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.