A Relative Lesson
On Swedish summers, inverting perspectives and appreciating rhythm
The rhythms of the heart and of life are deeply entwined. When the heartbeat of a loved one stutters, the pulse of everyone around is thrown offbeat. Beautiful melodies can quickly transform into a grating, minor-key dissonance.
This struck me particularly hard one summer. Sun-drenched days follow one another in an endless succession, and a timeless idyll takes hold. Swedish summer is always wonderful. Well, except for when it isn’t. Thankfully, that’s not too often.
One afternoon, the sky is a radiant azure, dotted with cotton-white clouds. And then it happens. A sudden discomfort. Tangible. Palpable. A three-lead thumb ECG confirms it: that all-too-familiar irregular irregularity. Its unpredictability keeps you waiting for the next beat, like listening to a jazz musician improvise on a stage in front of you.
The heart is a marvelous thing. A muscle that works non-stop, year after year, decade after decade - a biological wonder that outshines anything modern engineering could hope to replicate. A motor that endures staggering pressures and extreme conditions for decades before requiring its first repair. But we forget. We take it all for granted.
Most hearts will beat around three billion times, continuously feeding the body’s hundreds of thousands of kilometers of capillaries. And the heart’s magic doesn’t fade, no, it deepens, for each time you see its electrical activity on 25 mm/s paper or its pulsing silhouette on a fluoroscopy screen. That such a small bundle of muscle can do so much, for so long, for so many - that’s nothing short of astonishing. But we take it for granted. Until it stops working.
Atrial fibrillation. No concerns about the what or the why - the condition is far too familiar after many episodes across several decades. The main concern is the who: which doctor will my relative meet in the ER? Most know the condition, the guidelines and the treatment options, and as a result usually cardiovert with great results. But now and then, someone less knowledgeable invents their own approach, defying all established medical knowledge. Or someone who doesn't bother reading the medical journal, or doesn’t want to talk to the patient before deciding on a course of action. Being a family member can be very educational.
Guidelines, of course, have their limits. “Bad doctors don’t know the guidelines. Good clinicians follow them. Great clinicians know when to ignore them.” But before guidelines became so widespread, the risk of running into a doctor who made up a management plan, with no regard for our accumulated knowledge, was much higher.
For most of history, atrial fibrillation led to a disabled life, haunted by the devastating consequences of stroke and the threat of early death. But in the last 60 years, defibrillators and blood thinners have spared us so much suffering. Again, we take it for granted.
Today, cardioverting an arrhythmia is a quick, safe, and uneventful procedure. But just because something is routine and relatively low-risk doesn’t mean it isn’t important - or beautiful. The fusion of medical knowledge, physiology, and technology can banish most forms of atrial fibrillation and accompanying fears. Except, perhaps, the fear of who your loved one happens to meet that day - where the doctor happens to fall on the bell curve of clinical competence.
Fortunately, that day, my loved one meets a thoughtful colleague. Someone who listens, who’s secure in their judgment, and who understands why the guidelines are written the way they are. The visit is brief. One small jolt, and eight hours later, my loved one is returning to summer’s gentle waltz.
The next day, the sky is just as blue, just as summery - but we take a few less things for granted. And maybe that’s as it should be. To be reminded now and then to appreciate the music that we often forget to listen to.
Swedish healthcare is always wonderful. Well - except for when it isn’t. But thankfully, that’s not too often.