Lee Grossman

Lee Grossman

Life and Death

I have always been on good terms with my doctor. Russell and I understand each other. As a master hypochondriac, I have used my medical education to conjure up some truly arcane and sometimes charmingly quaint threats to my well being. Journeymen hypochondriacs worry about strokes or cancer; I tend more toward yaws or pinta or leishmaniasis. Some doctors would be annoyed by my bottomless need for reassurance, but Russell finds my sense of doom entertaining. He doesn’t complain about getting paid for his work, but I am grandiose enough to suspect that, in my case, the money is just a bonus.

It was with this history in mind that Russell responded to the message about the arrhythmia. I had been sitting in my office taking my pulse (even apprentice hypochondriacs know that one) and noticed that it was irregular. I felt fine at the time, no symptoms of any kind, unless you count compulsively taking my pulse as a symptom. It was what doctors call an incidental finding. Still, you can’t be too careful; I called Russell.

At the end of his day, he called me back. He spoke in that voice you use to tell your child that, yes, there are bad people in the world, but we aren’t going to let you get kidnapped. He reminded me of the usual preliminary steps we would normally go through to evaluate this finding—physical exam, EKG, treadmill test—and he told me that we both knew that if they were all negative, I still wouldn’t be satisfied, so he suggested we go right to a Holter monitor. A Holter monitor is a device about the size of a paperback book that you carry around for twenty-four hours while it records your heart rhythm. Then a computer scans the entire record and prints up a report.

I stopped by after work on Monday to get hooked up, and then I dropped the gadget off at the end of the day on Tuesday. Late Wednesday morning Russell called me.

“The Holter results just came in. They are concerning. You have to go to the hospital.” “Concerning” is a medical euphemism for “alarming.” I said okay, and asked when he thought I should do that. I told him I’d be done in the office at five o’clock, but I imagined he’d say the next morning would be fine.

“No, now. You have to go now.”

Russell is not an alarmist; he is not even a concernist. So I was out the door and on my way to the hospital. It is a curious event when a black belt hypochondriac finds out something is seriously wrong. You would think I would have been prepared. The fact was, I felt cheated; all that worrying in advance had failed to inoculate me against disaster.

I arrived at the hospital and signed forms. After an exhaustive diagnostic assessment of my insurance and finances, I was admitted—to the Intensive

Care Unit. I think that took me aback almost as much as being sent to the hospital at all. I had just spent maybe two hours doing routine paperwork, and now they were saying I needed to be monitored every second. It was as if I had to apply for a bank loan first, and then they would stop the bleeding. Even more disorienting was the fact that at no time had I felt at all unwell.

Once I was deprived of my clothes, put to bed, and hooked up to a cardiac monitor, Russell came in with another man whom he introduced as Dr. Strane. He was to be my cardiologist. Dr. Strane went over the Holter results with me and I got the message what the alarm—excuse me, concern—was all about. The main point was that I had had several runs of ventricular tachycardia, each lasting for twenty or more beats. I had enough cardiology background to ask and have Dr. Strane confirm that 80 percent of people with “nonsustained runs of v-tach” die suddenly within five years of diagnosis.

On other occasions of illness, I had noted that my awareness had tended to split in two. On one side, I was sick and immersed in being small and helpless and (ideally) looked after by mothers and their ilk. On the other side, I was fascinated by the pathophysiology and science and technology. But no previous illness had been life threatening. On this occasion, my awareness split in a different way. I had no interest in the whirlwind of diagnostic tests and procedures; I let myself be poked and scanned and echoed as if I weren’t quite inhabiting my body. But on the other, I was trying to make sense out of something that, despite my hypochondriasis, I had never seriously considered: I was going to die.

For the next two days, I had an echocardiogram, an MRI, a thallium stress test, and I don’t remember what else. On day three, I was scheduled to have an angiogram, but before that happened, Dr. Strane came in to talk to me. He told me he had consulted with Mel Scheinman, the director of the electrophysiology lab at the University of California San Francisco, who was the expert in these kinds of arrhythmias. Scheinman had said that there was a subtype of v-tach that was benign, which accounted for the 20 percent that survived. There was a simple, noninvasive test that would identify the subtype. It was called a signalaveraged EKG, and he thought we should try that before doing an angiogram. We did, and it turned out that I had the benign variant.

I was discharged the same day, with no medication, no treatment, no need for follow-up. I was officially fine. I felt as if I had been abducted by aliens for their experiments and then summarily beamed back down to my cornfield, where I stood blinking and confused.

Beyond the immense relief of a narrow escape, I found myself feeling cheated again. I had barely had time to notice that I was dying, and now it wasn ’t the case. But, of course, I was wrong. The question of my dying was never an “if.” For two days, I felt as if I had been granted a glimpse at my own mortality, but without the time to learn from it. Now I had the time back, and

I knew—I knew!—I was going to die, even if I didn’t know when, and I was sure there was treasure in that knowledge, if only I could mine it.

But somehow it kept slipping away. Over the next few weeks, it felt less and less real—or more accurately, more and more familiar. The memory was transforming itself from an eye-opening, life-altering experience to another dinner conversation. I could not hold onto it.

It is now twenty years since Russell’s phone call. Russell died eight years ago from an unexpected heart attack. Dr. Strane has retired. I met Dr. Scheinman once since, to confirm that no follow-up was indicated. He warned me how some people organize their lives around being cardiac patients, and he advised me to get on with my life. He did not know me the way Russell did. I have gotten on with it, and I am no less a hypochondriac now than I was then, although, curiously, I find that I don’t worry about my heart. The one lingering effect of the whole ordeal is that I still feel that, somehow, it was an opportunity lost.