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The White Orchid

Leaving my office this evening, I see the white orchid’s last petal struggling to hold on. With its faded grey veins and withered brown edges, it looks like a bit of old, crumpled paper. Even the sunlight streaming through the window doesn’t brighten it. Tenderly, I reach down to touch its softness.

The touch transports me back to when I first met Shirley, who gave me the orchid. I remember it vividly.

I was the interventional cardiologist on call that night. Shirley’s husband, Mike, had developed severe chest pain after dinner. He arrived in the emergency room as a “CODE STEMI”–a patient suffering a heart attack in which one or more coronary arteries are blocked.

Seeing this code, my cardiac-catheterization (cath) team and I readied ourselves for an emergency procedure to unblock the arteries.

Mike, only forty, was handsome, with a square jaw and grey-green eyes. Lying on the stretcher, he looked very ill. Beads of sweat clung to his forehead and clumped his hair. His heart was racing; his blood pressure, dangerously low.

As I wheeled him towards the cath lab, Shirley, holding their fourteen-year-old daughter Katie’s hand, leaned over to kiss Mike’s forehead.

Please, God, I prayed silently, let it not be their last kiss.

“Will he be okay, doc?” Shirley asked innocently.

“Mike is very sick–he’s having a massive heart attack,” I told her. “I’ll do my best.”

In the lab, we were greeted by Becky, the scrub tech.

“We’ll take care of you,” she told Mike warmly. Drew, the nurse, and Jack, the fluoroscopy tech, joined us.

A highly competent team, I reassured myself, hoping strenuously that the lab’s whitewashed walls and bright lights could ward off Hades, the dark god of death.

As we shifted Mike onto the table, he retched, vomiting greenish bile and partially digested food onto the blue sheet. Drew cleaned it up and redraped Mike in a sterile sheet.

“I am so sorry for vomiting,” Mike mumbled. “I am so sorry.”

Who is this man who’s so kind that he apologizes while having a heart attack? I marveled.

Suddenly, on the monitor, the regular green spikes of Mike’s heartbeats melted into a quivering, chaotic mess–ventricular fibrillation, a potentially fatal arrhythmia.

“Call code blue!” I said. Drew signaled the hospital staff for more help while Becky pounded on Mike’s chest, trying to restart his heart. When Jack was ready to use the defibrillator, she stepped back.

“Everyone clear! Go ahead–shock!” I said.

Shock 1: Mike’s body jolted; but his heartbeat didn’t resume.

“Becky, continue chest compressions. Drew, give 1mg of epinephrine and 300mg of amiodarone,” I ordered. Adrenaline rushed through me; my own heart raced. I felt like a swan–seeming calm above the water’s surface, but paddling furiously underneath.

Dr. Brady, the ER physician, arrived, with a swarm of other people. I didn’t know who they were or what their roles were. The room was dissolving into a chaotic mess that matched the chaos of Mike’s heart rhythms.

Raising my voice above the clamor, I announced, “This is Dr. Mallidi. I am running this code.” The voices fell silent.

“Dr. Brady, go ahead and intubate the patient,” I said. “Becky, continue compressions. Drew, give another 1mg of epinephrine.”

Shocks 2 and 3: Still no normal heart rhythm.

I stood beside the table, my gloved hands touching the femoral artery in Mike’s groin. Under my fingers, his pulse bounded in time with Becky’s compressions. There was no independent pulse.

Dr. Brady stooped his balding head over Mike, trying to intubate him so that we could connect him to the ventilator. This was crucial: The ventilator would take over Mike’s breathing and reduce the stress on his heart.

“I can’t see anything,” Dr. Brady rasped, exasperated. “His throat is covered with vomit. Get me a glide scope, please!”

Shock 4: Mike’s arrhythmia continued. As Becky pounded his chest, his body jerked with each thrust.

I punctured his right femoral artery, inserted a long catheter into the coronary arteries and injected contrast dye. An image of his arteries sprang into view on the fluoroscopic camera. The sight made me shudder: Two of the three arteries supplying blood to the heart were completely blocked.

Shock 5: We used several more resuscitative drugs, but Mike’s heart stubbornly continued its ventricular fibrillation. Dr. Brady was still struggling to intubate him.

“We are going to insert the Impella,” I said, referring to a device that temporarily helps the heart to pump.

I knew that any second now, Mike’s heart would stop entirely. The image of Shirley and Katie holding hands and kissing him flashed through my mind.

What will I tell them? I thought desperately. That beautiful young girl will be without a father…like me.

The summer after my first year of medical school, I lost my father.

Like many in my family, my father was a doctor. His specialty was orthopedic surgery. I remembered how, the day before the final exam for anatomy, I’d called him in a panic from a tiny red cubicle, the only public telephone booth on campus. Gently, my father had calmed me and advised me on which topics to review.

He passed away a month later–before the end-of-year honors were announced. I never had the chance to tell him that I won the “Best First Year Student” award. And I lost my guide and my go-to person for everything in life.

Without her dad, Katie will be a ship without a compass, I thought miserably. Like me, for the last nineteen years.

All about me, I felt Hades hovering in the air. After a split-second prayer to God, I looked up at the ceiling light and offered my dad a prayer:

Please, please help.

“Endotracheal tube is in,” Dr. Brady announced.

I took a deep breath. “Jack, shock again.”

Shock 6: On the monitor, Mike’s squiggly, disorganized heart rhythms reverted to neat, regular spikes.

A sigh of relief whispered through the room. Becky stepped back from the table.

Over the next two hours, we inserted the Impella, opened the blocked arteries with stents and transferred Mike to the ICU, in stable condition.

Knowing that Shirley and Katie were waiting, I removed my heavy lead gown and headed to the restroom for a moment.

The face staring back at me from the mirror was covered in large, circular red welts–a result of the adrenaline surge that had flooded me in the past few hours. I splashed cold water on my face and took a deep breath.

Closing my eyes, I saw my dad’s smiling face.

Jaya Mallidi is an interventional cardiologist at Santa Rosa Memorial Hospital, CA. She writes regularly as a columnist for Medscape. “I started writing as a cardiology fellow, mainly as a way to connect with my own emotions, which then organically channeled into productive endeavors. Physicians face myriad problems as they practice modern medicine. The one saving grace untouched by technology is the human connection, filled with care and compassion. Writing is my way of reaching out and feeling this joy in medicine.”


12 thoughts on “The White Orchid”

  1. Carol Van de Wetering

    What a beautiful and moving account. Having just had the privilege of your performing my TAVR, my emotions are very sensitive to your amazingly talented hands and gentle, tender heart. You have chosen the perfect profession, You may not realize it, but you share your heart as you heal others’ hearts. It is evident in your intellect, your genteel demeanor, and your patient and listening ear. Your dependence upon divine intervention is evidence of your modesty and humble spirit. I wept at reading of the loss of your father; clearly you miss him so much because you loved so much. He is surely proud of the apple that did not fall from his tree. I do not doubt that one day he two of you will embrace and rejoice. ❤️❤️

  2. A very moving event! Amazing what you all as doctors and the frontline people through this pandemic are doing on an everyday basis to save lives! Glad your parents caring legacy has been passed on to you all and your father’s fond memories/ giving spirit are constantly strengthening & supporting your work.

  3. Beautifully penned Jaya. Gives a whole new respect to the medical fraternity whom we kind of take for granted as emotionless.

  4. Mandel Ellen D.

    The spiritual connection of a supportive parent transcends death. You may have lost your father in life, however, his memory lives on. For that, you and your patients are fortunate. Brought tears to my eyes. Thank you for sharing this story.


    Agree, very well written that touched head and heart. Transported me back to my time as an ICU and ER nurse. Thank you for sharing your story and your thoughtful., accessible and profound writing.

  6. I felt the same as Pris Campbell, who commented above! All the emotions were there. Thank you, Dr. Mallidi, for sharing this story.

  7. This account had be breathing heavily all through each event. Will he make it? You truly put us in the shoes of someone desperately trying to save a life.

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