Ejection Fraction

Disclaimer: The first few days of my hospitalization were quite blurry. I don’t recall some of it because of the medications & sedatives I was on, but I do have notes written down from how I was feeling during those times, so I will be alluding to the notes occasionally.

Anyways … continuing with my hospitalization:

Nobody knew what was going on. I was extubated and breathing on my own (barely). My heart rate was too high, my cough wasn’t getting any better. My liver function tests were abnormal, my electrolytes were off. My chest x-ray showed complete "white-out" of both lungs, which is Medical Speak for “Something serious going on in the chest.”

I had almost every consulting service seeing me. I’m on my way to becoming an Internal Medicine resident’s winning case report in the New England Journal of Medicine. If you can’t tell, my dry humor got me through a lot of this.

One of the doctors in the Intensive Care Unit came to my room during the morning of Hospital Day 3. He was determined to solve the puzzle. He asked me a few questions and then proceeded to do a full physical exam on me— probably the 8th or 9th one in the last 24 hours. He spent some time pontificating about what this could’ve been, and what we should’ve done, and what the next step would be. 

He was in deep thought when suddenly he realized that he may have figured it out.

“I think it’s your heart, Alin.”

He turned to the resident physicians and calmly said, “Get Cards on board. Someone send a troponin and a BNP.” 

This is Medical Speak for “I think that your heart is failing.” He then asked me a few more questions, and we talked about the plan. The team left the room quietly.

My HEART!? My heart? My lovely heart! The one that got me through the last 30 years of my life! The one that kept me going. The one that helped me physically exercise every day. The one that helped me at work, while I ran around room-to-room in the ER trying to convince patients to stay in the hospital for their own good because I genuinely cared about them. The one that I wore on my sleeve. The one that was “too much” at times. The one that loved everything so passionately, and was always loved in return. 

I took a look at my lines and my tubes. I stared at the intravenous medications— “the drips." I was getting all sorts of antibiotics, antivirals for this possible infection of mine. My blood pressure had been running low, so I was put on a medication to help my heart pump. I had a catheter jammed into my radial artery that was reading my low blood pressure, my low mean arterial pressure (that’s the one I always look at … why’s it 60? We need to up my Levophed, guys). I then came to the conclusion that I was … pretty sick.

I picked up my pen and paper and wrote down: Heart???? I still can’t breathe. Why can’t I breathe? I feel like I’m drowning. Dying. 

A very long hour passed. One of the cardiologists walked into my room. We joked about how this definitely could not have been my heart. He then proceeded to place an ultrasound probe on my chest wall, something we do often to check a patient’s heart function.

And there it was.

Global hypokinesis. Thin walls. Dilated chambers. Chronic changes. Terrible squeeze. Severe mitral regurgitation. Ejection fraction? 5-10%. 

This is Medical Speak for “A poor, poor heart walking on thin ice.” 

He quickly put the probe down, noticing that I had seen the images already. We were both quiet for a few seconds, but he broke the silence. “I’ll be right back with a couple of the attendings, hold on." That’s Medical Speak for “You are … pretty sick.” 

I didn’t need him, or any of the attendings, to interpret anything. I knew how bad this echocardiogram was. That was, by far, one of the hardest parts of my whole experience— trying to be a hospitalized patient while, in reality, I myself was a medical professional. I had completed 9+ years of school, had finished almost 3 years of training in Emergency Medicine, and I was just about to start a specialized fellowship in Critical Care Medicine. I was supposed to be the doctor pontificating & telling young, healthy, scared, sick patients that “it" was their hearts. I was supposed to be putting the ultrasound probe on their chest walls, and ordering the serum troponin levels.

I knew how dire my situation was. I didn’t need anybody telling me this. 

I screamed a little bit, internally.

My heart, you’ve given up on me! 

To end this post, here’s something lighthearted. A direct quote from one of my attendings in medical school— a mentor of mine, a one-of-a-kind radiologist who recently texted me after hearing about my situation.

I remember you and your energy, Masha’Allah. Going through a few months of residency with a 5% EF? Only you could have done it.