometimes severe side effects. You would actually be cured of your illness. Take your time with your decision and call me when it's made."

Three days after this conversation I decided to have the procedure. My heart's disease did not tolerate further delay.

On January 17, all preliminary examinations and surgical preparations were completed. At 9 o' clock I fell asleep after an intravenous injection. Two to three hours later everything should be all right. Around noon I'd wake up from anesthesia.

When I opened my eyes, the wall clock of the intensive care unit showed 6:00 pm. "Are you all right? Can you hear me?" the anaesthetist asked. I recognized him as a vague and shady man. I nodded, had a furry feeling in my throat, just wanted to go on sleeping. "Do you understand me?" the doctor asked again. I nodded.

"The surgery didn't go the way it was supposed to. Your heart muscle was accidentally perforated in two places. We've had to treat you by emergency surgery. Don't worry, it'll be all right." He said something else, but then I was asleep again.

It took me a whole week and a lot of persistent questions to get a clear picture of what was going on that day. It is easy to understand that it was only hesitant to come out with the whole truth, and not every patient would have been able to cope with it. I felt strong enough for the facts.

The catheter ablation had gone very well, after two hours all interfering sources in the left atrium were isolated. The electrophysiological control indicated a good success of the operation. The team relaxed, my trachea tube was removed and I was to be transferred to the guard station. At that moment my circulation collapsed, cardiac arrest, out of the blue, completely unexpected. After two minutes of bloodlessness, brain death begins, as you know.

In this incredibly short period of time, the surgical team saved my life. Fortunately, the ultrasound device was still ready for operation and the diagnosis of "cardiac tamponade" was quickly made. Under ultrasound control, a puncture needle was pushed through the pectoral muscle into the pericardium in a flash. With the help of this needle, the blood was drawn off so far that the heart could unfold freely again. Due to the two holes in the heart wall, new blood constantly ran into the pericardium and had to be sucked off continuously. Highest haste was required. The house's senior cardiac surgeon decided to split my sternum in an emergency surgery, open the chest and literally take my heart in his hand. It only took him a few minutes to sew over the two injury sites. The bleeding was permanently stopped, my circulation remained stable, the cardiac arrest had not exceeded the critical time mark. I was saved.

I stayed in the intensive care unit for two days, after which I was transferred to the cardiosurgical ward for a few days, and after one week I was able to start the rehabilitation treatment, which lasted three weeks.

Professor Paulus met me halfway when I entered his office for the second time, on the eagerly awaited day of discharge.

He greeted me with a powerful handshake and led me to a comfortable leather armchair.

"How are you?"

"I'm better every day."

"That's what I like to hear." He sat down across from me and took a close look at my medical record: "Well, that looks great", he summed up his impression. With an apologizing gesture he came back to talk about the "grave misfortune", which obviously caused him problems.

"You have been very cooperative and understanding, for which I would like to thank you most sincerely. And you were brave, too. Exemplary!" He gave me a look of warm-hearted admiration.

I nodded friendly to him, but I didn't reply. He gently touched my arm.

"You know, even in the best specialized hospitals, things don't always go according to plan. Even if doctors and assistants make every effort to follow all the rules of the medical profession. The ablation treatment is still new worldwide. It was only a few years ago that it has outgrown the field of experimental cardiac surgery. The risks are naturally greater than with traditional methods. You've been well prepared for the risks, haven't you?"

It didn't keep me in the armchair any longer, I had to create air and movement for myself, needed a distance to the flatter of the chief physician, who seemed to have the reputation of his clinic in first sight.

"They have prepared me for some risks," I replied, "but not for this. And certainly not that I was told that this incident occurred in your house not for the first time."

"You know about that?", the professor asked in astonishment and leafed aimlessly through my medical records.

"Yes, I heard yesterday." After a break, I gave in. "Bottom line, I don't blame your clinic. Anyone who has sailed so close to death like me can only be grateful if he has survived everything without any lasting damage. Your team did a great job, at least after the incident."

"We're all very happy that you see it that way," he breathed a sigh of relief. "Two doctors had sleepless nights because of you." He rose, gave me his hand again and wished me all the best for the coming time and, of course, a speedy and lasting recovery. He accompanied me to the door.

How am I doing today? Well according to the circumstances, as they say. I'm not quite the same old man yet, I also have occasional pains in my left chest, but I can walk again two to three kilometres without breathlessness and heart pain. The most important thing is that my heart beats normally. I'll soon be able to drop all the drugs.

There is one subject that I think will occupy me for a long time to come. My ward nurse wanted to know whether I had "otherworldly perceptions" at the moment of my cardiac arrest. No, I didn't, at least I don't remember it. The nine hours under anaesthesia are like wiped out in my memory. Before the operation and several times after it, I found comfort in the Psalm verse: "The Lord has commanded His angels to protect me in all my ways, that they may carry me on their hands, so that I may not bump my foot against a stone". Did praying help me? I don't doubt it, not for a moment.

Will my life change now? Am I going to be more aware, more serious, deeper in dealing with the precious good? Am I humbled by the miracle to which I owe my salvation? Do I keep an awesome feeling for the vulnerability and fragility of life? I hope that this will now become my true heart's business.


I wrote down this true story eleven years ago, under the influence of the dramatic events that have changed my life. Today I feel so good that I call myself "heart-healthy" without hesitation. My heart is more powerful than before this time, it beats calmly and in stable rhythm. I haven't needed specific medication for a long time. Catheter ablation for the treatment of atrial fibrillation has left the stage of experimental cardiosurgery for years and belongs to the beneficial standard treatment of a number of cardiac arrhythmias in good specialized clinics. Accordingly, the risk of surgery has been reduced by progressive practice and experience. I am often asked how I assess the risks of this type of treatment according to my own experience and survival. I cannot give a generally binding answer to this question, because any cardiologist who knows the patient will be able to judge this better than I am able to do. However, I am not holding back on one point: I do not regret my decision at the time. And I have remained grateful and humble in the face of the miracle to which I owe my salvation.