The Saturday Rumpus Essay: Infarct, I Did

By

If you roost in a cave or even the hollow cavity of a tree you will probably understand everything I have to tell you. This essay is about blood, and draculin, and the truncated pumping of one human heart.

This essay is not about love. Love doesn’t enter into it. We are talking mechanics. Four chambers, ventricles and atria. The mammalian heart, and thus, the bat heart, and thus, the human heart.

Please, folks, sit down in the aortic vestibule. The heartbeat will surely join you shortly.

 

1)

The relative weight of the vampire bat heart:

Facts:

Diaemus youngi. White-winged vampire bat. Pug-nosed.

Diphylla ecaudata. Hairy-legged vampire bat. Pug-nosed.

Desmodus rotundus. Common vampire bat. Pug-nosed.

Only three of eleven hundred bat species are vampire bats and they exist mostly in Central and South America.

Weight, per bat: two ounces.

Weight, per, of a vampire bat heart: Guesstimate: 2 g or 200 mg (.007 of an ounce).1

 

2)

FACT:

Heart murmurs are similar to air turbulence but are caused by blood turbulences through valves. They might whoosh, blow, or rasp. Through auscultation, aortic stenosis sounds like someone dragging a heavy piece of furniture—redecoration under the ribcage. Could you move that painting a little to the left, please? No, no, the couch should be on the north wall.

Sometimes murmurs are called “innocent.”

If the human heart is innocently murmuring, what is it saying?

Some heart sounds are snakes in the grass. You simply can’t trust them. They’ll tell you one thing to your face and do the opposite. They’ll rob you blind. They’ll tell lies. But the innocent murmurs, well. They stick to themselves. They’ve never had a drink. They are virgins. They wear princess hats at birthday parties.

Presumably, bats, too, have “innocent murmurs.”2

If the sound of your heart murmur is innocent, what is its shape?

“Heart murmurs can … be described by shape: crescendo (increasing intensity), decrescendo (decreasing intensity), crescendo-decrescendo (increasing then immediate decreasing intensity).

“Crescendo-decrescendo is also called diamond shaped.” 3

If one’s heart is an innocent diamond, is this a card game?

 

3)

Tag cloud:

911 angiogram angina angioplasty aorta ambulance artery atrial attack blood bypass cabg CAD cardioversion cholesterol circulation co-morbidity coronary crushing CT death diastolic diet disease doctor enzymes ER exhaustion fibrillation gender graft hdl heartbeat hospital hyperlipidemia hypertension illness inflammation intervention irregularities ischemia ldl medication MI MIBI MRI nurse oxygen perfusion pressure pulmonary septal shortness-of-breath staples stent stroke systolic transplant treatment trigycerides ventricular vessels weakness

There is nothing flighty about a human heart.

Is there?

 

4)

But a bat! A bat is nothing if not flighty.

A bat flies on skin wings called the patagium.

Did you even notice bats have no feathers?

When I was six, a bat flew down our chimney and roosted in our curtains. My mother got it into a Cheez Whiz jar for show and tell. At the time, I was bald from alopecia totalis, so that bat, scruffed with fur on its back, was more hirsute than me

A bat is a mammal. Haven’t we determined that? Only birds have feathers.

To wit: bat fossils. Late to the game because of bone fragility and fossil-unfriendly habitat.

Bats are known for flight, of course, although not exactly for aerial display, taking to the skies as they do in the dark, but (the relatively few) vampire bats also creep, hop, walk and run.

Bats more closely resemble humans than rodents.4

Like whales and dolphins, bats echolocate.

A vampire bat jumps on a cow’s pastern, under its dew claw, or attaches to a hen’s brood patch, where blood vessels rise close to the surface. It shears off hair like a barber to expose bare skin. It doesn’t suck blood. It licks trickling blood for 20 minutes but begins to offload the weight immediately. So if a vampire bat licks your blood, it is also likely peeing on you.

 

5)

A human heart has an average weight of 300 grams, the same as the weight of 120 pennies, 60 nickels, or 300 dollar bills. 15 CDs. A half loaf of bread. Three newborn kittens.

A human heart is the size of a clenched fist.

A fist.

Hold my heart in your hand. Or don’t, because this essay isn’t, after all, about love.

My hypertrophic cardiomyopathic heart beats through the gaps between my ribs like midriff bulge for you, baby.

One of these things is true. And it wouldn’t be the love.

A bat’s inferior colliculus can hear me breathing. My inferior colliculus can hear you breathing.

That’s also not about love. That’s about you as prey. That’s about you as a blood meal. At least for bats.

 

6)

The best poets should live above ground, but Dorothy Livesay did not. Christmas Day, 1985 I fetched the famed Canadian poet from her basement.

After dinner, Dorothy slumped in the corner, grey hair springing, holding wine bottles by their necks—a serious, solitary drinker. I was thirty-one, queer mother to two, with a weird pain suffusing my chest and rising into my neck.

Her throttled wine bottles. My throttled carotid. Even though the air supply is jinxed at heart level, without a heart supplying oxygen to the rest of the body, everything goes under, so think of angina as hands around your throat.

Three nights later, the poet long back in her basement cups, I had that pain again after hot turkey and gravy sandwiches. It sucker-punched me and rose into my jaw and I tumbled into bed moaning.

Bat car to Emergency. Triaged, IV started, bloodwork taken. The nurse suggested an ECG to r/o heart attack,

but the doc said:

WRONG AGE AND GENDER

 

7)

Tag cloud:

bat cave cavern creatures eat echolocation egyptian flying fruit food fox frugivorous habitat humans hunt images large little-brown-bat little-brown-myotis megabat microbat mouse-eared bats myotis lucifugus night nocturnal old-world-fruit-bat photograph prey research resting sounds tree upside down vampire5

 

8)

I harsh-whispered for help.

Doc shook his head with a cockeyed smile and an eye roll, prescribed T3s, said “See your GP.”

One thousand bats climbing his white coat with their thumb hooks, grasping him in their pulmonary arms.

Posterior-surface-view-of-the-human-heart

 

PLEASE DON’T MAKE ME LEAVE

Just just just just just just just just listen.

(Low-income queer mother, bad teeth.)

He scuppered off to important cases.

Nurse hauled me upright.

HURTS TOO MUCH

My partner pull-dragged me to car. Got me upstairs to bed.

How do people dream during a home heart attack?

Women, I mean. Because, realistically, was there ever a man discharged from ER during a heart attack?

A night has twelve hours. A home heart attack has thousands of throats and each one must be strangled. A home heart attack has a million choking fingers.

Have you ever watched bats explode from a cave?

Have you ever watched skies rain blood?

The earth tumbled like a slow marble towards dawn.

 

9)

Female vampire bats find a nursery, tuck themselves inside, hang themselves like lollipops. Vampire bats nurse their young on milk from mammary glands under their armpits.

Vampire bats regurgitate blood to feed orphans.

Vampire bats ascribe to peer-group reciprocity: You vomit blood for me, I’ll vomit blood for you.

 

10)

There’s no reciprocity for invisible pain. The doctor who caused it doesn’t feel it.

The heart attack stopped after twelve hours when I wretched. I crawled back into bed, wrung out. My partner called the doctor.

A couple hours later, a furious apparition of an on-call doc asked why I was still in bed.

“Tired,” I whispered. I regurgitated the pain, the ER, the blistering night, the Tylenol 3s, the sudden cessation of pain with vomiting.

“But it’s ten in the morning,” he said, looking at his watch.

I looked at him.

He didn’t come closer than the end of the bed, didn’t examine me, scribbled a note for an over-the-counter antacid. “You have esophagitis.” He passed the scrip to my partner, said, “And my other prescription for you, young lady? Get out of bed and look after your kids.”

Bat nursing them under my pits.

 

11)

Surviving was:

Luck.

Fortune.

Kismet.

Serendipity.

 

Fluke.

 

12)

A bale of bats. A knob of bats. A bellowing of bats. A bask of bats. A badling of bats. A benevolence of bats. A boil of bats. A bazaar of bats. A bloat of bats. A backbone of bats.

Bats in a barn. Bats in the boarding. Bats in the bark of the beech trees. Naturally, bats in a belfry.

If women weren’t mad before they encountered the medical system, they would be afterwards.

 

13)

My GP flagged an enzyme on her routine go-through of ER test results: Cardiologist, stat. The ECG told the simple story: “Old myocardial infarct.”

A past heart attack, but also, my heart muscle was necrotic from long hours without oxygen.

 

14)

I had just spent the vulnerable first month post-MI treating elephantine angina with antacids.

 

15)

If this essay were about love, it would be about loving a living corpse.

 

16)

An artery of bats. A scar tissue of bats. A misogyny of bats. A medical school of bats. An emergency room of bats. An angiogram of bats. A doctor of bats.

A heart attack of bats.

 

17)

In the alternate version where my life didn’t get hit by Fuck You For Making Plans, splatting star-shaped against the concrete, I did keep studying and launched my career researching interspecies communication.

In this alternate version, I could talk to bats.

I asked bats to tell me the secret of life.

 

18)

The GP said, “You are probably going to die very soon. You see my logic? If your body clogged your arteries at your age… the chances are excellent for a swift progression. Go home and arrange your affairs.”

The cardiologist said, “We can offer open heart surgery, but even if you survive it, you’ll only last five years.”

“Ah,” I said.

“We can only go in twice,” he noted while cleaning his nails with a letter opener. He passed me a brown glass bottle of nitroglycerin tablets. “One under your tongue with every episode of angina.”

My kids were seven and three.

“Or take a chance on medical management,” the cardiologist said, meaning calcium channel blockers nitro beta blockers.

I picked the dice-toss of pills.

I was disabled. I struggled to do anything physical—even walking. Even stress brought on angina.

Their prognoses seemed reasonable to me, given the body I had to struggle to live in.

I gave up the hope of my degree. If at any given time, I had just a bit of time left with my children, then I would not waste it courting exhaustion in classes that couldn’t come to fruition.

Had I but known.

 

19)

I flew with bats. I took my life-giving cunt and echolocated across the windy clouds of time. I dropped my babies, pink squawling infants, safe into other women’s arms. Men ran, hands over their heads, screaming that I’d dropped bombs.

 

20)

In Bali, I held a flying fox upside down by its feet.

 

21)

I felt like I’d thrown myself onto the ER sign naked. Like I’d crawled through the junkies and folks horking up a lung on my hands and knees.

And failed. It wasn’t transpicuous. It was shadowy and arbitrary, and it filled the brain pan of my mind like a garden hose with red chemical fertilizer.

In the desiccated cold of winter, my corpuscles bounced red balls in a rubber hallway praying for treatment.

 

22)

I took up writing because it was the only thing I loved left that didn’t trigger angina. My entire career exists solely because of the actions of one ER doc one night in late 1985.

 

23)

At some point, nitro ceased being administered by pill and became a spray. I spent years pretending I wasn’t as stricken as I was. I faked that I wasn’t having angina walking, angina during sex, angina while standing. Turning away to administer nitro under some other guise. Making an excuse to scratch my ankle.

“I don’t like your breath spray,” said a lover.

“That makes two of us,” I said.

 

24)

GP, maybe ten years in:

“There’s new research that tells us every time you have angina you kill cells, so increase your beta blocker until you don’t get any more.”

Still got angina.

“Increase it again.”

Got more angina.

“Keep increasing it until you don’t have any.”

Ended up with what they called rebound angina. My partner finally realized it was caused by the medication dosing. Still, the cardiologist ordered a MIBI scan—a nuclear medicine scan with methoxy iso butyl isonitrile. I was allergic to it or its antidote and flushed purple for months, tore myself apart from itchiness. Was told my reaction, plain to anyone’s eye, was “impossible.”

Was put on massive dose steroids. Without eating more, inflated from 106 pounds to 250 pounds in a few months, having induced Cushing’s Disease. Stopped the steroids, but my metabolism was shot for life.

 

25)

Bats are grouped with lemurs and primates in a group called Archonta.

Bats aren’t blind. Aren’t dirty. Groom incessantly.

They are the world’s only flying mammal.

Only three of 1100 species consume blood.

Humans consume blood, too, if we eat meat. We consume cooked blood. But no one gets freaky about this.

 

26)

Conservatively, five episodes of angina a day times 365 days a year equalled 1000 episodes yearly, times thirty years. 55,000. So I’d had angina and taken nitro at least 55,000 times. But since I was downplaying that, probably 100,000 times.

100,000 doses of nitroglycerin.

Who else alive can say that?

 

27)

Did you have a heart attack?

In farct, I did.

 

28)

I had CAD disease. Who could not love that? (The doctors.) I was acronymonious.

CAD for the heart that wouldn’t function, that couldn’t function any longer.

(Not that this is about love. This is not about love.)

 

29)

Oxygen in blood looks like nothing. It’s made up of haemoglobin. Hemes bind iron, iron binds oxygen. The screaming heme jeemies are red, you betcha, and they get a bit tetched in the head when they can’t scoot through arteries.

 

30)

Blood consumption by bats:

Titmice. Beans. Poison ivy. Opossums. Naked mole rats. Beasts of the field. Chickens.

Not so much with the humans.

 

31)

Common_Vampire_Bat_Skull

 

32)

I got heart failure after a decade. You could hear it—(You are such a failure, heart!) —in my harsh wheezed breath, my difficulty drawing breath. By my cough from cardiac asthma. The way my ankles flopped over the sides of the shoes.

 

33)

In the order of appearance, my most florid symptoms/treatments:

  1. Angina
  2. angiograms
  3. angioplasties
  4. MI: myocardial infarction
  5. CAD: coronary artery disease
  6. heart failure
  7. stents
  8. cardiac asthma
  9. hypertrophic cardiomyophathy, or enlarged heart
  10. unstable angina
  11. massive MI
  12. CABG: coronary artery bypass surgery or open heart surgery
  13. SOB: shortness of breath
  14. A-fib: atrial fibrillation, or electrical misconduct
  15. cardiac ablation surgery

 

The docs had their rules but I was constantly twisting them and always had: twenty minutes of unresolved angina = a trip to hospital. I knew where that would lead: to a cracked sternum, requisite for open heart surgery. 30% of women’s sternums never knitted again. (Did men’s sternums knit?) Maybe I could go 25 minutes. Or, say, 30. Why not 35? Or if it didn’t resolve by 45? Then, maybe?

 

34)

The last five years have been worst, bar none, because of stress worsening my condition.

 

35)

Hammer Headed Bat from Africa

Hammer Headed Bat from Africa

 

36)

Characteristics of unstable angina (a medical emergency):

  • Occurs even at rest
  • Is a change in your usual pattern of angina
  • Is unexpected
  • Is usually more severe and lasts longer than stable angina, maybe as long as 30 minutes
  • May not disappear with rest or use of angina medication
  • Might signal a heart attack6

 

Lasts all fucking night, every night, for twelve hours. On, off, on, off, on, off. You can’t lie down.

“I have unstable angina.”

“You don’t.” Thus spake the cardiologist.

“I do.”

During angiography:

“You don’t.” Thus spake the interventionist cardiologist.

“Please, as you said, an artery is now 90% blocked. May I please have a stent to get me through to my minimally-invasive CABG in December?”

“But you weren’t booked for a plasty.”

“Please?”

“No.”

I suspect this was a ruffle of feathers. Not bat feathers. (Bats are mammals. Bats have hair.)

The cardiac infrastructure in Vancouver was not equipped to do the kind of surgery I’d chosen (due to my fear of death or an unknitted sternum): minimally-invasive cardiac surgery.

 

37)

Paint blood black to the corners of your mind.

Blood is always red, even if it looks black. It drips. It catches the lamp light and glistens like a sparkler.

Ask a vampire bat.

 

38)

Two unstable-angina months later, I suffered a massive MI and considerable heart damage.

More heart damage equalled open heart surgery equalled increased heart failure equalled hypertrophic cardiomyopathy equalled atrial fibrillation equalled cardiac ablation surgery.

 

39)

LEGENDS:

“In ancient Greece and Rome, it was thought that sleep could be prevented … by tying the head of a bat in a black bag and keeping it near to the left arm. In France 1332, Lady Jacaume of Bayonne was publicly burned simply because bats were seen to fly about her house and garden. In the Tyrol regions of Austria, it was believed that if a man wears the left eye of a bat on his person, he may become invisible, and in areas of central Germany, if he wears the heart of a bat bound to his arm with red thread, he will always be lucky at cards. It was commonly thought that witches used the blood of bats as an ingredient when making flying ointment. In folklore, to wash your face in bat’s blood will enable you to see more clearly in the dark. To keep a piece of bat bone in your pocket will ensure good luck.”7

 

40)

Stray cardiology over the years:

“You should be dead.”

“But I’m not.”

“But you should be.” Tapping his pen.

“But I’m not!”

“But you should be!” Sitting forward in his chair.

“I’m alive.”

“But you should be dead!”

“Why aren’t you curious why I’m not?”


 

“You are a vascular disaster.”


 

“The tree of you is dying.”


 

“The inside of you is seventy years old.”


 

“Just stay on the treadmill. We need to get your heart rate up. If we can jump-start a heart attack here in the hospital, that’s good news for you. Think how much better than if it happens at home.”

 

41)

“In North America, white-nose syndrome has been associated with the deaths of 5.5 million bats since 2006. The fungus grows on hibernating bats, irritating and possibly dehydrating them so they wake up. Being aroused from hibernation costs the bats a lot of energy, which makes them lose body fat and can lead to starvation.”8

 

42)

Bypassing my life.

When I woke on a respirator after open heart surgery a month after the second heart attack, the room was the colour of blood thinners, rose pink, the colour of the 1970s. I was covered with a warming blanket, a sleeping bag of hot air.

When I swooned back into life, there were footprints on the ceiling as if a doctor had walked upside down through the room in blood galoshes.

 

43)

I no longer had pulses. Left arm was guttered in an angiogram. Right arm artery was transplanted and sewn onto my heart.

But I have killer scars.

 

44)

How to Build a Pet Bat Cage

Things You’ll Need:

  • 24 (6-foot wood 2 x 4 studs)
    9 (5-foot wood 1 x 2 studs
    120 square feet of plastic mesh
    72 square feet of half inch plywood
    Saw
    Tape measure
    Screws
    Drill
    Screwdriver
    Staple gun
    Hinges
    Slide bolt hardware
    9
  • Padlock

 

Once the cage is complete, attach the padlock, run the keys upstairs, go back to the bat cage and lock yourself inside. Please. Do the world a favour. You cannot keep a pet bat.

 

45)

Three post-CABG years I insisted to my cardiologists that I was sicker, not better. I said I couldn’t manage the ordinary chores of living. I said sometimes I had to crawl to get to the bathroom. I often had cough with continual arrhythmias. Every time I stood up, I had shortness of breath (that son-of-a-bitch), severe weakness, exhaustion.

In those years, several three-month-long runs of arrhythmia were often checked with electrocardiograms and Holters (overnight electrocardiograms) to no result. If you don’t happen to be having the particular arrhythmia that is causing you grief while you’re hooked up, there’s no diagnosis.

I got the alternate diagnosis that was no diagnosis at all: iatrogenic SOB. Meaning they couldn’t determine why I was so ill. I got sicker while they kept pushing me to do more in cardiac rehab and laid on the guilt.

That ridiculous non-diagnosis followed me to ER.

I was awobble when I stood but the doctors thought that it was street drugs. I didn’t drink, didn’t do drugs, but they didn’t believe this.

Urinalysis. Proof I was not lying.

I needed a cardioversion. The doc would not hook me up to test this. “No monitor available,” the ER doc said.

One would imagine having such a strong cardiac history would at least earn me the benefit of the doubt.

But all it provoked was discharge.

Why go to ER at all? I can write the script of what will happen.

Check. Check. Check.

 

46)

I would be no more than an ‘X’ on a slip of paper if I died.

Pt deceased.

Not even an object lesson.

 

47)

Discharged with a stat Holter.

Luckily, this Holter saw what endless practitioners had dismissed during my three years of complaint: eight hours of atrial fibrillation.

There is no great result from this.

I had to go on blood thinners for life or be considered medically-noncompliant (a diagnosis that also ruthlessly follows people). The choices of blood thinners, which themselves can kill you, but which are somewhat useful in preventing stroke, are warfarin (rat poison), or apixaban and its ilk herd, a group of drugs that scare even doctors because, if you have a bleed (in a car accident, for instance) they can’t help you to clot.

I had ablation surgery in December.

 

48)

The bat is a natural anti-coagulant

Say a bat sat on my shoulder.

It pierced the thin skin behind my ear without me realizing; licked me like a lover for twenty minutes while urinating in a stream that ran between my breasts

Q: Did my blood stop flowing or did the bat get full?

 

49)

“Bullets from a gun swabbed with a bat’s heart will always hit their target.”10

 

50)

My life has been a medical batastrophe. But at least I have it.

 

51)

When medical smugness lays waste to lives. When misogyny almost kills.

Doctors batting: 0

In that I got not one apology. Ever. For all the times they were dismissive. For all the times they hindered. For all the times they were wrong. For all the damage they caused my body. For the life in research that I didn’t get to lead.

In that in making the choices they made, my body was ravaged. In that making the choices they made, my life was laid waste.

Doctors batting: 1000

In that the emergency interventionist cardiologist during my second heart attack placed the stent the first interventionist cardiologist would not and saved my life.

In that CABG worked and my angina radically decreased.

In that ablation surgery diminished my A-fib.

But a damaged heart is a damaged heart is a damaged heart, isn’t it? A broken four-chambered mammalian heart still has an animal attached to it who deserved so much better.

***

1 Sioux Browning

2 MedlinePlus, “Heart murmurs and other sounds.”

3 Practical Clinical Skills, “Heart Murmurs – Heart Sounds.”

4 HowStuffWorks, “How Bats Work.”

5 adapted from “Bats in Popular Culture”

6 Google results for “symptoms of unstable angina”

7 CrystalWind.ca, “Bats – Myths, Folklore and Facts.”

8 Bat Conservation Trust, “Bat Roosts.”

9 Total Darkness Vs. Blinding Light, “How to Build a Pet Bat Cage.”

10 CrystalWind.ca, “Bats – Myths, Folklore and Facts.”

***
Image credits:
Feature image by the author.
Image #1 from Anatomy & Physiology, “Heart Anatomy: chambers, valves and vessels.”
Image #2 from Wikimedia Commons.
Image #3 from Listverse, “Top 10 Bizarre Bats.”


Jane Eaton Hamilton is the author of 9 books of short fiction and poetry, including the 2016 novel Weekend. Her books have been shortlisted for the MIND Book Award, the BC Book Prize, the VanCity Award, the Pat Lowther Award and the Ferro-Grumley Award. Her memoir was one of the UK Guardian’s Best Books of the Year and a Sunday Times bestseller. She is the two-time winner of Canada's CBC Literary Award for fiction (2003/2014). Her work has appeared in publications such as Salon, En Route, Macleans and the New York Times. She lives in Vancouver. More from this author →