Bill’s Pacemaker Implant: 5 Days & 5,000 Words (September 2025)
The Planned Implant
Just like every early September, we were on fast-reverse in rewinding our journey to the Italian Alps to return home to the Pacific NW on September 5th and in record time, on September 16th, we were off to Palm Springs for Bill to receive his much anticipated pacemaker. He had been in count-down mode for the procedure since his second difficult cardiac ablation on April Fool’s Day. We arrived in Palm Springs on the 22nd, stowed our trailer, and checked into a nearby hotel to evade the 100° temperatures. Thirty-six hours later, Bill was off in a Lyft at 4:15 am on the 24th for his procedure.
“The operation was a success but the patient (almost) died” was familiar dark humor from the 90’s but was too close to reality for both of us on that Wednesday, around 11 am. Bill’s leadless pacemaker implant went smoothly when it began a little after 7 am, just under 3 weeks after touching down in Portland from Amsterdam, but 3 hours later, his “pericardial effusion with tamponade” had the Grim Reaper’s cold finger tips on his shoulder. The prediction from one of his cardiologists had been “You’ll be back on the trails in 48 hours.” The words from his cardiologist to me immediately after the implantation was complete around 8 am was “He is doing great.” There had been no allusion to the Reaper’s visitation in those cheery descriptions.
A little before 11 am, while Bill was still in the recovery room, he was overcome with panic because he could hardly breath and was in severe pain. In the flurry of activity over the course of minutes, his cardiologist appeared at his bedside, took one look at him, and apparently knew exactly what was happening inside: the inflexible sac around his heart was strangling his heart as it filled with fluid and blood. He said: “You are safe!” and left the room. Those were the exact words Bill needed to hear and he trusted that they were true in the face of his body sending dramatically different signals.
A little after 11 am, I was told of the “fluid” that urgently needed to be removed but then, in a second phone call a few minutes later, I was consenting to Bill receiving a blood transfusion. They had immediately sedated him and had no time to gain permission from him. My first career as a medical technologist in hospital labs was more than enough background for me to decode “fluid” to being blood. Their words to me that Bill was OK rang hollow.
I panicked and could barely get the words out between stifled sniffles on the 2 calls from the nursing staff. I knew that there wasn’t time to properly “Type & Cross” his blood with the donor(s) blood, a procedure I had done many times, because they were ordering blood under extremely emergency conditions, like “Get it here NOW!’ and they would deal with the consequences later. Just as well I didn’t know if they wanted one unit on hand or were preparing to replace his entire blood volume, expecting him to “bleed out”. Fortunately, that detail occurred to me later, long after the instinctive panic had set in. I had found a chair in the vaccination area of the CVS pharmacy I happened to be in and sat sobbing quietly through the second call with the other customers politely looking away.
That was Crisis #1 and it was over in an hour. They performed a pericardiocentesis to drain the accumulating blood from his pericardium, the sac around the heart. With difficulty and at my insistence, we learned days later that he had not been transfused, which prevented potential future complications. We also learned later that another cardiologist had been recruited to assist with the procedure.
Bill’s cardiologist again called me, reassuring me that Bill was “Doing great!” I had learned from receiving Bill’s post-ablation calls from the same cardiologist that he had an effective, non-verbal, way of communicating that I had space for about 20 characters to be spoken and then he would hang-up. I knew any details would be filled in at some later time by Bill.
Once stabilized, they took Bill from the procedure room to the ICU. I was only able to visit him for a few minutes around 3 pm because I had an inconsequential but long-scheduled medical appointment at 3:30. Because I get very frail with my stroke symptoms around 4 o’clock each day, I had to head to the hotel after my delayed appointment, but at least we were able to touch.
Apparently it wasn’t long after I left him that Bill started having intense pain again, and he and the doctors were sure it was more accumulating fluid in the pericardium. More scans showed that the pain was not due to additional fluid and it was deemed residual pain from the same pericardial tissue that didn’t like being stretched when the blood had previously accumulated. Apparently his pain was recognized and respected as the classic, intense, pain from irritating that particular tissue and he started receiving hourly morphine and other pain medication and anti-inflammatories. It didn’t take long for Bill to conclude that morphine was a necessary but un-fun drug: it blunted but didn’t eliminate the pain and made him miserable all the next day.
Some hours later, Bill started having very distressing tachycardia, a racing heartbeat. His pacemaker only intervened in the case of slow heart rates, not fast ones, and they began giving him medication to rein in his heartbeat, which was anticipated as a part of his implant aftercare, though not expected to be needed this soon. Late the next day, Thursday, a chest scan revealed he had a small embolus in his lungs though, days later, it was described not as a single small embolus but had been a “shower” of emboli compromising his breathing and perhaps adding to his pain. Those emboli may have triggered the pain that resulted in the administration of morphine in the afternoon hours after the implant.
The Discharge Day That Didn’t Happen
Twenty four hours after the implant, Thursday morning, the tech from the pacemaker company was evaluating the pacemaker’s functioning at Bill’s bedside and was confused by what he was seeing on his reports. He commented that in a short period of time, Bill’s heart had demonstrated for him all the possible rhythm abnormalities of the upper chambers (atria.) The pacemaker was behaving normally, it was Bill’s heart that was not. Bill’s cardiologist delayed seeing him that morning until the results of additional studies were received to plan his next steps in stabilizing Bill’s traumatized heart.
In text messages on Thursday morning, Bill told me about his rough night with the presumed embolus, the morphine, and the tachycardia, but he was confident he was going to be OK. I had a full morning of my own appointments and did not see him until about 12:30 but I was able to stay for two hours.
When I saw Bill Thursday, he was sitting up, but that was about it. I said “You look like you’ve been run over by a truck” and he concurred that was how he felt. He was quite distressed by the morphine hangover, which had him falling asleep and waking up every 10 or 20 minutes. He still had substantial chest pain and was on other pain medication, but was off the morphine. He was miserable and had to return to his bed because sitting to greet me intensified his pain from the pressure on his heart. He was horribly constipated and wasn’t able to eat. He concluded his lack of appetite was a signal from his body to be respected and didn’t bother with the food he was served.
More Complications?
Friday morning, I called asking to speak with his nurse around 5:30 am because he was overdue in texting me since we had been waking up at 4 am for months. Panic was building inside of me because of the multiple crises on Wednesday and now his silence. I needed my panic to subside so I could focus on my day.
I calmly said to his nurse “I need to know that my husband is alive, he has had a difficult time with complications.” She was sweet, optimistic, and up lifting. In the wee hours, she reported she had taken Bill for his first walk since Wednesday morning and he peed a couple of times but was still horribly constipated from the morphine. When he finally texted me about 7 am, things had changed and he wasn’t feeling well. He didn’t expect to get any news until the doctor rounded about 8:30am. Fortunately, he texted a second time and said he was a little better but it was hard not to worry about what might be ahead.
I was miffed on Friday afternoon when I saw him: I could hardly speak with Bill. The pacemaker technician was there again, probably for 30 minutes, monitoring him and the functioning of the device. Then there was the kind internist and resident who had been assigned to work him up for a long list of complications, including an elevated white blood cell count, a urinary tract infection, a blood infection, a pulmonary embolism, and other non-cardiac issues. There were two nurses who came in several times to collect multiple samples for Covid testing and later put him in a brief Covid isolation.
When multiple staff came to haul him off for a chest CT scan, Bill struggled to stand to be transferred to a gurney and I slipped in behind him and insisted on a full body hug we hadn’t had for days. Thankfully, the staff accommodated my brief intrusion. By then, I had given up connecting with him after about an hour of waiting and left for the day. He ultimately silenced his phone because of the constant bedside commotion that afternoon. He then forgot to switch it back on before he luxuriated in what turned out to be a long nap. Just as well, because he needed the rest.
Though it was early in the afternoon, I had needed to take care of myself as best I could. It was Friday and I had been pushing hard since our late arrival in Palm Springs on Monday afternoon at great personal expense because of my stroke. I hadn’t been able to do my share of driving or household chores since my stroke a year ago and I was abruptly forced to do it all, alone, and without Bill’s moral support. About 4 o’clock each day on a busy day, my overloaded brain started shutting down. The night before, I had experienced it at its worst, which is when I was finally heading to bed an hour late, I could not stand unsupported. I had to carefully walk between my bedtime chores and getting into bed by hanging on to walls and furniture. In addition to the physical collapse, my over loaded brain could barely think, and I struggled to keep my eyes open to navigate. I was a zombie. I try to avoid triggering that overload response but once it hits, all I can do is be careful to get safely into bed, especially when I’m alone, as I was every night for 4 nights.
About three hours after waving goodbye to Bill while he was wheeled off for his scan and being in the early stages of my daily shut down, I began the slow progression into panic. He hadn’t responded to 4 texts over the course of 90 minutes and I needed to know he was alive.
For the second time that day, in the late afternoon, almost 12 hours apart, I called the hospital, asking to speak to his nurse to make sure he was still alive. I again said “I don’t need to talk to him, please don’t disturb him if he’s sleeping, talking with doctors or involved in a procedure, I just need to know he is alive.” Each time they obliged me and reassured me that he was OK.
I was surprised to receive his phone call after being reassured by his nurse he was alive. She apparently didn’t want to hear my controlled desperation again and demanded that he call me immediately. He had just awoken from a rare, 90 minute deep sleep and was eager to speak. Bill apologized, saying he had forgotten he had silenced his phone earlier because he had been too busy.
It was our only call during his 5 day stay and we talked for almost 45 minutes. That in and of itself was information: we both recognized that the long conversation signaled he was getting better, a lot better.
Suddenly, he was a person of substance again, not someone hanging on at the edge of darkness. He had sent the Grim Reaper fleeing. He was energetic and engaged. I had begun the process of canceling our 6 weeks of reservations for trips to Flagstaff and the Grand Canyon that were supposed to begin the next day. It was a hard job given we had no idea when he would leave the hospital but he was suddenly available to participate in the planning.
While we talked, I urged him to ask a nurse if his doctor would be on call or making rounds on the weekend. His primary cardiologist would be “ The Decider” and just knowing if he would be in the hospital was important information for our planning. Bill was reluctant but asked anyway and in 10 minutes, was on the phone with his cardiologist who happened to be calling again on his day off to check on Bill.
Unfortunately, his cardiologist would not be in until Monday, but he reassured Bill that the attending physician was fully briefed on Bill’s case. More importantly, Bill learned that he had indeed had a small pulmonary embolism, and it had likely been the cause of his second crash the night of his pacemaker implant. It probably triggered the tachycardia, the high heart rate, in which his pacemaker could not intervene.
Where did these complications come from? Did the anticoagulants play a role in either of the complications? Would Bill have better off not to have taken his anticoagulant that morning? Would that have reduced the pericardial effusion at all, or enough, to make it less of a problem? Would that have made the pulmonary embolus which occurred later worse? Would the lack of anticoagulant have increased Bill’s stroke risk when he developed heart arrhythmias again after the pacemaker placement? These are unanswerable questions.
Both the pericardial effusion with tamponade and the pulmonary embolus are known complications of pacemaker placement, each occurring at rates of <2%. Bill’s doctors have vacillated on the role his anticoagulant and other medications might have played in both complications. In reality, we will likely never know the origins of these problems, but it highlights that no medication or procedure is without risks, and that while people in otherwise poor health tend to have most of the complications, no one is immune. As Bill’s father used to say: “You pays your money and you takes your chances.”
Joy!
I hadn’t heard from Bill on Saturday morning but I was more comfortable waiting than the day before. I was trusting I didn’t need to make a third call asking his nurse if he was alive. It’s was another busy day for me (I had 7 appointment that week) and hopefully there would be fewer intrusions when I went to visit him. Hopefully his belated healing trend would continue uninterrupted. There were still many problems ahead because his heart had not stabilized since the implant, but hopefully the rolling stages of panic were behind for both of us.
My mind and body had done poorly that morning because of antihypertensive medication side effects and I’d had to spend time in bed waiting for both of them to recover so I could safely drive and mobilize for the day. I was hours late in getting to the hospital on Saturday but when I arrived, I acted on my intention to have more closeness.
The Planned Implant
Just like every early September, we were on fast-reverse in rewinding our journey to the Italian Alps to return home to the Pacific NW on September 5th and in record time, on September 16th, we were off to Palm Springs for Bill to receive his much anticipated pacemaker. He had been in count-down mode for the procedure since his second difficult cardiac ablation on April Fool’s Day. We arrived in Palm Springs on the 22nd, stowed our trailer, and checked into a nearby hotel to evade the 100° temperatures. Thirty-six hours later, Bill was off in a Lyft at 4:15 am on the 24th for his procedure.
“The operation was a success but the patient (almost) died” was familiar dark humor from the 90’s but was too close to reality for both of us on that Wednesday, around 11 am. Bill’s leadless pacemaker implant went smoothly when it began a little after 7 am, just under 3 weeks after touching down in Portland from Amsterdam, but 3 hours later, his “pericardial effusion with tamponade” had the Grim Reaper’s cold finger tips on his shoulder. The prediction from one of his cardiologists had been “You’ll be back on the trails in 48 hours.” The words from his cardiologist to me immediately after the implantation was complete around 8 am was “He is doing great.” There had been no allusion to the Reaper’s visitation in those cheery descriptions.
A little before 11 am, while Bill was still in the recovery room, he was overcome with panic because he could hardly breath and was in severe pain. In the flurry of activity over the course of minutes, his cardiologist appeared at his bedside, took one look at him, and apparently knew exactly what was happening inside: the inflexible sac around his heart was strangling his heart as it filled with fluid and blood. He said: “You are safe!” and left the room. Those were the exact words Bill needed to hear and he trusted that they were true in the face of his body sending dramatically different signals.
A little after 11 am, I was told of the “fluid” that urgently needed to be removed but then, in a second phone call a few minutes later, I was consenting to Bill receiving a blood transfusion. They had immediately sedated him and had no time to gain permission from him. My first career as a medical technologist in hospital labs was more than enough background for me to decode “fluid” to being blood. Their words to me that Bill was OK rang hollow.
I panicked and could barely get the words out between stifled sniffles on the 2 calls from the nursing staff. I knew that there wasn’t time to properly “Type & Cross” his blood with the donor(s) blood, a procedure I had done many times, because they were ordering blood under extremely emergency conditions, like “Get it here NOW!’ and they would deal with the consequences later. Just as well I didn’t know if they wanted one unit on hand or were preparing to replace his entire blood volume, expecting him to “bleed out”. Fortunately, that detail occurred to me later, long after the instinctive panic had set in. I had found a chair in the vaccination area of the CVS pharmacy I happened to be in and sat sobbing quietly through the second call with the other customers politely looking away.
That was Crisis #1 and it was over in an hour. They performed a pericardiocentesis to drain the accumulating blood from his pericardium, the sac around the heart. With difficulty and at my insistence, we learned days later that he had not been transfused, which prevented potential future complications. We also learned later that another cardiologist had been recruited to assist with the procedure.
Bill’s cardiologist again called me, reassuring me that Bill was “Doing great!” I had learned from receiving Bill’s post-ablation calls from the same cardiologist that he had an effective, non-verbal, way of communicating that I had space for about 20 characters to be spoken and then he would hang-up. I knew any details would be filled in at some later time by Bill.
Once stabilized, they took Bill from the procedure room to the ICU. I was only able to visit him for a few minutes around 3 pm because I had an inconsequential but long-scheduled medical appointment at 3:30. Because I get very frail with my stroke symptoms around 4 o’clock each day, I had to head to the hotel after my delayed appointment, but at least we were able to touch.
Apparently it wasn’t long after I left him that Bill started having intense pain again, and he and the doctors were sure it was more accumulating fluid in the pericardium. More scans showed that the pain was not due to additional fluid and it was deemed residual pain from the same pericardial tissue that didn’t like being stretched when the blood had previously accumulated. Apparently his pain was recognized and respected as the classic, intense, pain from irritating that particular tissue and he started receiving hourly morphine and other pain medication and anti-inflammatories. It didn’t take long for Bill to conclude that morphine was a necessary but un-fun drug: it blunted but didn’t eliminate the pain and made him miserable all the next day.
Some hours later, Bill started having very distressing tachycardia, a racing heartbeat. His pacemaker only intervened in the case of slow heart rates, not fast ones, and they began giving him medication to rein in his heartbeat, which was anticipated as a part of his implant aftercare, though not expected to be needed this soon. Late the next day, Thursday, a chest scan revealed he had a small embolus in his lungs though, days later, it was described not as a single small embolus but had been a “shower” of emboli compromising his breathing and perhaps adding to his pain. Those emboli may have triggered the pain that resulted in the administration of morphine in the afternoon hours after the implant.
The Discharge Day That Didn’t Happen
Twenty four hours after the implant, Thursday morning, the tech from the pacemaker company was evaluating the pacemaker’s functioning at Bill’s bedside and was confused by what he was seeing on his reports. He commented that in a short period of time, Bill’s heart had demonstrated for him all the possible rhythm abnormalities of the upper chambers (atria.) The pacemaker was behaving normally, it was Bill’s heart that was not. Bill’s cardiologist delayed seeing him that morning until the results of additional studies were received to plan his next steps in stabilizing Bill’s traumatized heart.
In text messages on Thursday morning, Bill told me about his rough night with the presumed embolus, the morphine, and the tachycardia, but he was confident he was going to be OK. I had a full morning of my own appointments and did not see him until about 12:30 but I was able to stay for two hours.
When I saw Bill Thursday, he was sitting up, but that was about it. I said “You look like you’ve been run over by a truck” and he concurred that was how he felt. He was quite distressed by the morphine hangover, which had him falling asleep and waking up every 10 or 20 minutes. He still had substantial chest pain and was on other pain medication, but was off the morphine. He was miserable and had to return to his bed because sitting to greet me intensified his pain from the pressure on his heart. He was horribly constipated and wasn’t able to eat. He concluded his lack of appetite was a signal from his body to be respected and didn’t bother with the food he was served.
More Complications?
Friday morning, I called asking to speak with his nurse around 5:30 am because he was overdue in texting me since we had been waking up at 4 am for months. Panic was building inside of me because of the multiple crises on Wednesday and now his silence. I needed my panic to subside so I could focus on my day.
I calmly said to his nurse “I need to know that my husband is alive, he has had a difficult time with complications.” She was sweet, optimistic, and up lifting. In the wee hours, she reported she had taken Bill for his first walk since Wednesday morning and he peed a couple of times but was still horribly constipated from the morphine. When he finally texted me about 7 am, things had changed and he wasn’t feeling well. He didn’t expect to get any news until the doctor rounded about 8:30am. Fortunately, he texted a second time and said he was a little better but it was hard not to worry about what might be ahead.
I was miffed on Friday afternoon when I saw him: I could hardly speak with Bill. The pacemaker technician was there again, probably for 30 minutes, monitoring him and the functioning of the device. Then there was the kind internist and resident who had been assigned to work him up for a long list of complications, including an elevated white blood cell count, a urinary tract infection, a blood infection, a pulmonary embolism, and other non-cardiac issues. There were two nurses who came in several times to collect multiple samples for Covid testing and later put him in a brief Covid isolation.
When multiple staff came to haul him off for a chest CT scan, Bill struggled to stand to be transferred to a gurney and I slipped in behind him and insisted on a full body hug we hadn’t had for days. Thankfully, the staff accommodated my brief intrusion. By then, I had given up connecting with him after about an hour of waiting and left for the day. He ultimately silenced his phone because of the constant bedside commotion that afternoon. He then forgot to switch it back on before he luxuriated in what turned out to be a long nap. Just as well, because he needed the rest.
Though it was early in the afternoon, I had needed to take care of myself as best I could. It was Friday and I had been pushing hard since our late arrival in Palm Springs on Monday afternoon at great personal expense because of my stroke. I hadn’t been able to do my share of driving or household chores since my stroke a year ago and I was abruptly forced to do it all, alone, and without Bill’s moral support. About 4 o’clock each day on a busy day, my overloaded brain started shutting down. The night before, I had experienced it at its worst, which is when I was finally heading to bed an hour late, I could not stand unsupported. I had to carefully walk between my bedtime chores and getting into bed by hanging on to walls and furniture. In addition to the physical collapse, my over loaded brain could barely think, and I struggled to keep my eyes open to navigate. I was a zombie. I try to avoid triggering that overload response but once it hits, all I can do is be careful to get safely into bed, especially when I’m alone, as I was every night for 4 nights.
About three hours after waving goodbye to Bill while he was wheeled off for his scan and being in the early stages of my daily shut down, I began the slow progression into panic. He hadn’t responded to 4 texts over the course of 90 minutes and I needed to know he was alive.
For the second time that day, in the late afternoon, almost 12 hours apart, I called the hospital, asking to speak to his nurse to make sure he was still alive. I again said “I don’t need to talk to him, please don’t disturb him if he’s sleeping, talking with doctors or involved in a procedure, I just need to know he is alive.” Each time they obliged me and reassured me that he was OK.
I was surprised to receive his phone call after being reassured by his nurse he was alive. She apparently didn’t want to hear my controlled desperation again and demanded that he call me immediately. He had just awoken from a rare, 90 minute deep sleep and was eager to speak. Bill apologized, saying he had forgotten he had silenced his phone earlier because he had been too busy.
It was our only call during his 5 day stay and we talked for almost 45 minutes. That in and of itself was information: we both recognized that the long conversation signaled he was getting better, a lot better.
Suddenly, he was a person of substance again, not someone hanging on at the edge of darkness. He had sent the Grim Reaper fleeing. He was energetic and engaged. I had begun the process of canceling our 6 weeks of reservations for trips to Flagstaff and the Grand Canyon that were supposed to begin the next day. It was a hard job given we had no idea when he would leave the hospital but he was suddenly available to participate in the planning.
While we talked, I urged him to ask a nurse if his doctor would be on call or making rounds on the weekend. His primary cardiologist would be “ The Decider” and just knowing if he would be in the hospital was important information for our planning. Bill was reluctant but asked anyway and in 10 minutes, was on the phone with his cardiologist who happened to be calling again on his day off to check on Bill.
Unfortunately, his cardiologist would not be in until Monday, but he reassured Bill that the attending physician was fully briefed on Bill’s case. More importantly, Bill learned that he had indeed had a small pulmonary embolism, and it had likely been the cause of his second crash the night of his pacemaker implant. It probably triggered the tachycardia, the high heart rate, in which his pacemaker could not intervene.
Where did these complications come from? Did the anticoagulants play a role in either of the complications? Would Bill have better off not to have taken his anticoagulant that morning? Would that have reduced the pericardial effusion at all, or enough, to make it less of a problem? Would that have made the pulmonary embolus which occurred later worse? Would the lack of anticoagulant have increased Bill’s stroke risk when he developed heart arrhythmias again after the pacemaker placement? These are unanswerable questions.
Both the pericardial effusion with tamponade and the pulmonary embolus are known complications of pacemaker placement, each occurring at rates of <2%. Bill’s doctors have vacillated on the role his anticoagulant and other medications might have played in both complications. In reality, we will likely never know the origins of these problems, but it highlights that no medication or procedure is without risks, and that while people in otherwise poor health tend to have most of the complications, no one is immune. As Bill’s father used to say: “You pays your money and you takes your chances.”
Joy!
I hadn’t heard from Bill on Saturday morning but I was more comfortable waiting than the day before. I was trusting I didn’t need to make a third call asking his nurse if he was alive. It’s was another busy day for me (I had 7 appointment that week) and hopefully there would be fewer intrusions when I went to visit him. Hopefully his belated healing trend would continue uninterrupted. There were still many problems ahead because his heart had not stabilized since the implant, but hopefully the rolling stages of panic were behind for both of us.
My mind and body had done poorly that morning because of antihypertensive medication side effects and I’d had to spend time in bed waiting for both of them to recover so I could safely drive and mobilize for the day. I was hours late in getting to the hospital on Saturday but when I arrived, I acted on my intention to have more closeness.
Flashback: like happier picnics.
It was magical! We had effectively walled ourselves off from the stressful hospital scene by turning our backs to it and focused on our old world on the distant mountain. It felt like we were beginning to take back our personal power we had surrendered to the medical crises. We suspect we’d had a little help from the nursing staff who must have decided that what we were doing was more important for his wellness than their next task with him.
I would bring him home the next day, Sunday. He was still tired and weak but out of pain. His heart was still chaotic. We learned that his pulmonary embolism was not a small one, but it was a massive shower of emboli, but appears not to have damaged tissue. It will take time to heal. One doctor commented that it was stunning he had emboli within 24 hours of being off anticoagulant after the procedure— unheard of. Days later, we learned we wouldn’t know until the first of the year if he had permanent lung damage or not, though he had significant shortness of breath because of it.
The doctor Bill shared my texted joke with, embellished with doctor talk, about using leeches to bring down his high hematocrit wasn’t amused, but at least his resident snickered. I thought the joke was hilarious because leeches weren’t phased out of common therapies practiced until about 100 years ago, and even funnier that the doc couldn’t crack a smile. At least the resident learned something about relating to patients by observing his stone-faced superior: it’s always best to meet people where they are.
Managing the Mind
It was only minutes after Bill’s life-threatening medical crisis began, three hours after his pacemaker implant was completed, that I was quietly sobbing alone in a CVS Pharmacy. A first, and then 2nd call from OR nurse instantly had me feeling like I was going to burst from the fear of losing him. Knowing my stroke had deprived me of my prior emotional resilience didn’t blunt my pain or improve my capacity: I desperately needed another person with whom to share the heavy load.
I’d been casually exchanging emails with a longtime friend about eyelid surgery, a procedure she had had and I was anticipating, and I impulsively assessed that she was emotionally resilient enough to receive my pain, so I instantly changed the content of my emails to her. I apologized for intruding on her serenity, saying I hoped it was OK. I emphasized that I didn’t need her to reply, I only needed to express and narrate my intense emotions for my own well-being. The release of my unimaginable pain is what I needed most but I deeply appreciated her replies to my updates over the next week. Every time I felt that horrible pressure from my unrelenting fears, I wrote her. I don’t know what I would’ve done, how I would’ve survived, without her immediate and solid support.
I had taken advantage of another friend’s casual reaching-out a year ago when Bill flew to Palm Springs from the Grand Canyon in October and I panicked when his icon on Apple’s “Find My” stopped moving when he was near the cardiologist’s office. He had texted saying he didn’t feel well, then there were no more texts, his icon was still, and my Texan friend immediately learned of all of my fears. She hung-in there with me the remainder of the day, until the crisis was over. The lesson learned after that experience and Bill’s most recent medical crisis is that I will make an “appointment” with a friend for the same time as his next procedure so I don’t intrude on friends unannounced with my boatload of panic and fears.
In addition to needing another person to help hold my pain, on the third day of this medical chaos, I found myself saying “I need to know he is alive”. I didn’t need the reassurance of speaking to him, just I needed someone to tell me he was alive. I called his nurse, twice, 12 hours apart to hear the needed “Yes”. Taking care of myself by finding these 2 ways of reaching out for help to get relief from such emotional overloading was critical to me staying afloat.
My emails to our friend and others friends served as a form of journaling for both Bill and I. In addition to being an emotional outlet for me, it was a way to make a diary of his various medical events and reading them was a way for Bill to keep track of what he had been experiencing. (Once home, he said “I don’t remember any of this!”).
Texting between us was a huge help for us remaining connected during his five-day stay. We’d learned from his prior 2 ablations at the same hospital that part of the instructions to patients are to bring your phone and a charging cable. It was startling, but a relief that the institution had institutionalized texting for the support of the emotional well-being of their patients.
One of my goals in frequently texting Bill as his stay got longer and longer was to keep him in touch with reality, which can be a problem for hospitalized patients, especially ones in the ICU. I would update him on how I was doing, the results of my many appointments, and other things that were happening in our immediate world, like applying the annual licensing tags to our 2 rigs.
One evening, I tucked myself under the eve of our bungalow at a Palm Springs hotel so I could be on the edge of the thunderstorm while I ate my dinner. I dictated the scene of increasing winds in the palms, graying skies, and thunder and lightning as they occurred. He had a great view of the mountain from his hospital room 10 miles away from where I was seated outdoors and I hoped he would watch.
I had alerted him to the storm but when I received no response from him, I assumed he was napping and would enjoy the vicarious experience when he awoke. It was wonderful for both of us that he was later riveted my narration and relived the many storms we had witnessed together, sheltering on the road as international cyclotourists, or as guests safely inside a Dolomite hotel. Sharing this thunderstorm was yet another way for us each to stay grounded and maintain connection during the prolonged ordeal.
Bill, of course, was having his own emotional journeys with others. An unannounced visit by a chaplain who called on all the ICU patients was quite the surprise. He started off by inviting Bill to share his feelings, which Bill did freely. Later, when Bill told me about the visit, I was reminded of a podcast we had listened to this summer that included this new model of hospice care, which is to start patients talking about their feelings and fears, what they are experiencing in the moment.
God wasn’t even invited into the conversation by the chaplain and instead, Bill was always the main character in the entire dialogue, which he deeply appreciated. The prescribed process is to support patients in going as far as they want to go in exploring their new feelings and vulnerabilities. Bill thanked the chaplain profusely for letting him dump a load of feelings on him. I suggested to Bill that even when he wasn’t in the ICU, if he told the nurses he’d like to speak to a chaplain, that they would all surely oblige him. Bill didn’t act on that, but it was a nice hip-pocket option for him to have.
A bit later, when the brain-numbing residue from hourly doses of much-needed morphine started to clear from Bill’s head, he began listening to podcasts. His body was limp but his mind craved substantial input that wasn’t about him. It was the podcast from Ezra Klein that resonated the most for him. Klein, in passing, mentioned Buddhism’s 5 Remembrances of which he only described three. They were “I am of the nature to become ill. I am of the nature to grow old. I am of the nature to die.” Ezra stopped there and poised the question: “Knowing that, how am I to live my life?” It was Klein’s question that was still echoing in Bill’s mind days after he returned home.
It was as if Klein was channeling the Buddha’s teachings to Bill and it was the exactly the right question at precisely the right time for him. Bills questions of late had been more pragmatic, like “When am I going to be able to do the Grand Canyon‘s Rim to Rim hike again?” It’s been difficult for him to accept that he should be running parallel tracks of plans, with one being if he was able to resume his prior lifestyle and the other would be what it would look like if he wasn’t able to do so. The wisdom of the Buddha totally reframed Bill’s current situation and he took great comfort in pondering the new question.
Who could resist staring at this view of the Dolomites?!
Another important opportunity during this medical crisis that opened up for Bill was deeply connecting with his cardiologist. Having lived his life as a shy and understated guy, it was a reversal for Bill to be strongly compelled to directly thank his cardiologist for his excellent care during the emergency pericardiocentesis. The cardiologist was also not an effusive person and had a bias towards standing for short monologues instead of dialogues, so Bill knew he would have to be assertive to get his “Thank You” launched. Fortunately, Bill had been clear about his need to express himself and strategizing about how he would deliver his message.
On Friday morning, when the cardiologist came in on his day off and pulled up a chair very close to Bill, Bill knew his opportunity was close at hand. In a rare pause, Bill put his hand on his doctor’s knee and said “I want to thank you for saving my life on Wednesday.” The gruff PA in silent attendance in the back of the small room went bug-eyed and then smiled broadly. The cardiologist got up to leave, turned around, and said “No one has ever said that to me before” and the PA took that statement in as well. Bill having set an intention to be openhearted with his expression of gratitude had served all 3 of them well and the message was delivered and clearly received.
Bill’s sudden capacity to accept comforting and deeply connecting with others was because of his amazing transformation the end of August in unraveling the origins of his anxiety and his open heart was now penetrating the hearts of others.
Phase 2
With Bill at home with me in the trailer and smiling, I could turn my attention to my medical issues that arose during our chaotic week. My Portland neurologist answered my 3 questions sent to him via a patient portal with a personal phone call, for which I was very grateful. Sadly, I struck out on all 3 of 3 questions hoping to improve my plight, but at least he was kind, respectful, and empathetic. He even commented that one of my questions was “Very astute.”
My appointment with a cosmetic surgeon regarding my droopy eyelids confirmed that I needed them treated for my vision but unfortunately, there were multiple issues, not just one, and she referred me on to an oculoplastic surgeon for my blepharoplasty (too many new words). I took the first available appointment, which was November 12th, and will be lucky to be treated by mid-January.
An even bigger surprise came with visiting my desert dermatologist’s office and being seen by a PA who declared my newly diagnosed case of eczema was an autoimmune disease that would only get worse and not better. The definitive biopsy had been done days before we flew to Europe back in June and weeks later, when I got the results, I was only told “eczema” and to schedule a follow-up appointment for when I got back. Learning the bad news from the PA had an upside when Bill did further reading. It was a serious diagnosis but the diagnosis might be the key to unlocking the door that Bill had tried to unlock for years: eczema could be cause or contributor to my gut, brain, and sleep challenges, as well as my skin issues and other problems. November will be a busy month for me when I see the dermatologist on the 5th, a week before the oculoplastic surgeon. Lemons or lemonade? Time will tell which will be the dominant outcome!
I was also pleased to pick-up a compounded pharmacy product in the desert that was far superior to the Portland pharmacy’s concoction from the same prescription, so things were looking up for me.
The recovery was officially on!
The forecast cool-downs in Palm Springs never arrived and Bill devised an intermediate Plan B for salvaging our anticipated escape in the Grand Canyon: after 3 short days of driving, we arrived in St George, UT, 2 weeks after Bill’s pacemaker implantation. At 3,000’ instead of the 7,000’ of the Grand Canyon, it would be more heart and lung friendly for him with more scenic “out-the-door” views and comply with doctor’s orders.
It and the gorgeous, nearby red rock country of Snow Canyon, were still too hot for a few more days but were 15° cooler than Palm Springs by night. Luscious cooling! His pacemaker and heart had worked things out as to which was in charge a few days earlier and he started feeling better and better every day. He still tired easily and would spend 3 months building his daily walking distance up from 1 mile a day in 2 walks, to his former 8 miles a day by the New Year. It would be a welcome teeter-totter: as the miles walked went up, the hours spent napping would go down.
Bill reassured me that the last 15 months of too frequent alerts about his cardiac condition and rushes to ERs were behind us. He expected our respective panic buttons to take a rest. Bill’s conversations were now started by referencing his “new” heart. He was at peace at last. The focus for the next 3 weeks for both of us would be deep healing for our minds and bodies.