Amor Fati

A few weeks ago, I did not know much. I did not know that in the late sixties one of my male relatives had died in a car accident. He was 35 years old when he lost consciousness and drove his car full speed into a truck. I did not know that his father, my great-grandfather, had also died suddenly in his sleep. He was not yet 50 years old, and his 3 children were all under 10.

I have a wonderful wife and two incredibly beautiful kids who are currently 6 and 4 years old. I turned 40 just last month. Although I worked for more than 15 years with cardiovascular MRI, I had no idea what Brugada syndrome was.

I ran and jumped my whole life, mostly chasing an orange ball, and every year in which I competed in a basketball championship, my treadmill EGC stress test was normal. Since I started working for Siemens Healthineers , even during my PhD, my heart was the object of countless MRI scans.

A few weeks ago, everything was the way it had always been, and once more I was running, this time to catch yet another train, after yet another work meeting. I had just come out of the Inselspital in Bern and I was feeling great with the cold air on my face, thinking I would soon be home to my family, looking forward to the weekend plans. I slowed down, I accelerated again, I felt some sort of sudden dizziness, and I thought to myself that I needed to stop, and let it pass.

And then I was on the floor.

Until today, I do not have the memory of the fall.

As I regained my senses, I saw that a stranger was trying to help me stand up. He spoke German, he was clearly concerned, and he was handing me something that he had just picked up from the pavement: it was one of my teeth.

It took me a few seconds to realize what had happened. Someone gave me a paper tissue and they asked me to sit down on the sidewalk. A colleague that was with me ran to get some ice in the restaurant across the street and I called my wife to tell her that I had somehow fallen on my face while running and that I was injured, but that I would take the train to come back and go to the local hospital to get checked.

Fortunately, I did not.

Instead of a train, my wife and my colleagues talked me into taking an ambulance back to Inselspital. The ride was short, and the two paramedics were extremely kind.

The wait at the ER was the usual experience: a long still time punctuated by short periods of intense conversations and exams. I got a head CT and a contrast chest CT. A surgeon somehow put some of my teeth back in place and placed a metal wire for my broken upper jaw. Among all these things, they also took a 12-lead ECG and the cardiologist saw something.

I was kept in the hospital for almost one week, constantly attached to a portable Holter monitor. I had a complete echocardiography, and even a cardiac MRI exam.

It was probably the 200th time I was in an MRI scanner, but this time was different.

I googled “Brugada Syndrome” countless times and every single time it was something cold, scientific and rational. This was not me! I fell? Yes, but it was certainly some sudden drop of blood pressure. There was something in the ECG? Yes, but an ECG is not specific, that could be anything!

As I said: a few weeks ago, I did not know much.

Finally, they performed an ajmaline provocation test and, though I felt nothing, they showed me the progressive change in the ECG, the type I pattern coming up as they increased the dosage. The day after, I had a more familiar treadmill ECG stress test and the pattern was there too.

The diagnosis: Brugada syndrome. The prognosis: enough risk to warrant the implantation of an ICD. The implications: on that day, when my dash for the train had come to a sudden stop on the pavement of the sidewalk, I did not just break a few teeth, I had been extremely lucky.

I knew very well what an Implantable Cardioverter Defibrillator was. I saw many of them in the University Hospital in Lausanne, or better, I saw the artifacts they create in the MR images, and I also worked to try reducing it and improving the diagnostic quality. I knew very well what it was and what it meant.

The physicians on my case were wonderful, full of humanity and empathy, and, above all, extremely competent. They sat with me in multiple occasions and answered all my questions.

As I went through all the exams and the surgery, I experienced what being “on the other side” looks like. Being told in simplified and reassuring terms how the CT and the MRI exam were going to be like. Feeling the warm and the cold contrast agents coming up my arm, holding my breath when told to do so, not knowing how long I had been inside the white tunnel, how long more I had to lay there, and, above all, what they were seeing in the images reconstructed in the room next door.

While laying still, looking at the white ceiling of the tube, there was not a single moment in which I was scared or completely lost. I felt proud: proud to work for physicians and patients that, exactly like I was, are looking for an answer, for a diagnosis, and for a solution.

With all that was happening to me and around me, I had a lot to think about.

Most of all, I realized in first person how illusory is the feeling of controlling what happens to us.

I was also in touch with a huge feeling of gratitude, with the extreme eagerness of going back home and hugging my family once more, and with how the things I care the most, and that I often take for granted, can be the most fragile.

We cannot control everything, even if our brains try to tell us so, to make us feel safe. The power is in how we respond to what happens to us, in every single action we take and every single word we say.

The power is in how we treat ourselves and other people, in how we use the limited time we have, in what we do with our energy, our skills, and our passions.