In a Heartbeat

Notes from Kosovo #4

It was the nightmare I had been hoping to avoid. I had arrived at the inescapable conclusion: I would have to go to the emergency room. Questions that I had been worrying about now needed quick answers. Where was the nearest ER? Would they speak English? Would my insurance pay for medical treatment in Kosovo? Who should I call for help?

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I had already experienced three episodes of atrial fibrillation dating back to 2009. The first two times, my heart righted itself with little effort – some IV hydration or a dose of a fast-acting beta blocker. The third time was a bit more dramatic. The easy fixes didn’t work and I was sedated for a procedure called cardioversion – the application of two electric paddles that deliver a shock to the heart to jolt it back into rhythm. The attempts were unsuccessful and my heart continued to go rogue through the night until it decided on its own to return to regular beats. These two instances left me feeling uneasy and, although I had not had a reoccurrence in many years, it had remained a background fear as I traveled to unusual places such as Kosovo and the Caribbean Island of Nevis.

It began at 5:00PM on a Tuesday evening following a tense day of waiting to hear whether or not I was going to have to travel across the mountains of Albania to the Adriatic coast to lead a two-day workshop. I was on a two-week mission to the Republic of Kosovo as part of a relationship begun in 2010 in which I was providing consultation to their Ministry of Education. Funded by the World Bank, the project was nearing completion and this was likely my last visit. I had been working with twenty-one School Inspectors – the officials tasked with monitoring instructional effectiveness – to develop a teacher assessment process and to train them in its use. This final workshop was set to wrap up the work and make final edits to the assessment manual. The Director of the Inspectors had wanted it to be a special event and had booked a venue on Albania’s coast. I had been having issues with my back and was not looking forward to the trip which was set to head out that evening. I had visited that exact spot last year and, although the area was beautiful and the mountainous drive spectacular, I didn’t relish the four rough hours in a cramped Ministry car. I had packed a suitcase and waited all day for the confirmation that the trip was on. Finally the word came through that approval had not been granted and we would be staying in the country. Relieved, I changed my work clothes into comfy sweats and plopped down on the bed to relax.

Minutes later, I was aware of my heartbeat – never a good sign. I always find comfort in the trust that my heart is sitting in its spot in the thoracic cavity quietly and efficiently doing its job. I never enjoy becoming aware of it whether due to its pounding in fear, aching in disappointment, or throwing me off with an irregular beat. Checking my pulse, a recurrence of atrial fibrillation (annoyingly called a-fib in our abbreviation-obsessed culture) was clear. I confirmed this with a simple device that I carry with me at the advice of the cardiologist. Paired to a simple app, in sixty seconds it records an EKG and analyzes it as normal or otherwise. The diagnosis confirmed, I quickly popped a dose of the medication I had for just such occasions. No effect. A repeat dose in an hour was followed by the same result. I was beginning to panic.

By 8:00PM, I had taken three doses of the medication and had reached the limit of that strategy. With the time zone difference, it was only 2:00 in the afternoon back home and I called cardiology at Dartmouth Hitchcock. Several conversations with the cardiac nurse there gave me comfort knowing that someone was following my condition. But by 10:00PM Kosovo time, the nurse had only one piece of advice left: go to the hospital. I dressed myself, gathered my passport and cellphone, and went downstairs to the hotel desk.

This begins the uplifting part of the story. If I had ever felt the friendship and warm-heartedness of the Kosovar people, this night would confirm it unequivocally. The night desk clerk moved swiftly to get me transportation to the Spitali Amerikan – the closest ER where they would be likely to speak English. Arriving at the hospital, I was immediately ushered into a curtained area, hooked up to a monitor and had an IV inserted. Multiple nurses swarmed about me as my vital signs were recorded and I was given both a cardiogram and an echocardiogram. Soon after, the doctor arrived at my bedside. He was an elderly and soft-spoken gentleman with a kind smile. His English, though heavily accented, was perfect. He took my history and throughout the night provided care and exhibited medical judgment equal to any American emergency room physician. I was reassured that he understood my situation and was carefully choosing his approaches to restore a regular heartbeat. Medication flowing into my veins were his first choice, with cardioversion being the last.

My heart maintained its irregular beats throughout the night. At 5:00AM, twelve hours after the onset of my symptoms, the doctor came in to consult with me and make a determination as to the next steps. He was still hopeful that cardioversion could be avoided.

“I really need to go to work today,” I pleaded.

“I will let you go, but if your heartbeat doesn’t return to normal by mid-afternoon, you will need to come back for a cardioversion.

“If I come back this afternoon, will you be here to do the procedure?”

The doctor paused thoughtfully. I could tell that the answer was going to be ‘no.’ But instead, he said, “I will give you my phone number. If you have to come back, call me and I will come in to do it.”

 As I stood at the admitting desk with my credit card to pay for my treatment – something that would be free for any Kosovar citizen – the attendant answered the phone and handed it to me. 

“It’s for you,” he said.

It was the head Concierge from my hotel, who had handled my hotel stays for almost a decade. He was apparently beside himself when he learned of my whereabouts and he anxiously asked about my condition. He assured me that when I returned to the hotel, he would send someone to get my new medication. And as I spoke to him, the desk attendant handed me my bill for the entire adventure: €108 – or about $123!

Back at the hotel, it seemed as if the entire staff from the waiters to housekeeping were on red alert. They greeted me with concern and affection, assuring me that they were all there to make me comfortable and fulfill any needs. And as I took my shower and got dressed for the workshop that I was about to lead, my heart, tired of creating such a fuss, decided to return to normalcy and has remained steady ever since.

That night, as I sat in the hotel restaurant eating supper, the desk clerk summoned me to the phone. It was the doctor, concerned that he hadn’t heard from me, calling to check on my condition. I thanked him for his care and assured him that my heart was behaving itself. His concern was touching and completely in character with what I have become accustomed to in my years of association with the people of Kosovo. Would I feel comfortable putting my health and life in their hands again? 

In a heartbeat.

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