Adventures in Flatlining: A Tale of Adenosine and Tachycardia

I am a ticking time bomb.

I guess in a sense we all are, but some of us are more aware than others of the numbers counting down to the inevitable, final blow.

From the time I was in elementary school, I knew there was something wrong with my heart. I would come home from playing with the neighbors, and for an hour my heart would keep pounding away. My mom taught me to close my eyes and imagine a place I enjoyed, and for a time I remember that being on a tube slide at a nearby waterpark.

Most of the time, though, it wasn’t just a reaction to playtime. In fourth grade, as my teacher read to the class, my heart took off like a rocket. I remember staring down at the large butterfly screen printed onto my blue shirt, watching it quiver with the pounding like it was ready to take flight. By the time I raised my hand to tell the teacher, the episode had stopped as quickly as it had started.

The episodes continued in that fashion very sporadically—once a year, maybe—until a particularly frightening one in eighth grade made us seek a cardiologist. Finally, I thought, we’ll get some answers.

Of course it wasn’t that easy. My EKGs were normal. My echocardiogram was normal. It was a matter of catching an episode while it was happening, and as they were so random, I had my doubts. I was given a monitor to wear, and if I was having an episode, I was supposed to press a button that would record the electrical patterns of my heart.

Being in eighth grade isn’t easy. Being in eighth grade with a bunch of wires hanging off of you is even harder. I had expected to hear some kind of commentary from my classmates, but the joke actually came from one of my teachers. I walked up to him to ask to go to the bathroom, and on seeing the bundle of black wires sticking out from the bottom of my shirt, he said, “You’re going to have to try a little harder to hide your MP3 player.”

I stopped wearing it. The next day I had an episode, and it went undocumented.

Because we were unable to catch it, my cardiologist basically shrugged his shoulders and said, “It’s not a fatal arrhythmia. It might be uncomfortable, but you can live with it.”

Instead of answers, I came away from my appointments with more awareness of my numbers ticking down to the next cardiac episode.

Every year in high school I had to leave in the middle of our spirit games because my heart would lose control. It was like a bongo drum played by a delusional crackhead, soft and hard, slow and fast all at once. Then it would level out in terms of the rhythm but would be hammering along at 150-170 beats per minute. After experiencing this for three spirit games, I skipped the games my senior year—the only year my class won.

My life has been ruled by this fear in the back of my head that at any moment—at any place or time—my heart could lose control. While driving. While on stage at a talent show. During an exam. Once it happened during a choral rehearsal, and I remember so vividly sitting on the asphalt outside of the church, propping open the door with my trembling body, praying to God to keep me alive, to make it stop.

The first time I went to the hospital for it was in 2012. In the waiting room for the emergency room, I tried to count the beats, but it was so fast I couldn’t keep track. Every 30 seconds or so I’d feel a beat so hard I genuinely thought my heart would explode, as if such a thing were possible. I clutched onto my mom’s arm, thinking that, if I had to die, at least I would be there with her.

By the time they took me back to get an EKG, my heart had already done its first attempt at calming itself, which meant 156 beats a minute instead of 200. It was enough that they gave me a beta blocker “to put the brakes on this thing” so I could see my cardiologist. The same cardiologist who was so nonchalant about it in the first place.

Even after seeing a documented episode, he just said to stay on the beta blocker and see what happened. I was 20 at the time, taking a beta blocker for a sporadic arrhythmia I hadn’t even gotten a diagnosis for. I was scared and frustrated, but clung to some shred of hope that this medicine would stop the madness, even though my own cardiologist wasn’t convinced.

It didn’t. Several more hospital visits followed, more frequently as the years went on, and each was the same: they would do an EKG when I got there, would hook me up to a monitor, draw blood, take urine, and leave me alone in my room for six hours. The episode would break on its own, and they’d send me on my way. “It’s not a fatal arrhythmia. There’s nothing more we can do for you here.”

I was tired of hearing it wasn’t fatal without anyone telling me what it was, and when it was happening—when my heart lost any and all control—it didn’t feel as benign as they made it seem.

In December of 2015, in the few minutes I got to spend with the ER doctor during my six-hour stint at the hospital, he mentioned that my cardiac episode was an SVT without explaining what that was or what it meant. At least I had something to go on, so I took that information to my primary care physician, who told me to see an electrophysiologist.

On Friday, September 2, 2016, I went to see Dr. Vijay, whose full name is so long and unpronounceable that everyone, including his staff, just calls him “Dr. VJ.” He explained that SVT, also known as supraventricular tachycardia, happens when the heart starts beating along rogue electrical pathways. There are a few different pathways that can cause the heart to beat quickly or abnormally, and the way to treat SVT with the highest efficacy is a procedure called catheter ablation.

So I asked this kind man, who looks like an Indian Ray Romano, what a catheter ablation is, and upon hearing the answer, I wish I hadn’t.

Catheter ablation is when they make an incision in your groin and run a long, flexible wire up through your vein and into your heart. The tip of the wire sends electrical impulses through your heart, stimulating the rogue pathways so the doctors can map where the improper beats are coming from. Once they’re relatively certain which circuits are abnormal, they use the wire to burn them.

I mean, it’s all well and good to have parts of your cardiac tissue literally burned to death, but the great thing is that you’re awake while they’re doing it. You get a local anesthetic for the incision site, but other than that, they sedate you but keep you conscious. So yes, you can feel when they make your heart go on its crazy circuit, and you can certainly feel them burn your cardiac tissue.

I was, understandably, freaked out. The idea of it was insane, but with a 95-98% efficacy rate on the first try, I couldn’t not consider it. I took the weekend to think it over, and by Monday I agreed to have the procedure, which he scheduled for October 6th. He also gave me a monitor to wear so they’d have more information about the type of SVT I had, and he encouraged me to try to induce one episode just so they’d have the data.

“You’ve been having them for so long. What’s one more?” he said.

I did not have any conscious plans to induce something so uncomfortable and terrifying, but my body had other plans. On Thursday morning, not even a week after my appointment with Dr. Vijay, I felt the telltale kick of my heart and knew an episode had begun. Since starting the beta blockers four years ago, I have to say that the episodes are at least more manageable. They don’t have the bongo drum phase, and they settle at around 120-130 BPM rather than 150+. They’re so manageable that I grudgingly go about my day and wait for them to end on their own. Apparently this is a bad thing, because Dr. Vijay said any episode lasting hours can cause damage to cardiac tissue, so if it’s been hours, I should go to the ER.

My episode started at 11:00 AM. By the time I had to leave for my 1:00 class, my heart was still chugging along at 125 BPM. I didn’t want to miss the class, so I ignored the palpitations as best I could and made it through an hour and a half of the three-hour lecture. During the break, I approached my professor, who was at least aware of the impending ablation procedure, and just pointed to my chest. She knew. She told me to go to the ER.

My boyfriend and I are down to one car at the moment, so I had dropped him off at work before going to class. He wasn’t due to get out until 9:30, and it was only about 2:45 when I got home. It’s not like he could have gotten home anyway, with my having the car. And I certainly wasn’t going to the hospital alone.

I tried what they call vagal maneuvers, which can sometimes cause a physiological response that lowers the heart rate. Nothing. I tried calling my boyfriend at work, but it was busy and he didn’t feel his phone vibrating. Finally I called my mom, who lives 45 minutes away, and she closed her business to come take me to the ER.

By 4:30 we were in the waiting room, and my heart was still going a steady 125. At 5:00 I was brought back to have an EKG in the triage room. They lead me to a bed in the corner of a room I shared with someone who was hidden behind a curtain. My monitor showed my heart fluctuating from 117-130 BPM, and when you consider that my resting heart rate is usually between 55-65, that’s not great. (It’s also not the worst I’ve been by any means.)

I settled in at around 5:20, expecting the usual six hours of waiting for the episode to break naturally with the occasional nurse checking in or a phlebotomist coming for blood. However, within a half an hour the ER doctor, Dr. Dave, came in to check things out. When he heard that this episode had been happening for six hours, he said, “We’re going to have to break it.”

In my 15 years of struggling with SVT and God knows what other arrhythmias, I had never heard that sentence, and it scared me. “What does that mean?”

“We’re going to give you a medication that’s essentially a reboot of your heart.”

“What does that mean?”

“It means we’re going to have to stop your heart.”

I’ve had anxiety my whole life. I’m accustomed to the feeling of panic, but up until that point I had never felt so much fear in one singular moment. He went on to explain that the drug is very fast acting and your heart stops beating for only a second or two, and it immediately starts back up. It’s completely safe, he’s administered it 200-300 times, and he’s never had a problem.

That did nothing to alleviate my concerns, because they were going to stop my heart.

He left to find me a bigger room since they were going to “need a lot of space” for the procedure. My mom reached over and held my hand, and I went to my default state when I’m overemotional: numb and in denial.

Because I’m me, I need humor in order to deal with traumatic situations. When the nurses came to wheel me to my new room, I told them I felt “regal” because I was being escorted by a team like a princess in a carriage. I kept making jokes with them, and Carmen, an Irish wiseguy himself, said, “She seems pretty asymptomatic.”

They wheeled me into a single room with a TV, which, I commented, was the height of luxury. I laughed with Carmen, trying to forget that this move brought me closer to potential (and technically real) death. Another nurse, Monica, came in. She was a beautiful black woman with meticulously curled hair, and she and Carmen bantered about going to bars and the length of their shifts. It was easy, then, to believe that I was just in a bed watching Newswatch 16 and listening to some friends get over a play argument about something insignificant.

Monica expertly put in the IV, which started to bring me back into the awareness that something was about to happen. Another man, whose name I never learned but who looked even more Irish than Carmen, came in wheeling a crash cart.

That’s when it became real. That’s when every cell in my body lit up with a terror I’ll never be able to describe. My heart rate shot up to 165, and with a shaking finger, I pointed to the cart and said, “Why is that here?”

“It’s standard procedure, just in case.”

Dr. Dave came in as they were putting the shock pads on me. I stared at the crash cart, which looked like one of those red tool chests, tears distorting its edges, and said, “This is the most scared I’ve ever been in my life.”

Time seemed to be speeding up, and everything was happening in an adrenaline-fueled blur. I was vaguely aware of my mom crying next to me, kissing my temple and saying over and over, “I won’t let anything happen to you.”

Ten years ago, she watched her husband—my father—die in a hospital after a case of medical malpractice. That thought was an undercurrent to everything that happened, that piled terror on top of fear and made everything—even this “safe” procedure—seem like a death sentence.

Carmen and Monica were on my right, attaching equipment to my IV line. The unnamed Irishman was to my left, trying to restrain my mother from draping herself across my body. Dr. Dave was behind me, his hands gripping the top of the bed behind my head.

“I’ll be able to see it on the monitor before you feel it, so I’ll tell you when to expect that weird feeling.”

“That weird feeling” meant the cessation of my heart beat.

I didn’t really get a warning when it was going to happen. I heard them say “Adenosine twelve” or something similar, and then I felt it enter my body.

It started as a deep, heavy ache spreading up my arm and into my right shoulder. Then everything felt heavy, like I was being compressed from all angles. It’s like when your vision goes black at the edges and you feel everything closing in on you, but there was no blackness. I felt my body shutting down, like I was a toy who needed its batteries replaced. My legs felt the strangest for some reason, almost warm… almost like I could feel the blood slow to a crawl. They were lead, and I felt like I’d never be able to move them again.

They always say that, when faced with death, your whole life flashes before your eyes, or you think of loved ones and remember them fondly, but this wasn’t the case. The only thing my brain grabbed onto was, “Stay conscious. Keep breathing. Stay conscious…”

Over and over this was my mantra as I felt my body slow, felt my heart near its flatline. This all happened before Dr. Dave said, “Okay, you’re going to feel it now.”

It was all a matter of seconds—maybe less—but it felt like the fabric of time had been stretched out and wrapped around me too tightly. At last I felt a final thump, and then an almost echoing emptiness filled my chest. At that moment, I was half-dead, no longer sustained by a heart beat. Had I been looking at the monitor above me and to my left, I would have seen the straight green line signaling the “weird feeling” that was the absence of my pulse.

The heaviness was deepest then; an ache so deep it was only a whisper, like I was accessing it through a concrete wall, crept into my arms and legs. Then, as they had explained, my heart did a “reboot” and slowly started beating again, and the rest of my body felt remarkably similar to the concept of a computer going through its boot sequence. It’s almost like I could feel the blood start to circulate again, and the weight started to come off incrementally. The nurses around me were breathing sighs of relief, even saying, “It’s down,” but I felt it before they saw it. My heart broke through its shackles, pounding its way back up to 167.

My visual awareness of anything other than my own feet and the crash cart was nonexistent. Even though I knew who was where, I didn’t see them—not because I couldn’t, but because my awareness was focused so far inside of me that the outside was close to an illusion. I was living inside my body, trying to will it into submission.

“You’re doing so great, baby. You’re taking it so well,” Monica said as she slipped an oxygen mask over my face. It had a bag on it, like the kind you’d use for a resuscitation.

“We’re going to have to go again,” Dr. Dave said.

I was so tired and still very heavy, and I tried to say, “Please wait,” but they were already prepping the next injection.

“Six?”

“No, twelve.”

My mom was trying to hold onto my arm, I think, but Irishman pulled her off again right as the second injection hit my bloodstream. The oxygen helped my brain feel less like it was going to slip away, but every other sensation was the same, if not more intense because my body was already exhausted from having been shut down once.

Again Dr. Dave told me the feeling was coming, and again I felt my heart stop. Oddly enough, the sensation of my heart stopping was the least uncomfortable of all, half because I was less aware of it than the other symptoms and half because I had experienced skipped beats before, and this just happened to be a very long skipped beat.

The psychological aspect of knowing that my heart had stopped, though, was the most traumatic by far. As my systems came back online, as it were, there was again a sense of celebration in the room since my rhythm was in normal range, but I knew it was temporary before it even happened: it broke through again, immediately racing to the 160s and scaring everyone in the room.

“We’re going to have to try something else,” Dr. Dave said, which to my panicked mind meant using the shock pads.

“It’s called cardizem, and it takes a little longer to work… maybe two or three minutes.”

If their first line of defense was stopping my heart, I was afraid to ask what this new drug would do.

“What will I feel?”

“Nothing,” Dr. Dave said.

“Nothing?”

“Nothing,” the Irishman answered, smiling at me.

I didn’t feel the cardizem enter my bloodstream, but within thirty seconds I felt my heart slow gradually until it rested at around 75 BPM. “It’s holding,” they said.

They took my oxygen mask off. “Thank God,” I heard. My mom threw herself across me as Monica said, “You did so well, sweetheart.”

“Most people swear or scream or try to fight,” Carmen added.

I made up for it by swearing a lot the rest of the night.

A lot of things come into perspective after you’ve half-died twice in a matter of minutes. Priorities make themselves clear in the coming days. Your own strength and resiliency are confirmed. Your loved ones seem all the more dear to you. Life itself is more vivid.

I’m no longer afraid of my ablation. I figure feeling a doctor burn electrical circuits in my heart can’t be as bad as feeling my heart actually stop. The only thing I’m afraid of now is waiting until October 6th, since, as the cardiologist who saw me in my room the next morning said, “You can try to avoid basic triggers like bending over and heavy lifting, but we both know that this thing could happen at any moment.”

So for now I have uncertainty hanging over my head like I have for the past 15 years the SVTs been happening, but at least people are taking it seriously and no longer trivializing the fact that sometimes my heart freaks the absolute fuck out. There is an end in sight, as long as the catheter ablation works.

I wish I could end this with a “happily ever after” and say that the experience fixed my heart forever and that it’s taught me everything will work out in the end. I’m not there yet. Struggling with the trauma of having legitimately flatlined and knowing it could happen again is not easy, especially when doctors tell me that, until the ablation, I’m at risk no matter what I do. However, I’m grateful to be alive—to be able to tell this story from the other side of what could have been a very different ending. I’m grateful to be sitting next to my dog and thinking of how fortunate I am to still be with the ones I love.

It worked out, but don’t think for a second I’d wish this experience on anyone. There are other ways to find gratitude in everyday life, and most don’t include having your heart stopped.