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End of shift: Nurseís son forced to consider getting an ICD

Monday July 30, 2012
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I was so excited to be in San Diego with my friend and co-worker, Barbara. We were there for a vaccinology conference to be followed by three days of freedom to explore the area.

We were there two days, found the conference very interesting and even fit in some time at the San Diego Zoo and a delicious dinner in Little Italy. We were looking forward to Sunday and the last half-day of the conference before heading to Coronado Island and Los Angeles.

Then it happened. A call on my cell phone at 3 a.m. I figured whoever was calling must have forgotten the time change from New Jersey to California.

My world changed right then and there. My daughter Jacki was on the phone saying Brian, my 24-year-old son, was in the hospital with a suspected heart attack. A heart attack? My healthy son? Is this a dream? My voice grew louder — "What do you mean, a heart attack?" I was numb. Barbara got me on a plane home. I donít remember the trip.

Brian and his girlfriend had gone to bed early that Saturday night. He didnít feel sick, just tired. At 2 a.m. his girlfriend awakened to the sound of air being sucked in with a guttural sound that she never had heard before. She thought Brian was having a nightmare and went to wake him when she realized he was stiff and having a seizure.

She screamed for her sister and brother-in-law, too hysterical to do anything else. Luckily for Brian, the brother-in-law knew CPR and started it right away. The police arrived with an AED, which gave Brian one shock. He was taken to a local hospital and admitted to the ICU. It wasnít long after that I got the phone call far away in California.

My son had a sudden cardiac arrest. This is a rare phenomenon, especially at his age. He was saved by the quick action of CPR and use of the AED. He was in the hospital for six days. His echocardiogram, electrophysiology test and cardiac cath were all normal. His cardiac MRI showed some inflammation, possibly from a virus.

A second MRI, three months later, showed great improvement. Still, no one was sure why it happened. Brian had been taking some herbal supplements for several months, but none of the healthcare professionals knew much about them. A mystery indeed.

Brianís doctors all agreed that he should have an implantable cardioverter defibrillator put in as soon as possible. Brian wasnít too sure, and neither was I. We felt pressured into having it done right then and there with no time to think. We needed time to think. Brian was fitted with a noninvasive defibrillator vest worn directly on his chest. It would send a shock if he went into a life-threatening arrhythmia. It gave us time to think.

Brian had to make a choice. Should he get the implanted device or not? The ICD would be there for the rest of his life and possibly would save his life if he had another SCA. The device requires a surgical procedure to place it and needs to have the battery surgically changed every five years. There is a chance of infection. Certain body movements are prohibited (mostly left arm movements, weight lifting and swimming), and it can malfunction and deliver an errant shock, which one doctor described as "a swift kick to the chest."

Brian wore the vest for three months without incident. He made the decision not to get the ICD.

The decision was difficult, but he feels good about it. He no longer takes any supplements, works out and tries to eat a healthy diet. He is a teacher and married to his life-saver girlfriend, Pina, with whom he has a 10-month-old daughter. He has moved forward.

I, as Brianís mom and as a nurse, always will worry about him — ICD or not. And one day, I hope to get back to San Diego, and maybe take the family with me. •


Susan Graziano, RN, MSN, APN, is a nurse practitioner and assistant director at Montclair State University Health Center in Montclair, N.J.Write to editor@nurse.com or post a comment below.