The Incident, cont’d

Last we left our heroine, she had called 911 and was waiting for the ambulance to arrive after several episodes of syncope…

So about five minutes after I called, the ambulance arrived to take me to the hospital. I was awake and alert at this time — no fainting while they were there. Truly, it’s what I do best — I’m always the calm one in the storm. Any time there’s a crisis, I go into what I call “clinical mode” — I refuse to give in to panic. I hyper-focus. My adrenaline pumps wildly, my brain prioritizes all its energy with the singular intention of communicating the correct information as clearly and concisely as possible. And to, above all else, remain calm no matter what happens.

I showed the EMTs the bottle of meds and gave them the dosage. They thought I was kidding (or lying). I assured them I was not. A total of 288 milligrams of a drug whose maximum single dose is supposed to be four. They asked if I was on anything else; I said no. Blood pressure, normal. Heart rate, slightly elevated. Temperature, normal. Patient, alert and oriented. I even walked out to the ambulance unassisted, climbed in onto the gurney, removed my coat and got my first IV attached. Things were so calm (and I felt soooo much better on the oxygen) that I chatted with the EMT about nothing in particular and joked about the weather on the way to the hospital.

We rolled into the emergency room where the EMT asked if I could move myself from the gurney onto the exam table. Confident (and feeling much better already), I said, “Sure.” and started over. I put one leg on and one arm on — and that’s the last thing I remember.

I blacked out. Again.

[I didn’t know it at the time, but all those fainting spells I was having, technically called “syncopic incidents” or “syncope”, were due to my heart — my heart was going into arrhythmia then going into cardiac arrest (which caused the blood to stop flowing, which in turn, caused me to pass out and wee myself). One of the ER nurses told me later that if I hadn’t gone to the hospital precisely when I did, I would have died at home.]

Next thing I knew, I woke up in the main ER, naked, strapped down, plugged into more IVs than I can count, and surrounded by a couple dozen doctors and nurses swirling about my staging area. I demanded to know why I was in so much pain — every part of my body felt like it was filled with metal and plugged into an electrical socket. They all seemed surprised that I was awake, and kept calling in doctors to see me and interview me, a constant stream of the same questions over and over again. “How much did you take,” and “Why did you take it?” were the most common. In fact, it became so tedious answering the same things over and over, I commented that they really should write it down since obviously someone was not taking notes properly. They laughed.

Once I was awake and alert, I was an amusing, if critically ill, patient. They loved me. My case, so rare and so unusual, is now considered legend in the halls of both the local hospital and the state trauma center where I was eventually sent.

But back to the ER. I wasn’t fun to be around at the start. Inbetween the time when I’d passed out on the table and when I woke up in the main ER stage, over an hour had passed. I discovered later that I went asystole on the table — that means my heart and breathing stopped altogether. Now, we see people get resuscitated in the movies and on TV so frequently that we may think it’s no big deal to “zap” someone back to life. In fact, it’s an extremely difficult feat. You might notice on shows like “House, MD”, once a person’s heart begins to go into “V-fib” or “V-tach” the doctors call a “code”, pull out the handy-dandy zapping paddles, and pop someone back into a “normal sinus rhythm” (if you don’t remember this, pay attention next time someone codes on TV). In fact, they do this because once the heart stops (goes into “asystole”) it’s VERY hard to get it back. As the folks in the ER later told me, once that happens, you are, for all intents and purposes, dead.

After I went asystole, the doctors called a “code blue” — hospital code for emergency (person is blue and near death) — and the doctors came a running. I was masked for oxygen and they prepared for resuscitation when, for reasons they couldn’t fathom, I spontaneously came back. My heart started beating and I started breathing. But “I” wasn’t there. Apparently, I was confused and basically delirious. As I’ve told people, the doctors were pretty much talking to my brain stem at this point — I myself remember NOTHING about this time. Lucky for me, while my brain stem didn’t know the date or who the president was, it DID tell them what I was on and what the dosage was, it knew and told them I wasn’t on any illicit drugs, but that was pretty much it. The doctors didn’t believe my brain stem that I wasn’t on heroin (or some other drug), so they — in their infinite idiocy — administered Narcan. Narcan is a drug used to reverse the effects of opiates in the body. It works by, basically, ripping all the opiate molecules out of the receptor cells throughout your body — the intent is to reverse an overdose that could be shutting down the patient’s breathing and heart — but it also puts the body into immediate and FULL withdrawal.

Sadly, I was not overdosing on Heroin or Vicodin or any other opiate. I was, in fact, already in withdrawal from the OTCATO (an atypical opioid) and, had I been fully conscious, I would have been able to tell them that. Hey, their intent was good, they just didn’t know what they were really dealing with.

The Narcan’s effect was immediate. I dissociated into delirium, and it started me screaming and crying from the excruciating pain for an hour (the exact length of time I was dissociative was equal to the elimination time of the Narcan). During that time, my heart began to go into massive arrhythmias of all kinds and I was “zapped” back to life a total of five times over an hour.

On the fifth zap, the doctors were preparing to intubate and sedate me — but that fifth time was the charm, and I became fully conscious, lucid, and alert — no longer needing intubation — I “woke up” and began to form memories again.

The doctors were amazed. This, apparently, simply does not happen.

Oh, my, God, everything hurt. Nobody would tell me WHY I was in such intractable pain, but I knew something in the treatment caused it. I looked around at the baggies hanging from the IVs, but nothing made sense. My mind raced to answer the question as to why I would feel as if I had glass embedded in my skin. It hurt SO much — but nothing they had in the IVs could account for the pain. Then I figured it out. Aloud, but to no-one in particular, I whispered the answer: “Narcan.” I heard a nurse say, “What?” but I ignored her and called the doctor over instead. I said, “You gave me Narcan.” He must have been shocked that I knew, but denied giving it to me. In fact, he wanted to know why I would even think such a thing. I replied, “It’s the pain. Nothing else explains it. I wasn’t in pain when I got here, but I’m in pain now. You gave me Narcan, didn’t you?” He said, “No, we haven’t given you Narcan.” I replied a terse, “Good. Don’t!”

I found out later after reading my records that it was a lie. I don’t blame him for lying — he was concerned about upsetting me further and causing me to fly into more arrhythmias. Still, I would have preferred the truth. At the time, I believed him and continued wracking my brain for the answer as to why I hurt so much — the truth would have been much simpler. By this time, the hospital’s toxicology report had come back and the staff had discovered that, in fact, I wasn’t lying about not taking drugs. NONE were found in my system. Not a drop of anything from opiates to benzos to alcohol. Negative on everything. The Narcan was all for naught. The doc must have felt so bad — in fact, he tried to administer 2mg of morphine for the pain (but it didn’t help at all). Hey, he tried.

Okay, enough about the Narcan. I made my point, I think. It didn’t do jack shit to help, in fact it might have exacerbated the problems considerably (among the known side effects are delirium and tachycardia… I’m just sayin’).

So…. okay, back to the ER when I woke up.

So here I was, stripped and tied down onto the gurney in the open room of the ER. Everyone was asking me a million questions. The doctors — all of them — came in to see me. I was a miracle patient (I guess waking up from that situation was pretty strange). Being lucid through the entire experience is also very strange. My medical knowledge, though rusty on cardiology at the time, came shining through as I began asking THEM a million (apparently impressive) questions. I was in full clinical mode — I want the FACTS! What do we know, what do we think, and what can we prove? Tell me everything. That’s my mantra. They were amazed again, not only that I was conscious, but that I was thinking, deducing, and trying to run my own differential! I listened to everything the doctors discussed amongst each other and wanted to know what they meant. I didn’t want to be left out of anything. One nurse even commented, “She’s listening to everything they’re saying!” to which I turned to her and jokingly shooshed her so I could hear more. (I was laughing and cracking jokes the entire time, to the point that it was even noted on my chart!). Hey, I gotta be me, even if I’m critically ill.

Shortly after I woke up and began asking my millionth question, I felt the “aura” of impending cardiac arrest. I can’t honestly tell you what it feels like. It wasn’t like I felt my heart going pitter-patter or anything. I just felt really “funny” — one of the doctors wrote in the notes that I said it felt like warmth moving up my legs into my chest. Sounds true enough, but it was more than that. It was, as some heart attack victims state, a sense of “impending doom”. It was just a feeling that something’s REALLY not right. I called out to get the attention of the doctor, “It’s happening!” at which point they all came running, announced V-Tach, and prepared to zap me.

For those among the unwashed, V-tach is short for Ventricular Tachycardia. That means the heart is beating out of rhythm — the atria (the top half of the heart) are being sent signals to beat, but the ventricles (the lower half) have “gone rogue” and race out of sync. This raises havoc on your body since the blood is no longer being pumped properly, and eventually leads to the heart just stopping. (Important note: I am a lay person explaining this process, so don’t yell at me if my metaphors aren’t working for you. Read here if you want to learn all about it.) It’s an extremely serious arrhythmia which most people in my position do NOT recover from. At that point, you pretty much have to electrically cardiovert by using the defibrillation paddles.

Now, let’s talk Cardioversion (returning the heart to a normal rhythm) for a moment. There are two basic types: Chemical and Electrical. Whenever possible, doctors like to “chemically” cardiovert, or bring the heart back to a proper rhythm, without using the paddles. They use things like beta blockers, chemicals like Lidocaine or Amiodarone, or even Sodium Bicarbonate, to try to get the heart to correct is electrical signals. If those don’t work, they have to use the paddles — the defibrillators — which basically “restart” the heart. Most of the time, people in critical care (like me) are on both. I was plugged into the works PLUS the defibrillation. All that and nothing was keeping me in a “normal sinus rhythm” for long. Let’s just say that’s considered a really bad sign.

By this time, they weren’t using the paddles for defibrillation on me anymore. They had a couple of big stickers, one on my chest and one on my back, attached to wires which were hooked up to a machine where they could, essentially, push a button to cardiovert me.

I had heard a long time ago that being zapped by the defibrillators was like being kicked in the chest by a horse. But I don’t know too many people who have been kicked in the chest by a horse, nor have I. Regarding defibrillation, I can now say that reference is probably accurate — as true as, say, being shot in the chest with a shotgun a point-blank range. (Nor have I had the latter experience either, but I can only imagine.) If you’ve ever accidentally electrocuted yourself — maybe turning on a lamp that had a short in it or plugging something into a socket while touching a metal piece, well,… defibrillation while awake and lucid is like that times a million — like being electrocuted through your chest (because it is!). It’s not for pussies. It hurts more than anything you’ve probably ever known, yet it’s unique in the properties of how it feels. I can’t describe it well enough except to say it sucked. Besides, the movies never show what it’s really like.

In the movies, you see the patient being zapped with the paddles, and he/she kinda bounces up in the bed and maybe grunts a little. Yeah, uh, no, it’s not like that. At least not for me. I bounced off the bed to my right and yelled “MOTHERFUCKER!” while a curtain of white electricity flew over my visual field. No quiet, dignified little grunt for me, no sir! After the first few zaps, I settled for a simple scream instead of profanity. I was too exhausted to use words anymore (besides, I guess I felt I’d made my point).

Yeah, it sucked, like, a million monkey balls.

And at THIS hospital, I got to go through that hell about 5 times, while awake — then 5 or 6 more times on the way to the second hospital, then, a dozen more times there. About 25 times in all while fully awake and lucid for the experience (not counting the times I was zapped while unconscious). Paging Dr. Mengele anyone?

Among the million questions I was asked was information regarding personal contacts. Family, friends, anybody that I wanted to be informed that I was, you know, dying. In these days of cell phones and speed-dial, who the hell knows phone numbers by heart anymore? I gave them my aunt and uncle (their number I happen to know), plus the names of my priest, the pastor at my new church, my workplace, one friend, and the names and locations of my asshole siblings whom I don’t really keep in contact with anymore. I told them the phone numbers should be on the cell in my purse (at least for my FL-bro), but the others, I had no idea. Frankly, most everyone is contacted via Facebook, if at all, so…

It really made me think about how pathetic it was that I had NOBODY to contact in case of emergency. Aunt and Uncle Crazypants didn’t seem to comprehend what was happening, so when the hospital called them, they really didn’t understand. My one friend wasn’t answering her phone, and the asshole relatives were out of reach. The only one who had a clue was my boss at work — AND the pastor at my new church.

Believe it or not, HE came to see me. The Pastor walked through the door right before I was to be transferred. Apparently, the hospital called him to say I was critically ill, and he dropped everything and came to the hospital — now THAT is a slice of awesome. He said a little prayer with me and, since I was headed out anyway, went back to the church to email the congregation and ask for prayers on my behalf. Awesome guy.

He was the only one to come to see me during the whole ordeal. But wait — I’m getting ahead of myself…

After a half-hour of being awake, answering questions, and being zapped repeatedly, the doctors (wisely) decided there wasn’t more they could do — their skills were limited — and since I was exhibiting just about every type of arrhythmia known to science, our little small-burg docs were understandably out of their depth. They wanted to send me to our state’s version of Dr. House’s Princeton-Plainsboro Teaching Hospital where I could be under the care of their top-notch toxicology and cardiology people. I agreed wholeheartedly because I felt it was my best chance to survive. I was told that a helicopter wasn’t available to transport me, so I’d have to take an ambulance — also, oh by the way, I could DIE on the way. This upset me, but I agreed anyway. I was to be accompanied by the hospital’s Chief of Cardiology, their head Cardio nurse, and the head Cardio EMT — I made them all promise not to let me die on the way. They agreed.

They packed me up and put me on the gurney and rolled me out toward the ambulance — I coded again in the parking lot. ZAP! And… I was back. Again.

The hospital ride to PPTH (reminder: not the real one, just our version of it) was painfully slow and took just about as long as if I’d gone there in my own car. Seriously, do people NOT get out of the way of a rushing ambulance anymore, or what? I coded five more times in the ambulance, and they kept zapping me back to life each time. Meanwhile, (and usually precipitating each attack) the Head Cardio Doc kept asking me questions about my family, my career, my life. Jesus, man! I don’t want to talk about my crummy life! After a while, it became obvious that every time he hit a nerve and upset me (which was a lot), my heart would go into V-tach again and they’d have to zap me. I kept asking the doctor to tell me about HIMSELF — which would distract me — but he kept insisting he wanted to talk to me about me. JEEZ! Even the EMT could see that talking about my family, my crummy relatives, or my lack of a career was only upsetting me, and he asked the doc to stop and only ask me HAPPY questions. The doc’s response? “I thought I was.”

Hah — he doesn’t know me very well, does he?

So after almost an hour, we pulled up in front of PPTH, the doors to the ambulance opened, and they started rolling me into the ER. All I could see was sky, then the ceiling of the hospital hall that featured some round, fluorescent light fixtures. The EMT commented to me, “Getting a good view of the ceiling, huh?” To which I responded, “Yeah…”

Then I went into V-tach and crashed again right there in the hallway. That was the last thing I remembered until I woke up again… three days later.



About madmargaret

Nursing student, Mac nerd, medical 'genius', recovering addict, singer, ex-actor, and all-around swell egg. Really!
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