Chapter 12

May of 2006 arrived with no good answers. The loop recorder in my chest wasn’t providing the clues needed to validate or eliminate a heart arrhythmia, so Dr. Kaplan decided to perform a Tilt Table Test. I had not been given this test in California. It was never mentioned. It seemed like an idea out of a Frankenstein movie. The fact that it was administered in a hospital, not in a doctor’s office, was odd, but I didn’t give the test much credence. After all, I had taken some of the most sophisticated electronic tests in the world, and they hadn’t shown a thing wrong with my heart. I doubted that lying on a tilted table would provide new answers.

I checked in to begin the test on the third floor of Banner Baywood Heart Hospital. The nurse, Marty, guided me to the room. After climbing onto the bed I lay prone, and then she placed wide, thick leather straps across my chest and knees and buckled them tightly to keep me from falling off the table. The wires and cuffs from a monitor were attached to me, and the table was tilted with my head up until I was almost but not quite vertical.

The nurse sat down to record my heart rate, blood pressure, and respiration. There wasn’t a lot for either of us to do, so she told me the details of the test. She would record the monitor readings every five minutes. If nothing happened after thirty minutes, I would be given a nitroglycerin tablet under my tongue. This would temporarily speed my heart rate. We’d wait another fifteen minutes, and if no symptoms appeared, then the test was over.

Of the people who pass out, most do so in the second half of the test after being given the nitro tablet. Their hearts speed up, lose efficiency, and fail to pump adequate blood to the brain. In a minority of cases, some peoples’ hearts slow down to the point that they became dizzy and disoriented. Some people pass out, but most people don’t, and I felt certain that I would be among the majority. After all, how scientific could such a silly test be? Fifteen minutes into the test, I was mid-sentence, complaining, when everything went black.

“Mr. Horne! Mr. Horne!” said a feminine voice from far away. “How do you feel?”

I opened my eyes, blinking at the crowd of people surrounding the table. I was lying on my back. I was disoriented, confused, and I didn’t know where I was or who these people were. I was dizzy. Three white-smocked nurses and the Cardiologist’s Physician Assistant were at my side. All had concerned looks. Over the next ten minutes, I became more coherent, although the dizziness lingered. I had been doing some sort of medical test, I remembered, but I couldn’t think of what it was.

“I guess I passed out,” I said to the PA.

“I called for help and got to him as fast as I could,” Marty said. “There wasn’t much time. One second he was fine and the next he wasn’t. His blood pressure dropped like a rock.”

The PA nodded at the information, chewing on her lip and lost in thought as she looked at me. “Can you sit up, Mr. Horne?” the PA asked.

“I think so,” I said. “I’m dizzy, but I’ll try.”

Two nurses helped me to a sitting position on the table. I sat there staring at the floor, feeling like I really wanted to lie back down. After a few more minutes the nurses helped me to a chair.

The PA moved to another chair and sat down to talk with me. “Mr. Horne, I want to put you on Paxil. It’s an SSRI, a Selective Serotonin Reuptake Inhibitor, medication we use to treat your condition,” she said.

“I know what Paxil is. I took that stuff for three years. It’s an antidepressant. I’m not depressed! I passed out! No one knows what causes this to happen, but it’s not depression; I know that much.”

“Mr. Horne,” said the PA, calmly reaching for a strip of white EKG paper lying on a table, “you didn’t faint. See this flat line? That’s your heart. It stopped beating for fifteen seconds, and your blood pressure dropped to 35/10. You lost consciousness because the blood stopped flowing to your brain.”

I couldn’t take my eyes off that long flat line. It seemed to go on forever. “Was I dead?”

“No, you weren’t dead,” she said. “The heart needs to be stopped for longer than fifteen seconds for someone to die. You have a condition called Neuro-Cardiologic Syncope. Most people who have it are born with it. Normally it’s a benign condition, but it is a concern when someone’s heart stops beating, so we should treat it with medication. Any variety of stressors in the body can trigger an episode.”

“What about sleep deprivation or hypoglycemia?”

“Either is a possibility. With medication, rest, and a healthy diet, you should go on to lead a long, normal life. Paxil is one of the medications that crosses boundaries to treat this condition. I’m not prescribing it for depression.”

I was stunned. How could my heart stop beating? I’ve never heard of such a thing. This explains why I passed out in California. Is the search for my mysterious illness over?

Dr. Kaplan came into the room, and the three of us chatted. Neuro-Cardio Syncope is a heart condition that can kill, but with medication, it can be treated successfully. For me, the bouts of dizzy spells came when I overloaded my life, was not getting the proper amount of rest, and was letting my diet suffer. Dizziness became episodes of unconsciousness as I grew older. In my case, the medical condition was normally dormant. Long and stressful hours at work and a diet of excessive sugar and caffeine gave it life.

Twenty years of enduring the demands of work and college, consuming too much caffeine and sugar, put me in continual insulin overload. As I aged, the chemical imbalance in my blood worsened the interruption of life-giving signals between my brain and my heart until I passed out.

When Jasmine was born, I naively began the deadly cycle again with coffee, Skittles, and other snacks. Rather than taking time off work and worrying about myself, I let the demands of others outside of my family control me to the point of exhaustion. The decision to stop at Lou’s after work had been my final mistake.

With my body chemistry distorted, depleted, and weak, a small amount of alcohol had put me into insulin shock, and my world was a dream after that. It was when I thought the beer was unusually strong that I had my last chance to save myself. I was entering insulin shock and I didn’t know it.

After that, I was unable to comprehend or control my actions. That’s why I lost all sense of time. My liver didn’t metabolize the alcohol normally while it was trying to save my life, so I became excessively intoxicated. My heartbeat became irregular once again, and I lost control of the truck on a simple straight stretch of highway.

The doctors told me that mental confusion is endemic to both hypoglycemia and Neuro-cardio syncope. The combination left me virtually mindless. That was why my memory was a perception of being in the altered reality of a hallucinogenic dream state. After my liver stabilized my blood sugar enough to save my life, it went back to metabolizing the other toxin in my blood — alcohol.

This explained why I had stayed at Lou’s, why I lost control of the truck in a sudden swoon of semi-consciousness and then passed out, why I was incoherent at the emergency room, and why my return to lucid thinking had been so sudden. I walked from the testing room to the lobby to tell Becky the good news. I now understood what had happened. I could forgive myself. I also had a defense. I could prove that I was unintentionally intoxicated.

Finally, I have the answer to this mystery, diagnosed as burn out and depression, I thought. This caused my early retirement in California. I now know what happened to cause the accident.

Proceed to Chapter 20.