7:00 am: The woman at registration gives me an A+ for having all my paperwork properly filled out and ready to present. I don’t tell her I’m a teacher. I don’t tell her I have to believe that following all the rules will mean everything will work out just fine for me on this day when I’ve come to Riverside Methodist Hospital, so my cardiologist can confirm the presence of a suspected hole between the atria of my heart, and, if feasible, close it.
8:30 am: The nurse prepping me for my transesophageal echocardiogram says, “Your TEE was scheduled for 8 o’clock. I’m waiting for your blood chemistry before we go. I don’t complain. I’ve taken two Plavix and a baby aspirin to make my platelets nice and slippery so they won’t clot around the closure device, if indeed the second procedure is needed. In my head, I keep saying, “nice and slippery,” like a mantra meant to ease me through this day.
10:00 am: TEE time. A different nurse comes to wheel me to the room for the transesophageal. As she pushes my gurney down the hallway, I try out a joke on her. “What did the snail say while riding on the turtle’s back?” I lift my arms in the air, feel the air on my palms. “Wheeee,” I say, and the nurse laughs. I’ll remember her later in the day.
10:45 am: “Swallow,” the doctor, one of the associates in my cardiologist’s practice, says. “I need you to swallow the tube.” They’ve promised me that they’ve started the sedative that will send me into twilight, though I’ll have to be responsive to her command to swallow the tube and later to cough, so she’ll be able to hear and see if blood shunts from my right atrium through the suspected PFO into my left atrium. “Swallow,” she says, but I can’t. “We’ll try a pediatric tube,” she says, but still I can’t. I can’t swallow the tube, and, therefore, the TEE can’t be done, which leaves my cardiologist knowing no more than he already did about my heart. There’s talk of ordering an endoscopy to access the condition of my esophagus. There may be strictures or a narrowing of the esophagus that’s making it difficult for me to swallow the tube. The nurse is wheeling me back to the prep room, only this time I’m telling her no jokes; I’m not raising my arms in the air.
11:15 am: “ I guess I failed the first test,” I tell my cardiologist when he visits me in the prep room, saying he understands there was a problem with the TEE. “If they do an endoscopy,” he says, “I won’t be able to go into your heart today.” He tells me there are two options: do the endoscopy or let him do the closure procedure. I ask him whether the procedure will give him the information he’ll need in order to decide whether to close the hole he suspects is there. He tells me it will. I’ve come this far. I want something accomplished on this day. “Let’s do it,” I tell him. “All right, then,” he says. “I’ll get things ready in the cath lab, and we’ll see what we’ve got.”
12:20 am: I’m in the cath lab and everything is in place for the procedure. My cardiologist enters in his scrubs. He puts a hand on my shoulder. “Okay, buddy,” he says. “Let’s get to work.”
12:30 pm: My cardiologist says, “I’m definitely in the left atrium now.” I’m wide awake, watching the procedure unfold on a screen. I don’t feel a thing. My cardiologist has entered two veins in my groin, one for the tube that has the camera that captures the images he needs, the other for the catheter that delivers the closure device. There’s a hole, and I’m glad. If my cardiologist hadn’t found a hole, I’d have two tubes in my groin and a week’s recovery period ahead of me, all for nothing. Plus, we’d have no idea what caused my stroke or when it might happen again. But there’s a hole. Hallelujah! There’s a hole, and this man is going to close it.
12:45 pm: “I’m done,” my cardiologist says. “There was a hole. We closed it. You’re going to be fine.” Then, like a rock star, like Elvis leaving the building, he’s gone. I ask my nurse about the size of the hole. She shows me the device they used to close it, and it appears to be slightly larger than a nickel, slightly smaller than a quarter. I ask her about an image still left on the screen, a fluoroscopic image, I’ll learn later. “Is that my heart?” I ask her, and she says it is. She shows me where the occluder, the closure device, is located, this titanium ring of mesh, locked in place to keep blood shunting from right to left. My heart looks like a face in profile. The ridge of a forehead, the hook of a nose, the mouth and chin. There between the atria rests the occluder. Such a light thing, such a beautiful thing. “Can I have a copy of that image?” I ask. I clutch it to my chest as they wheel me to my recovery room.
4:00 pm: Because of the incisions in my femoral veins, I have to lie in bed, not moving or bending my right leg. By the time the nurses come to remove the tubes, I’m a little bored, so I try out a few jokes on them. I tell the snail joke. No response. So I try a really bad pun that kids usually enjoy. “Where does the General keep his armies? In his sleevies.” Nothing. “Boy,” I say, “you’re a tough crowd.” Then I decide to try something a bit more, shall we say physiological. “Do you know what a man has when his alligator dies? A reptile dysfunction.” Finally, laughter. Giggles, snorts, guffaws. That’s what I like to remember as we turn toward the end of this day. I have three more hours of lying on my back. Then they’ll release me and I’ll sleep in my own bed. I’ll start to heal. I’ll wake the next morning, a lucky man. I’ll greet the rest of my life. . . bada-bing. . . whole-heartedly.