We recently had a very close call in our house. It’s pretty personal, and adds to the tale of the oddball health issues Jay’s had since having COVID in late 2021. Our trip to the UMASS Clinton Emergency Department a few weeks ago probably saved his life. I wasn’t sure I had it in me (or would have his permission) to tell this story. Now that he’s on the mend, he’s agreeable to me writing about it so that others can be vigilant if they, too, have his seemingly innocuous symptoms. This medical adventure started with Jay playing tennis for 2½ hours without drinking any liquids, a situation that resulted in an online self-diagnosis of dehydration. How wrong he was.
At the end of my work week, I pretty much just want to work in the yard and on projects around the house. However, Jay is quite social and is always bugging me to have people over. A few weekends ago we decided to have a small party, a few couples and some single friends, super casual, on a Saturday night. I also had three open houses that weekend, so I needed Jay to help me with hiding all of the clutter and Windexing all of the surfaces, in preparation for this get together.
On Friday, Jay started to work on getting the house ready for our guests. After playing tennis, he made 15 or so trips upstairs with boxes from our daughter Abigail’s former room that he was planning to turn into his painting studio. By the time I got home, ready to blast off into a marathon cleaning session on Friday afternoon and evening, Jay was feeling a little light-headed and dizzy, and said that he hadn’t had much water and had just overdone it with non-stop activity all day.
I went down to the Quickie Mart and picked up a few bottles of Gatorade, sure that would pep him up. Nothing to be concerned about, and between the Gatorade and some electrolyte powder we had, we were set up for success. Except on Saturday, he was still dizzy. Fine when sitting down, not fine when standing up. We decided we would make a call on the party early afternoon. He decided he needed another day to recoup, so I texted everybody that unfortunately our little get together would have to be postponed.
By Sunday, Jay thought he was feeling better. He was moving around, taking it slow, and Google had said dehydration can take from 3 to 5 days to overcome. This was day three.
On Monday, he still didn’t feel good, more of the same. After an entire weekend of trying to Gatorade the problem, I suggested we go to the emergency room (this was the night of the snowstorm which knocked out power in Princeton and Westminster). We had heard good things about the Clinton ER, seeing on Facebook that it’s referred to as a hidden gem, no lines no waiting. Jay agreed to go, but with the expectation that he would simply be administered some IV fluids to quickly rehydrate him, after which we’d head home. He was half right, as he did get a round of IV fluids, which made him feel considerably better.
However, we soon began to suspect that there was more to the story–the main tipoff being that his heart rate was hovering around 30 beats per minute, which caused a great deal of consternation with the staff in the UMASS Clinton Hospital Emergency Department.
Despite our age difference, Jay is in great shape, plays a lot of tennis and is very active. I believed his self-diagnosis. We were both incredulous when everyone in the room focused on his heart rate. I naively thought maybe they didn’t have him attached to the machine properly.
The nurses then checked it by hand, taking his pulse and counting it manually. They alerted the doctor right away. Sure enough, it kept coming out around 30 beats per minute. I wasn’t really ‘heart rate aware’ up to this point, so it was just another number on the screen to me, but apparently 30 is very low, and 25 became ever more increasingly alarming to the medical professionals in the room. Thanks a lot Google. At its lowest, his heart rate dropped to 21. I am SO grateful that this didn’t happen at home that night where there was no power (would my phone even work?), there were trees down on our road, the 911 people were fighting a house fire in town and the roads were terrible.
The situation was complicated by the fact that Jay was asymptomatic (other than the heart rate), meaning that he felt more or less fine, so he didn’t understand and much less appreciated all the fuss over how fast (very not fast) his heart was beating. We were told that this was an unusually low heart rate, and although some elite athletes might have very efficient hearts, and hence a heart rate of around 60, the normal rate for his age and condition was faster, at somewhere around 70-80 beats per minute. These numbers might be off a little, as there was a lot going on for me, but no matter what, 30 beats per minute is really low.
Everyone in the room had masks on, but I was watching their eye contact with each other. I think the most intense part was when we were moved to another room, just a few feet away, with no explanation. The new room was much larger. We have since learned they call that fancier place the Trauma Suite. Jay also was fitted with large sticky pads stuck to his chest, which I suspected were to be used in case he needed to be resuscitated. This is when we got into a little bit of an argument because he wanted his phone, obviously to do some more online research, and I didn’t want to give it to him.
The nurses and doctor at the Clinton ER were great, but they said they needed to get him to a critical care unit and a cardiologist, and that he’d be going by ambulance to UMASS Leominster campus. We asked if perhaps we could go to Worcester because that’s where he had his brain tumor surgery (23 years ago, a whole different story), but they said there was a CCU bed and a cardiologist immediately available in Leominster.
Keep in mind that during all this Jay felt fine, which made him a less than appreciative patient for all this commotion. This feeling only deepened after he was loaded into an ambulance around 9:30 PM, where the ambulance staff kept asking him what his name was, where he lived, birthdate, etc. to make sure his situation was not worsening. Since it wasn’t, these continual questions irritated him, until finally the ambulance staff realized he was doing OK, and they switched to just talking about his kids traveling the world and mutual acquaintances. It apparently turned into a relatively pleasant conversation, given the circumstances.
In short order, we learned that he would need to have a pacemaker installed. About half an hour later we arrived at the Leominster campus. He was taken directly to the CCU, where he was hooked up to an IV and given some shots in his abdomen. He didn’t like that much. The cardiologist took a look at his chart, and confirmed that he needed a pacemaker. Jay was still protesting that he felt fine.
He told me that it was somewhere around this point that he realized he wasn’t going to talk his way out of getting a pacemaker, and that, combined with the fact that every single medical person thought he was experiencing a serious medical emergency (defined as a Complete Heart Block), he came to the conclusion that he probably did need the pacemaker, and regardless, he wasn’t going to get out of it without making a huge scene.
The next morning, bright and early, Jay was staged for surgery. Because I had arrived home at about midnight, I figured I’d wait until morning to update the kids, so I started my calls from the hospital cafeteria when he was in surgery. With six kids (in various time zones) to update, I went in a specific order and in rapid fire succession so they each got the story first hand.
The plan was to put him under general anesthesia, but in yet another twist, after laying on a gurney for quite a while, and having an ultrasound of his heart among other things, he made what he now considers a major blunder by saying, “I feel a tiny bit nauseous”. The nurse didn’t say a thing, but when he was wheeled into the operating room, he got the bad news that they could not knock him out because the risk of his becoming nauseous under anesthesia was too dangerous, so he had to do the operation AWAKE…except for a giant shot of something similar to novocaine. He was tied down on the gurney by both his hands and arms for the operation. Upon asking why, he was told that it’s because some patients try to grab the tools from the doctor. Making a joke, he said, “I take it back. I feel fine”. That didn’t work. Then, when the doctor started the incision, Jay said, “Hey. That hurts”. That only elicited getting another shot, so at this point he just gave up and had to let it go. In no time, he was the proud owner of a pacemaker.
Coming out of the hospital, Jay was still sore (both mentally and physically) about the whole situation. He really felt like he was railroaded into it. I also think he just didn’t like the concept because it made him aware of his mortality. However, a few events over the past weeks have turned the situation around.
The first step for him, to emotionally adjust to having a pacemaker, was a trip to see his PCP, Dr. Eric Cotter, a person who he totally trusts, and whom he’s known for about 25 years, after being recommended to him by a friend, who also happened to be an emergency room doctor. Dr. Cotter spent quite a while talking with us, reviewing his situation, and told Jay that the cardiologist really had no choice other than to implant a pacemaker. Dr. Cotter showed us charts of Jay’s heart rate (very consistent) over the years that he’s been seeing him. The fact that his heart rate dropped as low as 21 was a complete anomaly.
I had my own list of questions for this visit, as we’re foodies and I was sad at the concept of having to make a complete lifestyle change. I asked his PCP if we had to change our diet and lifestyle~~does Jay have cheeseburgers in his veins, and do we need to fix that with a boring diet?. He said Jay’s heart issue was (my words) an electrical problem. Jay’s athletic, a non-smoker, not overweight and has no family history of heart disease, so it appears we can keep on keeping on.
That put us on the right track, but even more important, as time elapsed the pacemaker made him feel much better overall, in unexpected ways. In December 2021, Jay and I had both contracted COVID, and were sick for about a week, during which we mainly laid in bed feeling exhausted. Symptoms weren’t terrible other than that. However, after testing positive, we both had odd lingering after-effects. I lost my sense of taste and smell (still struggling with that), and only now am beginning to get it back, and it’s very inconsistent. Jay had completely different issues that were more physical in nature. It seems that somehow the virus got into his legs and his left shoulder. In particular, he could hardly sit for extended periods of time, his legs became so sore. That went away within a few months. The shoulder problem, however, lasted right up until he got his pacemaker. Similarly, his blood pressure is now fine, after being high ever since he had COVID. He also has more energy overall, which results in him being more ambitious. We don’t know where Jay’s initial problem of a low heart rate came from, but that has also obviously been taken care of, thanks to the pacemaker.
So, Jay is now reconciled to this new situation, and considers it a plus, since it’s allowed him get past a lot of physical ailments that had accumulated, while also being completely non intrusive. Jay’s pacemaker does nothing if not needed, and only steps in when needed. At the rate it’s being active for Jay, the device manufacturer said he won’t need a battery replacement for over 11 years. And of course the biggest benefit of having a pacemaker is that he’s still alive and kicking.