Heart Block

Rule of Life 72: if your mother calls for health advice, act fast. Case in point, about 5 years ago my mom called with a health question on a day where I just happened to be off work. She was dizzy, tired, and having a hard time breathing. After a brief conversation that ended in “I’ll be fine, I’ll just lie down for a bit,” I drove over to my parents house. As it turns out, you can get a Prius to go from zero to sixty in 2 seconds, you just have push down really, REALLY hard on the accelerator.

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We all have roles in life. Some are conscious, others subconscious. Sometimes, we fall into old roles and habits around select groups of people. We have tendencies, all of us. It’s not always bad or good, but rather something that just IS.

This is especially true of families. I’m the middle child, the peacemaker, the pleaser. If I have a problem I need to discuss, I reflexively look to my older sister. She’s the leader. If my Big Sister can’t fix the problem, maybe I really am hosed. My brother is the extrovert. He can find twenty friends in a room of 15 haters. It’s a skill I’d like to have.

In the best case scenarios, these relationships hopefully grow and are more malleable over time.

Case in point. On some level, I will always be my parents’ stupid kid. The obnoxious guy that doesn’t quite know when to shut up around them. The comedian. My mom would love to get a loving, sweet, and touching birthday card from me. It ain’t happening, folks. Or if it does, my mother knows that I must have a terminal diagnosis and I’m atoning for my old sins. And that would be much, much worse. For instance, one year for her birthday I gave her a birthday card with a picture of a chicken and a coiled spring on the front; inside, it read, “You ain’t.” (Look, my mom and I have this relationship… when I was a sophomore in high school, my mom tried to kill me twice in one day. She was baking something in a 400F oven and asked me to get it out for her. She bumped into my butt I was leaning over to pull out the item, a “mistake” as she terms it, and I nearly went head first into the oven. We then took the item to a potluck, and when arrived there, I was climbing out of the backseat, and she slammed the car door on my head. The hint was not so subtle. Come to think of it, maybe I should be giving her nicer birthday and Mother’s Day cards…)

To my mom’s credit, she knows that I don’t joke around when it’s important, even if I’m an annoying ass from time to time. I know when the joke is over, and she knows that she can trust me. That was driven home this past Thanksgiving.

I’ve told the abbreviated version on social media, but I think this is a good platform for the long form ordeal here.

My mom loves to cook Thanksgiving dinner. It’s her meal. As my folks have gotten older, they have relinquished some of their traditional duties. I don’t think the clutches of Death himself (I’m envisioning Death to like the depiction in Monty Python’s Meaning of Life. “Oh,no! The Salmon! I’m so embarrassed!”) can take away cooking that meal from her. We’ve suggested going out for Thanksgiving dinner ONCE, and no dice. It’s just her thing.

My mom tells a great story when she and my dad were first married, they took a trip to the beach. They were buying food in a grocery store when another guy asked my mom how much pasta he needed to buy for 4 people. My mom told him “two pounds.” I think he’s still waiting to throw leftovers at my mom. She sent care packages of food to me in college. I always had a huge appetite because I was running cross-country and track. She cooked dinner for 8 hungry runners when we were in St. Louis for a U2 concert in 1997. There were at least 3 lasagnas, tons of break and salad, and a cheesecake to boot. There wasn’t a scrap of food left. Food, according to my mom, fixes problems.

A few years ago, we did manage to convince my mom that if she’s going to cook huge on Thanksgiving, then perhaps the night before we should go out to eat. There’s a nice Thai restaurant close to our house, so that fits the bill. We eat, tip the servers nicely, and go home sans the mess. This year, due to our schedule, it was Wednesday-before-Thanksgiving-lunch-out. It worked great. A full meal at noon, and leftovers for dinner. Even less of a fuss for the day. We’re on to something.

To be upfront, my mom has lupus. She stays active and takes good care of herself. She’s also very tough (it’s where I get it from), and so sometimes she has a hard time reconciling that if she doesn’t feel well, it probably means 95% of the world would already have a bed in the hospital. It’s a balancing act.

At lunch, my mom casually brought up that she wasn’t feeling well that morning. She had gone to the store and felt short of breath, and her arms/hands were intermittently going numb. She felt tired. The old physician in me said something to the effect of, “Mom, at your age (she’s 39 + 39) that can be your heart.” She stated she felt better and seeing as how she ate a normal lunch and was goofing off with our kids, I took mental note of this. “We’ll see how this plays out.” We finished lunch, made plans when we should go by their place the following day, and hugged our goodbyes. A pretty typical lunch. I didn’t think too much about it after we were home.

This is the part where I tell all of you that if my mom calls me with a health question that I respond faster than a New York minute. Rule of Life 72: if your mother calls for health advice, act fast. Case in point, about 5 years ago my mom called with a health question on a day where I just happened to be off work. She was dizzy, tired, and having a hard time breathing. After a brief conversation that ended in “I’ll be fine, I’ll just lie down for a bit,” I drove over to my parents house. As it turns out, you can get a Prius to go from zero to sixty in 2 seconds, you just have push down really, REALLY hard on the accelerator.

A side story made somewhat shorter, my mom looked horrible when I got to their house. I took her to an urgent care (probably should have been an ER, but this ends well) – also doing 70+ in a 40 mph zone. They really should market the Prius to a wider audience. She was having an allergic reaction. After some steroids and diphenhydramine, my mom looked much better. The kicker is that it turns out my mom has developed a hazelnut allergy. As it turns out, the offending agent was a lunch that involved Nutella. My mom loves (loved) that stuff. I really can’t think of a much crueler, less funny allergy. There are multiple permutations of the desert knows as “Death by Chocolate.” Maybe my mom should trademark “Death by Nutella.”

With those two intervening, sidebar paragraphs, my mom called me just a shade before noon on Thanksgiving. She had gone to bed at 4 PM the day before due to exhaustion. She woke up on Thanksgiving morning and felt worse. Her hands went numb again. She was so tired, she couldn’t even begin to prep for making Thanksgiving dinner.

Al Unser Jr. would have been proud at how quickly I got over to my parents’ house. I asked my mom a few questions, and then, I decided to take her pulse. Actually, Sonia packed my stethoscope. I listened to my mom’s heart. Then I noticed something.

“It’s funny… there shouldn’t be that much time between heartbeats. Why, I’ll just pull out the timer on my cell phone and check this. Well, kick me in the groin and call me Squeaky! Her pulse is 30!”

For those not inclined with medical or nursing training, a resting heart rate should be 60-80. If you are really fit, like Shalane Flanagan or Meb Keflezighi fit, something in the 50s or upper 40s might be ok. Seeing as my mom was neither a marathoner and she’s 39+39 years old, I decided this was a decidedly abnormal result. I don’t have a diagnosis, but I know the problem. Her heart was beating much too slow. Like “I hope she doesn’t die” too slow.

I kept my best veneer of calm, while wanting to strike the right tone of urgency. “Why don’t we go to the hospital now?” I may have had too much calm, as my father had to put his shoes on. The only nickname I know that my father has is “Snag” – given to him by my uncle Warren after a cartoon character. It is duly noted that his nickname is not “Speedy Gonzalez.”

We got my mom to the ER, and she was taken back quite expeditiously. I think that was due to a few factors – the ER wasn’t crazy busy, her age, she had the right symptoms, and she looked like she just might fall over. The nurse and an EKG technician hooked her up to a monitor and 12-lead EKG right away. The monitor and nurse confirmed the pulse in the low 30s and left the room. She came back with the ER doctor.

I don’t remember an exact sequence of events after that. The ER doctor was super nice. He told my mom that she was in heart block (basically, the ventricles – the real “pumping” chambers of her heart – had their circuit cut off from the normal pace-making abilities of her heart. One’s ventricles have an escape rhythm where they can keep you going for a bit – probably not indefinitely). Her blood pressure was alright; so she got an IV and some blood work. And then we waited for a while.

My mom “didn’t want to be an inconvenience”, so she started suggesting to my dad and I that we should leave. She’d call us when a plan had been decided. We both politely declined; it was Thanksgiving, and presumably I would have been helping my mom and dad cook, and I’d be keeping my eye on a football game. I was doing essentially the same thing now. My mom insisted; so did we. We were staying for a while.

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In the emergency room with my mom.  You can see that she’s thrilled with me.

We carried on like this for an hour or so. I pulled out a phone and took a picture of my mother. I told her if she asked me to leave again, that I was posting the picture of her in her hospital gown on Facebook. This only stopped her for 15 minutes. So, I took a video of her. “Who’s grumpy? Is someone grumpy?” I started narrating a video for about 30 seconds. I told her if she asked me again, the video was going on Facebook. She didn’t ask me to leave again. Sure, the quasi-blackmail was questionable on my part. My methods are sometimes unorthodox, but effective (my kids will back this up). Besides, I love my mom, and it’s bad karma to leave your momma in the ER by herself.

We waited. And waited. And then waited some more. And then we ordered a second helping of waiting. The ER doc came back and asked my mom how she was feeling. “When do I get to go home?” She was somewhat surprised to hear that one can’t walk out of the hospital with a pulse of 30. Quite the contrary, they were booking her an ICU bed. The plan, as long as she stayed stable enough, was for her to get a pacemaker in the morning.

At this point, I needed to call my siblings. They needed to know what was going on. They both live out-of-town. My brother had to burn some vacation, so he was in Australia. I wasn’t quite sure how to strike the right balance with him. Realistically, even if he needed to get back home, given time changes and logistics, it would be at least 36 hours, if not longer. I didn’t want him to worry too much, but he needed to know what was going on with mom. We had a good conversation, and just let him know, that given time differences, I would text him if things went alright and call him if it was an “Oh, shit” scenario.

My sister had initially wanted to be in town for the holiday. Unfortunately for her, the weekend before, she had fallen out of bed (it’s elevated more than a typical bed) and hit her head on a table as she fell. She had a significant concussion. When I had spoken to her on the phone before all this had happened, she sounded muddled, like a mixture of Xanax and wine (a.k.a. The Keith Richards Cocktail). She was in no shape to be a passenger in a plane, train, or automobile, let alone drive herself to St. Louis. Again, I didn’t want to panic her, but this is Mom. She had to know. Her only request was for me not to text her, but call her with anything, as her post-concussion symptoms made reading anything off a screen with back-lighting nearly impossible. It had to be difficult for her, wanting to help out here, but effectively being out of commission through no fault of her own.

Sonia came up to the hospital to bring some food for my dad and I (my mom was NPO – no food for her). We ate tamales and chili as quickly as we could. Sonia may not be Kesselring by blood, but she might as well be. Food can fix anything. We weren’t complaining. Rather, we burped our gratitude as politely as possible.

By the time my mom was sent to the ICU, it was early evening. My dad and I divided duties; I would take tonight so he could go home and rest. He would take over in the morning. If anything went down that night, I would take care of it. My dad went home, and I stayed with my Mom until she was tucked in her ICU bed. I met her ICU nurse – we chatted briefly, and he gave me the password to use if I needed to call up in the middle of the night to see how she was doing. I told my Mom I loved her and I would call before I went to bed. I went home – it was probably 9 PM, give or take a few minutes.

I spent an hour or so at home. Sonia updated me on what I had missed from the day. We chatted, and I tried to unwind as best as I could. Long, long day. Just one more thing to do – call and check on Mom – and then I could sleep.

I got my Mom’s nurse; he very kindly but quickly informed me that the doctor was worried about my Mom and that she *might* wind up going to the cardiac cath lab tonight. Years of reading between the lines with my nursing friends taught me to interpret what that meant – get my ass back to the hospital. Now. I kissed Sonia goodnight and got back to my part hybrid, part NASCAR Prius.

When I got to her room, my mom apologized to me. As if she had control of going in to heart block in the first place. She’s just too sweet. I gave her a hug, and escorted the team taking her to the cath lab as far as I was allowed. I was shown to a waiting room where I would stay during her procedure.

There wasn’t much to do except wait, so the room wasn’t creatively named. I wasn’t sure what to do. I couldn’t focus enough to read, and I couldn’t sleep at this point. I grabbed a coffee and sat down in front of a TV. I turned it on, and The Godfather, Part 2 was on. I’m not a mob movie fan per se, but it’s almost a rule – The Godfather is on (parts 1 or 2), you have to watch it. I’m almost powerless over it. It just happens.

I waited maybe 45 minutes, and the phone in the lounge range. The cardiologist would be there to talk with me in a minute. My mom was out of the procedure and doing fine. I paced the room briefly. The cardiologist came in and spoke with me. In short, my Mom was going to be OK. They did a cath, and her coronary arteries were clean, which was a bonus. He put in a temporary pacemaker, and tomorrow they would place a permanent one. He was kind and polite, and I couldn’t thank him enough.

I also had a hard time focusing on him. You see, I made a tactical error. I had left the TV on, and while the doctor was explaining how my mom was doing, the movie was still on. In fact, it was the scene where Robert DeNiro stabs Don Ciccio to death to avenge his father’s murder. It’s really hard to pay attention when an old man is screaming due to being shived in the McRibs by a young mobster. The life lesson I learned is to turn the TV off immediately upon hearing “The doctor will be there to talk to you in a minute.” Sometimes it’s best not to extrapolate life lessons to other scenarios.

I gave my Mom another hug (again), told her I loved her (again), and I left the ICU (again). I texted my brother and called my sister with the update on our Mom. I drove home for the second and final time that night. It was a short night’s sleep as we had a busy day ahead of us. I needed to get back to the hospital before my Mom’s procedure to get a pacemaker. Then, my Mom had us promise that all her Thanksgiving prep work wouldn’t go to waste. So we needed to go to my parent’s house and bring turkey, bread for dressing, salad, and other assorted items to our house so we could cook dinner later that weekend (food is never far from our collective minds).

I got to the ICU before my dad. When I saw my mother, she looked ten times better. It’s amazing how much better one feels and looks when their heart can pump blood effectively. My mom wanted to move in the most desperate way; she couldn’t move as she still had the catheter for the pacemaker in her leg. She kept trying wiggle and set off alarms. When the nurse came in, she expressed how important it was that my Mom be still. The catheter is stiff enough that if she were to move too much, my Mom could tear a blood vessel and bleed internally in a most heinous manner. She had a way of reaching my Mom in a way that I never could, and if socially acceptable, I would have hugged her as she was the first person to ever make my Mom a compliant patient.

Things moved quickly after that. My Dad tagged in and I tagged out. Sonia and I cleaned out my parents’ refrigerator. We entertained Andrew and Allison for the afternoon. I went up to see my Mom after her procedure, and she was in a regular room. She looked really good. Again, it’s amazing how much better one can function when your heart is in normal sinus rhythm.

On Saturday, we cooked Thanksgiving dinner. My mom was released from the hospital and my parents came over in the late afternoon. Even after working in medicine for a long time, some things never cease to amaze me. As of Thursday, when I had raced over to my parents’ house, my Mom was lucky in some respects that her heart didn’t crap out the night before. In 48 hours, she felt good enough to eat a real meal. On Monday, she made it to Andrew’s basketball game. Incredible, and it has been upwards and onwards ever since.

I didn’t get to reflect much after I was hospitalized with meningitis. But I’ve had a chance to reflect here. I did ask my mom if she was scared that she might die during the ordeal. At first, she said “no” (this was a day or two after being released from the hospital). A while later, she changed her tune a bit. She realized it could have gone differently.

I know that some people, when they have serious illness (or have a terminal illness), can truly be at peace with their situation before they die. As if they have reconciled it and deep down, to their core, they are really OK with it. I wonder if it is a maturity thing, an insight thing, or a stage of life thing. I don’t know how I would react if I knew that, unless I got hit by a bus, I would die of condition X. Or that a loved one would die of condition X, where you could see it coming, but not do anything about it. I hope that I don’t ever get to have that specific of insight, and I don’t wish it on anyone. Those that go through it and can hold themselves together have my unending respect and admiration.

Living like it could be your last day, to me, doesn’t mean 5 shots of tequila and dancing on table tops. It means living with meaning and purpose. It means taking care of your loved ones, by blood or by your choosing, no matter what the circumstance. It means sharing experiences with important people. It’s the journey and the destination. And it certainly isn’t a bank account.

We see my parents at least once a week – usually for Sunday dinner. I’m still a pain-in-the-butt. When I hug my Mom goodbye, I now scream and yell like I’ve been shocked by her pacemaker. She hasn’t stopped laughing, at least not yet. I’ve gained some insight, but I’m not so deep and looking for meaning in every moment that I’m going to stop pushing her buttons. I might be her idiot kid, but I’m no idiot. And thankfully, I don’t (as of yet) need to get her a sappy Mother’s Day or birthday card, as long as her heart rate stays above 30.

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Only one month later, my mom looks great. Actually, we clean up pretty well, if I say so myself.

Author: Jason Kesselring

I am a 41 year old high school chemistry teacher (and former pediatrician), 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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