The night before I die

Against all the odds, today I celebrate my 60th birthday. Two and a half months ago, however, I was struggling to stay alive after a sudden cardiac arrest. That was when I found myself sitting in an ICU bed in the middle of the night, trying to make order of my racing, anxious thoughts by typing them out. I titled the file: “The Night Before I Die” and this is what I wrote:

As I write these words, it’s half past midnight. I’m in the Intensive Cardiac Care Unit of Jerusalem’s Shaare Zedek Hospital. As a patient, not a doctor (although I did train in cardiology early in my medical career). In the morning I’m going to undergo a near-death experience.

At least I hope it’s only going to be near-death.

It’s not going to be my first such experience. That one happened a week ago, after a game of squash. I had stopped the game early because I was not feeling well. As I rested outside the Hebrew University’s Cosel Sports Center, I felt an ominous tightening in the center of my chest. I knew exactly what that meant. I phoned my squash partner Bob, a professor of Talmud who has been playing with me every week for the last few years, who was still inside the changing rooms. I asked him to come outside immediately to help me. But I had left it too late. As he emerged, I collapsed, lifeless, hitting my head hard on the stone floor.

Bob called for help. An unidentified nurse who passed by at that exact time realized what was happening to me and started doing chest compressions. A lifeguard from the pool ran out with a defibrillator machine. The nurse and the lifeguard continued chest compressions and administered shocks until paramedics from Hatzalah and a Magen David Adom ambulance arrived. I was evacuated to the Emergency Room at Shaare Zedek Medical Center in critical condition, but alive. An urgent cardiac catheterization revealed the problem: two blocked coronary arteries (the blood vessels that supply the heart muscle itself with blood and oxygen). Balloons were used to reopen the arteries. Stents were put in to keep them open. I survived. And despite the fact that my heart stopped multiple times, cutting off the flow of oxygen to my brain, I am able to write these words.

I actually have no recollection of any of the above.

What I know is that one afternoon I woke up in an ICU bed in Jerusalem, with bruises and needle stick marks all over my body. I had a laceration on my head from my fall, and was unable to move, eat, or pee by myself. I learned that I had been ventilated for several days (a longstanding fear of mine, because ventilation is actually my current area of medical specialization and I know it from the professional’s perspective). My worried family were by my side and all movement was a painful challenge. Rosh Hashanah had come and gone, without my participation. But it seems that I had been written — if not yet sealed — in the Book of Life, at least for now.

Soon after I woke, my doctors noted the arrhythmias. Occasional, non-sustained, but definite abnormalities in the rhythm of my heartbeat. They are probably a consequence of the damage my heart muscle sustained during my heart attack, and are of major concern, because it is abnormalities in heart rhythm that make what we commonly refer to as “heart attacks” so deadly. Because defibrillator machines correct the deadliest types of arrhythmias, they are so life-saving.

So the plan for tomorrow morning is another cardiac catheterization procedure. This time, the purpose is to see if the arrhythmia that almost killed me can be re-recreated. My doctors will electrically stimulate different parts of my heart to see if there is a risk of a deadly arrhythmia developing. If there is, they will stop the arrhythmia with appropriate electrical stimulation, and recommend that a permanent defibrillator pacemaker be implanted. In other words, the plan is for another near-death experience.

I fully understand and agree with the medical logic here, but, philosophically, this terrifies me. One near-death experience during this High Holiday season is enough, thank you. But it is also the medical hubris involved that gives me pause. To test the very definition of life, to overstep that boundary of a normally beating heart and assume you can always come back again, seems to be taking full authorship of the Book of Life into our human hands. My current doctors do it all the time; that’s the nature of cardiology (and one of the reasons I was initially attracted to the discipline). But how do their hands not tremble under the awesome power they assume?

Ultimately, the issue here is the hubris of man. Coming during the High Holiday season, I find this particularly jarring. Tomorrow morning, I will put my faith in the hands of men and women who are challenging God’s realm. I pray that just as God sent me a nurse at the right time when I was lying lifeless on the ground outside the sports center, He will guide my medical team with wisdom and bring me back again.

I pressed “Save,” mailed my musings to my wife, snapped shut my laptop, and faded into a fitful slumber for the few hours left until morning rounds. Then it was off to the cath lab, passing my family who had gathered in the passageway outside the ICU to wave encouragement and kisses as my bed trundled by. Trusting my doctors implicitly, I drifted into a blessed sleep as a sedative began to take effect, and I lay on the catheterization table in the darkened room. Contrary to my midnight fears, I knew that such electrophysiologic studies are safe, almost routine, cardiac procedures, and are performed all the time.

Suddenly, a sharp SLAP to my chest jolted me awake. Wide-eyed, I was instantly aware that my heart had been shocked out of another deadly arrhythmia. The procedure, I realized, had achieved its purpose. That afternoon, a permanent pacemaker-defibrillator was implanted in my chest, a silent sentinel keeping watch over my most basic life-force, ready to intervene whenever, if ever, necessary, with another jolt. The finger of God? Or the work of man?

The next morning, on the eve of Yom Kippur, I was discharged home. The significance of restarting my life with a day of reckoning and introspection, of contemplation of past errors and arrogances, was not lost on me. Traditionally, leather shoes are not worn when standing in judgement before God on Yom Kippur. Chillingly, my only non-leather shoes, the ones I’ve always worn on Yom Kippur, were my squash shoes. For the first time since my cardiac arrest, I pulled them on, trying to ignore the bloodstains from my head laceration that were on them, and set out slowly, painfully, for synagogue.

Today, 10 weeks on, my body has healed significantly, though I still have some difficulty with memory. On my 60th birthday, I have many to thank, and much to be thankful for: the nurse, lifeguard, and other first responders who gave me a second chance at life; my wife and family who give that life meaning; the medical team that guides me to a healthier future; and my God, who orchestrates it all in ways beyond my understanding. To reach future birthdays, I know I have to take the responsibility for my health into my own hands: exercise daily, eat healthily, take my medication, listen to my body (and my doctors), and not rely on modern medicine — or on God — to rescue me at the last moment.

That would be the ultimate hubris.