With All My Heart

Janis Amatuzio, M.D.

---

From Forever Ours: Real Stories of Immortality and Living
From A Forensic Pathologist

---

As a physician, forensic pathologist and coroner for several Minnesota counties, I have had the extraordinary privilege of caring for families and their loved ones when death comes suddenly, unexpectedly, or traumatically. My job is to speak for the dead, to solve the mystery of “what happened?” I have occasionally, however, been faced with mysteries I cannot solve or explain. These experiences always baffle me, partly because as a scientist, I seek to reach a reasonable degree of medical certainty, a rational explanation. But I have come to realize that for some experiences there is no explanation, just a deep knowing that I have encountered the Divine.

The year was 1978. I was in the final months of my internal medicine internship, rotating on the cardiology service of the Heart Hospital. Nothing in my training had prepared me for what I experienced one day in March.

“Doc, am I going to be OK?” my patient, Andy Nelson, a confident 46 year-old pharmacist, whispered hesitantly to me as he watched the overhead monitor in the cardiac catheterization lab. Mr. Nelson was admitted with ‘atypical chest pain.’ An extensive work-up had revealed no cause for his symptoms. A coronary artery angiography was ordered to definitively rule out any undetected heart disease. Andy chose to be awake during the procedure and to hold my hand.

All eyes were fixed on the overhead screen. Dr. Thomas, the senior cardiologist, steadily threaded the catheter as he skillfully entered the left coronary artery opening. The carefully injected radio-opaque dye lit up the arterial branches like a beautiful oak tree outlined against a winter sky.

As the catheter was slowly advanced into the ostium of the right coronary artery, an abnormal “blush” appeared near the catheter tip.

The cardiology resident repeated the dye injection. The abnormal blush was unmistakable. “The attending! I want him in here STAT!” ordered Dr. Thomas.

I could feel my patient’s palms start to sweat.

“Pulse rapid at 90 to 95 beats per minute,” the anesthesiologist, Dr Stone reported.

“I think the vessel is torn, we have a perforation!” Dr. Orland exclaimed.

Just then the staff doctor, Dr. Sweeney, strode into the suite, hastily donning a gown and gloves. I remember Andy’s grip tightening on my hand.

“What have we got?” he asked sternly.

“A tear in the right main, at the ostium, it looks like a laceration “ replied Dr. Thomas.

Dr. Sweeney immediately took charge. “I want him put on bypass, STAT. Call the OR—tell them to clear an operating room for us. I need the cardiac staff surgeon on the phone NOW!”

I held tight to Andy’s hand. “Will I be OK?” he asked again. At that moment, I wished I knew better what to say. “It can be fixed, Mr. Nelson, but it is serious. I promise, I won’t leave your side,” I added.

“Thanks doctor” he paused looking straight up at me, “I’m scared, but I’m going to get through this.”

“Yes, we are,” I responded.

“One more thing, Doc—do me a favor?”

“Sure, anything” I replied.

“Tell my wife that I love her,” he whispered, “with all my heart.”

“I will, I promise.” I felt the words catch in my throat.

His grip slowly loosened on mine as the anesthesiologist administered medications to relax and anesthetize him.

Minutes passed, when suddenly the cardiac monitor began beeping loudly. The heart rhythm had abruptly gone from regular rhythm, into life threatening ventricular fibrillation. “V-fib arrest!” shouted the cardiac fellow. “Give me the paddles, prepare to shock.” Dr. Orland yelled, “Stand back.” Andy’s chest jumped as the charge was delivered and all eyes returned to the monitor.

The fibrillation continued, “Shocking again!” said Dr Orland. Andy’s chest jumped again. “Normal sinus rhythm, and we have a blood pressure!” exclaimed Dr. Thomas as everyone went back to their tasks with renewed intensity. “Preparing to transfer to bypass pump,” shouted one of the technicians.

As the staff crowded around his now still body, I found myself pushed back to the room’s edge, “Andy, I’m right here, I’m not leaving” I said silently as I whispered a quick prayer to the Great Physician.

All of a sudden, something happened. I saw, or more accurately, felt, a shimmer of light in the corner of the room, above the foot of the table. I quickly looked to see if the pump team was using a lighting device that perhaps reflected off of the wall—nothing. I looked again, somewhat puzzled, and had the profound sense of a deep, calm presence in stark contrast to the frantic activity in the room. As I starred at the glimmer in the corner of the room, an odd thought formed in my mind, “He’s watching and he’s fine!”

“What is going on?” I thought as I looked again, “Can’t anyone else see that? Am I losing my mind?”

Just then, the anesthesiologist shouted, “We’ve lost him, no pulse, no pressure.”

“Start CPR!” ordered the staff physician. “We’re almost on the pump.” Dr. Sweeney said, “Hold on to him!”

“OK! Bypass is on, bypass is working,” said the cardiac technician. “Take him to the OR,” Dr. Stone ordered. “I need the smallest person here to ride on the cart, to compress his chest once a minute.” His eyes rapidly scanned the room. “You!” he said pointing at me. I was lifted onto the cart; my hands clasped one over the other on Andy’s chest. “Compress when I tell you,” said the anesthesiologist.

We were whisked into the OR. I climbed off the cart. Andy’s body seemed still and distant. As the minutes turned into hours, the facts began to unfold. The right coronary artery was indeed torn by the catheter tip used for injecting dye into the coronary artery, the sac around the heart had filled with blood, and the heart muscle had been irreversibly damaged. Andy Nelson was pronounced dead.

Fatigued and defeated, we ungloved and ungowned. I felt reluctant to leave Andy’s body there, alone and covered with a sheet. The most difficult task still remained, speaking with Mrs. Nelson.

She was in the small private waiting room, looking hopeful and dazed. “I am so sorry, Mrs. Nelson,” Dr. Orland began, “we were unable to save him.” Her hand came up to her mouth and then covered her eyes. “We tried everything. The heart muscle was too badly damaged after the artery was torn.” She nodded and began to weep. I sat down beside her and put my hand gently on her back. “Do you have any questions about what happened?” he asked. “ No” she answered,” I can’t think of anything right now.” “If you do, just let me know,” he replied.

“I’ll stay with her awhile,” I said. He nodded and left the room.

“Do you have anyone to be with you?” I asked. “My sister is on her way,” she replied. A few moments passed as she openly wept. My heart ached as I sat there.

“Were you there with him?” she asked hesitantly,

“Yes,” I said, “I never left his side.” I told her how I held his hand in the cath lab, pumped his chest on the trip to the OR, and stood next to the surgeon as he valiantly attempted the vascular repair. “Oh, thank you so much,” she said as she clung to every word.

Remembering the day’s events, I said, “There’s one more thing ...” She looked at me; her eyes focused through the tears. “When we were in the cath lab and realized that something had gone wrong, he asked me to tell you something.”

“Yes?” she said expectantly.

I took a deep breath, “Your husband asked me to tell you that he loves you with all his heart.” I barely choked the words out. The emotion of the day overwhelmed me. We both sat there, awash in tears.

She looked up, “When did he say that?”

“Just before they put him out for the bypass procedure,” I replied. “I am still so stunned,” she said, “He was so smart and sure this would go well. He told me not to worry, because he would be watching and he would be fine.”

With those words, two things happened almost simultaneously: I felt a shiver go down my back as I remembered my experience of his peaceful presence in the cath lab. Then the door to the waiting room suddenly burst open as her sister and family arrived. I quietly excused myself, and as I walked away I thought, “Maybe he really was watching.”

It has only been with the passage of time that I have begun to make meaning out of these unexplainable happenings.

Proust wrote, “The path to wisdom lies not in seeing new vistas, but in having new eyes.” These glimpses into the great mystery have brought me greater insight, a sense of awe, and a profound peace.

---

Janis Amatuzio, M.D., is the founder of Midwest Forensic Pathology, P.A., serving as coroner and a regional resource for counties in Minnesota and Wisconsin. Trained at the University of Minnesota, the Hennepin County Medical Center and the Medical Examiner’s Office in Minneapolis, she has been in the field of forensic medicine for nearly 25 years. She lives in Minneapolis, Minnesota.

---

Next Article

Return to This Month's Index

Go to the Home Page