"Sweetie?"....

..."Can you take a listen to my heart? I don't know what is going on."

I glanced up from my textbook, my stomach sinking to my feet. I had felt that something was not right. My husband had practically slept the entire day away. He was now up at almost dinnertime, looking pale and worried. As I bounded up the stairs for my medical kit, differentials flittered across my consciousness... vitamin deficiencies, dehydration, sleep apnea...followed by the more serious diagnoses... myocardial infarction...ventricular fibrillation...and I quickly dismissed them. "He's only 34," I thought.

Before I even got my steth near his apex, my hand felt his heart almost bounding out of his chest. As I ascultated his mitral area, his irregularly irregular beat was clearly telling me what my mind could not fully grasp. He was in atrial fibrillation. With no sinus rhythm to count, I estimated his ventricular rate at over 170, still in shock that my husband's heart could sound like that.

"We need to go to the hospital."
"Really?"
"Yes, we need to go now."

With the kids safely ensconced with my parents for the night, we headed to the hospital where I was born, a place I was always fond of, a place where I may return as a practicing physician. In the ED, the triage nurse didn't even let him sit down. She listened to his heart and immediately called for an EKG. Within minutes, the portable machine was hooked up to my husband and I watched, still somewhat in disbelief, the chaotic peaks and valleys that appeared with the advancing readout. Atrial fibrillation, ventricular tachycardia, and premature ventricular complexes were all making their presence known.

The nurse placed an IV, meds were started, and the resident called for a cardio consult. After no less than three different docs came in to take the same history, I began to anticipate the questions and just supplied the answers before they could even ask. Did he drink, smoke, caffeine, thyroid problems, illicit drugs, other meds... and on. A little Caribbean voice inside my head was reminding me of the pertinent information to provide. Clinical tutors.... can't get away from them.

After an ECHO, different meds, countless questions, and more EKGs, the team left to discuss. The exam room was quiet. I held my sweetie's hand.

The resident stuck her head in the door. "When did you last eat??" "Oh, about 5 hours ago." "Ok, well, I think that's long enough. I am pretty sure we're going to shock you. The cardiologist will come and talk to you about it." She popped back out.

My husband had a panicked look on his face. "What does she mean, SHOCK me??"

I had encountered cardioversion in my studies, but I didn't know, clinically, how it was carried out. I had visions of old "EMERGENCY" re-runs with EMT's yelling "CLEAR!" and the patient being shocked and undulating on the table. My hubby wasn't that patient! He was conscious and aware! Not good. Also, that resident's bedside manner? She could have spared us the "shocking" comment or just took the opportunity to explain how cardioversion is performed. Note to self: when I am a resident, don't act like her.

The team came back in a flurry of activity. The consent was signed, the crash cart was brought in, pads were applied, full respiratory support was ready, just in case, and conscious sedation was prepped. They asked me to step outside.

I looked at my hubby and gave his hand a squeeze and walked out the door. As I stood in the middle of the bustling ED, I looked around at all the people, nurses, techs, physicians, cleaning staff, orderlies, volunteers, even the completely annoying lady from billing, and realized that every one of them was making the care for my husband possible. It was a surreal and chaotic scene but it was oddly comforting. I leaned against the wall, exhaled, and cried.

It was the longest 15 minutes of my life.

Since that initial ED visit and overnight admission, we have become quite familiar with a-fib. While most patients who get paroxysmal a-fib are over 55, my husband appears to have a pretty progressive course. His a-fib now occurs at least once a week, sometimes twice, and a couple of times, he had three episodes in one week. We have looked into procedures to cure it but he has to fail different regimens of anti-arrhythmia drugs before he is a candidate for ablation. My husband hesitates to even begin the therapies. These drugs that are supposed to prevent and treat arrhythmias also can cause arrhythmias which can lead to sudden death (the first dose has to be taken in the hospital just in case). The drugs also have serious side-effects that might not be debilitating for a 65 year old who takes the drugs for 10 years but my husband is now 35 and could be taking them for over 30 years.

We recently found in our research (and not from our cardiologist, who, frankly, is a poster boy for drug companies), that he might be able to exercise off his a-fib. It doesn't make a lot of sense, but my hubby is a trooper and was willing to try anything. The first time, it worked right away, but since then, it has taken a lot more intense exercise, which has been very hard on him. Imagine the energy needed to get up and run a full-on sprint with a resting heart rate of 170 beats per minute. He is wiped out after that. We still are not sure what long-term damage this condition will have on his heart but we do know his stroke risk is greatly increased, which is why patients with a-fib take warfarin or aspirin therapy.

Finally, begin rant. We continue to learn about a-fib, on our own, as again, our cardiologist has yet to suggest anything other than drugs, drugs, drugs. Seriously. Not even a peep about catheter ablation, the one curative procedure, or a sleep study, as obstructive apnea can cause a-fib, or an electrophysiology study, which gives some indication where the ectopic signals are coming from. Anything remotely procedural, he won't even comment on. Given, he doesn't actually perform the procedures, but it is still his field and I think, his responsibility to, at the very least, let us know about the only known CURE for a-fib. Ok, /rant.

The boys have been very supportive. They like to do jumping jacks with daddy when he is trying to exercise it off, they know to be quiet when daddy needs to rest, they are familiar with what a-fib sounds like, and they love it when "daddy is in sinus."

As to taking my board exam and clinicals? Well, it's a work in progress right now. I would like to take my exam in about a month and hopefully, I will get my placement soon after that. It has been a roller-coaster ride, truly.