On Saturday morning, halfway around my regular jogging circuit at the school where I teach in Turkey, I feel a light flutter in my chest and I know my heart is beating irregularly. Again.  This is the fourth time it has gone into atrial fibrillation--A-fib--, but the first time in over five years. And I know why. Caffeine and alcohol affect the heart's conductivity and I have been drinking enough tea and wine to set off the arrhythmia when I run. With sinking foresight I see the next forty-eight hours of my life: a tense ride to the emergency room, the ER nurses, the EKG, the wheelchair to the cardiac ICU, the hospital gowns, the IVs, the shots, the pills. This time, however, I am in Istanbul, Turkey, far from my home on the coast of Maine. 

An hour's ride through rainy traffic, my wife driving, me asking directions a dozen times, and we are at the hospital in one of the busiest parts of the city: narrow streets, a chaos of cars, pedestrians, fruit hawkers, sidewalk flower shops, pretzel sellers, no parking spots. In the Emergency Room I lie down and bare my chest for an EKG and an intake examination. "Smoking? Drugs you are taking? Any chest pain? Nausea? Any pain in arms?" I am reassured by the young ER doctor that it is not a life-threatening situation. He speaks only a few words of English, but he is calm and helpful. On the rolling table next to me, on the other side of the curtain, the teenaged girl recognizes me. She is a student from the school where I teach.  A cardiologist arrives and explains that if drugs do not restore my "sinus" rhythm in a couple of days, they will have to electro-convert my heart to normality. "It's safer than letting your heart continue out of sync," she says. I am skeptical. I have never been electro-converted and the prospect is frightening even though it always (or almost always) works on Chicago Hope.  

In the ICU I am put on a bed that rises and falls under my head and my feet when I push buttons. Every time I shift slightly the bed also adjusts of its own accord, its electric motor humming without command. I feel fine--no pain, no sense of being ill. But I can't move. I have a button to push for help. I have oxygen tubes in my nose. I have a plastic line in an artery (no, not a vein), dripping saline solution. I have a blood pressure pad on my arm that automatically inflates every few minutes gently squeezing my arm. I have a clip on one finger that indicates the oxygen level in my blood. I have several electrodes attached to my chest running to a large machine on top of which a screen shows two blipping lines mapping out my irregular heart pattern. A blue line under the heart lines indicates my breathing. If I hold my breath, the line is straight; a deep breath makes it swoop and dive. It is a familiar scene. For about twenty minutes, I check out the machinery and feel relieved to be in good care. Then I want to go home.  

Three times I have had A-fib on the rural coast of Maine and been admitted to local hospitals. But this time it's Turkey, and I have only a smattering of Turkish, mostly taxi and bazaar Turkish. I can ask prices, bargain, and get from here to there, but my medical vocabulary is nil. The cardiologist speaks excellent English; she has studied in Houston. She assesses my situation, writes up a protocol, and says goodbye. In the cardiac ICU nobody speaks English. I learn that "ordek" means duck, the plastic urinal you pee into when you aren't allowed out of bed. The nurses' shifts run from 7:30 to 7:30 . I can ask their names: "Sizin adin ne?" Nilufer ("water lily") is on duty first. My wife and I have just returned from a trip through Turkey's Aegean olive groves and Nilufer reminds me of an olive: a perfectly oval face, dark eyes, black hair, flawless skin. She is beautiful, and she attends to me in a perfunctory way giving blood-thinner shots in my belly, pills at various intervals, the "ordek" when I ask for it.  

My bed is positioned so that I can see Nilufer flirting with the interns behind the ICU counter. Laughter punctuates the night, and I wonder why some are endowed with such beauty. I am thankful to be taken care of by strangers, far from home. Aylin is on the next shift. She is plainer than Nilufer, but shows more interest in making me comfortable. She gives me alcohol-soaked pads to put on my swollen arm where the needle has poked all the way through the artery and ballooned my arm to double its girth with saline solution. She puts the IV into a vein. When I say "dush, lutfen," a shower please, she gives me a rub-over with wet towels. I indicate I have no toothpaste, so she searches out her own Colgate in her handbag. She is taking an English course in Taksim and has an exam the next day. I wish her good luck on her exam: "Lyi shanslar!"  

I want out, but after twenty-four hours, my heart is still out of rhythm. Aylin repositions my bed, and from my window I look out on red tile roofs, satellite dishes, minarets, a hotel, and in the distance, the two towers of the first Bosphorus bridge. It's grey and rainy. Turkey is 98% Islamic, but I cannot hear the calls to prayer from the mosques because of the thick hospital windows. Through a dip in the hill I can see ships moving along the Bosphorus; at night there are far fewer lights across this city of twelve million people than I expect. I long to be at home to wash the dishes, to make a pot of (herbal) tea, to take a walk, to sleep next to my wife.  

The doctors, after my earlier fibrillations, have warned me there is a probable link between caffeine/alcohol/stress and the fibrillations. I have been a teacher all my life. Teaching is stressful. I have given up coffee. But, in weakness, I slide back to a cup of tea, a glass of wine, then more, then fast jogging, then a flutter in my chest and another episode: number four.

The sinus node in the upper part of the heart is responsible for organizing the intricate electrical impulses that regulate the heart's pumping mechanisms. The sinus node's work can be affected by alcohol, and atrial fibrillation, which is a result of a malfunctioning sinus node, is known in emergency rooms as "holiday heart" since New Year's Day and other post-celebration dates generate these events. In an arrhythmic heart, a heart in atrial fibrillation, the blood does not move cleanly through the chambers and a clot could form in a "backwater," leading to a stroke. This is why I must go to the ER, why I am immediately given blood thinners and whisked off to the ICU, why the doctors take A-fib so seriously.  

Next day in the early morning I slide carefully out of bed, wires attached, and stand; standing is blissful and I can even peer out the window, looking four stories down to a busy street. There is a bronze plaque on the building across the street. Is it a school? A government building? There is a bust of Ataturk in the entranceway, a Turkish flag. I was on an island off the coast of Maine when I had my first fibrillation, called "onset A-fib" by the nurses. I had played to win in a tennis match, then felt flutters in my chest. I had no idea what was happening, but twenty-four hours later a concerned island medic called the ferry service and I was taken "off island" in the ambulance on a special ferry run.  

Thirty-six hours into my Turkish fibrillation, I stand by my bed watching the blipping lines on the monitor and realize-before the nurses behind the desk notice it on their screens-that the blips are evenly spaced at last. I will not endure electric shocks. I am home free again.

Author's Biography

Thomas Moore has taught in Iran, Mali, Turkey, and the US. The coast of Maine is home. 

He has published several essays and two books--one on Hawthorne and one on sailing language. 

The personal essay is his favorite kind of writing, and he is working on a collection of personal essays.

E-mail Thomas at tmoore@mma.edu

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