Subconsciously, I had known since Nick stepped onto the bus that night that something wasn’t right.
Maybe it was that his coloring seemed off. His face was always really red by the end of a concert, but this time, only his cheeks were flushed. The rest of his face, especially around his lips and eyes, was white. He was out of breath and looked exhausted, and I knew he had pushed himself too hard.
Looking back, I should have just taken his vitals right then and there on the tour bus. I would have realized that he was in trouble and saved him the embarrassment of blacking out in the bathroom, naked. I could have spared myself the awkwardness of finding him that way, too.
But instead, I let his stubbornness win, yet again, and figured I’d let him relax and get some rest before I bothered him about blood samples and all of that again. It could wait until morning, I thought, as I watched him walk off to the bathroom. I waited until I heard the tub filling to change out of my clothes and put on my pajamas. There was a double sink outside the bathroom door, so I washed my face while he was in the bath. As I stood there at the sink, I could hear him sloshing around in the tub. It was hard not to think dirty thoughts, as much as I tried to keep myself from picturing him naked.
Stop it, I scolded myself, as I patted my face dry. When I lowered the towel, my reflection in the mirror was smirking back at me. I looked away, turning to hang my towel back on the bar.
That was when I heard the thud.
As my heart leapt into my throat, my head whipped towards the closed bathroom door. “Nick?” I called, and when there was no answer, I immediately grabbed the door handle. I was filled with dread, expecting the door to be locked, so you can imagine my relief when the knob turned easily in my hand.
I peeked my head around the door, really not wanting to walk in on him naked, but when I saw his bare feet just lying there, I knew I had no choice. I threw the door open wide and rushed in. He was slumped on the floor, just in front of the tub, a towel draped loosely across his waist. He must have been getting out when he’d fallen – or passed out, more likely.
“Nick?” I said again, dropping down onto my knees next to him. I was relieved to see that he was already starting to come to. As I hovered over him, his eyelids fluttered and then opened. His blue eyes looked dazed and disoriented. “Nick,” I repeated, trying to get him to focus on me.
He blinked rapidly a few times, and finally, the confusion in his eyes cleared. He looked right at me and muttered, “You need to take me to the hospital. Something’s wrong.”
It made my blood run cold to hear him to say that. It was like he was finally admitting defeat, accepting that his condition was outside of his control, and even though that was a good thing, it scared me. Whatever he was feeling, it had to be bad for him to want to go to the hospital. I could see it in his eyes. He was scared, too.
“Okay… okay, hang on…” I looked around and spotted his robe, draped over the closed toilet seat. I grabbed it, bunched it up, and wedged it under his legs, to elevate them a bit. I found a clean, folded towel and slid that under his head, to give him some cushion. I didn’t think I should try to help him up from the floor just yet; if he passed out cold again, I wouldn’t be able to move him on my own. “Lie right there… don’t move… I’ll be right back.”
As I started to get up, his hand shot out and caught my arm. “Don’t call an ambulance,” he begged. His voice was weak, but firm.
I let out my breath and looked at him in disbelief. “You just said to take you to the hospital. How else do you think you’re gonna get there?”
“We can take a taxi…”
“You are unbelievable,” I said, exasperated, as I pulled myself out of his grip and stalked out of the bathroom.
“Please,” his voice drifted after me. “It’ll draw too much attention…”
He was right, of course. Loyalty to him overweighed my better judgment, and when I picked up the phone, I dialed the front desk instead of 911. “I need you to call us a cab, please, immediately,” I told the clerk who answered. When I hung up the phone, I got my medical bag and hurried back to Nick. I had more training than any EMT and enough basic equipment to monitor him until I could get him to the hospital.
“How do you feel?” I asked, as I sank down next to him again. “What’s wrong?”
“My heart’s racing,” he murmured, putting his hand on the left side of his chest. “It has been ever since the show.”
I took out my stethoscope and slipped it into my ears. Pushing his hand out of the way, I pressed the diaphragm to his chest and moved it around until I could hear heart sounds. They were strong, but fast and irregular. Frowning, I reached into my bag and pulled out the watch I always wore when I was on duty at the nursing home to check pulses. I watched the second hand, counting beats as I listened. In fifteen seconds, I counted fifty-some beats. Even when I rounded down to do the math in my head, the number was alarmingly high.
“You’re having an arrhythmia… an irregular heart rhythm,” I explained to Nick, trying to keep my voice calm so he wouldn’t panic any more than he already was. “It’s a form of tachycardia… rapid heartbeat. Your heart rate’s over two hundred right now.”
“How bad is that?”
I swallowed. “Well… normal’s anywhere between sixty and a hundred beats per minute. Your heart’s going double that.”
“Holy shit,” he breathed, his eyes going wide. “Is that… is it gonna kill me?”
For the first time, I saw it in his face: not just a flicker, but a full-on expression of fear that he was going to die. It made my own heart skip a beat, as if an invisible hand had reached up and squeezed it still for a second. “No,” I said firmly, taking the stethoscope out of my ears. “But you do need treatment… medications, to slow your heart down. The cab should be here soon. Do you think you can stand up?”
“Yeah…” he said uncertainly, lifting his head. I helped him sit up and put his robe on, and after he’d been upright for a few seconds without blacking out, I ducked under his arm to support part of his weight as he tried to stand. He swayed unsteadily for a moment, holding onto me, and I kept my arm around him until he’d gotten his balance.
“Nice and slow,” I said, as we walked out of the bathroom. “Tell me if you feel like you’re going to pass out again.”
“I’m alright,” he replied, though he sounded uneasy. “My heart’s just pounding…”
“I know. Sit here for a minute,” I said, guiding him to the edge of the bed. I left him there and went over to his suitcase, digging through it to find him some clothes. “Try something for me,” I said, as I held up a pair of shorts. “Hold your breath for a few seconds. Then cough, really hard.” I waited until I heard him cough. “Did that help?”
I glanced over at him; he was looking back at me like I was insane. “I don’t think so.”
“Okay…” I rummaged around deeper in the suitcase and pulled out a plaid, button-down shirt. “Then try this: clench your stomach muscles and bear down, like you’re about to have a BM.”
“Have a BM?” he repeated flatly. “Is that nurse code for ‘take a huge shit’?”
I smiled. “Uh-huh. Just do it.” I snuck another peek over my shoulder at him, in time to see his face scrunch up. It was eerily reminiscent of his facial expressions in the “Quit Playing Games” video, all those years ago. The thought made me want to laugh and cry at the same time. “Any change?” I asked hopefully, as I brought his clothes over to the bed.
“I don’t feel any different…”
I picked up his wrist to check his pulse again. It felt just as fast as before. Oh well, it had been worth a shot; sometimes vagal maneuvers helped. “Then we really do have to get you to the hospital. Here, put these on,” I said, dropping the clothes on his lap. “I’ll turn around if you promise not to pass out again.”
Finally, some color came back into his cheeks. “Yeah, alright…” he muttered, standing up slowly. I made myself turn around while he got dressed, praying I wouldn’t hear another thud from him collapsing again. I was relieved when he finally said, “Alright… I’m decent.”
He sounded somewhat calmer, which made me feel calmer, too. “Okay… I’m gonna grab my bag, and we’ll head downstairs.” I got my medical bag from the bathroom and slung it over one shoulder, remembering to slip my wallet and room key into one of the outside pockets. It wasn’t until I saw myself in the mirrored wall of the elevator that I realized I had forgotten to change my own clothes. I was wearing a black tank top, no bra, and red pajama pants with Betty Boop all over them. Really classy, Cary, I thought, rolling my eyes at my reflection.
If Nick had even noticed, he didn’t make fun of me for it. In fact, he didn’t say anything the whole elevator ride. In the silence, I could hear his breathing – it was fast and shallow, like he was on the verge of hyperventilating. I reached out and took his hand, squeezed it hard. “Hang in there,” I said, hoping to reassure him. “You’re gonna be alright.”
Then the elevator doors slid open, and my sense of calm evaporated. Staring out in dismay, I thought, Oh no…
The lobby was full of people… most of them girls. I recognized BSB t-shirts on a few and realized they were fans, either just getting back from the concert or waiting to see if the Boys would come down. If they saw Nick, they were going to swarm us. Why hadn’t I thought to jam that damn Celtics cap on his head before we came down? It probably wouldn’t have helped much, but it might have delayed the moment of recognition and given us a head start.
“Shit,” I heard Nick swear under his breath beside me. I looked over at him; his face was pale and streaked with cold sweat. I wasn’t sure how much longer he could stay on his feet.
“Come on,” I murmured, pulling him out of the elevator. “Don’t talk, and don’t stop. Just walk.”
I was still holding onto his hand, and that gave me an idea. Dropping his hand, I cozied right up to him and wrapped my arm around his waist, possessively, jamming my hand into his back pocket. He naturally slung his arm over my shoulders again, and I steered him towards the front doors. I tried to ignore the fans who cried, “Nick! Hi, Nick!” but I didn’t miss the dirty looks they gave me as I hurried him right past them, to the taxi that was waiting outside.
To the casual observer on the street, we must have seemed inseparable, walking with our arms around each other like that. They couldn’t see how heavily Nick was leaning on me or feel the dead weight of his arm on my shoulders.
To the cab driver who eyed us in the rearview mirror of his taxi, we certainly looked like a couple, holding hands in the backseat. He didn’t know that my fingers were pressed against the radial artery in Nick’s wrist, feeling every pulse of his racing heart.
“We need you to take us to the closest emergency room,” I told the cabbie.
He gave a quick nod. “That’d be Salt Lake Regional,” he said, already pulling away from the curb.
“Thanks.” I looked over at Nick. He stared back at me, but neither of us spoke. I didn’t let go of his hand, and his pulse fluttered beneath my fingertips the whole way to the hospital. It was a silent, but short ride.
I was relieved to see the words Salt Lake Regional Medical Center lit up on the side of a large, light-colored building up ahead, and when the taxi pulled to a stop underneath the overhang that said EMERGENCY in red letters, I thanked the driver again for getting us there so quickly and shoved a ten dollar bill into his hand. “Don’t worry about change,” I said, already opening the door. I scrambled out and then reached back in to help Nick. Arm in arm, we walked into the hospital.
It didn’t take long to get medical attention. As I was hurriedly explaining the situation to the triage nurse, she took one look at Nick and recognized him, and the next thing I knew, he was being whisked away in a wheelchair. I followed the nurse who brought him to a small, private room and helped him out of the wheelchair and into the bed. “He’s got a port, for IV access,” I told her, before she had even unbuttoned Nick’s shirt. “He’s being treated with chemo for Stage IV lymphoblastic lymphoma.”
Even though it made my stomach drop to hear the words out loud, it felt good to say them, to finally be able to tell someone the secret I’d been carrying around for Nick for the past six weeks.
The nurse looked at me in surprise. “Are you his caretaker?” I didn’t miss the way her eyes panned down to my pajama bottoms, as she gave me the onceover.
Feeling myself blush, I nodded. “I’m a CNP. I’ve been administering his outpatient chemo.”
“Stick around,” said the nurse. “The doctor will want to talk to you when he’s taking a history.”
I stood back and watched as she fit an oxygen canula into Nick’s nose and hooked him up to the standard cardiac monitoring equipment – heart monitor and twelve-lead ECG, blood pressure cuff, and pulse oximeter. It was almost a relief to see him connected to so many wires, to know that he was being closely watched and properly taken care of, and that the responsibility was off my shoulders.
While she was charting his initial vitals, a big, blonde man in a white lab coat breezed in and introduced himself as Dr. Harrison. “What do we have here?” he asked.
The nurse barely looked up from her chart. “Mr. Carter, age thirty, complains of rapid heartbeat with palpitations, shortness of breath, fatigue, and syncope…” She repeated all the information Nick and I had given her, including his cancer diagnosis. Then she glanced up at me and said, “This is his caretaker, Ms…”
“Hilst,” I supplied. “Cary.”
The doctor asked me a few quick questions, which I answered, and then focused his attention on Nick. He listened to his heart and lungs, palpated his chest and neck, studied his vital signs and the rhythm on the ECG strip, and asked him all kinds of questions. “You’re having what’s called supraventricular tachycardia,” he told Nick, “an abnormally fast heart rhythm. Have you ever experienced anything like this before?”
“I’ve had the palpitations before,” Nick admitted, “but not like this.” He filled Dr. Harrison in on his cardiomyopathy diagnosis, which gave me another sinking feeling in my stomach. I had assumed this episode was related to his cancer treatment, just another side effect of the chemo, a complication caused by him pushing his body past its limits. It hadn’t even occurred to me that it could be his heart condition flaring up, though all of a sudden it seemed like the obvious conclusion. Nick had never really talked about his cardiomyopathy, at least not to me, so I hadn’t thought much of it. Once I started, I couldn’t stop. It scared me. I knew certain chemotherapy drugs could cause damage to the heart muscle – or, in Nick’s case, worsen the damage that had already been done. Had the drugs I’d been giving him messed with his heart?
“What were you doing when the symptoms started?”
“I’d just gotten off stage. I’m a singer,” Nick added, looking unsure as to whether this middle-aged man would have a clue who he was or not. “I did a bunch of dancing, too, though…”
“Any drugs or alcohol before the show?” asked the doctor.
Nick shook his head. “I had a few Red Bull shots, but that’s it.”
The doctor and nurse looked at each other. “Draw a blood sample through his port and order a CBC, lytes, tox screen, and caffeine level,” the doctor told the nurse.”
I stared at Nick. “When were you drinking Red Bull?”
He shrugged, his face reddening. “In the dressing room, before the show.”
I wondered how long he’d been hiding that little habit from me. He must have known I wouldn’t approve. Energy drinks like Red Bull are loaded with caffeine and sugar – good for a rush of adrenaline, bad for a heart condition. “Caffeine speeds up your heart,” I told Nick, trying not to sound too exasperated with him, even though I was feeling that way. “That might be what caused this.”
I looked at Dr. Harrison, and he nodded in agreement. “There are a lot of things that can trigger SVT – caffeine and other stimulants, certain medications, alcohol, stress, overexertion, dehydration, changes in blood pressure, heart disease… Given your medical history, it could be a combination of any of those factors. Hopefully your labwork will give us some answers; if not, we’ll run some more tests. In the meantime, we’re going to give you some fluids and medicine that will hopefully slow your heart.” When he was done explaining this to Nick, he turned to the nurse and said, “Run in a liter of saline and six milligrams of adenosine, IV push.”
As the nurse moved around to his left side to hook up the IV to his port, Nick looked up at me. “Are you mad at me?” he asked.
For a second, I was confused. “Mad at you?”
“For the Red Bull?” He looked more sheepish than scared now.
“Oh.” I thought about it for a moment, then finally shook my head. “No. I think you’re kind of a moron, to load yourself up on that much caffeine before a show, but I’m not mad at you.”
He actually grinned. “Good.”
There was so much more I wanted to say to him, about what he was doing to himself, but this wasn’t the time or place. “We’ll talk,” I added, smiling sweetly back. “Later.”
The nurse hung a bag of saline solution on the IV stand; it ran into an infusion pump, which pushed it steadily through a thin tube that connected to Nick’s port. The fluids would help, I figured; he was probably dehydrated, from chugging Red Bull instead of water before the show. That did annoy me; I was constantly urging him to stay hydrated while on chemo, and he was more concerned about getting himself all caffeinated so he’d have energy on stage. As usual, his priorities were way out of whack. It was no wonder his body had started going that way, too.
I looked at the heart monitor; the waves were still double-timing it across the screen, showing his heart beating at a rate of two hundred beats per minute. “I’m going to inject the medicine now. You may feel a little funny for a few minutes after,” the nurse warned Nick. She injected a syringe full of adenosine into his port, followed by a second syringe of saline. I watched on the monitor as his heart reacted to the drug; the EKG wave bottomed out and flattened for a few seconds, then shot up and down in rapid peaks and valleys again. Nick groaned in obvious discomfort, his hand going to his chest, which was covered in electrodes. Whatever he felt, as his heart skipped a few beats and then started racing again, it couldn’t have been pleasant.
“No change,” said the doctor. “Let’s try twelve milligrams.”
The nurse shot him up with a double dose of the adenosine, and this time, while there was still no change on the heart monitor, Nick reacted poorly. “Oh god… I feel really bad,” he whimpered, clutching his chest. His skin was flushed and sweaty. An alarm started going off on the monitor, as his blood pressure dipped.
“He’s dropped his pressure,” the nurse told the doctor.
“He’s not stable,” was the doctor’s reply. “We’re going to need to cardiovert him. Get the defibrillator ready.”
My stomach dropped again. “What? What’s going on?” I heard Nick’s voice rise anxiously. I came up alongside his bed and took his hand.
“They’re going to give you a shock across your heart to get it beating normally again,” I explained, squeezing his hand. I knew how scary that had to sound, even though it was standard treatment for an unstable patient with an arrhythmia like this. It scared me, too.
“Fuck…” Nick moaned, looking like he was on the verge of tears.
Another nurse came in, and the two of them worked in perfect sync with Dr. Harrison. One of the nurses squirted a conductive gel onto Nick’s chest, while the other injected a sedative into his IV line. If it did its job, he wouldn’t remember the shock. I felt his hand go limp in mine as the sedative kicked in, and the nurse who had given it placed an oxygen mask over his face.
“Charge to fifty joules,” said Dr. Harrison, as the first nurse set up the defibrillator to synchronize the shock to the right moment in the cardiac cycle. If the timing was off, it could cause a cardiac arrest by sending Nick’s heart into a more dangerous arrhythmia, ventricular fibrillation. Just thinking about it caused my own heart to race from anxiety.
The nurse handed the doctor the defibrillator paddles. “Charged to fifty.”
“Clear of the patient, please.”
I let go of Nick’s hand and stepped back out of the way, as the doctor placed the paddles to his chest. While Nick’s heart took the jolt of electricity, mine skipped a beat as I saw his body twitch, and even though he was sedated, he let out another loud moan. Our eyes turned to the heart monitor, which flatlined briefly as it registered the shock, then went back to its irregular rhythm.
“Still in SVT,” said Dr. Harrison. “Let’s try again. Charge to a hundred.”
The nurse adjusted the knob on the defibrillator. “Charged.”
“Clear.”
I turned away as the second shock was given, but I still heard Nick’s cry of pain. When I looked back at the heart monitor, I was relieved to see the waves normalizing, spacing themselves out evenly across the screen.
“Sinus rhythm,” said the doctor triumphantly. “Keep him on the monitor until we get his labs back, and we’ll go from there.”
While the nurses cleaned up, I went back to Nick’s bedside. The sedative was already wearing off. “Did you feel that?” I asked, putting my hand over his again.
“What? No…” he mumbled, sounding a little out of it still. I was glad to know the shock looked worse than it felt. And if he had felt it, he didn’t remember.
“How do you feel now?”
“Tired… chest hurts…”
I figured that was from the shock and not from his heart. The heart rhythm on the monitor was perfectly normal again. The danger had passed, and now all we had to do was wait for his bloodwork to come back. It would show if anything was off, but I suspected it was a combination of dehydration and caffeine overdose that had done this.
“Just take it easy,” I told Nick softly, deciding the lecture I had in store for him could wait until later. After all the stress his body had been put under, he was completely worn out. “You’ll feel better after you’ve gotten some rest.”
He nodded, letting his eyes close again. I held his hand until he had drifted off to sleep.
***
