A Heart in Chaos, Part V: Familiar Symptoms, Invisible Enemies

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A chronic illness is a strange companion: the more deeply ingrained it gets into your body, your life and your psyche, the more it becomes a condition of existence, a normality rather than an abnormality.

For me, the chronic condition that was underlying much—who knows how much?—of these cardiac events was the fact that all my life I’ve been a terrible sleeper. Over the years this has got generally worse: my natural sleep-cycle is 90 minutes on the dot, so every night I wake up every 90 minutes. Sometimes I go back to sleep, sometimes not.

The worst part, though, is the actual trying to fall asleep. Unless I’m getting fairly strenuous physical exercise, the act of trying to sleep is a drama of frustration. For about ten minutes I’ll start to drift off, but the slightest distraction—a noise, an itch, a recollection of something I need to remember to do—pulls me back into alertness, and from then on it may be hours before I can let go. Come to think of it, the night of my first attack, July 13^th, I had gone to bed before 11 p.m. but once again had failed to make it across the border, and by midnight, when the a. fib. started, I was awake and despairing.

In fact, come to think of it some more, pretty much the previous four months had been even worse, in terms of insomnia, than usual. Twice, quite recently, I had not managed to get to sleep until around 5 a.m., and on top of everything else, my Restless Legs Syndrome symptoms had come back from wherever RLS goes on vacation. Far from being restful, nighttime had become the time of twitching, frustration, loneliness, and too many trips to the refrigerator in search of comfort foods.

My two night-time attacks of atrial fibrillation, of course, had made things still worse: Monday night I was up literally all night, and Wednesday night, after getting back from the hospital I didn’t get to sleep until maybe 4 a.m. My RLS was getting worse than ever, and to cap it all, various households of students in our neighborhood kept setting off fireworks until 3 a.m.

The attacks had also badly shaken me in other ways, too. My friend and former NPR producer, Bob Malesky, wrote to me later, putting this grim nighttime scenario into words that sounded awfully familiar. For nearly two months after his own heart attack, he said, “I no longer trusted my heart. Every little palpitation, twitch or odd rhythm in my chest suddenly portended an oncoming heart attack. It was hardest at night, when I lay down to go to sleep. I’d feel every beat and wonder if the heart might quit on me during the night. Needless to say, I wasn’t sleeping well.” Every moment, he said, was clouded with “the fear that my heart was going to betray me.”

Yet somehow this piece of the puzzle, too familiar to be visible, had not occurred to me. By now we were on to July 22nd. I was taking metoprolol, a beta-blocker, to keep my heart rate and blood pressure down, and I couldn’t tell whether it had the effect of suppressing my energy and spirits altogether, or whether my general sense of having turned into a crabbed and shuffling old man was depressing me. Determined to get out of the house and have at least the minimum of exercise,  I cycled half a mile across town (to meet a student) and back, and immediately after I put the bike away in the garage the fluttering started–again, not during exercise but afterwards.

Was I doomed to a life without any exercise at all? My God, I’d kill myself. And why did this disturbance, like my father’s angina, strike after exercise rather than during?

It settled back down, but on my way out to see my family doctor, Dennis Plante, at 4:30 p.m. I was exhausted, confused and scared.

He read the blood tests that he and John Fitzgerald, the cardiologist, had ordered. They had all come back normal: liver normal, prostate normal, cholesterol a little high but better than a year ago, kidneys normal. A beautiful heart, beautiful blood.

But it says a great deal about his skill as a diagnostician that we talked the subject into a slightly broader realm, and finally we tackled the triple issue of my inability to sleep, my RLS and my anxiety. He listened to it all—I’m fairly sure he was hoping to get out of the office by 5 p.m. but stuck it out until 5:30, bless him—and decided to tackle all three head on with a substantial prescription of Klonopin.

Klonopin is essentially a variant of the lorazepam I’ve taken occasionally, originally for fear of flying, but it’s a much heftier dose. The point, he said, is that we may not know what causes a. fib. but one thing we know for sure is that it’s exacerbated by tiredness. Likewise, we may not know what causes RLS but one thing we know for sure is that it’s exacerbated by tiredness. Let’s try guaranteeing a good night’s sleep and see what happens. Reboot not just the heart but the whole corpus.

Let’s spell this out more clearly: this one prescription had three values: (a) increase sleep and thus decrease a contributory cause of a. fib.; (b) decrease anxiety and thus help sleep; (c) suppress RLS symptoms. The complete trifecta.

Dennis Plante’s plan worked like a well-designed potato peeler. Took 1 mg around 10 p.m. and immediately fell asleep for almost an hour. Was woken up by loud noises that turned out to be skatebarders doing tricks on the road in front of our house. Asked them politely to move down the road; they agreed politely. Fell asleep again around midnight and slept pretty much straight through until 8. Can’t remember the last time I slept so well. Un-frigging-precedented.

The Klonopin didn’t make me feel drugged and dopey, thank God. The following day I felt a little sleepy at times but not nearly so wrung out as I had done for the past–um, well, for pretty much all of the recent past. Cycled to campus and back, and to the coop and back, with only one tiny flutter. My heart felt—well, sound. (Sometimes it feels uneasy even when it’s ticking normally.) My senses of humor and imagination were back. The a.fib. might not be cured, but my spirits were much less daunted and cowed than before. Aware of the (somewhat distant) danger of addiction, I decided I was gonna give the Klonopin another shot that night, and then maybe try sleeping undrugged for a night.

One last thing. Talking to Dennis Plante, I told him that one of the aspects of the whole cardioversion–in case you’ve forgotten the jargon, that was the bloody great electric shock they gave me to bump my heart back into rhythm–experience that struck me as the most remarkable was the titration of the sedative. A dose of somethingthat is strong enough to knock you out so hard you don’t feel all those volts, yet last only four or five minutes? That’s pretty impressive anaesthesia.

He nodded, but branched off in an unexpected direction.

“Plus it induces a certain amount of amnesia,” he said, no longer looking at me but away into the distance. “If you’re going to be shocked that hard, we don’t want you to remember it.”

Once again I had the frisson of knowing something terrible had been kept from me, even though I had been through the heart of that supposedly routine darkness.