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In the Operating Room, Matters of Heart and Spirit
By LARRY ZAROFF, M.D.
New York Times, Science
Published: June 21, 2005
When the heart stops, we are dead. Our constant heartbeat, our furious pulse when angry, the pounding in our heads when frustrated remind us of life. When the pulse slows, we get dizzy; when the heart moves to an irregular beat we are aware of a change.
Yvetta Federova
She, owning a frantic heart, one moment slow, another fast, then erratic, was calm, soothing like aloe on a burn. The prospect of having her mitral valve replaced was, she said, "of no concern."
After all, she was a nun who had worked, she told me, among those who owned nothing but their hearts. She smiled, saying, "I know everything about hearts."
I looked up from her electrocardiogram and saw an elf. She was perhaps four and a half feet tall, white as the lilies on her bedside table, silver haired, her blue eyes pale, almost alabaster. In hospital-issue white gown, her legs under white sheets, she seemed ephemeral, about to disappear.
She sized me up, the beginner, the trainee, not the great man, my professor, Dr. Dwight Harken.
At 78, she had spent her life teaching, hard teaching. She asked me as many questions as I asked her, not all medical. "What do you believe, Doctor?" she asked, as if I were sitting at a desk and she stood over me.
"Surgery, science," I said.
"But you are Jewish, aren't you?" she asked.
"Yes, born, but no follow-through."
Too kind to criticize, she was thinking, I am certain, "Foolish boy."
Two days later, she had open-heart surgery to replace her mitral valve. The valve was heavy with stone fragments, distorted, blocked and leaking, as much a sympathetic mirror of her hard life as her childhood rheumatic fever. The prosthetic valve functioned well and she recovered quickly, her heart rhythm reverting to normal. But wait.
On the third postoperative day, her heart declared its independence, again becoming rapid and irregular, the variable rhythm of atrial fibrillation. A danger: clots. An ineffective rhythm.
She would gain less energy, less benefit from her new valve.
We had recently acquired our first direct current defibrillator, more effective and safer than the alternating current devices. Sister was a good candidate for electrically converting her heart to a normal rhythm.
Doctors stand by the bedside, chat about patients, use medical jargon, assuming a patient is deaf to understanding. My nun listened as if to her sassy students' whispers. She heard every word. She absorbed our conclusion that "the sooner she was converted the better."
Later that afternoon, I medicated her with Demerol, a potent narcotic, in preparation for the procedure, in which paddles would be applied across her chest and an electric current passed. I walked beside the gurney as the attendant, John, wheeled her to the treatment room.
Now John, a former Army medic, a Vietnam veteran, had seen almost everything, but not a 78-year-old nun trying to abandon her stretcher as if she were heading for the next foxhole.
She rolled to the side, slipped under the restraints and sat up. Shaking her head, she opened her eyes to the size of Mercedes headlights and scared the daylights out of every patient in the ward by shouting beyond the capacity of a normal larynx - remember, she was tiny - "I refuse to give up my Catholic faith and become Jewish."
I stopped walking; John stopped pushing. She - a sound system at a rock concert - kept everyone in that wing of the hospital at attention, as she increased the volume of her complaints, now aimed in my direction. "You are not even a practicing Jew," she shouted. "How dare you, without my permission? Why, why, what did I do wrong, oh God." And so on.
Sister was now continuing her climb off the stretcher, heading God knows where, maybe Everest, with John and I restraining, imprecations resounding, a nun, a tiger.
The head nurse was about to send for security. I said, "No, call for the hospital priest."
He arrived as the Demerol wore off. After 20 minutes of what felt like a wrestling match in Madison Square Garden, the quiet of her face was completely restored. Peace.
The priest, John and I formed a semicircle around her. She sat numb, eyes closing, opening to each of us. Still groggy, she asked: "Why are you all looking at me? Where am I?"
I took her back to her room, explaining that she had experienced a bad effect from the Demerol, and that I would talk to her later.
Two hours after, she was fully awake, sitting up in her bed when I entered her room.
I explained what had happened, how powerful she was in belief and strength. I did not emphasize the latent force of her voice.
She was ahead of me, remembering the bedside conversation about conversion, and now realizing that we had been talking about her heart, not her religion. The next day I medicated her with morphine, which she tolerated throughout her successful cardioversion to a normal heart rhythm.
By LARRY ZAROFF, M.D.
New York Times, Science
Published: June 21, 2005
When the heart stops, we are dead. Our constant heartbeat, our furious pulse when angry, the pounding in our heads when frustrated remind us of life. When the pulse slows, we get dizzy; when the heart moves to an irregular beat we are aware of a change.
Yvetta Federova
She, owning a frantic heart, one moment slow, another fast, then erratic, was calm, soothing like aloe on a burn. The prospect of having her mitral valve replaced was, she said, "of no concern."
After all, she was a nun who had worked, she told me, among those who owned nothing but their hearts. She smiled, saying, "I know everything about hearts."
I looked up from her electrocardiogram and saw an elf. She was perhaps four and a half feet tall, white as the lilies on her bedside table, silver haired, her blue eyes pale, almost alabaster. In hospital-issue white gown, her legs under white sheets, she seemed ephemeral, about to disappear.
She sized me up, the beginner, the trainee, not the great man, my professor, Dr. Dwight Harken.
At 78, she had spent her life teaching, hard teaching. She asked me as many questions as I asked her, not all medical. "What do you believe, Doctor?" she asked, as if I were sitting at a desk and she stood over me.
"Surgery, science," I said.
"But you are Jewish, aren't you?" she asked.
"Yes, born, but no follow-through."
Too kind to criticize, she was thinking, I am certain, "Foolish boy."
Two days later, she had open-heart surgery to replace her mitral valve. The valve was heavy with stone fragments, distorted, blocked and leaking, as much a sympathetic mirror of her hard life as her childhood rheumatic fever. The prosthetic valve functioned well and she recovered quickly, her heart rhythm reverting to normal. But wait.
On the third postoperative day, her heart declared its independence, again becoming rapid and irregular, the variable rhythm of atrial fibrillation. A danger: clots. An ineffective rhythm.
She would gain less energy, less benefit from her new valve.
We had recently acquired our first direct current defibrillator, more effective and safer than the alternating current devices. Sister was a good candidate for electrically converting her heart to a normal rhythm.
Doctors stand by the bedside, chat about patients, use medical jargon, assuming a patient is deaf to understanding. My nun listened as if to her sassy students' whispers. She heard every word. She absorbed our conclusion that "the sooner she was converted the better."
Later that afternoon, I medicated her with Demerol, a potent narcotic, in preparation for the procedure, in which paddles would be applied across her chest and an electric current passed. I walked beside the gurney as the attendant, John, wheeled her to the treatment room.
Now John, a former Army medic, a Vietnam veteran, had seen almost everything, but not a 78-year-old nun trying to abandon her stretcher as if she were heading for the next foxhole.
She rolled to the side, slipped under the restraints and sat up. Shaking her head, she opened her eyes to the size of Mercedes headlights and scared the daylights out of every patient in the ward by shouting beyond the capacity of a normal larynx - remember, she was tiny - "I refuse to give up my Catholic faith and become Jewish."
I stopped walking; John stopped pushing. She - a sound system at a rock concert - kept everyone in that wing of the hospital at attention, as she increased the volume of her complaints, now aimed in my direction. "You are not even a practicing Jew," she shouted. "How dare you, without my permission? Why, why, what did I do wrong, oh God." And so on.
Sister was now continuing her climb off the stretcher, heading God knows where, maybe Everest, with John and I restraining, imprecations resounding, a nun, a tiger.
The head nurse was about to send for security. I said, "No, call for the hospital priest."
He arrived as the Demerol wore off. After 20 minutes of what felt like a wrestling match in Madison Square Garden, the quiet of her face was completely restored. Peace.
The priest, John and I formed a semicircle around her. She sat numb, eyes closing, opening to each of us. Still groggy, she asked: "Why are you all looking at me? Where am I?"
I took her back to her room, explaining that she had experienced a bad effect from the Demerol, and that I would talk to her later.
Two hours after, she was fully awake, sitting up in her bed when I entered her room.
I explained what had happened, how powerful she was in belief and strength. I did not emphasize the latent force of her voice.
She was ahead of me, remembering the bedside conversation about conversion, and now realizing that we had been talking about her heart, not her religion. The next day I medicated her with morphine, which she tolerated throughout her successful cardioversion to a normal heart rhythm.
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