Barbara
 Living on Planet Drum (with thanks to musician Mickey Hart)
by Barbara Shine
Thah-dump. Thah-dump-dump. Thah-dumpbumbum.
Thah-dump-bum-biddybiddybiddybiddybump-badump.
This is my heart, in unseen, muffled, but insistent rebellion. A noisy dysrhythmic protest against—what? Its unfair workload? Its anticipated collapse?
I've just rolled over, settling into the best posture for my night's rest. My left arm reaches around Bob's warm, solid middle, and he says "mmmmm" in response. It sounds like his smile, and I smile back into the dark, sleepy and content.
Just a moment later, though, my chest speaks, and I'm suddenly wide awake. This is probably the sixth or eighth spell of the day, but in daytime these attacks don't inspire so much fear. At night, lying next to my new husband, I worry about what all this means for him.
Thah-dumpdumpdump-biddybiddy-bump. Thah-dump.
I listen to flutters interrupted by deep booms, and behind closed eyes I can see the feeling: It's a large fish, gasping and flopping frantically inside a kettle drum. I feel the slap and slam of agitated heart muscle against the chest wall and wait to find out my future.
My heart has always been something of a renegade: racing, slowing, skipping beats. I was born with a mitral valve defect that worsened when I had rheumatic fever in early childhood. I was well into adulthood before realizing that not everyone can feel and hear their heartbeats as I do.
My poor old heart, worn and weary far beyond my 50 calendar years, has had to struggle all along. From decades of illness and unwise exertions, my heart is far larger and hence less hardy than it should be. In my teens, I was a majorette and I loved fast dancing; then I had three babies and smoked and drank too much. Now my heart is inelastic and spongy. It feels crowded in my chest.
These wild drummings are not entirely new. When I felt them before, my doctors diagnosed atrial fibrillation, "a-fib" to those in the know. It's less serious than ventricular fibrillation, which causes sudden death, but it's serious enough. A-fib can quickly change to deadly ventricular quivering, and a-fib often triggers strokes.
I cannot sleep while I wait for my heart to either normalize or burst up through my windpipe. The aberrant rhythms hold my thoughts like the opening hook of a Michael Crichton thriller: Will the beats soon revert to normal? Or will this be the last time I have to worry about it? Will the crazy flutters accelerate to the quiver of exhaustion that ends in a flat EKG? Or maybe worse, will the gyrating heart muscle eject a blood clot, swooshing it through the arteries to my brain?
If the pounding and fluttering don't stop pretty soon, I'll have to head for the emergency room. But how long is it safe to wait—a few minutes, a few hours? Can I decide by myself? Should I wake Bob?
biddybiddybiddy-bumpbumpbump...
In my twenties I invented a crude sort of biofeedback, which I used to slow my racing heart. When the beats started coming too fast, I'd start singing—just silently, in my head—"Way down upon the Swanee River...Far, far away . . ." I started singing fast, in time to the rapid beats. Then, gradually, I slowed my mental singing and the runaway heart rhythm slowed with it.
Over the years my heart has twice given in to infection and hosted rapacious bacterial colonies, sheltering those enemies and feeding them with the tissue of its very walls and gates. And just about 10 years ago, my fragile heart literally broke—at least the cords that work the mitral valve did: they tore from their moorings and could no longer open and close the valve leaflets.
So the surgeons requisitioned for me a new mitral valve, one fashioned from the generous-sized heart of a pig. I wondered, but never asked, whether that pig was cultivated just for its heart valves. Or were there byproducts of ham and chitlins as well?
My sons bought me a copy of Charlotte's Web to celebrate the porcine acquisition, and over time, my new valve and I adjusted to each other. But the porky prosthesis carries no special curative powers.
One day a couple of years ago, my heart started jumping around in those crazy rhythms but, oddly, it didn't stop after the usual few minutes of tom-tomming. It didn't stop jumping all day, and the sound-feelings became deeper, more profound. More rest, I thought; working too hard; get more sleep. I kidded myself that way until, after 3 or 4 days of relentless fatigue, I decided that the manic riffs of "Wipeout" bouncing around my sternum, and alternating with cannons from the "1812 Overture," might warrant a professional opinion.
My stoicism brought a tough lesson. I was sternly chided for procrastinating, rapidly admitted to GW University Hospital, infused with cardiac drugs and blood thinners, and then closely watched for symptoms of stroke or internal bleeding. By waiting for days, I had greatly increased the risk of a stroke. After we found that the drugs alone could not regulate my heart rhythms (and I held little hope for success with Swanee River), I was treated to a procedure called cardioversion. The docs put me to sleep just briefly while they applied an electric jolt of several hundred joules to my chest.
I think this real-life take on "Rescue 911" was supposed to scare my heart into behaving properly, but it didn't work the first couple of times. Hey, this is no faint-hearted heart! Eventually, though, the shamans of the ampere prevailed, and my rebel heart settled into a fairly normal pace and rhythm.
I left GW Hospital with painful burns on my chest, a tube of cream to assuage them, one prescription for a heart medicine that could be more deadly than the condition we're treating, and another for an anticoagulant called "warfarin." Basically, this is the stuff that's used in rat poison because it causes internal hemorrhaging. I didn't know whether to be more afraid of the a-fib or the cure! Between the drug side effects and the electric shock episode, I also carried home a residue of anxiety and depression that took months to subside.
Then, last fall, the drumming started again. As I sat working at my PC: Thah-dump. Thah-dumpdump. Then a few more, then back to normal. I took a few deep, stress-management-seminar breaths, ambled into the kitchen for some herbal tea, and decided there was really nothing wrong.
But now it happens more and more often, every day and every night, and I am both scared and curious. I'm frightened about pain and the prospect of disabling illness, but I don't dread a hospital stay. I am a good patient (I've had lots of practice), and my fascination with medical procedures prevails even while I'm at their center.
Thah-dumpbumpbump. Thah-dump-bumbiddybumbiddybiddy....
If my heart takes off on a flight of unremitting tympanic abandon, what will happen next? There is a promising new treatment for a-fib that lets the docs go in with a catheter and administer little electric burns right inside the heart! Wow, what an advance: Let's bypass those pesky skin burns and go for some real damage! This procedure is terrifying to ponder, and I'm certainly not ready to try it.
Sometimes when the thumping is severe, the cardiologist hooks me up to an electronic companion, a Holter monitor to nestle close to my heart. Like a baby in one of those canvas slings that new parents use, the techno-toy snuggles between my breasts, and it carefully records, for 24 hours, the tiniest electrical impulses of my every heartbeat. ". . . Oh, Lordy, how my heart grows weary . . . ."
Soon my cardiologist will have another Holter printout and a better idea of what comes next. She has already told me I'll need another mitral valve, next time a metal one, "in the not-too-distant future."
It is true that a spanking new mitral valve prosthesis could reduce my episodes of atrial fibrillation. But we are putting off the surgery as long as possible: My doctor wants to make sure the next valve replacement will be my last. And I'm afraid of the surgery, afraid of trading Planet Drum's frantic bongo beats for endless silence.
Postscript: Since writing this piece in 1994, I have had a St. Jude mechanical valve implant (July 1995) and a pacemaker implant (May 1997). Planet Drum is a quieter, less scary place now.
Copyright 1997, Barbara Shine
Reprinted with permission.
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