Wednesday, February 13, 2008

Jove's Own Hiccups


Thunderbolt
Originally uploaded by mandolux
Don't you hate a story that starts out "Don't worry, I'm fine now"?

My defibrillator fired off late Tuesday morning, nine times within five minutes or so. Anyone who wishes to know what this feels like can easily simulate it at home by licking a 9-volt battery and, at the same moment, having your mortal enemy smite you with a sledge hammer.

Nine times.

Failing that, remember the little bird in Shrek that tried to hit that high note?

Spare a few thoughts for roommate John, who wasn't sure anything was going on until he heard me break the toilet seat.

I had just experienced one jolt and was sitting on the closed lid. I had mostly reassembled my wits when I felt another one, and the next thing I remember I was sitting *in* the toilet on pieces of shattered plastic.

He: "Do I need to call 9-1-1?"
I: "I'm not sure..."
ICD: *ZAP*
I: "Yes!"

Sorry, no pictures.

I will say that lying naked on the bathroom floor having Jove's Own Hiccups every fifteen to thirty seconds made me feel as helpless as little else has or can.

I know now that the first few were 5 joule charges, and the last one was 35 joules. I sorta thought it might have been a bigger wham than the ones before, but it also could have just been the emotional reaction of "Oh, God, another one". (The nurse confirmed this: People generally can't tell the difference. A shock is a shock.)

The manufacturer says that someone who's touching me when it goes off might feel a charge of about 2 joules. (This is conveyed in answer to the questions everyone asks, "Can I still have sex?") But what I hadn't been able to learn is "What does 2 joules feel like?"

I thought about that when John was looking for my pulse. I was half afraid it would fire off while he was trying, and, I admit, half hoping it would. It didn't.

Well, now I know what 5 joules feels like, and can extrapolate. It ain't like touching a metal doorknob. It's ultimately harmless, but you'd know you'd been slapped pretty good.

By the time that 35 joule kick happened, the novelty had completely worn off.

I had finally had the sense to lie down on the floor, modesty be damned. I was in the middle of the hall, having made barely a token attempt to get my pants on, when John returned from the 911 call and found me. I'm afraid he thought the worst before I had a chance to speak and tell him that I was still awake and (relatively) lucid.

That 35 joule kick was, it developed, the last. Laying on the floor had helped calm my heart. It never did happen that John was actually watching when I received a jolt. It's a shame. I wanted to know what it looked and sounded like. It sounded like thunder to me, but I suspect it was silent. Except, of course, for me yelling.

Something In The Blood

I'll have to skip over the blur of the arrival of the ambulance and the trip to Emory Crawford Long (where my doctors are). I traveled alone in the ambulance, but I hadn't been there long before my wife (with my daughter) and John (with my son) caught up with us. By then, with the liberal application of modern pharmaceuticals (let's hear it for modern pharmaceuticals!), I was feeling well enough to be snarky about my own condition (it's a coping mechanism), something the nurses and doctor picked up on and responded to. If it's possible to have fun in an ER, I think we did.

One of the really unexpected things discovered in the ER was that my system was all but depleted of potassium. The nurse there had mixed a "cocktail" with the potassium supplement in its liquid form, ice and orange juice -- at least she said it was orange juice, but the potassium liquid must have a really powerful taste. It tasted like-- well, like nothing I'd ever had before. The medicinal equivalent of a Lovecraftian creature that the human tongue cannot describe because it exists in dimentions we cannot perceive. The Pharmaceutical Horror, the Drugg From Out Of Space.

I Have Been Assimilated

Now I have a fourth doctor writing prescriptions for me, another cardiologist, Dr Whelan. He was present when the nurse with the australian accent downloaded my ICD data. That's the only reason I know it fired nine times: I had lost count.

The doctor's official description of the incident was that the ICD had fired "inappropriately". (Not quite the word I might have chosen.) By this he meant that the situation to which it was intended to respond, ventricular fibrillations, had not occurred. It was confused by my rapid heart rate at the time, although there is no particular explanation for the rapid rate in the first place. (Probably the combination of low potassium and a missed dose of toprol.)

After it had fired once, the anxiety it created kept my heart rate elevated, which served to convince the ICD that its job was not yet done. It's programming giving it no alternate course of action, it kept firing.

That won't happen again. While she was reading the ICD's records, the doctor and nurse-tech tweaked the unit's programming to allow it to more easily tell the difference between atrial fibrillations, ventricular fibrillations, and "mere" high heart rate, and react accordingly. The unit's logs stored detailed information about my heart's day-to-day activity not available any other way: They used that information to recalibrate some of the defaults the ICD uses to decide what an extraordinary event is.

That is, the ICD is pretty capable straight out of the box, but the better configured it is to its particular circumstances and environment, the more effective it will be. As a computer geek myself, I find this fascinating, and not just because the gadget is in my chest. I'm awestruck that not only is this degree of care possible, but it's available to pretty much anybody who needs it.

No sense of rhythm

My heart rate was not just elevated, but irregular. As the machines reported a "rolling average", the numbers jumped all over the chart, from 90 to 160 beats per minute. Which is not to say that a minute ever went by in which my heart beat 160 times. My heart sounded pathetic when I was hooked up to a monitor that actually sounded each beat.

And all of this we learned before we ever left the ER. By the time I had a room, it was pretty much all over but the shouting. They kept me topped off with medicines, to keep my heart rate controlled until my system recovered from the trauma and my heart calmed to a regular, normal at-rest rate (60-70 bpm). There was talk of a "plan B" if it didn't do so, but the doctor was confident that it would do so after a night's rest.

And it did.

That's about all there is to tell.

Oh, and there's a new champion. The potassium supplement I now have to take is, without question, the biggest pill I've ever had to swallow. It's about an inch long, the circumference of a piece of chalk, and not half as yummy.

Some of my pills I can just pop 'em down without water. This one, I'll need a *lot* of water and a bit of mental preparation too. I almost didn't manage it in the hospital, and the nurse had broken those in half.

But it is over and I am here to tell the tale, and even laugh at parts of it.

SEE ALSO: LiveJournal.

4 comments:

Anonymous said...

'Let's hear it for modern pharmaceuticals!' Yay!

If you really want to kill conversation around the dinner table (or make people think -- often the same thing) play 'How Many Times Over Would You Be Dead, If Not for Modern Medicine?'

I figure my score stands at '1,' my wife's at about '3.' Younger son gets a 'Great Big Number Uno!'

Glad you're still with us. (Now cut this c**p out!)

RNB

Daniel said...

Well, remember that while this incident was pretty damn dramatic, it wasn't life-threatening. The ICD should not have discharged in this situation, and if there is a next time, it won't. There was nothing wrong with me that a 5-to-35 joule charge could fix.

Just as a point of comparison, how many joules would one take if one were to, say, lick a 9-volt battery? Anybody know?

billritch said...

I am happy that you are fine now. I can tell you I was shocked (not as much as you) when I read your mail yesterday.

There seems to be something going around. I also received mail that Stephanie Gould is in the hospital for some abdominal surgery. No more info at this time. AND Brad Weage fell Friday evening and hit his head. Brad says he won't be doing anything for a while.

As to your question:

As usual with electricity the number of joules depends on how much current you draw. So a joule is the force it takes move one coulomb through a potential of one volt. A coulomb is one ampere-second.

A guy measured the current of a 9V battery on his tongue (http://www.physicsforums.com/archive/index.php/t-168784.html) and it is 3-5mA. If you hold it for 1 second that is 4 mA-s or 4 milli-columbs. At 9 volts that's 36 milli-joules.

Perry de Havilland said...

Yikes. Glad it felt worse than it actually was. I still have a scar on my hand where I was electrocuted by a defective trousers press (of all things!). But unlike you I do not remember getting nailed (knocked me out cold) and it only happened once!