First Person: The ‘ejaculating’ heart

My heart, like yours, was working rhythmically, silently and tirelessly. Except for brief but inevitable flutters in my teens and occasional throbs in my youth, it lived unseen, oblivious to others, unsung and unlamented. It remained firmly in place barring moments when it jumped to my mouth or occasionally sank or times when I wore it on my sleeves.

People are called Daryadil or largehearted to differentiate them from others who are tangdil (mean/narrow-hearted). In any case, each heart does have two dariyas, canals called coronary arteries. Their job is to keep the heart adequately supplied with its perennial need for oxygen.

I thought I knew my heart inside out. As a doctor I did all I could to keep her in good shape. I adhered to the long list of dos and don’ts. But despite all the care I showered on her, out of the blue one of the two coronaries ceased its flow one night.

It struck like a bolt and I panicked. Had the moment we all live for finally come? At fifty-five, not surely me! Why me? Though God is not obliged to answer agnostics or atheists, and I am at best a fence sitter, in that critical moment, questioning God seemed pointless.

To cut that long and agonising moment short, I swiftly decided to make two phone calls. The first was to Dr Rohatgi, director of the Heart Hospital and a friend of long standing. ‘I have suffered a heart attack, keep things ready’.

‘Playing pranks as usual, in the middle of the night,’ he sleepily said before I cut him short. ‘Keep your cardiologist and the cathlab in readiness’, I curtly said and disconnected. The next call was to Bijay, the driver, to bring the car at once. He got duly alarmed by the urgency in my tenor and came rushing. By then my wife was fully awake, a mix of fear, horror and apprehension written large on her face but she maintained her calm and poise and without a word packed the bare essentials.

Dr Rohatgi was waiting in the Emergency ward’s portico and I was swiftly put on a wheel chair. Preliminaries quickly done or dispensed with, I was on the hot ‘seat’ (operating table) in record time. Dr. Vinney and his team worked wordlessly with practised movements. I was in a haze. Medications, apprehension triggered by my knowledge and experience as a doctor, a literally sinking heart and the gnawing fear of finality were taking a toll. I recalled the face of my wife and regretted all my failings to her.

I was jolted by a firm downward tug on my pyjamas. ‘Sir, please lift your waist’, commanded a medical assistant. Annoyed, I snapped, ‘Why and for what?’ The explanation came from the cardiologist, ‘Sir we will go through the Femoral.’

Femoral artery is the large artery in the groin that can provide a retrograde access to the heart vessels. I could not but smile even in that critical life and death situation. I remembered Kareena Kapoor in Omkara saying, “The route to a man’s heart is through his belly.” The chirpy Konkona Sen Sharma had quipped with a giggle, “It is actually from below the belly, my granny had said."

It was literally a jab in the groin that provided access to my heart. Coronary angioplasty is a procedure done through a series of catheter exchanges over the guide wire that goes from the groin (or radial artery on the wrist) to the coronaries. It involves sequentially to go across the blockage, clear it through dilatation (widening) and placing a cylindrical wire mesh called stent to prevent it from re-blocking. The deft hands performed this dance of puppetry with such dexterity that it was all over before one could say Jack Robinson. The restored flow of blood brings you back from the verge of death.

An acute blockage of coronary is an amazing conundrum. It could have given me a posthumous status in an instant or caused an infarction rendering part of the heart muscle non- functional, resulting in sub optimal pumping of blood by the heart. The timely intervention had restored the blood supply before any irreversible damage could take place, and there I was, my heart pumping and thumping, the pain miraculously gone and the relief I felt at being back from the brink showed on the glow on my face. It happened so quickly that there were no systemic effects at all and thus no sense of being unwell (malaise).

It was a piquant situation. I actually felt so fine that I could describe myself as being on top of the world. There was no pain and it all felt normal barring the discomfort of having a tube in the groin (Femoral catheter) that had been left there by way of abundant precaution, covered with elaborate dressing that had made an impressive tent on the bedsheet over the most unmentionable part of the body. It left me with no choice but to keep my pyjamas cord open and leg straight.

But for the bedsheet, in the words of Okhil Chandra Sen who had complained to the Indian Railways in writing about indignities he suffered, “all my shockings exposed”. It did make me feel vulnerable. Isn’t a well tied pyjama cord the first sign of civilisation? But then my pyjama cord was open.

My official and social status, added with my friendship with the hospital head, led to some special privileges, including a dedicated nurse. Her selection for the job could not have been better. This was clear to me at the first glimpse itself. I could have been dead or dying, but I was in fact alive and well with none of the amines and peptides in my system that makes one feel sick. I had the right mix of chemicals that make a man a man. And my pyjama cord was of course open with the thin sheet covering the embarrassing mound made by a kilo of dressing.

‘Blood pressure sir’, she lifted my arm, tucked it under hers (I leave the rest for reader to imagine) and proceeded to wrap the BP cuff securely with both her hands. The blood pressure not surprisingly was quite high and not entirely due to anxiety because my pyjama cord was open with the thin sheet covering the embarrassing mound.

‘How are you? Good morning’, it was an audibly weary Dr Vinney, the cardiologist, in the wee hours of the morning for the customary Echo before going home to catch some well- earned sleep. He was there to assess the actual insult during the just concluded saga of an acute coronary syndrome. Before I could return the courtesy, he had already pushed me to lie on my side from behind my back. I craned my neck back to look at him but could not, by then he had lifted the bedsheet and my shirt to bare the area of his interest, placed the jelly covered Echocardiograph transducer on the left chest wall with complete disregard to the sheet that had hitherto covered my modesty (if at all a man is entitled to whatever of it).

If that was not enough, seeing him do the echo the nurse returned to give him a helping hand and stood opposite him on the other side of the bed where the basic symbol of civilisation lay open- the cord of my pyjama.

The crux of the functioning of heart is a single measurement called ejection fraction (EF). It is the percentage of the blood present in the left ventricle that goes out with each contraction. Half-awake, anxious and embarrassed, I mustered as much dignity as I could and asked for the EF. What I blurted out, however, was a slurred, ‘what is the ejaculation fraction’?

Vinney made no attempt to suppress his laugh. ‘It is sixty. That is normal. You are lucky.’

Stupidly I tried to inject some humour to cover up the Freudian faux pas and asked ‘What of the remaining 40 percent?'

It was Rohatgi who answered. ‘That is for your wife, bloody fellow. Go to sleep.’

(This article was first published in National Herald on Sunday)