Close Encounters

Have you ever felt to be on the edge of life and death? Have you ever had a near death experience? It’s rare but it can happen.  On Thursday the 2nd of February I went out for my morning constitutional – a combination of walk and jog. It was slightly nippy and not very cold. By all accounts it was a good day for an exercise but I found it extremely difficult to move on the mild gradient in front of my house. I was out completely out of sorts and had to stop at least a couple of times twice or thrice, bending on my knees to catch my breath. It was too much of an effort. I was struggling and finding it very difficult to continue. After dragging myself for perhaps a kilometer or more I gave up. As I turned back and saw two policemen riding on a motorcycle. Should I stop them and seek their help? Before I could make up my mind they had already driven past me. I needed to get back home quickly. As labored my way back, I could experience it. Life was slowly ebbing out of me. Slowly I began to recite the kailma. There was no extraordinary sensation. No pain. No hallucinations. No out of body feeling. The morning was calm and fresh and there was a mild haze as I struggled up the stairs to our apartment floor. I have only a faint recollection of what happened after that. I probably removed my jacket, lay down on my bed and covered myself with the blanket and then I passed out. When I regained consciousness I found my wife gently shaking me and asking me if I needed breakfast. She told me later that I was sweating profusely and was very cold. After I had got ready my son took for an emergency medical check-up to a cousin, who is a doctor in the local hospital. The cardiologist found enough evidence of an Antioventricular or AV block. Next stop was the ER of the Armed Forces Institute of Cardiology. The diagnosis was confirmed after a 24 hour holter monitor test. “There are no two opinions about it; you need a pacemaker” was the verdict of the electro-physician.

In layman’s terms the kind of malfunction my heart has been experiencing means a deficiency of electricity supply causing an irregular heartbeat. The pacemaker kicks in to regularize the heartbeat. A personal UPS of sorts. Technically an AV block is one in which the conduction between the atria and ventricles of the heart is impaired. Under normal conditions, the sinatorial node (SA node) in the atria sets the pace for the heart, and these impulses travel down to the ventricles. In an AV block, this message does not reach the ventricles or is impaired along the way. The ventricles of the heart have their own pacing mechanisms, which can maintain a lowered heart rate in the absence of SA stimulation.

The causes of an AV block can be varied and may include ischaemia, infarction, fibrosis or drugs, and the blocks may be complete or may only impair the signalling between the SA and AV nodes. Certain AV blocks can also be found as normal variants, such as in athletes or children, and are benign. The causes in my case can be any or a combination of these. I lead a disciplined life. I exercise regularly that includes occasional swimming and hiking and I eat moderately. I don’t smoke or drink but I’ve my vulnerabilities. I have a family history for heart disease. My father had a bypass surgery and had a defribulator implanted inside his body. My mother has a stent to widen one of her blood vessels. I had a minor electric circuit problem described as a Right Branch Bundle Block. In my forties I had suffered syncopic attacks and would pass out. At the age of 49, ten years ago after a series of fainting spells I underwent investigations and was taken to the operation theater for insertion of a pacemaker but at the last moment the doctor decided against it. I was a borderline case. Next year I was in the US and showed my papers to a Pakistani cardiologist. I was advised to keep my electrolyte level in check by drinking lots of gatorade, a drink popular among athletes. Many years thereafter limopani (lemonade) was the regular drink for me until this episode happened I was totally unprepared for it.

Through a surgical procedure a pocket has been created under my left shoulder blade and a permanent pacemaker or PPM has been placed next to my heart. Electric cables have been extended to the ventricles to solve the problem of conduction. The operation didn’t take more than two hours. I was under local anesthesia so that I could hear the doctors talk as they went through the motions. It was alarming to hear them say that the batteries of the temporary pacemaker weren’t working and they needed new ones or that the doctor was still searching for the sweet spot as he tried to insert the electric cables in my ventricles. After a week the dressing was removed from the stitches but it still hurts and it will take a few months before the PPM becomes a part of my body.  The batteries have a shelf life of 9 to 13 years. Hopefully they will last longer.

My life would certainly need some changes now. I’m not sure when I’ll be able to resume swimming or jogging. I definitely need to cut out stress. What is there to stress about at this point in life? Nothing from the worldly point of view, I guess.  Everything is pretty much as I wanted. The children are married and leading their own lives. I have a stable career in the University. I can continue if I want. The house that my wife and I had been planning for some time will be ready inshaAllah this year.  There is so much to thank Allah for. He gave me a good life. I hope He will grant me with good health, good humor and abundant courage to face life’s challenges and die a contented man. Ameen!

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