A Match to the Heart (14 page)

In the hallway I asked if he converted heart rates often. After all, I'd seen him do a cardioversion with a defibrillator earlier in the week. “It only happens once in a while,” he said. “It's unpredictable. Patients just need to be touched, that's all.”

chapter 19

Does fire put out water? The smell of fire woke me and the eaves of my cottage framed maundering banners of smoke. I had heard how midwestern rivers can combust into rivers of flame, how gaseous slicks that look like floating galaxies can explode. Sometimes I imagined water was made out of flame, that rapids and waterfalls were incandescent coals, and that when fire trucks came their hoses spewed out sparks. But this was no house fire. A city—Los Angeles—was burning.

Balance that against the beauty of my long-legged friend Hillary swimming at dawn, her body curled inside a translucent wave, just her flippered feet waving, then her head bursting up in the midst of a school of dolphins and her loud yip of joy. For a moment I couldn't tell which fin was Hillary's, which a dolphin's.

By afternoon smoke hovered over water. Beneath, brown kelp was the rubble of burnt buildings. The surf was up, trying to vanquish what had already been destroyed. I sniffed the air and remembered the stench of my own body in the bathtub after being hit by lightning.

I couldn't sleep. It still startled me to be able to turn on a television and watch round-the-clock news after seventeen years of one or two fuzzy channels in Wyoming that went off the air at 10:00 P.M. On CNN I saw two handsome African-American men saving a Japanese man from being beaten by whites, black men beating up a caucasian truck driver, white cops bludgeoning a black man, and African-American rioters robbing Koreans. Every racial and cultural line was like a hot wire that had been crossed. One call from a friend in Los Angeles came through. After driving to his house across the city at midnight, hours after the mandatory curfew, he said: “No one stopped me, no one bothered me. It was like
On the Beach.
I think I was the only passenger car moving in the whole city.”

 
 
In the morning, fog rolled in backwards over smoke, then folded into waves, closing them so they couldn't break, as if sealing in rage. A dead seal floated by with birds perched on its bloated side, picking at its flesh. Jim, who lived down the beach, ambled by with his usual cigarette and glass of lukewarm tea in his hand, because Dennis, his dog, was lonely for Sam. As they played, Jim scanned the smoky skies: “It's all those shelved screenplays of mine burning. It'll take years to get them all,” he said sardonically. The rioting continued.

Blaine was on call that night and I decided to visit him. A long-time patient of his came in at 8:00 P.M. with a massive heart attack: a heart rate of 240 beats per minute and falling blood pressure. Because she had not called for help immediately when the pain began, she lost 50 percent of her heart muscle, since tissue death occurs when there is no blood profusion. An hour later, when I arrived at the hospital, she had already gone into cardiac arrest twenty times. “I've never had a patient arrest that many times in such a short period and survive,” Blaine said. “And she's no spring chicken, either.”

Small, light-haired, in her late seventies, Alice refused to give up, though very few people live if they've lost that much cardiac tissue. “Each time she arrested, she seemed to remain conscious: she couldn't speak but she looked me straight in the eye as I stood by the bed with the defibrillator paddles in my hands. I kept warning her, ‘This is going to hurt a little,' and she'd give me a nod and a look that said, ‘Do whatever it takes.' ”

The first time, Blaine zapped her at the lowest wattage, which, he said, feels like someone punching you in the chest, but that didn't do the job, so he upped it to 150 watt-seconds. Still nothing; and then 200 watt-seconds, which feels like a horse kicking you in the chest, and finally her heart started. “In the twenty times I had to do this to her she kept smiling and never complained.”

Blaine stayed with her all night taking wolf naps in the room next door. During that time she slid into somnolence because of the low oxygen content of her blood. “She responds better to you than to us,” one of the nurses said. Though she appeared unresponsive, he talked to her. “You're doing better, Alice.... I'm right here,” he said.

Blaine asked for a new blood panel: potassium, calcium, and magnesium levels were checked. When Alice became confused, Blaine suspected her sodium level was low, so they restricted her intake of fluids and she became coherent again. At midnight he called one of his partners and went over a checklist of things that could be done for her. No omission could be found. “She's only got about a thirty or forty percent chance of making it through the night,” he said, “but she's got one hell of a spirit.”

The beeper went off: a man had been admitted to the ER with rapid atrial fibrillation—an arrhythmia. As Blaine worked to convert his heart to a normal rhythm—first by touch, then with medication, the cardiac care unit called with the code “911,” which means cardiac arrest. Blaine bounded up the stairs. It wasn't Alice but another man and Blaine proceeded with his twenty-first resuscitation of the evening.

He checked Alice and decided to put in a temporary pacemaker to override her quixotic heart. This procedure took half an hour, and afterward, Blaine lay down in the room next to Alice's, but no rest was forthcoming: there was another arrest in the ER. “Maybe dermatology isn't such a bad idea,” he said, descending stairs to the ever-bright emergency room.

Alice slept quietly, but with breathing tubes and a Swan catheter in her neck, she hardly looked human. Blaine went home, slept an hour, showered, and dressed for a new day of rounds and office calls. He called me at seven: “Alice has come out of it,” he said excitedly. When he'd stopped back at the hospital she was sitting up and smiled at him as he came in.

“Unbelievable,” Blaine said later. “Is it really the same woman? She shouldn't even be alive. I thought I'd lose her last night. That's what I told her daughters. I worried so much.... God, I'm wrung out.” When Blaine went in to see her she pulled him close and said, “I care so much for you.” There were tears in his eyes. “I care for you too, Alice. You've made a remarkable, almost unbelievable turnaround.” She was so well at the end of the week they sent her home.

 
 
Survival is as much a matter of grace as fight. The expression, “grace under pressure” implies the attainment of equanimity and equilibrium. The fundamental durability of the human body surprises us because the pain can be so intense—yet pain is often transient and hides the tremendous efforts the body is engaged in to heal itself.

We're almost always unaware of the interior adjustments being made: chemical changes, dead brain cells being carried away by scavenger cells, new dendrites forming with each new thought and memory, tissue healing, heating, and cooling, blood pressure and heart rate adjusting, kidneys and lungs interacting ... It's not that this self-regulating system can't be overwhelmed and stop working, but so many variables make up the living and healing process, it is often impossible to know who will die and who won't, and why. Add to the biological mechanism the mix of doctor, nurse, and patient—another kind of chemistry—and the possibilities for disaster and miracles grow.

“A positive attitude is absolutely critical,” Blaine said. “If I walk into the room of a heart attack patient and see fear in his or her eyes, I know my main job is to get rid of that fear. If there has been tissue damage, life or death can depend on the health of the peri-infarction zone—the area around the wall of the heart—which in Alice's case wasn't moving at all. Fear releases catecholamines, which increase heart and blood pressure rates, which in turn can kill off that fragile zone. Then there's nothing left.”

 
 
 
Twenty-four hours later Alice was back with chest pain. They did what they could to make her comfortable, and almost immediately, she improved. Blaine went off call that afternoon. He badly needed rest. At fifty-six he's vigorous but not indefatigable. The last time he saw Alice she was sitting up in bed eating dinner. Late afternoon sun streamed in her window and her reddish gold hair shone. He told her she looked beautiful. That night she had another round of cardiac arrests. The doctor caring for her—not one of Blaine's group but a doctor who didn't know her—had no luck keeping her alive.

chapter 20

At the end of May, Kate, Clyde, Jim C., Hillary, Jim, and I had our final barbecue dinner. Steaks and snags on the coals, artichokes and avocado salad, fennel bread, and Australian cabernet, while the dogs stretched out in cool ice plant after hard play. In two days Kate would leave for Australia to see her mother, Clyde would go to San Francisco to stay with his son, Jim C. would begin rewrites on a screenplay, Hillary would begin her book of “sealosophy,” her husband, Jim, would go out on his boat to dive for abalone and sea urchins, and I would finish packing up my house, the lease being up, and drive with Sam to Wyoming.

“It will never be the same down here,” Kate said. By midsummer she and Clyde would move into their newly rebuilt house, and on my return in late August, I'd be moving to another part of town altogether, if and when I returned. The casual, dog-filled intimacy of that cove had been broken.

 
 
I counted down the days: four left. Each was more brilliant and balmy than the last. How could I leave? Sam hung his head over the seawall, scanning the beach for dog friends. Impatient with my packing, he finally took off, running the half a mile to Dennis's house, and together they ran up the beach to see me.

 
 
When the fog came it filled my veins like a narcotic. I dozed on the couch, surrounded by half-packed boxes. It had been almost a year since the accident, yet I didn't want to move; I didn't want to leave. I was still so tired. On June 13, the day before my departure, Blaine gave me a last blood pressure test. When I stood after lying flat, my pressure dropped twenty points, but my heart pumped valiantly—as it should—in order to deliver more blood to the brain. But at a price: I felt clammy and broke out in a cold sweat, and the old chest pain started up again. On the other hand, the fact that my heart was compensating for low blood pressure showed that I was getting well. In the morning I started on my journey home.

chapter 21

Mid-June. I was in new skin: no history, no past, no future, only the present becoming more of the present.... I drove past condor sanctuaries, up the eastern slope of the Sierra, past Manzanar, and the water-poor Owens Valley. Just beyond Bishop, it began to snow. Six hours into the trip, I was too exhausted to drive farther. I pulled off onto a wide sage flat, bundled up in a sleeping bag, and breathed in the piquant mix of sage and snow.

When I woke, lightning was breaking over my head, its branches tangled in clouds, and all across northern Nevada thunderstorms collapsed on top of me. I drove in a trance, each lightning stroke a sword driven through my back, pointing at some new spot on the map. Sometimes Sam and I huddled ridiculously in the middle of the seat by the side of the road. Lightning was hunting me down on this lonely Nevada highway. “What are we doing here?” I asked him nervously. During another storm, we drove recklessly on curving mountain roads with a Shostakovich symphony turned up full blast, wishing we were already dead and being ferried away to the underworld.

Halfway through the journey, I received news that one of my dearest friends had died in a car accident. Attending his funeral was my first act on returning to Wyoming. The ceremony was in the high school gym and five or six hundred people attended. Bruce had been a newspaperman all his life. He could build a story out of vapor; he also loved good champagne and well-bred horses.

The whole town was there in its ragtag splendor. A young woman sang his favorite song to the accompaniment of a tape played on a bright yellow ghetto blaster, and the bleachers in which we sat were alive with random snippets of gossip. I overheard someone say, upon seeing me walk in: “Hell, I thought she was dead too.”

Everywhere I went people told me lightning stories: of seven cows lying dead in a circle around a lightning-struck tree; of five horses, all killed walking a fence line; of the pointed ends of rowels in spurs melting; of a horse with a white streak down his shoulder and across his belly where he was struck; of houses exploding; of ball lightning coming down the chimney and bouncing into a baby's crib; of sheepherders walking for days unable to remember who or where they were.

Afternoons, storms dominated. The sky was so dark we had to turn lights on. At Stan and Mary's ranch lightning struck the field where their son was haying; a park ranger was struck while opening a ranch gate, and in Big Timber, where I visited a friend who is an EMT, a storm broke out during the rodeo and for safekeeping she made me sit in the ambulance. Sometimes I got up in the middle of the night and watched lightning flash whole mountain ranges in and out of existence and tried to understand how such a vast and distant phenomenon could have entered me.

The ranch looked the same but was different. The pastures hadn't been cut for hay, no irrigating water was set in the meadows, beavers had built a domed house attached to the lake's tiny island I called Alcatraz, and in the process had cut down the fringe of willows where grackle nests once hung in protective safety over the water. It was wonderful to see the animals—cows and calves, horses, dogs. Rusty was deaf and and didn't recognize me. He walked sideways because his left hip had given out after seventeen years of working livestock, but his eyes were bright and peaceful. Sam and his sister, Yaki, and I walked up to the spot where we had all been hit, but there was nothing to see.