Coming Up For Air

I DIED ON this day last year.

Well, let me back up a step.

I was drowsing uncomfortably in a swanky private clinic in oldtown Heidelberg, dormer windows thrown open to a warm, glowing summer evening. It was the second day after my disc replacement surgery, and I felt like hell—sore, irritable and dispirited. An hour earlier the nurses had tried to help me to stand (doctor’s orders), but I had barely been able to sit up and dangle my legs over the bedside. Getting my feet onto the floor and putting any weight on them was just out of the question.

Preposterous, I thought. I had been under the knife for six hours; it plunged into the navel, through a sheath of muscle, around viscera and arteries, to my desiccated fourth lumbar disc, which it scraped out and tamped in a titanium replacement. The invasion assailed my whole body; the hours of controlled anasthetic death left behind a narcotic lethargy I felt no will or ability to shake off. Stand? It seemed to me the nurses might as well ask me to start up a wrecked car and drive it. After my pathetic effort I just wanted to sleep, and I asked for my second dose of morphine that day, 15 minutes ahead of schedule.

Some short time later, Marcus, one of my nurses, came to take a routine blood sample. He slipped the needle into my forearm and began to draw. He asked me how I was, but he was unsurprised when I didn‘t respond. The morphine had taken effect, and I was in a deep opiate sleep, finally. It had been a long day. Marcus finished his draw and got ready to walk away.

Then he noticed I was turning blue.

But I’m getting ahead of myself again. Or to put it more precisely, I’m getting outside myself. I have no direct knowledge of what happened in my room that evening between six o‘clock and eight thirty. The patchwork of information that fills that gap came from others—nurses and doctors who broke the calm of that golden evening, rushing, shouting, crashing a ventilator through my doorway, and, in the process, disturbing the peace of my fellow surgery patients. We had all been promised in the clinic’s brochure we would recover in quiet luxury, and up until the eruption of activity in my room, that is what we had been doing.

The loud, jagged reality that called me back to consciousness that evening started as an inchoate, desperate feeling that I had been under water too long—far too long—and I was coming up for air. The darkness shattered and became suddenly, violently bright.

Junger Mann, junger mann, kannst du mich hören?” The voice was loud and hoarse, in my face, rising to outdo a profusion of background noise. It did not belong to any of my nurses. Why was a stranger seeming to plead with me to hear him? But I was too occupied heaving for breath to feel properly curious. Taking in great gulps of air as fast as I could, I was getting only the tiniest sips of what I needed, and felt I was falling behind. I was still drowning. Improbably, a chorus of voices around me began to say, as if to reassure each other, “Er atmet wieder.” He’s breathing again.

Only barely, I gasped inwardly. I cast wildly about to consider why that was the case. Hadn’t J just drifted off to sleep on a beautiful summer evening? Why did I feel like I was drowning?

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In my ear, an electronic voice clacked and instructed someone—me?—to breathe normally. The even, minatory words repeated in a loop, like an emergeny weather announcement. Although I was l little aware of what was going on, I pieced together that the voice belonged to a machine, and the machine attached through a tube to a mask on my face. That’s why I couldn’t breathe; my mouth and nose were covered. I tried to remove the mask, but a hand descended to cover mine, holding the mask in place.

Looking back, this was the moment I began to make crude sense of my situation. I had fallen too deeply asleep and my breathing slowed. I’ve always been a deep sleeper, and the morphine took me too low. The clattering machines and swirling bodies must have been there to pull me back up and get me breathing right again. My account of the situation was, I would learn later, on the right track, but I was indulging my usual bias for optimism. It’s funny how we revert to form.

 

“Ok, call his wife and tell her there was a pulmonary insufficiency,” said the man who had implored me to hear. His voice was calmer now, but only slightly; he sounded like an athlete still on the field after a big game. “Tell her that he’s going to be in the Uni Clinic and give her the phone number.” The voice must belong to the attending doctor, I thought. My breathing was improving to the point that I reined in my drowning panic, but I now became aware of an ache in my chest.

I took it as a good sign that I could still understand German. Whatever had happened, my brain had not gone. I raised my hand to wave the doctor over, and between gasps I aksed him if I had had a heart attack. “You had a pulmonary insufficiency. We are calling your wife to let her know, and we are arranging to send you to the University Clinic.” I noticed, or perhaps I recalled days later, that he did not begin his answer with “No.”

For reasons I didn’t understand at the time, I then proceeded to the Heidelberg University Clinic. Wasn’t I already in a perfectly good hospital? I was rolled on to a gurney, taken down the elevator and deposited in a waiting ambulance.

On my way down I paused mentally. Why was the bed I was rolled out of so hard? And why had I been unstrapped from it? My bed didn’t have straps. I recalled from my EMT training years ago that we had secured cardiac “patients” on a rigid plank called a backboard to enhance the effect of chest compressions. Had I been strapped to a backboard?

The drive to the University Clinic was exquisitely painful. We lurched and bumped over the cobblestones of Heidelberg’s oldest, most corrugated streets.  I had been given a counter-agent for the morphine, and the pain bloomed unmedicated  from an epicenter at my fourth lumbar vertebra. When we arrived, I was wheeled through the hot darkness of the night to a floodlit double door marked “Chest Pain Unit.” Strange, I thought, I did have chest pain, but hadn’t I just been told by a doctor that my “deficiency” was pulmonary?

Lying there in the heat and darkness, all I really wanted to do was call my wife. The message I knew she would receive—”pulmonary insufficiency”—would be just enough to alarm her, and I wanted to give her a proof of life, not life struggling to hang on, but my own, normal life, albeit in a drowsier, inconvenienced form. I therefore economized the truth when I reached her. I had fallen asleep too deeply, I said, and my breathing had slowed down to a worrisome rate. It was basically my original construction of the events, which I suspected of lacking detail but which I nonetheless stamped and sealed as the official version. It would do for the moment.

Another patient in the open-air ward was also on the phone. He had had a heart attack. An elderly couple were making solemn, muffled conversation, which, like my inner monologue, strained to find a bright, domestic theme. He had had a heart attack too. I felt my chest and wondered if I was in the right place.

Eventually a doctor arrived. He looked at my chart and told me my breathing had stopped after an overdose of morphine, and I was being monitored for cardiac problems. There had been no cardiologists on duty at my private clinic, so I would spend the weekend with them at the University Clinic. I passed a miserable night, refusing anasthetics and thrilling to the variety of unanswered alarms that plague an emergency medicine ward. They seemed designed to prevent sleep.

The next day I was placed in a room whose westard wall was made entirely of glass. I was glad to be through the night. It had been too eventful. The sun of the hottest day of the year streamed through wall-sized window, warming me and evoking, inwardly, the same glad burst Robert Graves felt at finding himself alive after being wounded at the Somme, “Oh sun, oh life!”

After a very short time, though, I was thoroughly roasting, and the poetry drained out of the moment. The room was a furnace; it throbbed with cartoon waves of heat. By what sadistic impulse, I wondered, had the curtains been left open to the massive, thick windows that framed a huge sun that seemed to  hang in the sky mere feet away? Did the resulting inferno not contravene medicine’s first principle to do no harm?

Mopping away sweat, I asked the nurse for something, anything to cool myself. She closed the (inexplicably open) curtains, disappeared, and after five minutes, reappeared, with a small electric fan. I marveled that, in a hospital with hundreds, perhaps a thousand over-warm patients, she had so quickly produced a fan. Then I recalled, with relish, the European’s deathly fear of indoor breezes. I was safe, and I knew it. Even in 100 degree heat, no right-thinking person among the hospital’s masses would covet my fan, capable as it was of producing a killing draft. I turned it on.

I was not a model patient at the Uni Clinic. Despite the fan, the room was still far too warm, and I called the nurse to ask her whether I ought to be moved. It had dawned on me that I had had an emergency the night before, and I thought the precarity of my state might prove useful. Instead of succor, I received a brisk lecture on the general level of disomfort throughout the hospital and the paltry ability of one nurse to re-arrange patients to their personal liking. Partly as a survival measure, partly in protest of the clinic’s pathetic inability to cool, or even ventilate, itself, I stripped utterly and lay naked on my bed. I stayed that way until I was released, two days later.

The nurse left, and I removed my oxygen mask, which had been compounding my misery the whole, hot morning. It was a mistake. My breath began to quicken. I put the mask back on, but my breathing still felt too fast, and a hint of panic returned from the night before. To calm myself I lay staring at the hot, white ceiling, focusing on steadying my breathing. In the quiet, though, I discovered a new complaint—again an ache in the middle of my chest. When did that start? Could it be a mere coincidence that I would have chest pain and shortness of breat at the same time? I called the nurse.

She called a cardiologist, and within minutes, I was receiving my fifth or sixth blood test since arriving. As blood-drawing seemed to be a habitual proceedure for the University Clinic, a kind of casual greeting, I asked, “Can you tell me why you’re testing my blood?” “Of course,” said the cardiologist, “to see if you are having a heart attack. We have a lab test that will tell us in 15 minutes.”

“Well, do you think I am having a heart attack,” I asked, with somewhat forced equinamity.

“It doesn’t seem that way,” he said, “but since your heart stopped last night, we are not taking any chances.”

“My heart stopped?”

“Yes, then you were resuscitated.”

So there it was. My heart had stopped. Much later, when I would receive the University Clinic’s bill, I would see the facts in black and white: “Patient’s symptoms or condition upon admission: cardiac arrest.” Together with my pulmonary “insufficiency,” I had satisfied the conventional definition of clinical death. Which explains why it was so hard, and unpleasant, to come back to the light. I had just dipped my toe into the infinite sea of unconsciousness which preceded my existence and will receive it again. The pull is strong at eternity’s edge.

So where had my chest pain come from? Was I really having a heart attack as I lay there roasting in the University Clinic? Was the ache a lingering illusion triggered the night before by the sign over the doorway of the Chest Pain unit? No.

Marcus, the nurse in the private clinic, filled me in later. On the night of my emergency, when he finished the blood-draw and saw I wasn’t breathing, he checked my pulse. He found none and started chest compressions. I don’t know how long they went on, but when the doctor on duty arrived to give me the morphine counter-agent, he found a pulse and instructed Marcus to stop. I recalled something else from my EMT training. The CPR instructor had told us that real chest compressions, if they are to billow the heart’s chambers properly, go deeper than TV chest compressions, a good two to three inches. It is not uncommon to crack a patient’s rib loose from the sternum while massaging the heart. I had been sore from this rough treatment and remained so for a week.

After two nights of small but continuous horrors in the University Clinic, I was released by the chief physician of my ward. He thought I was back in the clear, and, anyway, it was a Monday, and the private clinic would have its cardiologists on duty again.

During my time in the University Clinic I more or less actively avoided any attempt to comprehend what had happened. Anyway, the hallucinations of morphine withdrawal, the discomforts of the heat, and my rebellion, after the first day, against the policy of keeping me flat on my back round the clock, occupied me sufficiently. I just wanted air conditioning, a chance to try standing again, and my surgeon to tell me that all the banging around of CPR, rough transfers from one bed to another, and the punishing drive through oldtown Heidlerberg had not ruined his work. I felt it had—that I had a worthless piece of titanium bulging outside its assigned position in my spinal column—but, luckily, what did I know? My new disc was fine.

On the morning of my release, the orderlies used a blanket to roll me from my bed onto a gurney. I said goodbye to the nurses I had treated so poorly. In the ambulance, the driver traced the way back to my original clinic, through the old streets again. As we passed over the Neckar River, he announced our position jauntily, like a tour guide, and I knew we were only five minutes away.

Stopped at the clinic, the orderlies slid me halfway out the back of the ambulance, and the gurney’s front legs swung down and deployed with a clack. The sun, directly overhead, struck me full in the face. The light was nearly blinding, but I could just make out the lime-green leaves of the maples and elms lining the street. The orderlies pulled me the rest of the way out, and the gurney’s back legs snapped into place. I was back.

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