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Of course, I was hoping that my visit to the cardiologist the day after next would not only answer my questions (Why had this all started up again? What was causing the individual attacks? Why had the one on Monday night seemed so different to the one two days later? Would I have to keep getting shocked? Would I have to have a pacemaker? Would I have to have that terrifying-sounding operation in which the surgeon burns away part of the heart?) but even go so far as to tell me that nothing had really happened, and that I would play soccer until I was a thousand.

Of course, nothing of the kind happened. Total number of questions answered definitively: zero.

The cardiologist, Dr John Fitzgerald, took a good listen to my heart and his tech stuck more of the EKG electrodes on my formerly hairy chest, which was now starting to resemble the patchy hide of an extremely unhealthy donkey. At that particular moment, my heart was beating away with a quiet confidence I personally didn’t share. This, I realized, was the problem with having an intermittent condition (like asthma, or headaches, or a weird noise emitting from the transmission at any time exceptwhen the car was in the shop: they couldn’t tell me much until things started going wrong again.

Fitzgerald ordered a more comprehensive EKG accompanied by an ultrasound. In return, I asked him about ablation: was it really as routine as Weimersheimer had made it sound? (After all, cardioversion was simultaneously as routine as he had made it sound and yet really, really not.) I imagined the chest being opened, a stainless-steel or chrome spreader opening the ribs, and the surgeon leaning over me holding something that looked suspiciously like a soldering iron.

But no: the surgeons go in through the thigh, Fitzgerald explained, pushing thin, flexible wires up through major blood canals until they reached various key points of the heart. (I was inwardly boggling, imagining someone in scrubs pushing a piece of well-cooked spaghetti in through my thigh while squinting intently at a map of my vascular system that looked like a more complicated diagram of the London Underground.) Having miraculously persuaded these wires to these critical points, the surgical team (also called electrocardiologists or electrophysiologists) can first take readings to plot the electrical circuitry of the heart, and then send a high-frequency radio signal to burn out a particular nest of nerves that was misfiring, burning it to scar tissue. So many parts of this procedure defied belief I couldn’t bring myself to think about it.

In the meantime, I was facing the even less answerable question of how to live my life while waiting for all the big cardiology questions to be answered–and on this issue, nobody in the medical profession had been able to give me any advice that was any more fine-tuned than Weimersheimer’s cheerful reassurance that if things went wrong again, I could always come back to the ER and they could shock me back into shape.

How much activity could I do? Was a certain amount of exercise a good thing? I had an appointment to meet a student across town and cycled there, all downhill, and though nothing untoward happened, my heart felt as if it was laboring. On the way back I pushed my bike up the uphill stretches and rode it only on the (mainly) flat, but even so by the time I got home it was skipping and hopping every few beats, though it settled itself down, thank God. I named this kind of event (borrowing epilepsy terminology) a petit mal, or minor event: something was wrong, but it wasn’t disabling and it seemed self-correcting. The attacks I’d had on Monday and Wednesday nights were the grand mal, the real deal.

If I had to come up with one defining difference between the two, it would be the racing heart. I’ve now heard from at least a couple dozen people who suffer from a. fib., and it has astonished me how many of them have put up with it for weeks, months or even years. Yet if I think of the petit mal and imagine that low-level skipping and jumping, I can imagine not noticing it. A couple times recently, even in my ultra-heightened state of awareness, I’ve not been sure if I’m on pulse or not. But the grand mal, the heart beating at 150 or even 180 times a minute, threatening to burst up through your throat–some of the a. fib. sufferers I’ve been corresponding with or talking to have never had that.

The ultrasound, which was set up for Saturday morning, was something I’d had before (see A Barrel of Monkeys) and had found utterly fascinating. Once again the tech (whose name was Jeremy) had me lie down, then wired my threadbare chest to his computer, made with the gel and began moving his wand around to see the ghostly sketch of my working heart from various angles.

By inclination and training he was an artist; his day job simply involved making pictures for doctors. As we talked, he moved the ultrasound wand a little like a joystick, his eyes on the screen, and when he got exactly the angle and the image he wanted, he took the mouse with his other hand and plotted a number of salient points on the screen, converting the pulsing sketch to data.

“You have a beautiful heart,” he said, examining his monitor closely.

Under the circumstances, this was both a compliment and a relief, and I told him so.

He’s seen all kinds of hearts, he said, many of which were not beautiful.

Genetic issues, I asked, or damage?

Damage, he said. Oddly enough, congenital defects, which normally seem both ugly and frightening, are rarely the worst of our troubles. It’s amazing how our bodies adapt, he said. No, the main problems are all self-inflicted: smoking, bad diet, bad lifestyle.

Every so often he punched a key that made the computer broadcast the sound the heart was making, or perhaps more accurately a digital facsimile of the sound. I was struck by how it sounded almost like a chuckle: cheerful, optimistic, just going on with its business.

To some people, he said, it sounds like a washing machine, turning the water and the laundry in the drum back and forth, back and forth. “You should hear the mitral valve,” he said. “We’ll get to it in a minute. People say it sounds like a dog barking.” But to me it sounded like a deejay rubbing the vinyl on the turntable with his fingertips, wacka-wacka, wacka-wacka.

I told him how stunned I’d been by the mitral valve, when I had first seen it on the ultrasound.

Yeah, he agreed. We think we invented plumbing and electricity, but it’s all there in the heart, in far greater complexity than we can even fathom.

Imagine an engineer being asked to design something as supple and perfectly-fitting as the mitral valve, I suggested, and then saying, “Oh, yes–and make it work perfectly, without stopping, for 85 years.”

Jeremy nodded. “We’ve tried, and we *know* we can’t do that.”

I left with yet more mixed messages. No heart murmur, no valve leakage, no signs of heart disease–but, at the same time, no understanding of what was causing my condition, what might help it, and how the heck I should live my life until we found some of those answers.

As you can probably gather, this is by no means the end of the story. I hope you’ll follow as I add new chapters every few days and continue to explore both the narrow subject–atrial fibrillation–and the broader subjects, such as the heart itself, and what Whitman called “the body electric.”

I also hope you’ll forward this to anyone who has arrhythmia. This may possibly turn into a book, in which case I need all the help I can get from others, whether what they have to offer is answers or questions.

Back soon.

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By the following day, Wednesday, my don’t-care view of a. fib. had been replaced by a cringing wariness. I walked around carefully, as if my heart were made of glass, and I was carrying it on a velvet cushion of my breathing. I felt whipped. The procedure had jangled my entire system, as I knew it would—any operation, no matter how minor, takes anywhere from a week to a month to recover from, and don’t let anyone tell you otherwise—but this particular event had left me shuffling around like an old man in bedroom slippers. Life in the household went on around me. I once knew a bunch of ageing rockers who decided to name their band Old And In The Way, and I knew just what that phrase meant.

Even walking up and down stairs took a certain deliberateness, as if I were carrying a loaded tea-tray in my chest—but once again it wasn’t when I was active that things went wrong. It was when I tried to be inactive.

The event started out around 10 p.m. like a no-account threat, a slight uncertainty. My heart stuttered, but then beat fine for half-a-dozen beats or so, then stuttered again, then picked up its rhythm once more. I walked into the bathroom, which seemed to throw things off balance a little more, and took a bath, which seemed to settle everything down completely. It wasn’t until I tried to lie down in bed that everything got out of control. For the first time I felt the familiar invasion, the abrupt manic whacking in my chest. I sat back in an armchair and laid my right palm over my heart, as if this would somehow offer it sympathy and encouragement, and slowed my breathing to cathedral calm. And for a while that worked.

Over the next twenty minutes, though, the tension and the stakes rose. By 11:30 I felt as though I were in a medieval morality play in which the stage represents Everyman’s soul, which in turn is the battlefield on which the forces of chaos strike at the forces of order, trying to overthrow them and establish violence and despair.

My heart beat normally for four or five beats, sometimes as many as thirty, but then a kind of invasion took place: my arms felt as if they needed to flail or twitch, and this current converged on my heart, which abruptly went into spasm, beating hard and fast, feeling less as if it were beating and more as if it were being beaten. These were heartbeats that had nothing to do with circulation of blood: they were a kind of war drum, or a great gate being battered. My chest and throat constricted, and that sense of squeeze rose into my ears, which grew hot, and my head. I felt dizzy, and head a soundless buzzing. And yet this most extreme symptom was the sign that everything was passing, because the energy, like a tiny, vicious whirlwind, seemed to rise out of the top of my head, leaving silence and calm behind, and when I recovered and looked around—well, inside—the attack was over, and my heart was like a mild sea breaking at the foot of the castle walls.

During the attacks, I felt so besieged I couldn’t speak, and had to give Barbara instructions in sign language. As soon as it had passed, though, I had the absurd sense that I was talking as casually as a Noel Coward character, sitting in a drawing-room armchair, wearing a dressing-gown and mildly waving a cigarette-holder to make his points.

After about an hour and a half, I quit trying to fight this battle on my own. I got Barbara to drive me to the hospital again.

It was like Homecoming Weekend. I was delighted to see the action-figure silhouette of Dr. Peter Weimersheimer, who greeted me like the artistic director of a summer-stock theater company greeting one of his New York actors, back for another season on the rural boards.

Once again I was on the bed, wired to the monitor, IV in my arm. Yet Weimersheimer seemed curiously reluctant to describe what was going on as atrial fibrillation. Like me, he felt that this curious two-phase see-saw that was going on was different from the out-and-out madness of two nights previously. “There’s something called atrial flutter,” he said, but on the discharge sheet he would ultimately write simply “Palpitations.”

As usual, I was trying to deal with the weirdness and anxiety of the situation by studying it, and myself. The most peculiar aspect of the night’s upheaval was that it reminded me more than anything else of Restless Leg Syndrome.

RLS, as it is abbreviated, is a mysterious neuromuscular disorder. Nobody knows what causes it, though in my case there may be a genetic component, as my mother had RLS, too. It’s one of the strangest and most infuriating of sensations: a kind of energy or impulse appears in (usually) one leg, making you feel as if you need to twitch or kick it. (I heard a Tourette’s Syndrome sufferer describe exactly the same build-up that, no matter how hard you try to relax or to fight it, forced him to burst out in a kind of verbal twitch.) It can go on for hours, and most frustratingly—and most like my a. fib. symptoms—it typically starts just when you’re trying to relax. I’ve had it since I was 19, though often it has vanished for years at a time, and at its worst it would keep me up virtually all night until, utterly exhausted, I felt like crying in frustration.

Whatever this particular cardiac event was all about, it seemed to behave much like RLS—only instead of creeping into the nerves and muscles of my thighs or calves, it crept into my left shoulder and pectoral muscle. The first sign that my calm phase was about to end, in fact, was that my pec/shoulder area started to feel that build-up of electrical charge, which then seemed to dive down and sideways, sending my heart into its manic phase. It was as if I had Restless Heart Syndrome.

I twitched around in this fashion until around 1 a.m., and then began noticing something else that seemed odd. The phases seemed to be polarizing. The manic phase was, if anything, more manic—at its peak I felt hot and dizzy and on the verge of passing out—but the calm phase lasted longer and longer. In the end, it was as if the existential battle was won by the forces of order if only because the forces of chaos had retreated, perhaps to regroup and mount another attack another day, perhaps to go and try to win someone else’s soul.

I left sometime before 2 a.m. Weimersheimer gave me one metropopol, a beta-blocker that would slow my heart (though not do anything specifically about the arrhythmia) and another one to carry home and take in the morning. He also left phone messages for my internist and the cardiologist I had seen five years previously, Dr. John Fitzgerald, who would make time to see me later that same day.

They were clearly serious about this chaotic cardiac event, whatever it was. Time to ramp up the gear and find out what the heck was going on.

As you can probably gather, this is by no means the end of the story. I hope you’ll follow as I add new chapters every few days and continue to explore both the narrow subject–atrial fibrillation–and the broader subjects, such as the heart itself, and what Whitman called “the body electric.”

I also hope you’ll forward this to anyone who has arrhythmia. This may possibly turn into a book, in which case I need all the help I can get from others, whether what they have to offer is answers or questions.

Back soon.