“Oh daddy” she sighed, a shallow whispered voice, as her weak carotid pulse disappeared and her rhythm vanished to the flat line of electrical inactivity.
The eldest of my four children, Marley, 30 years old, is full of life; active, artsy, and a great mother to three of my eight grandchildren. Since high school, her mid teens, she experienced intermittent episodes of palpitations, feeling faint at unexpected times, chest discomfort without a cause, and a situational anxiety precipitated by the anticipation of recurrence. A colleague describes as “squirrelly girly” symptoms that young women have at the most random times. Being the typical “doctor dad,” I too was convinced that the “squirrelly girly syndrome” was rampant not only in my home but throughout society with increasing pressures both socially and situational on our young female citizens.
Shortly after the birth of her second child, after a brief stroll with her newborn, she once again proclaimed: “I’m having it again.” Questioned, she described palpitations and near-syncopal symptoms. After assuring her this was the result of childbirth, being out of shape and trying to exercise, I thankfully paused to check her pulse which was about 180, thready and barely palpable. After attempts to break what I assumed was a supraventricular tachycardia with carotid massage, ice water, valsalva: a rapid trip to the ER ensued. Unfortunately, as the leads were attached to her chest, she proclaimed “it’s gone,” and indeed, she was back in normal sinus rhythm.
A cardiac workup ensued, negative, and eventually she was diagnosed with Graves disease. After ablation of her thyroid and normalizing her endocrine status, the next year or so passed with only minor episodes of palpitations, rarely enough to make her stop or alter activities.
Three years after the first ER visit we enter the Magic Kingdom. This 30-year-old child of mine loves the world created by Walt Disney and would gladly vacation in Orlando on a monthly basis if finances and the daily grind of life allowed. Christmas season in Disney is likewise magical to me, especially when accompanied by my growing brood of children and grandchildren.
We had just finished a very late meal in the classic Disney venue, The Liberty Tree Restaurant. I had just escorted my grandbabies outside when suddenly I heard the call for help back at our table. Lethargic and laid out on a bench, my daughter was weakly arousable, diaphoretic, and with an almost undetectable pulse. Recognizing the probable SVT, my oldest son, a third-year Baylor medical resident, and I began the usual attempts to break the attack: carotid massage, hard valsalva, and even throwing ice water on her face as we became increasingly worried about her apparent severe hypotension and increasing chest pain. We feared an impending medical disaster.
Arrival of an efficient and well trained group of paramedics immediately revealed a heart rate of 220, profound hypotension, and an EKG revealing supraventricular tachycardia. After gaining IV access and rapidly repeating attempts to break the tachycardia, the situation only worsened. Sensing a rapid deterioration in her status, adenosine was called for, and pushed with prayers for rapid conversion. I warned her, she might feel some discomfort or unusual symptoms, as the ACLS instructors have warned me in the past, even though I had never seen it administered in my 25 years of practice. Expect a flat line of electrical inactivity.
“Oh daddy” she sighed as her weak carotid pulse disappeared and her EKG went to the flat line of electrical inactivity. The flatline was prolonged, but within several seconds the sinus rhythm returned, as did the blood pressure, cognitive functions and my own breathing. On questioning months later about the “feeling,” she replied, “I knew I was dying.”
She was loaded on a gurney, rolled across Disney Boulevard, with the Christmas parade halted by a small army of mouseketeers, roping off a small corridor to pass through to a hidden entry down to underground Disney World. She looked up to the seven dwarfs on a Christmas float waving her on, a very strange medical send-off. From an extensive underground network of support services, an ambulance awaited to transport to the local emergency department.
The miracles of medicine, since graduating 30 years ago, they never cease. The myriad of resources with diagnostic tools, and medications at our disposal have me in awe. Adenosine briefly stopping the SVT and allowing the normal rhythm to resume, amazing! Even more impressive is the current crop of cardiologists like my daughter’s physicians, Drs Chris Waterer and Judson Coley the electrophysiologist, who can identify and obliterate the accessory nerve pathway that leads to AV Nodal reentry tachycardia. These talented physicians are working on minute pathways that were almost imaginary when taught to us 30 years ago. Now they are mapable, treatable, and shown to me on a smart phone at the end of the procedure! Frequently curing one of the most common arrhythmias in young women.
I’ll always be a “doctor daddy, or granddad” but now one much more attentive to the “squirrely girly” symptoms so commonly encountered in many of our practices. Vague, harmless sounding symptoms suggestive of anything but a life threatening rhythm disorder; I am refocused, attentive, and forever grateful for the many miracles of modern medicine. Modern Medicine, and the grace of God, my magic kingdom.
Dr. Reed Hogan is a Northsider and a gastroenterologist.