A Shot from Heaven

Or: How I learned that my heart needed a hit to its restart button

Author: Patrick Angulo ’13


I first hypothesized that my four-night stint in the intensive care unit of San Juan’s premier hospital was caused by a single lightning strike. Cursory WebMD research offered no support for this theory, and later I was too embarrassed, and lacked the Spanish, to run it by my doctors. But that lightning bolt, somewhere in the green of Puerto Rico’s Cordillera Central, had lit up the dark gray sky and stricken no more than 100 yards ahead of our car.

“Did you see that?” yelled Jake, a backpacker whom my friend and I had picked up in Vieques, and who was now riding shotgun.

Of course I had.

The time of the strike was 4:15 p.m. I base that estimate on the time stamp of my most recent photo: Jake, stripped down to his boxers, swimming at a Barceloneta beach, some 30 minutes before. Still amazed by what we’d just seen, I turned the car left and headed east toward San Juan.

But as we entered the on-ramp to the highway, a funny feeling crept into my chest. Butterflies began to flutter, and my heart began to race. I took some deep breaths and waited for it to subside. It didn’t. Jake, always keen on sharing his eccentric thoughts, continued talking about the Iran-Contra affair, or maybe his travels in Thailand, or maybe something else. My focus was elsewhere, so I feigned interest, asking safe questions that wouldn’t reveal my inattention. “Oh, is that right? I didn’t know that. . . .”

By the time we entered San Juan, my discomfort was worse; the butterflies swirled with greater intensity, and my breathing exercises had done nothing to smoke them out. But I pressed through, stopping first at a souvenir shop — I had, of course, left shopping for my last day — and then at a food truck. After dinner I told Jake I had a headache (an easier explanation) and retreated to my hostel. I entered my room, drank a big glass of water and spread out on the bed. All I need to do is hydrate and relax, I told myself.

No luck. The butterflies had been replaced by a drum line. As I lay on the bed, my back pressed against the crappy hostel mattress, the pounding of my heart, now faster than before, gently rocked me from side to side. I peeked down my shirt and saw my chest contorting in ways I’d never seen. “That’s not good,” I muttered aloud. Minutes later I was driving myself to the hospital.

I was greeted at the emergency room by a kind but slow-paced receptionist. As I struggled to give my information through broken Spanish, the woman asked the reason for my visit. “Me duele mi corazón,” I replied, before realizing how ridiculous that sounded. But she took my concern seriously, gave me a number and asked me to take a seat. Within minutes I heard my name called.

In triage I was greeted by a no-nonsense nurse. Learning from my previous interaction, I more articulately described my situation. He raised his eyebrows and cocked his head to one side in evident disbelief. His doubt vanished when he took my pulse: 195 beats per minute. He sprang into action, gathering the necessary information with frantic speed. He then poked his head outside the room and barked out an order to a man named Julio.

Seconds later, Julio arrived with a wheelchair. “Haha, no, gracias,” I said, confident I could walk. The triage nurse pointed at the chair with his right index finger and put his left hand on his hip. “Sientense!” Just like that, Julio was wheeling me past all the COVID-19 patients in the hallway and into the ER.

Speaking in perfect English, this young, fit man told me my condition could be addressed with a cardioversion — a manual restart of the heart via electric shock. Simple enough, I thought. He scheduled the procedure for Monday.

Upon arrival, I was immediately poked and prodded by two ER nurses. Blood was drawn, two IVs were started and an anticoagulant was injected into my belly. Q-tips tickled my brain and another injection stuck my left arm, its contents causing an icy feeling on my left side that soon spread all over. I was hooked up to an electrocardiogram monitor, which immediately began beeping danger. The nurses would flip off the alarm, only for it to restart a minute later. What an obnoxious sound to die to, I thought.

The doctor arrived and ordered some drug that was soon dripping from a bag into my bloodstream. “You’re dehydrated. You party here?” he asked with a smile, in broken English.

Solo birra,” I replied, as I thought of the countless Medalla beers I had downed that week. He came over and gave me a fist pound. I obliged, not knowing if this expressed “You’re a boss” or “We’ll take care of you, you dumbass gringo.”

At first, the drug seemed to help. My heart rate slowed to 90. Thinking that this miracle medication had fixed me, I called my parents and my girlfriend. I even snuck in a lighthearted call to the college friend who had left the island the previous day. “If I croak, there are some great pictures of you on my iPhone,” I joked.

That joke got less funny when my heart rate began climbing again. With my EKG monitor standing just a few feet away, I watched my heart rate yo-yo from 180 to 120 and then back up to 170. At 9:10 p.m. the nurses slapped a new ID band around my wrist and sent me to cardiac care.

The cardiac ICU lacked the hubbub of the ER. The lights were dimmed, and the patients were hidden behind curtains. The ER nurses wheeled me past these curtains and into my own room. It was spacious, with a bank of windows on the far end. In the center of the room was a hospital bed hooked up to an arm that resembled the examination light in a dentist’s office. Hanging from the arm was a massive computer monitor that surely predated Y2K. The VHS-like machine below it and the CPU box to its right appeared equally ancient. A great assortment of cords made the machine look like some 1980s cyberpunk octopus. The bed faced the curtains and, to my chagrin, was noticeably cattywampus.

The ER nurses bid me farewell and released me to two ICU nurses who connected the electronic octopus to different parts of my body: a blood-pressure cuff on my left arm, a pulse oximeter on my left index finger, EKG ports scattered across my chest, two IVs in my right arm and an oxygen tube through both nostrils. The octopus had found a new host and reawakened, its screen now flickering with various green, blue and red lines and numbers.

“Two tattoos, one here and one here,” said one nurse in Spanish, as if he had found the clues to crack the case. “Write that down,” he instructed his colleague.

“You see, we are very thorough here,” he told me. “So, you’ll be just fine.” I didn’t doubt his conclusion but thought his logic was shaky.

Soon a physician came in to check on me. A nice man, he ultimately proved unhelpful. He either didn’t know what was going on or lacked the English to explain it. I hoped for the latter and spoke to him in Spanish without any luck. I learned he was not a cardiologist but a doctor of internal medicine. The cardiologist — “a fat man” this first doctor said — would speak with me in the morning. Then I realized I was stuck in a cardiac ICU without a cardiologist, and I wondered if my Google search had failed me.

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Once the doctor and nurses left, I tried to catch some sleep. But each time I drifted off, I was jolted back awake, my body tricking itself into thinking that my elevated pulse meant danger, like awakening in the middle of the night from a vivid, heart-pounding dream. And without Wi-Fi or a book, I had little else to do as the night crept on. I read the welcome packet and the posters on the walls. This hospital is your home, one sign read in Spanish. I sure hope not, I thought in reply.

Beneath that poster stood a single chair. I imagined my father trying to sleep in it, just as he’d done during hospital stays when I was a kid. But I reminded myself that I was 31 years old, that I was doing this on my own, and that this was OK.

Outside, I heard water falling. At first I thought it was rain, which I found comforting, but I soon realized it was condensation dripping from an overworked air conditioner. I couldn’t turn around to see it, so I allowed myself to think it was rain.

The nurses had left the curtain wall in front of my bed wide open. My room sat across from the nurses’ desk and the hallway that led out of the ICU. With this scene perfectly framed within the size of a small movie screen, I imagined myself in the front row of a one-set play.

The graveyard shift put on a lousy act. One nurse sat with her back to me, fiddling on the computer. The other sat facing me, his head propped up with one hand and his other hand, I assumed, doodling on an unimportant piece of paper. They spoke in hushed voices and occasionally broke into suppressed laughter.

At some point the nurse facing me looked up. “Todo bien?” he asked with raised eyebrows.

I could tell this question was partly motivated by genuine concern and partly by the weirdness of my staring at them. I responded with a thumbs-up, which I figured was the least weird response. He pointed to the curtain and said something quickly, presumably asking if I wanted it closed. “Uh. Sí, sí,” I replied, more concerned with their privacy than mine.

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With the curtain closed for intermission, I looked around my cream-colored shoebox for more distractions, but to no avail. The room was dark and filled with all sorts of noises from throughout the ICU. The rhythmic, rapid beeping from my own EKG monitor was strangely comforting and, if nothing else, announced to the world that I had survived that crazy day.

At some point, my blood-pressure cuff began squeezing my left arm, letting me know that another two hours had passed.

I woke up Friday morning and began to meet the cast of characters who would define my hospital experience. There was my incredibly kind, middle-aged nurse who couldn’t believe I was there alone. “Pobrecito,” she kept repeating. Her name was Dyana or Dayna or something. I played it safe with “Señora.” The managing nurse was slightly older and slightly less warm. Finally, I met the cardiologist, the “fat man.” He entered the ICU through the double doors at 10 a.m. with the kind of bravado you’d expect from the doctor in charge. From my front-row seat, I watched as he made a beeline to the desk and began speaking with the two nurses present.

Hola, Doctor!” the two women said in unison, setting down whatever they were working on. He leaned across the counter towards one of the nurses and spoke to her intently. I doubt it was all business because they both soon erupted in laughter. The conversation concluded with the nurse playfully hitting the doctor’s shoulder with a rolled-up stack of papers. He looked over at the other nurse, who was leaning against the wall and inspecting her nails, and he presumably asked her opinion on the topic. She also laughed and shook her head.

Dyana wasn’t present for this. And good thing, too, because she wouldn’t have had patience for such unprofessional frivolity.

After spending 15 minutes with the nurses, the doctor granted me an audience lasting about two minutes. Given his fast Puerto Rican Spanish, I’m sure he felt he had provided all the relevant information in that short period of time. I asked him to repeat himself more slowly. He laughed and told me not to worry. But even with my limited Spanish I picked up that my heart rate was too fast, that this drug would hopefully fix it, and that I would meet the electrophysiologist later that day.

The last bit about the EP was the only new information, and it piqued my interest. With my hopes pinned to this mysterious EP, I eagerly waited for him to arrive. It was no fun. Because I was in the ICU, I was told to remain in my bed. I drifted in and out of sleep. Mostly I just lay there with nothing but my thoughts. These thoughts contrasted sharply with the perfect island weather spilling through my window: I was alone in an ICU, far from home, with a problem no one seemed to know how to fix.

Luckily, at 3 p.m. the EP arrived and put me at ease. Speaking in perfect English, this young, fit man told me my condition could be addressed with a cardioversion — a manual restart of the heart via electric shock. Simple enough, I thought. He scheduled the procedure for Monday.

After the EP left, I said goodbye to Dyana and met the second shift. These ladies had an edge. They spoke more loudly, smacked their gum and wore graphic tees or hoodies over their scrubs. Although I couldn’t understand a word they said as they huddled around the desk, I imagined them exchanging raunchy jokes or discussing the upcoming weekend. And when they came in to prod me, it was all business. Needle in, blood out. I fell asleep early, just as the third shift was arriving, eager for the morning crew to return.

Saturday was a great day. With my condition stable, the nurses allowed me to move around on my own. And the Wi-Fi signal had improved. With the benefit of my EKG monitor and a radio broadcast from the mainland, I could finally measure the physiological impact of a stressful Notre Dame football game.

Shortly after that narrow victory, I encountered a new, albeit less serious, physiological problem. My stomach growled and my bowels lurched: I had to poop. I asked Dyana where the bathroom was. She shook her head somberly, as if she was delivering sad news to family members. “No hay baño,” she whispered before adding, with a raised finger, that she would bring me one. She exited behind the curtain and soon returned with my “toilet”: a bucket placed inside an old man’s walker. “No freaking way,” I muttered, hoping she didn’t hear me. But she understood my tone and nodded with a pained smile. She placed my throne at the foot of my bed and asked me to buzz when I was done.

I pondered my options. Unable to give up without a fight, I decided to give the normal baño another shot. I poked my head out of the curtain. No sign of Dyana. Dragging my IV pole, I waddled over to the nurses’ desk.

Dónde está el baño?” I asked innocently. They raised their heads and looked at me as if I were a student who had snuck into the teacher’s lounge. I calmly repeated the question and shot them a nice smile. They looked at each other in bewilderment. One began to explain the policies of the ICU. But before she was done, I saw Dyana round the corner, eyes on her clipboard. I thanked the nurses and shuffled back to my room like a crazy old man with my bum in the breeze.

Dyana spotted me just as I tucked behind my curtain. She called my name, confusion and frustration in her voice. Her footsteps drew closer. She stood outside my curtain and called my name once more. Not knowing what to say, I yelled back “Ocupado!” as if I was in the stall of a public restroom. When I figured I was safe, I lifted up my gown and did my business.

On Sunday, I woke up early. I pooped in a bucket, peed in a cup and brushed my teeth — all before 10 a.m. Normally, I’d call that a morning and retire for my midday nap. But my father was arriving from the West Coast to visit me before Monday’s procedure. In anticipation, I began picking up trash and organizing my things. I was still connected to two IVs, an EKG monitor and a blood-pressure cuff, so it was a difficult task. I caught my reflection in a window, waddling around like some tortured, tethered Roomba.

My father arrived soon thereafter carrying an açai bowl. I was too happy to mind his questionable lunch selection. I introduced him to Dyana, who was just as excited as me for my visitor. But with no common language, their interaction was as awkward as you’d expect. We spent the day enjoying food from the outside world, working on The New York Times’ crossword puzzle and stumbling through conversations with the nurses. After dinner, as my father gathered his belongings to head back to his hotel, he asked what time my procedure would be. “Sometime in the morning,” I replied. That was as specific as it got.

After he left, I jotted down these scattered thoughts. The Wi-Fi was out again, so it was a good opportunity to reflect. It was also a chance to think about the procedure to come. Would I be sitting or lying down? Would I be unconscious or just sedated? Would the electric shock ignite my chest hairs like it does in the movies? I wasn’t afraid, just curious. And without many answers to these questions — at least not in a language I understood — my mind was left to wander.

The EP had described the procedure as hitting the heart’s restart button, which had a nice appeal. The previous four days had been scary and exciting and boring and funny. For all of its good and all of its bad, and despite all the nice people I had met along the way, I was relieved to be able to put the experience behind me. Above all, I was deeply grateful for this restart button and the ticket it gave me home.

Patrick Angulo resides in Washington D.C. and is an attorney specializing in government contracts.