Empathy and SVT

But experience adds an extra level of understanding. Your mind might believe it, but shared experience makes the GUT believe it.

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Sonia with Andrew in his “wizard” outfit in winter 2005-2006.

Empathy. In some respects, you have it or you don’t. At a minimum, if you aren’t born with the tendency, it has to be taught and “hard wired in” at an early age. Because in my former profession, you’d better have SOME if you want to be more than a passable physician. I’d like to think this was a strength for me, but you’ll have to interview my co-workers.

Even if you are an empathetic person, it’s helpful to have experiences that re-inforce the concept. During residency, I would give AAP endorsed advice on getting infants to sleep. I was matter-of-fact about it. Then we had Andrew, who as an infant, was a horrible sleeper. After parenting him, I gave the same advice, but I was a lot less bland about it. I was a lot more understanding of the struggle when parents didn’t follow “the book.” Lose sleep for a few weeks, and you’ll understand the predicament.

I tried HARD to be patient with families (extended families, too) when I was caring for a sick child. Even if it seemed to be a minor issue, I really tried to understand things from a family’s perspective. “The only person a procedure is minor for is the surgeon.” It’s a good axiom.

But experience adds an extra level of understanding. Your mind might believe it, but shared experience makes the GUT believe it. My wife had issues with SVT (a rapid heart rhythm in which your heart rate gets stuck around 200, higher for infants) since we were in college. For whatever reason, she improved when she was pregnant; maybe the ONLY physical benefit for her of pregnancy. I joked that it was me making her heart go pitter-patter. Without evidence to the contrary, I’m still taking credit.

Usually, the rhythm will correct itself. Sometimes it won’t, and your heart is beating so fast that it doesn’t pump blood appropriately. Then you have to be cardioverted. Sometimes, you can “valsalva” and bear down and force a vagal response. If you go the ER and they have time, you’ll get a bag of ice really shoved in your face. Failing that, you either get chemically cardioverted (a medication called adenosine that stops your heart for one or two seconds and then maybe a normal rhythm restarts), or you get the “paddles” – electrical cardioversion. This 2nd method is saved for when someone is not responding to other treatment or is really tanking.

It was the fall of 2012, Andrew was in first grade and at school, and Allison had three-day-a-week morning preschool. I was working, per usual, at the office. It was time for Sonia to pick up Allie-Al at school. Sonia started in a run if SVT. So she waited. One minute. Two minutes. Three minutes. No improvement. Five minutes. Nothing.

She’s up against the clock. She HAS to get Allison, so she gets in the car and drives to the preschool. Still in SVT, but now she feels lightheaded. Now there’s a problem. She’s there with Allison, but can’t drive home. She needs to get treatment. The preschool director stuffs Sonia & Allison in her car, and takes off for an urgent care close by. They get there, and Sonia starts explaining what’s going on. They don’t help her, see her, or even call 911 for her. They tell her to go to an ER (because having a 60 year old woman speeding around the roads with a sick woman and a 4 year old is WAY smarter than calling an ambulance. Incompetent asshats.) So the trio takes off for the ER.

Around this time, Sonia calls me and briefs me as to what’s going on. I hang up quickly, call my mom and ask her to urgently meet me at the ER; Sonia’s sick, I need to be with her, and can she PLEASE take Allison home. Her answer is an obvious yes. Great, we have a plan. I fly out if the office like a bat out of hell.

I don’t know how fast I drove to the ER, but it seemed to be at the upper capability of my 1998 Honda Accord. Let me take this opportunity to apologize to anyone driving on my route that day. I’m not normally that aggressive.

I walk in to registration. Sonia is in a room being treated. The preschool director has Allison. I thanked her profusely and she goes home (she had done enough as it was, saving my wife and caring for Allison). Here’s a small problem; Allison hasn’t had lunch. And hell hath no fury like a four year old one hour late on a meal.

I call my mother and instruct her to please meet me in the hospital cafeteria. Normally, we try to eat fairly healthy. We’re not nutty about it, but we try to be reasonable. However, this was not the scenario for today. Chicken strips! Great, we have the fried, strip food group. French fries! Hooray! We need the saturated with grease group! Milk! The carton looks like it still might be good! We have a winner.

At this point, I should explain something about my daughter. She’s wonderful. She’s smart. She’s tenderhearted. And she’s the slowest god-damned eater on our side of the Mississippi on a good day. Since she had my attention, her pace was even slower. A bite of chicken strip. Dab the mouth with a napkin. Smile at Daddy. Nibble a fry. Dab the mouth again. Smile at Daddy. Take a hummingbird sip of milk. Smile at Daddy. Repeat. I love her, but I thought my wife was going to die, and the last moments of our marriage were to be spent on my end watching a child eat like someone who had time for a seven course meal. Not a Hollywood ending.

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Sonia, post ablation in 2013, with Allison (the child that turns a ten minute meal into a one hour affair).

My mom showed up. I kiss Allison and tell her to have a good afternoon with Grandma. I kiss my mom and sprint to the ER. They direct me to Sonia’s room quickly. I run down a hall, burst through the door and…

She’s sitting up by herself. She’s fine. What the hell happened?

As Sonia explained it, the ER workers descended on her like her life depended on it. Two ER docs. Two nurses. A tech. An EMT. And that’s who she remembers. She gets an IV, gets hooked up to an EKG. She hears commotion. “Is that SVT?” They slam home a medication (adenosine). More commotion. “Did the waveform change?” “I think so.” “What about this signal?” “She’s still kind of fast.” “Are you sure?”

Sonia pipes up, “If it makes any difference, I FEEL better!”

And then the room calmed down. I was there shortly after all the hub-bub; I missed the show. They monitored her for a few hours. I asked Sonia what it felt like to have her heart stop. Could she feel it? I’d administered adenosine to infants once or twice in emergency situations. But she could describe it. Her response: “It’s like waiting for the LONGEST SKIPPED BEAT EVER to go back to normal.”

We went home that afternoon. She wound up seeing a cardiologist, and getting a cardiac catheterization and ablation (to fix the malfunctioning circuit) several weeks after that. She’s never had a problem since.

After that, I took even more time explaining medical problems in emergent situations. Did it help? I hope do. I think so. I wasn’t bad before. But my gut had the same knowledge my brain did. My gut believed. That’s a game changer. In my mind, I could have lost my wife; widower and single parent of two young children at 35. That’s not a reality I was going to vote for. In hindsight, that was an unlikely outcome. But it felt scary. It felt real. That’s how the families that had sick children felt when I talked to them. In away, our “guts” had a shared experience. That can counts for something.

I don’t know if there are any shortcuts to empathy. The world needs more of it. We all have some, and more can be nurtured, via family, via experience. Lord knows I’m not perfect, but hopefully I had more than enough empathy (and smarts) when necessary. We can always learn and use MORE. And I’m thrilled my wife came through the other end relatively unscathed. But I must be getting uglier; I can’t make her heart race anymore. I’m OK with that.

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Sonia, about 4.5 months pregnant with Allison, at her surprise 30th birthday party in Jan. 2008.

Author: Jason Kesselring

I am a 40 year old pediatrician on sabbatical, happily married, and a father of two wonderful children. I fell out of the Ugly Tree, and hit every branch on the way down.

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