Reprise
by Dr. Blair P Grubb
Image source: Unsplash
I really did not want to do this. She was not a very pleasant person. An elderly frail woman, she exhibited a sense of anger, frustration, and melancholy, that made her difficult to be with. I cared for her as a patient for a very long time, the defibrillator/pacemaker that I implanted in her long ago had supported her failing heart for many years. Yet despite her bitterness, there was something about her, some hidden secret waiting to come out. After more than a decade of caring for her, and trying to look past her grim demeanor, she finally began to confide in me. She had not always been so encased in sadness. The mother of twin girls, she had been living a normal life when, while driving them in her car, she was hit by a drunk driver, with such force that one of the daughters was killed. The other daughter was left unharmed. While the police have absolved the woman of any responsibility for the accident, the surviving daughter somehow blamed her mother for her sister's death. Over time they had grown distant and then estranged, the daughter severing all contact with the mother. Years passed and the mother fell into greater and greater degrees of despondency. As her health declined, she finally entered a nursing facility and spent much of her time isolated. Not long after entering the facility, she was diagnosed with metastatic pancreatic cancer. She chose not to pursue treatment and entered the hospice wing of the facility. She contacted me and said that she wanted her pacemaker/defibrillator turned off. This was no simple request. Over the years she has become completely dependent on the pacemaker function of the device for survival. When we had briefly inhibited the device from pacing during her follow-up clinic visits, she did not have any underlying heart rhythm of her own. A complete flatline would appear on the oscilloscope screen. She could not survive without the pacemaker. Some physicians would refuse to turn off the device. Yet both medically, morally, and legally she had the right to remove an artificial modality that was keeping her alive against her will, just as someone could request to be taken off a ventilator or to stop dialysis. I could have had someone else do it, but in my soul, I could not. She was my patient. I was the one who would put this device in, and I would be the one to turn it off. When the appointed day arrived, I entered her room and hooked up the electrodes of the pacemaker/ICD programming device to her chest. Several of her close friends were present as well as her minister. After she said goodbye to those present around her and prayers were said she turned to me and thanked me for keeping her alive all these years. For now, she was in constant pain, both physical and emotional, and all she wanted was peace. She told me that she had tried to contact her estranged daughter, but to no avail. Her dying wish had been to somehow reconcile with her daughter. "Please turn it off now." I nodded and pushed the button on the programmer to deactivate the device. As soon as I did the pacing function stopped and the cardiac monitor showed a continuous flatline. The woman's eyes rolled back, her eyelids closed, and she became silent. I prepared to unhook the device, but then, it happened. Amazingly, her heart began to beat again. Slowly at first, and then with ever-increasing frequency, blips indicating her own heartbeats began to appear on the monitor screen. Slowly (her heart rate was only around 35 bpm) but nonetheless present. Then, the woman suddenly opened her eyes, looked around, and said, "I thought you were going to turn it off." "I did," I said. Over the many years of checking her device in the clinic, we had never observed her having any spontaneous heart rhythm. The heartbeat was slow, but strong and constant. All of us stood there dumbfounded, not knowing what to say or do. Finally, the minister spoke, saying that we had all just witnessed a small miracle, and he offered a pair of thanks. The woman sat up in bed, an incredulous look on her face. I detached the programmer from her. As I turned to leave, I leaned over and hugged her. "You have been given a gift of time," I said, "use it well." And she did. For 3 days her heart beat on its own, slow but strong. While the rhythm was not enough to make her completely normal it was enough to keep her functional. During those few days, she underwent a transformation from dour and despondent to exuberant, conversing with others (despite the pain of her malignancy) and laughing in a way she had not done for years. When her daughter heard of what happened, she saw it as a divine intervention and quickly arrived to reconcile with her mother. While this reprieve from death only lasted a few days, when the time came, she passed peacefully with her daughter by her side.
While the rational part of me would argue that we had never inhibited the pacing function of the device long enough while she was in the clinic to see if she had an underlying escape heart rhythm, another part of me would say that something miraculous had happened. Something beyond what reason alone could explain.
All too often we let our personal problems overwhelm us, we give up on hope and forget about the beauty of the world around us. We sit, hopeless and helpless, drowning in our own misery, until something dramatic happens to awaken us from our sleep and alert us to the wonder of the universe, the gift of being alive. In the end, the woman’s greatest wish was granted, a chance to do things over again. To “reprise,” or repeat a critical moment, a final chance to make things right. The woman was given the chance to reprise her role as mother, and her child out of a daughter. Perhaps we could all see the opportunities available to us in each moment. “Memento mori,” the ancient Stoics said, “Remember that you will die” while adding to it the phrase “Memento vivere,” therefore “Remember to live.” Fate does not often allow us to “reprise” our lives and complete the tasks we have all left undone. The time to act is now.
Dr. Blair P. Grubb is a professor of medicine and pediatrics at the UTCOMLS. He is the author of The Calling and The Fainting Phenomenon: Understanding Why People Faint and What Can Be Done About It.
