Blog | Thursday, January 2, 2014

Reflections on a near-death experience

Now that it has been nearly two months since my cardiac arrest and resuscitation, I have finally found the leisure and the motivation to put fingers to the keyboard to gather some thoughts and feelings about it. Of course these include at least in part the sort of changes in attitude and philosophy people are commonly supposed to experience, but for the most part, my own experience seems different.

In my particular case, the way it happened was not a bolt from the blue, but during a test specifically designed to provoke signs of cardiac ischemia. I knew I had mild coronary disease, but I was on lipid-lowering medication, had a good blood pressure, didn’t smoke, exercised regularly, wasn’t significantly overweight, and had passed two previous stress tests. On the other hand, I had just come to the emergency room with chest pain. But on the other hand, (I guess that’s the first hand), my EKG and cardiac enzymes had returned normal. So the event was a surprise, but not a huge surprise. Nonetheless, it’s a bit daunting to know that there but for fortune, the event could have occurred on the airplane I planned on boarding that evening.

First, let’s attend to all the questions, truisms, and philosophic platitudes.

No, there is no white light. At least not in my case. Perhaps I wasn’t out long enough. (Although long enough to have a seizure and need CPR until the paddles were charged and shock administered. ) Or maybe I’m not headed in the “white light” direction anyway. On hearing of my failure to see a white light, a friend asked, “Well, how about a red one?” Or maybe I just don’t believe in a benevolent God who watches over me. In any case, there was no white light and I did not witness the scene from above. I would love to have had that opportunity to watch it though. However, the experience was that one minute I was walking and talking on the treadmill and the next minute I was being rudely awakened from a sound sleep by a slap on the cheek and a bustle of frenetic activity. Nothing spiritual about it.

Next, that thing about “no longer sweating the small stuff,” “stopping to smell the flowers,” appreciating “the big picture,” etc. I wish I could say I have been changed by the experience but I really haven’t. I’m still compulsive. I’m still what they call “Type A.” I still sweat the details about patient care. I still worry about stupid stuff. The same minor irritations still annoy me; in fact, they annoy me even more sometimes because I feel I have less time to be bothered. Mind you, I do smell the flowers, but I don’t stop. Flowers are nice but I have other things I want to get done. And to illustrate how little I have changed, I will relate an incident that occurred walking our dog in a park where picking up after your pooch is the law. It took me only a minute to realize my foolishness, but I actually had the temerity to tell my wife she was going about picking up the dog poop the wrong way. (I won’t explain my logic, but I thought she should start with the small turds and work her way to the larger ones.) She reminded me that I was criticizing a woman with a bag of dog shit in her hand, standing within an easy hurling distance. So much for stopping to smell things.

Naturally, having turned 60 last year, I spent a lot of time contemplating my mortality for 6 months before and really ever since that birthday. I was even thinking, the day before my event as I was driving to work, how beautiful the nearly bare trees looked in a sunlit morning mist, and how I would miss that sort of beauty if I was told my life would be cut short.

But since the arrest, the notion of mortality has taken on a more immediate flavor. I have always had the sense that we spend our days skating on thin ice and not knowing it, never realizing how it all could fall apart without a moment’s warning. Lately, that sense is keener. I am reminded of a rented DVD that has skipped a few times, frozen, and been rescued by going back a scene. If you have had that happen, you know the feeling that it might freeze again and this time not allow you to finish it. So you watch every moment knowing it could be the last you see of the movie. I never really have been able to “live in the moment,” but I think I have gotten a bit better at it. The other observation I have come to is a firmer conviction that the thing we spend the most time worrying about is never the thing that gets us. It is always something from a completely unexpected angle.

The awareness that my span on this mortal coil is finite leaves me with less patience for people or things that waste my time. I am quicker to throw out some item on my desk that I would have previously contemplated making use of at a later date. I am less inclined to have my philanthropy dictated by letters with appeals from charities that happen to enter my mailbox or appeals to add a dollar that are made at the checkout counter; I am going to make my contribution how I want to, when I want to, and to whom I want to, of my own accord.

For better or worse, I am less inhibited about expressing my feelings, both benevolent or angry. On the streets of Manhattan, my wife and I were nearly struck by an aggressive driver in an SUV who was turning right onto a side street as we were crossing the same street with a walk sign in our favor. I turned and thrust an accusatory finger at him. He rolled down his window. I yelled, “I had the green, buddy! “ He yelled back, “So did I!” I responded, “Pedestrians have the right of way, mister!” My wife, seeing he was half my age and fearing he might get out of the car to continue the discussion, tugged at me to continue walking (but only after she chimed in, “Yeah, read the book!”). As we walked on, I turned my head to look back and saw a crowd of pedestrians gathered around his vehicle scolding the man. I am not sure that before two months ago I would have confronted the guy. I guess I felt like, “I’ve been DEAD before, buddy, and you think YOU scare me?”

By the same token, I am much more liberal with my praise, generous with my smile, and generally more understanding of other people’s limitations and frustrations. I am nicer to everyone I encounter, even if they are dunderheads or nincompoops. After all, they are probably doing the best they can. I don’t hesitate any longer to say what I think, but I am quicker to forgive. (Exception: None of this applies to those jerks on the Merritt Parkway who think they will get there faster by first tailgating me in the left lane and then going around me on the right to cut in front when traffic is doing 65 in the passing lane, 60 in the right lane, and everyone is 3 car-lengths apart as far as the eye can see.)

I still think a lot about what it will be like when death does finally catch up with me. Will it be sudden, or will I be given a fatal diagnosis? Will I find that I have been obsessing about a healthy diet and exercise, only to learn I have pancreatic cancer next year? Or will something take me from completely out of left field? I know this much: I was looking back on my life this morning, waiting for some minor surgery with propofol sedation, wondering what I would choose to look back on. I found myself looking back on all the good times and not the bad ones. There have been many bad times, perhaps as many as good, but they seem to recede in my recollection. It is the joyful ones that stand out. Some people have criticized the effect that digital photography has had, allowing us to so easily edit out the bad images, unflattering takes, and blinked eyes. But memory does that too, and maybe that’s a good thing.

After my bypass surgery, and hospital discharge, I had the most uncanny sensation as I was being wheeled through the hospital lobby out to the car. Traversing the lobby was a crowd of people there, walking in all directions, most of them not looking down at the man in the wheelchair, each seemingly preoccupied with his or her concerns or plans. I was overcome with an acute awareness of each of them as a thinking, feeling individual with all of these cares and concerns, each with a life that was infinitely complicated with circumstances I would never know. It was reminiscent of that movie where the protagonist hears everyone’s thoughts, but for me like a world where I now almost expected I might hear them but knew fully I was deaf. That sensation has faded with time, but I think it can only be described as a heightened sense of empathy.

I guess one of the most positive consequences of having survived my experience is the feeling of gratitude that I have for my return to life, health, work, family, and all the joys of living. I am grateful to everyone who worked so hard to bring me back to health, people who number in the hundreds in one way or another. I am grateful to my good fortune, if not to a God who I have serious doubts about. I find it easier to believe I am incredibly lucky than to think that a supreme being should concern him or herself with the fate of one person on a planet of 7 billion souls among a galaxy with hundreds or thousands of planets occupied by millions or billions of equally sentient beings. It’s enough for me to thank my lucky stars.

David M. Sack, MD, is a Fellow of the American College of Physicians. He attended Harvard and Johns Hopkins Medical School. He completed his residency at Lenox Hill Hospital in New York City and a gastroenterology fellowship at Beth Israel-Deaconess, which he completed in 1983. Since then he has practiced general gastroenterology at a small community hospital in Connecticut. This post originally appeared at his blog, Prescriptions, a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.