HEART IN MY HANDS

★ ★ ★ ★

Photo credits, left to right – Missy Bishop and Emily Ross

By Jim Ross

“Wake up! Michael’s stopped breathing. We gotta go.”

The voice seems familiar, perhaps a childhood playmate’s. I cling to sleep, intrigued where the voice might lead.

“Get up! Emily needs us,” comes the voice, strident, impatient.

Eyes open, I sit bolt upright.

“Move!” Ginger pleads.

“What is it?” I ask.

“Baby Michael stopped breathing. Emily did CPR. The paramedics just got there.” Ginger pivots and runs downstairs.

I pull on sweatpants and follow.

“Grab two days of clothes and pills. I’ll be in the car,” she says.

I throw a handful of clothes into a Trader’s bag, count pills into a bottle, and drop into the passenger seat at 5:20 a.m.

“WAZE says we’ll get there at 6:02,” I announce as we pull away.

After a few minutes’ silence Ginger says, “Poor baby.”

“Poor Emily,” I respond.

Two months earlier, our daughter’s preeclampsia caused her blood pressure to spike like Roman Candles and her kidneys to piss out far more protein than she took in. It looked like a race between stroking out and kidneys shutting down. After her C-section, we breathed in relief when the doctor ordered her to take it easy.

When two-week-old Michael’s heart and respiration rates started bouncing erratically, the pediatrician advised, “Rush him to the ER.” After an echocardiogram, the cardiologist said, “Two small holes in his heart should close on their own.” The pediatrician said, “We’ll keep an eagle-eye on him.” Days later, Emily’s husband, Matt, became so sick he couldn’t get out of bed. Within days, their 17-month-old twins, Bella and Ben, became too sick to get up. At five weeks, Michael came down with RSV, a virus that can kill newborns. Emily spent nine days in the NICU bonding with Michael without distraction while Matt, still home, tried getting Ben, Bella and himself well.

“We should’ve done more!” Ginger says.

“We always should’ve. But, damn it, this one’s on the hospital. Michael hadn’t stabilized but they rushed him out the door.”

“He’s going to be okay,” Ginger says.

“What makes you so sure?”

“Emily needs him to be.”

“How’d she sound?”

“Frantic. I could barely follow what she was saying.”

“I should’ve baptized Michael.”

“You don’t even believe in that stuff,” Ginger says.

“Knowing he was baptized would give people comfort.”

“Why would they need comfort? He’s not dead.”

At 5:50, our son Alex calls. Like Emily, he’s a nurse. Ginger takes the call on speaker.

“I’ll be there in five,” he says.

“What’s going on?” Ginger whispers.

“When Emily started CPR, he had no vitals,” Alex says. “When the ambulance arrived, they shocked him twice and got him back. He started coming to and tried to talk, but his speech was garbled.”

“What d’you mean his speech was garbled? Michael can’t talk,” Ginger says.

“What’s Michael got to do with it?” Alex asks. “Matt’s the one who stopped breathing.”

Ginger goes pale, stops at green, then drives through red.

“Matt?” I ask, as ice invades my diaphragm.

“Emily was talking fast, she didn’t exactly say Michael, but I thought…” Ginger says.

“You thought wrong,” Alex interrupts.

“What happened?” I ask.

“Emily was downstairs with Michael,” Alex says. “She heard a thud and ran upstairs. Matt was lying on the floor. She started chest compressions. Matt’s mom called an ambulance. Em kept Matt’s blood circulating until the paramedics came.”

“Oh, my God,” Ginger says. “Matt! What would they do without him?”

“That’s for another conversation,” says Alex. “I’m pulling up to the curb. They’re waiting for us.”

“Where’s Matt?” I ask.

“Alexandria Hospital,” Alex says. “It was closest.”

“Was he conscious when the ambulance left?” Ginger asks.

“I wasn’t there, Mom,” Alex says. “My understanding is he started thrashing and they sedated him. I’m going in. Just get here.”

At 5:58 a.m., we step into the family room. Matt’s mom Fran, Emily, Alex, and their Physician’s Assistant friend Amanda close in on us. Emily and Matt’s former roommate, Thomas, amuses Ben and Bella on the couch.

“When you said he stopped breathing, I thought you meant Michael. I was prepared for that. But Matt?” Ginger says.

“If it were Michael, would that make it any less?” Emily asks.

“I only mean, Michael’s breathing was already perilous,” Ginger rationalizes.

“We gotta go,” Emily says, stepping toward the door.

* * *

An hour earlier, Emily was pumping milk in the family room with sleeping Michael cradled. Before sending her home from the birthing unit, the obstetrician said, “You’re not off the hook. For eight more weeks, your preeclampsia still keeps you high risk.  Until then, you’ve got to go up and down stairs at most once daily, lift nothing heavier than Michael, avoid vigorous activity, don’t drive a car, perform only light chores, and find ways to decompress emotionally.” Emily set herself up in the family room where she could pump whenever her breasts felt full and answer Michael’s cries without disturbing Matt or the twins, who slept upstairs.

But once Matt got sick, who else could drive Ben, Bella, and Michael to doctors’ appointments? She started driving two weeks after her C-section. She was lifting one twin after two weeks and both after four. With everybody depending on her, she didn’t have time or place to decompress emotionally.

While Emily lived in the NICU with Michael, she was allotted 10 minutes daily for showering. Anyone entering the isolation unit was required to scrub up and don gown and mask, then dispose of both upon exiting. Emily, as part of the isolation unit, was exempt.

When the twosome broke out of NICU jail, Emily brought home 50 two-ounce bottles of her frozen milk. Once home, she dropped onto the couch, shouted “Alexa, play ‘I love to love,’” and watched Ben and Bella dance to Tina Charles’ singing. She poured herself a glass of wine, took a sip, didn’t like the taste, and dumped the rest.

Next day, Amanda texted, “Let’s do Happy Hour!” Instead, Amanda came over. Matt took the twins upstairs at 8, came down by 9, and washed dishes. Then Emily and Matt gave each other a slow kiss and caress—something they had neither time nor inclination for lately.

Before Matt went back upstairs, he turned the baby monitor off. Emily later turned it back on.

* * *

At 5:01 a.m., Emily heard a thud overhead. Her first thought was: One of the kids must’ve fallen out of bed. Then she thought: That’s too loud. A piece of furniture must’ve tipped over. At 5:02, she texted Matt: “WTF.” No instant reply. After hearing faint cries emitting from the baby monitor—Matt’s cries—she detached herself from the breast pump, placed two partially-filled bottles on the window sill, and bolted upstairs.

She slammed the light on and found Matt lying on his back, slightly twisted to the side, between the kids’ beds and her dresser. “Matt, what’s the matter?”

A veteran ER nurse, Emily squatted, confirmed presence of a radial pulse, and felt his cheek: “Matt, what are you doing on the floor?” Matt mumbled, his arms contracted into his chest, hands clenched, legs jerking, eyes staring blindly.

“Fran!” Emily yelled down the hall. “D’you hear me?”

“I hear you,” Fran answered. “What’s wrong?”

“Call 911!”

Ben and Bella sat on the edge of the bed, holding each other, crying.

“Daddy’ll be okay,” Emily told them. He better be. She dropped to her knees, adjusted Matt’s 250-pound body so he lay perfectly flat, straightened his head mouth up, and cleared his airway. She then placed two fingers over his carotid artery: no detectable pulse. Like a storm rushing in, he was turning blue from the nipple-line up. He’s going down right before my eyes. It could be stroke or M.I, but whenever someone’s turned blue that fast, they’ve had a P.E.

Matt took two agonized breaths. Those could be the last breaths he takes on his own. I gotta keep him oxygenated till the paramedics arrive.  

After checking landmarks, Emily placed her hands two finger-widths above the xiphoid and with straight arms landed on Matt’s heart to force blood out. I gotta give this everything I’ve got to get blood to Matt’s brain. She came down on his heart with all her strength, pumping about 90 times a minute.

Fran got 911 on the line at 5:04 a.m. When the dispatcher asked her questions she couldn’t answer, she told Emily, “They need to talk with you.”

Emily grabbed the phone with her right hand while continuing chest compressions with her powerful left. She hit the speaker button, threw the phone to the floor, and resumed two-handed compressions. “Cardiac arrest, due to probable P.E., possibly M.I. or stroke. I’ll keep him warm and his blood circulating. Don’t stop for coffee on the way,” Emily told the dispatcher.

Emily looked at Ben and Bella holding each other like orphans abandoned on a pier. Without breaking rhythm, she said, “I love you. Daddy loves you.” For a moment, their crying subsided. Emily pumped even faster. I may be out of shape, but lugging those two kids around has kept me strong.  

Starting to tire, she compensated by attempting to compress Matt’s heart halfway through his body, knowing the rule of thumb is a third. She visualized she was Matt’s heart, keeping his brain alive, keeping his cells oxygenated.

Black crows quavered: You can’t do it. Who d’ you think you are? You know no matter how skilled the compressor, the victim usually dies. You’re weak and fat. Your emotions are going to get in the way, not to mention you’re violating doctor’s orders to avoid vigorous activity. Get real.

Emily shouted, “Fuck off. Matt’s gonna be okay. Right Matt? You’re gonna be okay.”

I’m not coming down on his heart with enough force. I’ve never seen anybody do this, I’m going to stand up. Emily transitioned from kneeling to standing without breaking rhythm, compressing Matt’s heart repeatedly from a hunched-over, standing position.

“Stay with us, Matt!  You’re not leaving us. We’re a team. I can’t do this myself!” she shouted. Hearing Emily yell, Ben and Bella cried louder. “You hear Ben and Bella, Matt? You hear them? They love you. They need you. I need you.”

I don’t know how much longer I can keep this up.

She pumped faster. I’ll keep going till I die. If Matt dies, what right do I have living? Emily’s left shoulder felt dislocated. Her hands burned.

“Come back to me, Matt! Come back!” I need to control my emotions. If I start crying, I’ll lose my rhythm.

“Hang in there, Matt. We can do this together.” I gotta live for the babies. “These babies need you, Matt!”

She looked over at Ben and Bella. “I know it looks like I’m hurting daddy. I’m not. I’m helping him feel better.” What a pack of lies. I’m beating him up. And if he leaves me, I’m gonna beat the hell out of him.

At 5:10 a.m., there was a commotion downstairs. Emily felt cold air flooding the hallway and footsteps on the stairs. “Keep holding on, Matt. Your Peking Duck just arrived.”

Ignoring the presence of three paramedics, Emily kept compressing Matt’s heart, landing with straight arms full-force on his chest, visualizing she compressed his heart halfway through his body. Bella cried louder and held Ben more tightly after seeing strangers. The first paramedic stepped around Matt to set up the defibrillator. The second said, “You can give it a rest. We’ll take over.”

As she stood upright, Emily’s head spun: “I’m an ER nurse. He turned blue so fast, I think it’s P.E.”

On his knees, the second began giving Matt chest compressions.

“Have you checked carotid lately?” asked the third.

“No, I just kept going,” Emily answered.

Ben and Bella, standing, teetered on the bed’s edge, reaching to be held. Emily lifted, embraced, and kissed them.

At 5:12 a.m., while the first paramedic started hooking Matt up to the monitor and the second attached the paddles, the third said, “You know the drill. Let us do our magic.”

Emily stepped unsteadily down the stairs, Ben and Bella clenching her throbbing arms. Fran tried to relieve Emily of one of the twins, but neither broke grip.

“Oh, Emily, tell me Matthew’s gonna be okay,” Fran said. “Are you okay?”

“I’ll be okay if Matt’s okay. Can you watch them?” Emily placed Ben and Bella down. Bella screamed and ran after her. Fran intercepted Bella and held her fast.

At 5:13 a.m., Emily reached Ginger by phone: “You gotta come now.”

At 5:14, over the kitchen’s speaker for the baby monitor upstairs, Fran heard a feverish conversation over the baby monitor between the paramedics upstairs: “We’re losing him. We’re losing him.” She swallowed hard. That’s my baby. They’re losing my baby. She squeezed Ben and Bella closer.

The fourth paramedic ran back downstairs.   “I’m Lieutenant Simba. I gather you’re an ER nurse. What’s your take?”

“Probably P.E., maybe stroke. No family history of widow-makers.”

“We’ve shocked him twice. No response. Doing more chest compressions now. We’ll shock him again soon. Hang in,” Simba said.

Three police officers paced the family room knowing that if Matt, who was young and apparently healthy, died, the house would be investigated as a crime scene. Ben and Bella each gripped one of Emily’s legs. An officer walked to his car, returned with a little brown bear, and held it out to Ben and Bella. Usually no shier than a honey badger, Ben held fast to Emily’s leg. The officer placed the bear on the floor five feet away. Ben broke hold, ran to the bear, scooped it up, ran back, grabbed Emily’s leg, reached across, said “Bella,” and handed her the bear.

At 5:20, one of the paramedics yelled, “He’s awake. What’s his name?”

“What’s his name?” repeated Simba.

“Matt,” Emily answered. Simba ran back up.

Simba asked, “Hey, you, what’s your name?”

“Matt,” he mumbled.

Matt seemed embattled, as if he fought off the fog enveloping his brain. After intubating him, the paramedics administered a sedative plus ketamine as an amnesiac.

Simba ran downstairs again. “I know you said you doubted heart attack. Maybe you’re right. But the electrocardiogram had ST elevations on three leads, suggesting MI. We’re gonna call the ER and have them activate the cath team.”

“That would be a surprise,” Emily said.

“You saved him,” said Simba.

“I just kept his blood circulating.

“Between your love and skills, there’s no way Matt’s leaving us tonight.”

The paramedics left with Matt at 5:45 a.m. When he again became combative, they administered a more powerful sedative. Matt calmed. They reached Alexandria Hospital at 5:54.

* * *

Emily, Fran, Amanda, and Alex leave the house at 6:04 and reach the hospital at 6:12. After she registers Matt, who arrived moments earlier as a medical Doe, Emily is escorted with her entourage to a small waiting room, lit as dimly as a confessional. Emily attaches her pump to both breasts.

Alex stands, crosses the room, turns a chair backwards, sits facing the corner, and says, “I didn’t come here to watch my sister’s breasts.”

Emily says, “Come back here so we can talk. I’m covered.”

Seeking to maximize the comedic distraction, Alex turns his chair face forward, but initially covers his eyes.

Emily starts recounting events that transpired after the inexplicable thud. Amanda and Alex probe for details, taking turns playing Gregory House, M.D. Emily’s convinced Matt had a stroke. “Given the choice, I’d pick P.E. because it’s more readily reversible,” she says.

“I’d prefer P.E. too, but do we have the indicators?” asks Amanda.

“Nothing makes sense,” says Alex.

Stumped, feeling anticipatory loss, the foursome withdraws into silence.

“How’s your shoulder?” Amanda asks.

“It’ll recover. I can’t think about it,” Emily answers.

Called at 5:45, the cath team arrives by 6:15. By 7:00, the results are in: No blockages, no evidence of M.I., leaving stroke and P.E. as likely culprits.

Em calls us. “Matt had a fatal arrhythmia.”

“And you foiled it,” I say.

“His ejection fraction is only 20 percent, really low. But they don’t know yet whether it’s low due to the arrest or its already being low caused the arrest.”

Ben and Bella cry inconsolably because neither Matt nor Emily is around, and they’ve just watched mommy beating on daddy, who didn’t get up. Bella places both hands over her heart and jerks them down about four inches, as if stabbing herself with a dagger, and wails.

“Children her age understand far more than people give them credit for,” Ginger says.

Around 3 p.m., Emily calls again. “When they were extubating him, he pointed to his cheek. I asked him what he wanted. He puckered his lips and again pointed to his cheek. So I kissed him there and he made the ‘I love you’ sign with his hand.”

Over the next two days, tests rule out stroke and P.E., meaning Matt had a sudden cardiac arrest (SCA) for reasons unknown. Best guesses: a virus weakened Matt’s heart; Matt has a hereditary predisposition toward cardiomyopathy and SCA; or the Z-pack Matt had been prescribed six days prior, which carries a black-box warning, caused a fatal arrhythmia. Whatever the cause, Matt had gone into ventricular fibrillation. Because his heart may be at continued risk of electrical malfunctions, the cardiologists determine Matt needs an internal defibrillator, preferably linked to a pacemaker.

When Matt learns this, he tells Emily his only regret is that having a pacemaker means he won’t be able to use a chainsaw again. When one of the cardiologists visits, Matt asks, “Will I be able to play electric guitar?”

After scratching his head, the cardiologist says, “I see no reason why you can’t.”

Matt says, “That’s great, because I wasn’t able to play before.”

Word gets out that Matt survived an SCA with no deficits; in particular, no cognitive deficits. The cardiologists inform Emily and Matt that patients who experience SCA outside a hospital survive only 5 percent of the time and almost never without deficits. People who hear their story go out of their way to tell Emily, “You worked a miracle.”

“Have you considered making a hefty bet on the lottery?” one cardiologist asks Matt.

“As a matter of fact …” Matt begins.

Emily interrupts, “Babe, you already won the record jackpot Powerball.”

Three days after his brief death, Matt receives an offer for a high-powered job he interviewed for weeks ago and promptly accepts. As he’s wheeled off to the OR, Matt announces, “I’ve come up with a new job search strategy, but I wouldn’t recommend it.”  The surgeons implant a dual pacemaker/defibrillator in the fleshy pocket beneath his left shoulder. He goes home with his left arm in a sling to discourage use while he recovers. Once home, he initially camps on the couch in the family room to be around Ben and Bella. After Bella dives toward him, he cries out in pain and migrates upstairs.

For two nights Matt can’t sleep because he can feel the pacemaker counting every beat: “It’s driving me crazy, hurts bad, I feel dizzy, I want to puke.” The next day, he and Emily meet with the electrophysiology team. They’re puzzled by Matt’s complaints, but shut down the left ventricular aspect of the pacemaker for 30 days to allow his heart to heal from the agitation associated with insertion. The right aspect of the pacemaker and the defibrillator stay on.

A week after Matt’s surgery, he and Emily go to Alexandria Firehouse 207 to thank the paramedics. Emily brings homemade cookies and popcorn as treats. “You don’t get thanked often enough,” Emily tells them. A paramedic responds, “We appreciate being thanked. But you’re the one who saved him.”

Matt initially tries to get his required walking in by pacing indoors. Emily breaks the impasse by picking up a cheap treadmill at Costco and lugging it down to the basement. “It can’t tilt, but at least it’ll keep you moving without pacing the family room.”

Six days after Matt’s brief death, I ride with Emily to her appointment with the cardiologist she began seeing while she was still hospitalized after giving birth to Ben and Bella.  She confides, “Even after they revived Matt, I didn’t expect I’d ever see him alive again, much less intact.” After the appointment, she repeats the cardiologist’s words: “If Matt wasn’t a believer before, he ought to be one now. There’s a reason he’s here.” Emily keeps monitoring her blood pressure daily. “I want to be around to see these babies grow up,” she says. “I’ll get back to the gym once it fits into my schedule.”

Ben and Bella learn how to hook the pulse ox and blood pressure cuff onto Matt and Michael and watch for the lights to blink on. If Matt sits suddenly, Ben grabs the stethoscope, runs to him, and places the chest piece over Matt’s heart. If Matt starts coughing, Bella brings Matt a heart-shaped pillow to hold to his chest. After watching Emily examine Matt’s feet for fluid retention, the twins begin checking out Matt’s feet.

Emily orders Ben and Bella their own plastic stethoscopes and blood pressure cuffs. The two can be seen walking around the house with stethoscopes hanging from their necks, and placing the chest piece on whoever’s around. On one visit, after I lay down on the floor, Ben climbs onto my chest and pounds repeatedly, crying, “Grandpa, Grandpa.”

“We’re sending these kids to med school early,” says Emily.

Ben and Bella settle into new routines. In the family room, they drag out an inflatable mattress at bedtime. As it rises, they jump on it like a trampoline. Emily sleeps on the mattress with Bella. Ben starts on the couch but joins them if he feels like being held. Michael, in-the-clear medically, stays in his pack-n-play unless he’s having a rough night. At wake-up time, Ben and Bella throw themselves onto the mattress to accelerate deflation.

“Why’re you sleeping downstairs?” I ask Emily.

“At first, so Matt could heal. He wants us to move back upstairs. But I tried. I can’t.”

“Why doesn’t Matt have the same problem?”

“He was dead for most of it,” Emily says, laughing. “I was hoping he’d tell me what being dead was like—did he see light or anything—but no. He says, ‘I don’t remember.’ When I’m in that space, I see Matt dying, I feel him leaving me. Yet, every night, he waltzes in and it’s lights out, sweet dreams.”

Another day, as Ben and Bella play with the talking teapot and drink imaginary tea, Emily blurts out, “I feel like I cheated death, like in Final Destination.”

“Isn’t that your job as an ER nurse, cheating death?” I ask.

“Never like this,” says Emily. “I played blackjack with death and beat the house.”

“Is death finally at bay?”

“Oh, no,” Emily answers. “I still feel like death’s coming, every bump and crash, every time the kids fall and don’t get up right away, whenever somebody’s too quiet.”

“What d’you do about that?”

“For now, I’m just in awe I held Matt’s heart in my hands. I kept it pumping, I watched him come back.”