When I Half-Died

Heart rate of 12! I see it on the monitor just behind me.


MY heart rate! Not compatible with life!


My vision closes down, tunnel-like. I'm sinking through the operating table on which I lay, both arms stretch out and tied down, crucifixion style.


I need atropine.


The surgeon's voice, "Cough, Mike." I cough. I see the resulting blip on the monitor. Cough, cough, cough. Blip, blip, blip. To live, I must keep coughing.


Heart rate up to 30. Barely compatible with life, but I'm not sinking any more. I can talk.


"I need atropine!" I wonder how I can thump my own chest. But I can't move my arms. And now I descend again.


The voice, "Give him 0.04 milligrams of atropine." That's pre-anesthetic dose! Not good here.


"MORE atropine!" I demand in grave voice. "Half to one milligram!"


The voice, "Give him 0.5 milligrams of atropine IV."


I've stopped sinking. My vision is coming back. I'm lucid. I no longer need to run my own resuscitation. My heart rate is up to 60. I'm alive!


I remembered this story last night as a friend described his recent hernia repair. I recalled the time, now over 20 years ago in my pre-Navy days, when I tasted near-death while undergoing a similar procedure. I practiced emergency medicine at that hospital. I knew the anesthesia staff fairly well. Somewhat haughtily I reasoned that a surgeon could not kill me on the operating table if he tried, but an anesthesiologist could do so without half trying. Being an active triathlete at the time, I considered myself beyond healthy. So I eschewed general or even spinal anesthesia and elected to have the procedure under local anesthetic only.


The local didn't work so well. I was uncomfortable from the instant the knife hit my skin. When the surgeon manipulated the peritoneal sac, I experienced an intense vaso-vagal reaction. My vagus nerve reacted reflexively to the intense discomfort by slowing down my heart rate. My triathlon-trained resting pulse in the 40s left little margin, and hence my near-death experience. By my own choice, I was the only one in the room with recent training and experience in resuscitation. So I labored to fight off the impending darkness to direct my own life saving. 


"Physician, heal thyself."


Fortunately, it all worked out. A post-operative cardiac evaluation rendered the diagnosis of "Athlete's Heart Syndrome." I was pretty proud of that diagnosis at the time. Retrospectively, "Arrogant Doctor Syndrome" might have been more appropriate.


In spite of all the peri-operative dramatics, the hernia repair has held up just fine over the years. The surgeon, at least, knew to stay within his skill boundaries. Should the occasion for a repeat procedure occur any time in my life now, his former arrogant patient will most certainly trust his anesthesia colleagues to exercise their skills as well.


That particular emergency physician truly has no interest in healing himself again.