An excerpt from Krooked Ketamine.
OK, here’s the thing: I had a little problem that needed correcting if I wanted to continue to work as a government surgeon. I had a janky heart, and it had a tendency to fire off at the absolute worst possible moments. I needed a pacemaker to help with the recalcitrant muscular metronome, but I absolutely hated the thought of lying down and feeling, at least metaphorically, the cold steel of the belly of the number-ten blade on my own skin, wielded by someone else’s hand. I put it off as long as possible, but even I was growing weary of the pestering jankiness deep beneath my left breast.
On the day in question, I felt, as the French say, in idiomatic contradistinction to the more familiar déjà vu, a definite feeling of jamais vu: a familiar thing or place that seems eerie and wholly unwonted. The holding area for patients waiting for procedures – being the same in every hospital; a setting so obvious in its pragmatic, curtain-cubicled layout, allowing the candidates for demonetization to be smoothly ushered through the system – should have been as familiar to me as a briar patch is to an old, brash hare, but I was scared. I wasn’t used to being on this side of the frowzy paisley gown, cold, clammy, and shaky, like the new kid at cotillion.
Nurse Queequeg and her twenty-two-gauge harpoon had let my inner Tashtego leech out after her third attempt at an I.V. in my forearm. I had visions of the Nantucket sleigh ride, harpooned by the needle, held fast to the gurney by the I.V. line, and eased alongside the captain for the final spading (go read Moby Dick, for Pete’s sake, if you don’t know what I’m talking about).
“Your veins are rolley,” she mused, plumping my arm with the elastic tourniquet and surveying my arm’s landscape, blood vessels popping up like mole tunnels in a barely-seeded backyard.
“Maybe it’s your hands that are rolley,” I wanted to say, but wouldn’t.
Finally, she found the antecubital hose in the crook of my elbow that even she wouldn’t miss.
Next in the line-up was the anesthesiologist, the guy who would be putting me to sleep for the procedure. He was tall and thin, had salt-and-pepper hair and looked to be in great shape. I always secretly distrust the guys in medicine who have time to go to the gym on a regular basis; don’t they know their priorities?
“Hello. Dr. Sands,” I think he said. My mind was too much on other things that day to roster the names of everybody I met. And, besides, I don’t think I would remember anyone’s name on the first go on a good day. “How are you doing …” he paused, looking down at the chart, then with a rising tone, “Dr. Anderson?”
How do you think I’m doing, numb-nuts?
“Fine,” I offered. “Nice to meet you. Ben Anderson.”
“What kind of doctor?”
“Surgeon … general surgery.”
“Where do you work?” The medical community, even in a large city, is remarkably small and tight-knit; he would certainly know some of the people I worked with, if it were one of the big health systems in town.
“The VA,” I returned.
“The VA?” in a tone as if my chosen employment was some kind of sentence an ax murderer might be subjected to on the fourth level of Hades, for bloody peccadilloes meted out in a different life when there were better paying and more prestigious jobs for surgeons all across town.
“Yep. Government pay but also government hours.”
“Does it feel weird, you know, on the other side?”
I subconsciously broke the fourth wall, turning to the audience, though my neck never moved an inch. What kind of idiot is this guy? No, it feels great! I wish I could do this every fuckin’ day! my inner Italian homunculus was begging to break out.
“Yeah, not something I want to get used to, if you know what I mean.”
“How long have you had a fib?”
“Feels like forever, but I guess it’s only been a little over a year.”
“Did you ever require cardioversion?”
“No, never did have to zap me. It’s been controlled with the meds.” In other words, the drugs got me back into a normal rhythm, rather than the thump of the electric paddles that are used for stubborn or unstable hearts.
“I see you’re on a blood thinner. Did you take it yesterday?”
“No, last dose was two days ago.”
“I also see that your EF is low. Are you having symptoms?” The “EF” – or “ejection fraction” – of the heart is the measurement, usually by ultrasound or echocardiogram, of how well the heart empties with each beat. When the EFc is low, it can be the sign of a failing heart or simply one that’s been injured by a virus or a sudden shock.
“No, not really. It was a surprise after the first episode to find out it was low; I had no symptoms – nothing.”
“No shortness of breath?”
“Nope.”
“No leg swelling?”
“Not a drop.”
“That’s weird,” he mused.
“I’m a puzzle wrapped in a mystery, I guess.”
“How old are you?” he asked, not wanting to do the math laid out by the birthday labeled in the chart.
“I guess I’m older than Hell but younger than dirt,” I chuckled. “Fifty-eight, if you count the rings.”
“Well, to be on the safe side, we’re probably going to use a little ketamine to get you off to sleep. It’s a little less of a cardiac depressant than some of the narcotics we usually use. Can cause some weird dreams, though, just so you know.”
“Yeah, we used it a lot on the burn unit. Didn’t quite put the kids out, but they didn’t feel a thing. You’re the doc, Doc; whatever you think.” Now I really was playing the patient. I don’t know how many times I’d heard that line from the trusting veterans I usually operated on when I tried to explain in plain English some of the esoteric maneuvers of latter-day surgical practice that lay in store for them.
“OK, that does it for me. I’ll see you back there with the anesthetist to keep you comfortable.”
“Alright, then. See you on the other side …”
A few more pages of paperwork, followed by an acre of shaving from an aide that would have made an Amish Brazilian proud, and then they wheeled me out of the preoperative holding area and into the operating room.
It was a simple procedure, in theory, if you were of the opinion that placing electrodes into the heart by way of accessing a major vein in the chest was a simple procedure. The audacity of repetition made it seem simple. But this time I was the patient, on the wrong side of the needle, cataloging in the not-far-enough reaches of my mind all the complications I had seen and been a party to, in my thirty-odd years of medicine and surgery, with similarly invasive procedures. My teeth chattered away in the cold austerity of the cath lab – I couldn’t help it.
“Nervous?” came a voice from above my line of sight. Another astute gas passer: the nurse anesthetist, trying to be friendly. Wasn’t everyone dragged into this place in their boxer shorts and paisley moomoo, dazzled by the interrogation lamps and petrified by the sundry sharp objects arrayed on the stark tables, nervous?
“Apparently, my nipples are,” I feigned nonchalance. “It’s freezing in here.”
The warm blanket arrived and was some relief, but it didn’t stop the shakes.
“Don’t worry. Dr. Patel is the best,” the nurse assured. “Walk in the park.”
Right on cue, the good doctor strolls in and announces: “Alright, everyone on your toes today. This guy is a surgeon; he knows more about this than I do.”
Oh, shit! The fuck I do! Nice try, Patel, but self-deprecation is not what you want in the guy about to jab you in the subclavian. Besides, I wanted these guys on their toes before they knew I was in medicine.
I guess I have a sick sinus node. My heart, at rest, likes to beat about forty times a minute, which, if you’re an elite athlete – something I would never be accused of – would be OK, but for the average schmoe, like you or me, it’s a whole suit shy of a full deck, jokers and filler cards included. So, here I am, nearly naked, definitely afraid, and laid out like a chicken on a spit, about to get poked with a sharp stick in a vein precariously close to the lungs – which, if injured, is exactly how you kill a buffalo or the great white whale (again, I beg you, go read Moby Dick).
Except for vacation and likely fewer than two weeks of sick leave, I have worked every day of my life after graduating from medical school. Now my boss wants to kneecap me, and she’ll use any ball bat she can find. This pacemaker was my ticket to getting her off my back and me safely back in the operating room. My heart was slow, but when I got worked up, it would beat fast. Really fast. Like, one-hundred-fifty-beats-per-minute fast! So fast I would get weak and nearly pass out, which is not good for the surgeon in the middle of a tough case, not good for his ability to keep his job, and even worse for the guy on the table, with blood welling up in his gallbladder fossa. Putting in the pacemaker would allow the pill-pushers treating me to up my dose of the medication, slowing my heart down and keeping me out of those stress-induced fast rhythms without having to worry about slowing down my already torpid baseline cardiac metronome. The pacemaker would set the pace, and I could guzzle the beta-blockers. And my boss couldn’t say shit about it if I had some control over these damned spells of ventricular dispatch.
In went the juice in my vein, and out went the lights …
“Ketamine is in …” I vaguely remember the gas passer mumbling.
The coldness of consciousness was replaced by a warm embrace of audacious color: kaleidoscopes of oranges, reds, and scarlets that coalesced into a wall of flame and conflagration. Suddenly, as I recall, the sheets of fire built to a crescendo and then condensed into individual bonfires and licks of hellfire, punctuating the darkness like madness in a dictator’s gray matter. Vague shapes in the darkness were burning: apparitions with hazy outlines resembling haystacks, Conestoga wagons, and carts piled high with planked boxes, appearing like some damned wagon train crossing the River Styx …
Now, here’s where it kinda gets weird …
Arthur Williams is a general surgeon.
