Saturday, December 12, 2009

Sans Pericardium


I was trying to give my heart to my cardiologist, let’s call him Dr. Sing.
“Why would I want your heart?” he asked in his soft, singsongy voice, a little smile on his round, brown face.
“For research,” I said, holding out my hands as if they were holding the very heart I was offering.
“I’m not doing any research,” Dr. Sing protested. “Besides, there are plenty of hearts to be had if one is to be looking.”
“But my heart has been without a pericardium for over forty years now,” I said. “Surely that means something to medical researchers.”
I had chronic pericarditis as a young man and my pericardium had to be removed. Without going into all the gory details, think of the pericardium as a partially inflated balloon into which the heart is shoved. The balloon, the pericardium, forms around the heart and acts (I’m guessing here) as a kind of shock absorber. Pericarditis is an inflammation of the pericardium. It can have a variety of causes. Mine was caused by an unknown and very persistent virus. After many episodes, my pericardium had begun to constrict the heart and so had to be removed. Think of peeling a peach; a peach that has a lot of arteries attached to it.
“Medical researchers are very much acquainted with pericarditis,” Dr. Sing said. “In fact, last week I had a man come in with chest pain and as soon as I listened to his chest I knew what it was.”
“You heard a rub?” I said, showing off my knowledge of the so-called pericardial friction rub caused by the outer and inner walls of the inflamed pericardium rubbing against each other.
“Yes, of course,” Dr. Sing said, handing me a slip of paper. “This is an order for a chest X-Ray.”
I took the X-Ray order without looking at it. I’d derailed my argument by trying to show off. I tried to get back to it. “Yes, there’s a lot of information on pericarditis, but what about information on what happens to the heart when it has to get along without a pericardium?”
“Well, your heart seems to have done just fine,” Dr. Sing said. “Look at your stress test.”
The stress test involved hooking me up to an EKG and having me run on a treadmill, on which Dr. Sing kept increasing the incline until I was about to fall off the back. When I quit, breathing hard and drenched in sweat, Dr. Sing said, “I’m disappointed.”
“Why?” I asked. “I went longer than I did last year. What was it, eleven minutes? More?”
“Well, I had a man do almost twenty minutes,” Dr. Sing said. “Of course he was half your age and a tri-athlete,” he said, chuckling.
He was beginning to get on my nerves.
I was seeing Dr. Sing because I had been experiencing a recurrence of upper back pain, mostly under my left scapular. I have had chest and back pain on and off ever since my pericardiectomy in 1965. My doctors over the years had explained it as very probably inflammation of pericardial tissue remaining around major arteries.
“They can’t get everything,” one doctor told me, squeezing my shoulder reassuringly.
“Ouch!” I replied. When I asked about why I got back pain from inflamed tissue around heart arteries, I was told the pain was “referred.”
I learned that referred pain happens when nerve fibers from one region of the anatomy converge with nerve fibers from another region at the spinal cord. Nerve impulses apparently jump the track and cause, for example, that horrible, aching pain that runs down the arm during a heart attack.
But I digress. After all these years of living without a pericardium, I was wondering why we have it in the first place. Maybe, I thought, it’s vestigial, like the appendix. If so, removing it would probably have about as much impact as removing the appendix, although recently, medical researchers may have changed their mind about the usefulness of the appendix, describing it as a little factory that manufactures “good bacteria.” Surely the pericardium has a useful function, as well. Maybe it manufactures good acne. Wouldn’t it be useful to know what happens when a person has to get along for most of his or her life without one?
I started researching the question of what effect removal of the pericardium might have and came across an abstract in the International Journal of Cardiovascular Medicine that began, “The removal of the pericardium does not appear to have…” This could be what I was looking for. I brought up the article itself and read on. “The removal of the pericardium does not appear to have any deleterious effect in the normal dog.” Well, that was a start, wasn’t it? What about the bovine?

3 comments:

  1. I must say, not to be callous, I did quite admire your complement-- only, if imperfect, it felt too impersonal the text... perhaps still in that nascent stage where I exist for love, rather than critics; Really, the formations
    all fall apart, as they shape themselves; So not to be a total ass-- In th end
    it will either be better
    or so much worse--

    ReplyDelete
  2. Oh, I am glad that you explained this here.

    And I'm glad that you have been able to keep your sense of humor about the whole thing, especially as painful as it sounds!

    ReplyDelete

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