palmoscopy: observation of heartbeat or pulse as part of a medical diagnosis
The triage nurse asks about my symptoms as I huddle at the ER registration desk in Grand Haven. They know me well by now. Last night, I tell her, I felt pressure against my heart. And sweating. I don’t tell her I feel fine now. Nor, this morning, do I even consider an appointment with my primary care physician. Test results as an out-patient take days. I want answers. I want them now. In the ER you get instant gratification even if the news is bad: two weeks to live. If last night’s episode was a heart attack, it’s apparently not life-threatening. Yet I swoon over the reception desk to appear frailer than I feel. This claim must seem legitimate.
The word “heart” bumps me to the head of the line. The wide doors to the treatment rooms swing open.
I change into a hospital gown, slide onto the bed, and describe the symptoms to a nurse. She checks blood pressure, pulse, temperature. All normal. In fact my blood pressure is low. She attaches electrodes over my upper body for an electrocardiogram. Cold, gooey patches dot my skin. She explains this shows the electrical activity of my heart. Impulses, recorded as waves, flow along a monitor if you’re lucky. “The muscle of an injured heart doesn’t show electrical impulses,” she says. I press a finger to my chest. A gentle thrumming. I’m not flat-lining. Yet. But the overly processed air in the ER, the discordant noises, the flashing and beeping, the unrelenting fluorescent lights, don’t sound like the real world. I almost feel as if I died last night—halfway between awake and asleep—or not knowing the difference. And if it isn’t a heart attack, how to interpret the mystifying message sent to me by my heart?
Last night I think a flutter in my heart awakens me around midnight. From the start, however, I’m confused by my lack of conviction or empirical evidence. Perhaps I haven’t yet fallen asleep. Perhaps I’m in a state of semiconsciousness.
Whether awake or not this is what I feel unless I hallucinated the entire episode. No, let me make one definitive statement. This is what happens: My skin sweats, mildly. A thin pressure encapsulates my heart. The pressure deepens, but softly, as if a palm cradles it. Then, for a brief moment, the hand hugs it. This mental image is distinct. No arm is attached to the hand, only a portion of a nondescript wrist. Is the gesture meant to convey a farewell? A greeting? Love? A subtle warning? In this quasi-conscious state I’m not scared. I passively accept this gesture, whether it’s a vision, a dream, or something else.
Then I fall asleep.
In the morning I remember the sensation. Now, more alert, I want to understand. It felt good, but was it actually bad? A heart attack? Perhaps a metaphor. If so, for what?
Another nurse, carrying a slotted tray of test tubes, pulls back the curtain encircling my bed. She’s here to draw blood. “What’ll that show?” I ask. Apparently, if the heart has been damaged, certain enzymes leak from it into your blood stream. I imagine chartreuse-colored enzymes contaminating my veins because the word “enzyme” sounds chartreuse. I might be dying, so indulge me. She slides a needle into the crook of my elbow and fills vial after vial of blood.
Next up is a chest X-ray. I worry about radiation but, at this point, I’m too far into the heart attack scenario to say “never mind.” They maneuver my entire bed out the door, the aide soundlessly gliding me down one linoleum corridor and up the next. A breeze gusts my skin. I experience the sensation of floating through space. Who knows where I’ll land?
I’m still here on earth, however. The technician asks me to stand in front of the machine. “Don’t move. Hold your breath.” When I ask what the X-ray might reveal, he replies, “fluid in your lungs. Also, the size of the heart and the blood vessels.” But won’t the X-ray appear skeletal, I wonder, a vest of ribs protecting a defenseless heart. I want to ask the technician for a copy of the X-ray, a snapshot to be saved for a photo album. Not that I believe in ghosts or otherworldly creatures, but what if a hand has been dispatched to my heart with a message? I want to see it. I want to know the message.
I’m wheeled back to my room, a double, which now contains another patient. A man coughs and sneezes, spewing galaxies of germs into the air.
I nod my head toward the man and ask the nurse for a face mask, the kind surgeons use to protect themselves from the common cold, Ebola, the plague. She sighs but gives me one. The man seems closer to death than I. The nurse must understand how hard I work, on a daily basis, keeping it away. Why isn’t everyone as vigilant as I?
The ER doctor sits on a stool and scoots close to me. He wants to know my symptoms, what happened last night, what did I feel? I again explain the sweat, the pressure on my heart. He waits for me to say more.
“It was gentle,” I say, hoping he can hear me through the face mask. “Friendly.”
He puts down his pen. He flips through my chart that might, at this point, contain the results of the blood and X-ray tests. He looks at me. “I’ve never heard anyone describe a heart attack as gentle,” he says. “Or friendly.”
“Maybe it was a little heart attack,” I say.
“I’m scheduling a stress test for you,” he says. “Just to be on the safe side.”
“Three days,” he says. “But the ECG, the blood work, the X-ray, all are normal.” He is not unfriendly, exactly, but suspicious. “Sometimes, you know, people imagine things,” he adds. “Especially when they’re stressed.”
I want to tell him of course I’m stressed: about dying. After all I’ve been stressed, or so it seems, about dying since birth if not before. Isn’t he himself terrified by the sheer nothingness of it all? I also want to ask him if it could have been symbolic. Isn’t it just as important to unravel the meaning of a symbol or a sign as it is to diagnose a physical symptom? Isn’t there a test for that?
Three days later I report to the Nuclear Medicine Department for the stress test, which will determine if I had a heart attack or not. I want to declare that I am suffering the aftereffects of a metaphor and call off the test. But being a hypochondriac, I can’t.
So here I am, trapped in a high-tech-fluorescent-lit-nuclear-medicine chamber.
A myocardial stress test determines whether blood flow to the heart was blocked long enough to have caused damage. I sit on a chair while the nurse ties a thick rubber band around my upper arm. She plunges a needle into a vein injecting me with radiopharmaceutical Tc99m Myoview. It takes time for the material to flood my system, though I expect to glow electric-green immediately. With a cheery smile from the nurse, I’m encouraged to go to the cafeteria for breakfast. Return in an hour.
I order an English muffin and a bottle of water. I sit alone at a small round table. A few doctors and nurses, at neighboring tables, laugh and eat. I remove a pencil from my bag and, on a paper napkin, I write: For breakfast I had an English muffin with a radioactive chaser. Not exactly a balanced diet. Surely I did not have a heart attack. The radiation will kill me instead. It reads like a suicide note. No need for an autopsy. If it weren’t for the radiation coursing through my system—if I didn’t feel like a nuclear bomb about to detonate—I’d sneak out and go home.
I’m given a cardiac computerized tomography before the stress test. I lie on a table inside a doughnut-shaped machine while a tube rotates around my body collecting images of my heart and chest. I turn one way. Then another. The machine whirrs. I want a copy of this procedure as well. I want to see inside my skin. Who am I? What was that gentleness? What was that shadow? What do I look like on the inside? Can such a printout convey—if not the actual distance or length of time between me, today, and my eventual but hope-to-be-avoided death—a history of my life? What I really want to ask the nurse is whether these machines and tests are smart enough to differentiate between heart attack and metaphor.
I’m next brought into a room with a treadmill as if this is a gym, and I’m here for a workout. If this is a test, I’m sure I’ll flunk. While I walk half an hour every day, let me emphasize the word “walk,” as in “saunter.” I’ve been on treadmills only once or twice, and they seem intimidating.
The machine starts slowly. No problem. Piece of cake. The nurse turns up the speed. I don’t even break a sweat. My heart doesn’t feel as if it’s about to attack. They speed it up and, again, no problem keeping pace. I feel as if I’m accomplishing something significant as making it through the Olympic trials. The doctor studying a printout smiles. The nurses beam. They crank the machine faster. Surely I’m soaring back and forth in time as if the computer will spew out a complete history of my heart from the moment I was born to now. I’ll understand everything I need to about my heart and soul—if I have one.
Finally the machine slows before stopping. The doctor tells me I have the heart rate of someone at least fifteen years younger.
How then to explain that hand holding my heart? I didn’t dream it. What was it? Whose was it? What did it mean? Was it a warning? A message?
Sometimes people imagine things, the doctor said.
But death is my obsession, I should have answered. I imagine everything, every possible kind of death! Little everyday deaths. Near-deaths. Death-defying deaths. Emotional deaths. Existential and metaphysical deaths. Minor inconvenient deaths. Pseudo deaths. Final death. I need a system that ranks various deaths on a scale from zero to eternity.
After I return home, I Google symptoms for a “gentle, friendly heart attack,” which the doctors don’t think I had in any event. I find sites that describe a squeezing pain in the center of your chest, pain in your shoulder and arm, even your teeth and jaw. Prolonged pain in the upper abdomen, shortness of breath, sweating, fainting, nausea, clammy skin, fatigue. Besides the sweating, which could be symptomatic of anxiety and stress, none of these descriptions fit me. Nothing about shadows or symbols.
I must discover what it is.
What other words pertain to the body to make it more of what it is—or more than what it is—keeping me on the safe side.
The side of life.