I was humbled by the complexity of her arrhythmia a year ago. She was so sick. Heart failure. Relentless, ventricular tachycardia. No cause was ever found. Back then, I had to resort to a MacGyver moment and patch together a make-shift system to over-drive pace her recurrent ventricular tachycardia. I didn't think she'd make it. But with time, patience, and a bit of luck, she got better. Someone had other plans for her.
At first, I didn't know her except as an arrhythmia. She was a tough case, a bed number, a person on a ventilator. But as she awoke from sedation and her eyes blinked "thank you," I grew to know her. Remarkably, she recovered from what seemed like an impossible situation and for the past year, I came to know her and her husband a bit better: her graciousness, her kindness, her delightful smile, their love for one another and their gratitude for her care.
I continued to see her from time to time in our device clinic. Smiling, joking, moving slowly, gracious, befriending the nurses, amazed at the technology in side of her. For nearly a year since her presentation, she had done so well.
But lately she had become increasingly short of breath. Her cardiologist admitted her and asked me to see her again. I soon discovered that her left ventricular pacing lead had dislodged and wondered if this might be why she struggled. I suggested we might try repositioning it to improve her situation. She seemed relieved a cause had been found. I was reserved for I was uncertain it would help her, but offered to try. But as things would have it, her blood thinner precluded proceeding right away, and despite our best efforts to correct her coagulopathy for surgery, she returned to the ventilator once more.
On the machine, she felt better. At least sitting upright. Her eyes smiled the next morning even as the mechanical tube protruded from her mouth. The nurses marveled at her ability to tolerate the tube without sedation. I returned to her later to explain the situation, the risks, the options available to her, about the uncertain outcome if we proceeded. She nodded understanding, looked to her husband who sat beside her, then looked back and gave a thumbs up as if to say "Let's go for it." We planned to do her revision the following day, opting to keep her on the ventilator for safety's sake. All seemed set.
The next day, she was brought to the laboratory and lifted carefully to the table. As she was situated, she became abruptly short of breath, even when sitting at 45 degrees. Her oxygen was increased, she was allowed to sit up further. Her eyes looked anxious, exhausted, and defeated. It was clear we could not continue. Despite this, she blinked a tender blink of acknowledgement as I told her our problem, and made arrangements to take her back to the intensive care unit. She knew.
Shortly after arrival back in the ICU, she began to improve a bit once more. Her oxygen level climbed and she seemed more comfortable. Her husband was there and she looked at him adoringly, weakened and accepting. She clutched his hand. They talked of options with her, of more diuresis, of doing things to keep her comfortable, but she heard little as she drew the air from the machine and stared into his eyes.
Barely an hour after agreeing to avoiding resuscitate measures, her oxygen levels dropped and her breathing became labored, quickly shallowed, then stopped. Her hand became flaccid and the color drained from her face. Soon the scurrying of humanity left the room and it became eerily quiet as the monitors were turned off, the wires and tubes disconnected. This was not how I knew her, this way. But in the still of moment it was clear that peace had come to yet another remarkable woman I had the privilege to know. In her own way, she taught me creativity, resourcefulness, the value of perseverance, the promise of hope, and the power of kindness.
Imagine: doctor, teacher, and humbled student still.