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 stretched 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!” Can I thump my own chest? I can’t move my arms. Again I descend.
The surgeon’s voice. “Give him 0.04 milligrams of atropine.”
That’s pre-anesthetic dose! Useless here.
“MORE atropine!” I demand. “Half to one milligram!”
The voice. “Give him 0.5 milligrams of atropine IV.”
I’ve stopped sinking. My vision is returning. I’m lucid. I no longer need to resuscitate myself. My heart rate is up to 60. I’m alive!
I remembered this story when a friend described his recent hernia repair. I recalled the time, decades ago, when I tasted near-death during a similar procedure. I ran the emergency medicine department at that hospital. I knew the anesthesia staff fairly well. Younger and more haughty then, I reasoned that a surgeon could not kill me on the operating table if he tried. An anesthesiologist could do so without half trying. Being an active triathlete, I considered myself uber healthy. So I eschewed general or even spinal anesthesia and elected to have the procedure under local anesthetic.
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 to the intense discomfort by slowing down my heart rate. My triathlon-trained resting pulse in the 40s left little margin; hence my near-death experience. By my choice, I was the only one in the room with recent training and experience in resuscitation. I labored to fight off the impending darkness to direct my own life-saving resuscitation.
“Physician, heal thyself.”
It all worked out. A post-operative cardiac evaluation rendered the diagnosis of “Athlete’s Heart Syndrome.” I was proud of that diagnosis. In retrospect, “Arrogant Young Doctor Syndrome” would have been more appropriate.
Despite the peri-operative dramatics, the hernia repair has held up just fine over the years. Should the occasion for a repeat procedure occur any time in my life, this former arrogant patient will trust his anesthesia colleagues to exercise their skills.
Because this emergency physician has no desire to heal himself again.