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A new beginning (short story)

Harald Renner

When I first met Professor Paul in my heartfelt affair, the cardiologist’s youthful appearance and forceful, gentle voice impressed me. I would have expected it more from a politician than a medical doctor. A well-groomed ambience that impressed solidity and seriousness surrounded him. I liked how much time he took for our first conversation. I could tell him about my history of suffering. He focused, interrupted me only with specific questions, and took notes.

My “heart condition” had been bugging me for about ten years. At first, I believed my arrhythmias were a onetime event, then I believed the attacks were avoidable triggers. I developed avoidance strategies: avoiding alcohol, coffee and extreme stress, reducing stress. I learned autogenic training, exercised and changed my diet. In the following years, the attacks increased in frequency and duration. The end of each attack was like a relief: the heart palpitations, malaise and the tightness in the chest disappeared. Three years ago, they diagnosed me with atrial fibrillation and started on medication, but nothing could stop the disease. Three months ago, my heart went out of rhythm. I felt miserable, exhausted, and “off my game”. I lived in retirement for four years and no longer had to prove myself at work.

The heart doctor rose from his chair and hurried to the bookcase behind the desk. He found what he was looking for: an atlas of cardiac arrhythmias. He opened the book where the bookmark protruded over the edge.

“Do you know what a catheter ablation is?”

“Not much,” I admitted.

“Then let me explain with these pictures. Look, this is the left atrium. You can see the four junctions of the pulmonary vein. We now know additional electrical impulses from the pulmonary veins can trigger that atrial fibrillation. We therefore design catheter ablation to isolate the pulmonary veins so that these impulses cannot spread further. It’s as simple as that.”

“And how does this work?”, I asked.

“In the anaesthetised or sedated patient, we insert catheters into the right atrium via the inguinal veins. Through a puncture of the atrial septum, it reaches the left atrium. There, we heat the critical tissue with high-frequency current in a punctiform manner and it destroys its structure.”

“How risky is that?”

“Catheter ablation is a gentle procedure. Complications are rare, but occur. In two percent, we must expect a stroke or heart attack, in another two percent, an occlusion of the pulmonary vein which would need surgical treatment, and in an extremely low extend, an injury to the heart muscle with pericardial effusion can occur. On the positive side, in 96 percent of cases the operation is free of complications.”

“What do you advise me?”

“I cannot take this decision away from you. Make it yourself. When we talk about the risks of the operation, we must not overlook the chances. If everything goes well, you will get a normal heartbeat again, without medication, with the sometimes severe side effects. It would cure you. Take your time with your decision and call me when you made it.”

Three days after this conversation, I decided for the procedure. My heart’s matter would not tolerate any further delay.

On 17 January, they finished all the preliminary examinations and preparations for the operation. At 9 o’clock I fell asleep after an intravenous injection. Two to three hours later, everything should be over. Around noon, I would wake up from the anaesthesia.

When I opened my eyes, the ICU wall clock showed 6pm. “Are you all right? Can you hear me?” asked the anaesthetist. I nodded, had a furry feeling in my throat. Just wanted to go back to sleep. “Do you understand me?” the doctor asked again. Again, I nodded.

“The operation didn’t go as it should have. It perforated your heart muscle in two places. We did an emergency operation on you. Don’t worry, everything will be fine.” He said something else, but by then I was asleep again.

It took me an entire week and a lot of persistent questioning to get a clear picture of what had happened that day. It was quite understandable that they were reluctant to come out with the whole truth, and not every patient would have been able to cope with it. I felt strong enough to face the facts.

The catheter ablation had gone well, after two hours they had isolated all sources of interference in the left atrium. An electrophysiological control suggested that the operation had been a splendid success. The team relaxed, they removed my tracheal tube, and they prepared me for the recovery ward. At that moment my circulation collapsed, cardiac arrest, out of the blue, unexpected. After two minutes of bloodlessness, brain death begins, as we know.

In this brief time, the surgical team saved my life. The ultrasound machine was still operational, and they diagnosed a “pericardial tamponade”. Under ultrasound control, they advanced a puncture needle from the outside through the chest muscle into the pericardium at lightning speed. With the help of this needle, it sucked the leaking blood out so much that the heart could unfold again. Fresh blood was flowing into the pericardium through the two holes in the heart wall and had to be sucked out. It was a matter of the utmost urgency. The senior heart surgeon at the hospital performed an emergency operation to split my sternum, open my ribcage, and take my heart in his hands. It took him only a few minutes to stitch over the two injury sites. The bleeding had stopped, my circulation had remained stable, the cardiac arrest had not exceeded the critical time mark. It saved me.

I stayed in intensive care for two days, then they transferred me to the cardiac surgery ward for a few days, and after a week I could start rehabilitation treatment, which lasted three weeks.

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

“How are you feeling?” he inquired after greeting me with a firm handshake and ushering me to a comfortable leather chair.

“I’m getting better by the day.”

“I’m glad to hear that.” He took a seat opposite me and studied my medical file. “Well, it looks splendid!” he summed up his impression. With an apologetic gesture, he came back to the “serious mishap” that was bothering him.

“You were very cooperative and understanding, I would like to thank you very much for that. And brave you were too. Exemplary!” He gave me a look of warm admiration.

I nodded to him but did not respond. He touched my arm.

“You know, even in the best special clinics, not everything always goes according to plan. Even if doctors and assistants try to observe all the rules of medical art. Ablation treatment is still new worldwide. It outgrew the field of experimental heart surgery only a few years ago. The risks are greater than with traditional procedures. We have you well prepared for the risks, haven’t we?”

I couldn’t stay in my chair any longer, I had to get some air and movement, needed distance from the flattery of the head physician. The repute of his clinic concerned him.

“Your team prepared for some risks,” I replied, “but not for this one. And I wasn’t told that this exact incident had already happened in your house four years ago.”

“You know about it?” the head doctor asked in amazement, leafing through my medical file.

“Yes, I found out about it yesterday.” After a pause, I relented. “The bottom line is that I don’t blame your clinic. Anyone who sailed as close to death as I did can only be grateful if they survived everything without permanent damage. Your team did an outstanding job there, at least after the incident.”

“We’re all very pleased that you feel that way,” he breathed a sigh of relief. “Two doctors had a few sleepless nights because of you.” He rose, shook my hand once more and wished me all the best for the time ahead and, of course, a speedy and lasting recovery. He accompanied me to the door.

How am I doing today? Well, as the saying goes, according to the circumstances. I’m not quite back to my old self yet, I still have occasional pains in my left chest, but I can already walk two to three kilometres again without shortness of breath or heartache. The most important thing: my heart is beating in right order Soon I will stop all medication.

One topic will occupy me for a long time. My ward sister wanted to know if I had “otherworldly perceptions” at the moment of my cardiac arrest. No, I didn’t, at least I don’t remember it. I have erased the nine hours under anaesthesia from my memory. Before the operation and several times afterwards, I found comfort in the verse from the Psalm: “The Lord has commanded his angels to keep me in all my ways, to carry me on their hands so that I will not strike my foot against a stone.” I wonder if praying has helped me. I don’t doubt it, not for a moment.

Will my life change now, will I be more aware, more serious, more profound with the precious commodity? Will I remain humble in the miracle's face to which I owe my salvation? Do I keep a reverent sense of the vulnerability and fragility of life? I hope that this will now become my true heart’s desire.

I wrote this true story 14 years ago, still impressed by the dramatic event that changed my life. Today I am doing so well that I call myself and feel “heart healthy” without hesitation. My heart is more efficient than it was ten years ago. It beats in a stable rhythm. I have not needed specific medication for a long time. Catheter ablation for the therapy of atrial fibrillation has left the stage of experimental heart surgery years ago and belongs to the beneficial standard treatment of several cardiac arrhythmias in good specialised clinics. Progressive practice and experience have also reduced the risk of the procedure. I am often asked how I judge the risks of this type of treatment according to my experience and survival. I cannot give a binding answer to this, because every cardiologist who knows the patient will judge this better than I can. However, I do not hold back on one point with my opinion: I do not regret my decision for one minute. And I have remained grateful and humble in the miracle's face to which I owe my salvation.

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