Death for a moment: life after a cardiac arrest

Fokke Obbema
Author Fokke Obbema. Beeld Jitske Schols
Author Fokke Obbema.Beeld Jitske Schols

Last year, I suddenly died, for a moment. To be exact, it happened on Saturday, 1 April, around one o'clock in the morning. After a week of night shifts at the editing department of de Volkskrant, I was fast asleep. The day before, I had done seventy kilometres on my road bike, cycling at a pretty high average speed. With my age of 54, I thought it to be an indication of my good health. I never smoked, I'm a moderate drinker, not overweight, have a healthy diet, and I do sports activities several times a week – what could go wrong?

I had never taken my mortality very seriously. The first time I was directly confronted with death, I was already in my fifties, when my father died. He was 84 years old, a good age, considering the amount of tobacco and alcohol he consumed. He died on 2 April. His own father had already died decades before, on 1 April, in the middle of the night. Suddenly. And now it was the weekend of 1 April 2017, the weekend during which I would remember the death of my father.

And then my heart suddenly stops. And with that, my breathing. My darling Carine is dozing beside me, almost falling asleep. She stayed up a bit later as our eldest daughter had to come home from a party. It takes her a while to fall asleep immediately after that. My luck. 'I suddenly heard a loud, snoring sound. I listened, as I felt I had to check that you continued breathing.' A crucial reflex. 'It’s the sixth sense that women have', my cardiologist would say.

She pushes me. No reaction, a deathly silence. She turns on the light. She slaps my face a couple of times, shouts, yells, no reaction. I'm as white as a sheet. She runs downstairs to raise the alarm. A deciding moment, as others in her position lose precious time when they want to solve matters themselves, or simply freeze with fear. 'I immediately realised that I could never handle this on my own.'

Mobile phone, enter the access code, then 112. 'My husband is not waking up!', she screams. It is after midnight on 1 April, so the operator asks if it is not some prank. 'No, no, I cannot wake him up!' Straightaway, she gets resuscitation instructions. 'Drag him onto the floor, he needs to lie on a hard surface.' Boom, there I go. 'One, two, three, four', at every count, she has to push down on my chest as hard as she can. A race against time, as there will be irreparable damage to the brain after five minutes.

She massages my heart with all her strength, first only on the fourth count. 'No, on every count', the 112-lady instructs her. I'm now foaming at the mouth. 'You looked really frightening', Carine will tell me afterwards. Our 10-year-old daughter is watching, our eldest who is 15 decides to run downstairs to let in the auxiliary troops. They arrive in no time: police, firemen, the ambulance with the emergency medical staff, and after a short while, even a mobile elevating platform. Within minutes, there are eight people running up to the fourth floor. Wonderful country.

Four firemen enter the bedroom. One of them takes over the resuscitation, the others create more space – they throw the mattress into the hallway and put the bed straight up against the wall. Carine has to stay with the children in the adjacent bedroom, accompanied by two female police officers. The firemen notice that the AED they brought with them cannot be used as I have 'flatlined' – there is no more electric activity of the heart. They need to use the old-fashioned CPR method. One of the ambulance nurses gives me an injection with adrenalin straight into my heart. Each fireman can only give CPR for two minutes, after that, their muscle strength decreases. They need many rounds of CPR, resulting in ten broken ribs. I am completely unaware of all this. The first step is getting oxygen to my brain. After that, my heart slowly becomes active again. It takes two hours before the firemen can carefully lower me from my house using the elevating platform and get me into the ambulance. 'He's alive, but his situation is very serious, madam, very serious', one of the ambulance nurses explains to Carine. The ambulance takes me to the nearest hospital. Carine and the children follow in a police car. Our youngest gets a cuddly bear from one of the police officers.

Saturday, and part of the Sunday, I'm in the intensive care unit, in a coma, with artificial respiration and cooled down to 35.5 degrees in order to spare my brain. It is now clear that I will survive, but the big question is: how? When Carine sends a message to family and friends, by the end of the day, she says: 'Please, picture him in radiant health and feel the confidence in his full recovery. That will truly help us!'.

The first attempts to wake me up from my coma, on Sunday, are not a great success – I get so restless that I pull the tubes out of my body, and they tie me down. Sedatives have to calm me down. The nursing staff constantly have their eyes on me, my situation is still very precarious. Carine observes how they treat me with the utmost respect ('Mr Obbema, we are now moving your wrist') even though I'm completely out. Later on, she will call them 'the angels of the OLVG'. When, around ten o'clock, a nurse asks me if I can squeeze her hand, I do. 'He can hear us, he understands and reacts!!' Carine informs the outside world, elatedly.

That afternoon, I pull the same trick on our eldest daughter. I never made her so happy. Gradually, I regain consciousness, totally confused. I have no idea how I ended up at the intensive care unit. But I do have some awareness. 'Will you take the kids to school?' is my first question. The feeling of gladness my nearest and dearest have about this presence of mind is enormous. But I'm still completely washed-out.

On Monday morning, they move me from the intensive care unit. I mostly feel exhausted. On a photo taken that morning, I'm sitting halfway up in my hospital bed, looking sheepishly into the camera while holding a fresh Volkskrant. The photo reaches many of my colleagues. Only just before, they were told that I had suffered a cardiac arrest during the weekend. There’s widespread confusion.

Not in the least within myself. I repeatedly ask what's wrong with me. 'A cardiac arrest? Ah, yes, they gave me a pill for that.' The trail of emails and WhatsApp messages that I send also show my own muddled state of mind. I cancel an interview request to a minister, 'for the time being', with the strong excuse: 'I suddenly suffered a cardiac arrest'. I tell my friends that I'm thinking about not entirely finishing the Amstel Gold Race in two weeks’ time. I let my colleagues know that I'll be back at the office next week. I worry about a weekend shift and an unpaid bill. Back into the old track, as a plough that hasn't noticed that soil has turned into asphalt.

My memory is disturbed, as with a computer that suddenly had its plug pulled out. 'Your short-term memories had not yet been stored on your hard disc', the cardiologist explains. That's why the previous week has become a black hole. But I also cannot store new experiences and impressions. Over and over again, I ask Carine about what happened. It slowly dawns on me that she has given a new level to the expression 'the woman of my life'.

I, myself, have no recollection whatsoever about my cardiac arrest – and I have to disappoint everyone who asks me about my near-death experience. The only thing I know is that I got into bed at home, just to wake up over 40 hours later at the intensive care unit. 'Carine and the girls have been through a horrible ordeal, but I haven't', I later tell my friend Pieter. 'You still have a long way to go, mate', he thinks, without saying it out loud.

What I tried most of all, those first days and as far as my failing memory allowed me to do, was looking for the cause of this disaster. At the hospital, they suspected that a coronary artery had been almost completely clogged with plaque, a gooey deposit containing cholesterol and other fats. A piece of that had possibly become dislodged and entered the blood supply towards the sinus node of the heart, causing a short-circuit and thus disabling the electrical system. Or the coronary artery had suddenly become entirely blocked by plaque.

In any case, for the cardiology team, a team of ten people as I was told later on, the remedy was clear after two weeks of examinations and observation. The vulnerable location in the coronary artery would now be permanently kept open by placing three stents, a kind of plastic tube with a combined length of 4.5 centimetres. Lifelong use of blood-thinning and cholesterol-lowering medication would minimise the chance of a relapse. They told me not to worry about that risk: 'After this procedure, the average Dutchman runs a higher risk than you do. With you, it has shifted from an unknown risk to a known one, and you receive treatment to counter it as well', one of the cardiologists explained to me enthusiastically.

Thirteen days after my emergency admittance, the stents were placed – a procedure I was able to follow live on a TV screen filled with pumping vessels around my heart. Two days later, my daughter and I cycled to the bakery. I felt like one very lucky bird. The statistics said I was right to feel this way. 80 per cent of the people who have a cardiac arrest outside a hospital do not survive. Of the other 20 per cent, half of the people will have permanent brain damage. I was one of the 10 per cent who had come out of this unscathed. Could life just go on as normal after this? Could I just go from 'healthy' to 'dead for a moment' and 'back to healthy' again in, let's say, two weeks’ time? The one thing I knew for sure was that this was exactly what I wanted.

In the beginning, I had the strong urge to downplay the whole event. 'The plumber came and did the job', I stated cheerfully during the days after my hospitalisation. I liked to call it a 'triviality', a term our youngest daughter was eager to use as well – to the annoyance of Carine, who believed that I needed to take in every lesson there was to learn from this experience. For me, the best thing seemed to go back to my old way of living. That I had already reached a new stage in life was something that hadn't hit me yet.

So I thought we just had to go ahead with our May holiday to Valencia, which had already been planned. It was a debilitating, exhausting week. And therefore, a month later, I joined a traditional cycling week with friends. Climbing in the Ardennes – as my physicians hadn't given me any restrictions on sports activities. I obediently followed the rehabilitation programme in the OLVG, amidst breathlessly panting fat and old men.

But even so, something did feel off base all that time. I believed that going back to work would be a matter of days, but I postponed it again and again. And every time I did, I felt relieved. I clearly wasn't ready, but I found it hard to pinpoint what was bothering me. Where had my work drive gone? 'Take your time', was advice I got from everyone, also from the newspaper. But time for what, exactly?

I used my sudden freedom to pay a visit to my rescuers. Barely three weeks after 1 April, Carine and I rang the doorbell of the Victor fire station, near the Muiderpoort railway station. The firemen invited us to sit down in their canteen. Some of the men present had also been at our house during the calamity. We told our side of the story, and they told theirs. For example, that they give CPR more often than that they extinguish fires, an astonishing fact. And how unexpected our visit was for them. 'This is the first time in the fifteen years of being a fireman, that it happens to me', a tough guy told us with great emotion. He was once given a biscuit by an elderly lady whose husband had not made it, but that was about it. Touched by their words, we said goodbye, with firm handshakes and hugs.

In my mind, I regularly thanked the medical world and all higher powers as well. But well, that wasn't a day job. The worrying started to take over. 'Why did this happen to me?' became a haunting question. Where had this plaque in my arteries come from? As factual as the substance and the way to remedy it with stents and pills actually were, the answer to its origin remained as vague. The usual risk factors for cardiovascular diseases did not apply to me, the cardiologist affirmed. Heart failure was not a family trait and my cholesterol had been slightly raised, but not enough to prescribe medication. So basically, there was only one risk factor on the list that I could take seriously: stress.

Over a quarter of a century in newspaper journalism – to the outside world it was quite clear where the problem could be found. I was less convinced of this myself. During the months prior to my cardiac arrest, I had been a co-reader of a book about the subject. In Van big bang tot burn-out (From big bang to burnout), my friend and psychiatrist Dr Witte and my colleague Wilma had given us 'the big story about stress'. I had been very interested to read how modern man suffers under his outdated stress-response system.

Not for one moment had I taken this personally. When comparing myself with my colleagues, I positioned myself amidst the more stoic types on the imaginary stress axis. Managing the economics section of the newspaper during the credit crunch or reporting on the terrorist attacks in Paris had not been a tough job for me. At least, no sleepless nights and no heart palpitations. When I treated myself on a walking holiday along the Breton coast in the fall of 2016, as a celebration of my 25th anniversary with the paper, stress had not been a theme. The word did not even pop up in the diary I kept during those weeks. Whoever would have asked me about my stress level in the days before my cardiac arrest, would have gotten surprised raised eyebrows in return. It played no part in my life, or I believed.

Colleagues more or less reviewed me in the same way. 'For me, you actually were an example of how to deal with it', one of them said. Some of them saw my cardiac arrest as a reason to hurry to their own GPs, under the pretext 'when something like that happens to him, it can certainly happen to me'. But had my stoic demeanour not been some outward appearance, was I not suffering internally after all: was I, deep down, a person who keeps things bottled up? These words just kept going through my mind. They had a tempting power as it offered a ready-made explanation for the plaque. Or was this too simple? Doubt hit me.

I took stock of all the factors that could have given me stress at work. And this resulted in a surprisingly long list. The day-to-day, 'ordinary' deadline stress; tiring late-night shifts; routine jobs with frustration about underachieving as a result; the number of terrorist attacks the international editors had to cover; the stress as a result of being 'permanently available' since having smartphones; the office garden with its low ceiling and lack of fresh air.

When I went to the OLVG for a check-up, I broached my findings to the young cardiologist. She shrugged: 'Stress? I don't know. With you, I would sooner say it was a case of bad luck'. Bad luck? How on earth could that be true: I nearly died because of bad luck? I felt as if I wasn't taken seriously. At a garden party along one of the Amsterdam canals, a befriended specialist shocked me with the same conclusion. 'Stress is bullshit', he stated subtly. 'It has to do with your internal physique – people differ from each other as much on the inside as on the outside. The reason things went wrong with you was purely bad luck.

Up to then, the world of medicine had, most of all, invoked warm feelings. And still, the respect for its professionalism still dominates – as I had not been able to write this without these specialists, it's as simple as that. But the fact that the question into the deeper cause was being avoided disappointed me. It was only addressed when I insisted. And then, again, it seemed that the question was not a really interesting one. 'Of course, stress is never a good thing', was a much-heard platitude.

'I understand that you want to know, but we are still not much more than plumbers', my highly experienced cardiologist confessed when I urged him for some answers. 'And I understand that you cannot be sure', I replied with a slight desperation in my voice, 'but if you had to say something, what do you think that caused it?'. Silence. 'I believe that it is related to genetic factors', he carefully said. 'The thing is, this is still rather uncharted territory. If you ask the same question in twenty or thirty years, we will undoubtedly know a lot more.' He was also not a great fan of the 'stress' excuse: 'That relation was never soundly proven'.

The fact that researchers of Leiden University had just published an article in The Lancet, in which the relation was obviously suggested, as I had thoroughly checked on the Internet, was something I decided to keep to myself. Stress is not as easy to measure as cholesterol, so cardiologists find it hard to use it in their diagnosis. I understand that, but it doesn’t prove that it had not played a part.

Besides that, there were different views even within the hospital. A team of psychologists were giving a workshop about 'stress and cardiovascular diseases' and invited me to join. For four mornings, I and a dozen other patients gathered in a meeting room. I started with some scepticism, but I noticed that sharing my experiences with people who had been through similar experiences was comforting. We could really identify with each other: how everyone tried to convince their loved ones that there was no reason to be anxious, even though no one could actually be sure. How we all suffered from stress, in various degrees, but still. And how unsure everyone was about getting back to work and a normal life with a faltering heart. I could share these deep emotions with people I didn't know.

During these sessions, it also became clear to me how important a permanent job is when you become sick. A societal divide showed itself within our group. My employer would pay my salary for a year. 'Don't put any pressure' was the mantra of the paper, and it was diligently and convincingly repeated and professed at every moment of contact. How different was the fate of the artists' manager who had suffered a heart attack in his thirties? Since then, he had drastically decreased his workload, causing his income as a self-employed person to drop substantially as well. And he had a wife and child. That, to me, would be reason enough for a second heart attack. Already after four months, one of his business relations accused him of 'using the heart attack as an excuse'.

The average period for recovering from a 'heart incident' is twelve months, the psychologist explained to us. All the participants were eager to log that as a beacon in a sea of uncertainties. I used it many times when I felt aversion to doing my job. On the other hand, all the attention to stress also seemed to have a disadvantage – I became stressed. Or maybe I created the wrong mental relationship and was I just dealing with the aftermath of the visit of death, which had just come to me in my sleep. It was hard to separate the issues. What I did know was that life gradually became harder.

Having a lunch appointment and then making sure to get there in time could already have me pretty stressed beforehand. Fixed routines (daughter to school, getting groceries, cooking) somewhat helped me to get through the days. But besides these activities, I couldn't see myself making time for work as well. This made me worry, especially about the financial misery I would find us in when I didn't have a job.

Author Fokke Obbema. Beeld Jitske Schols
Author Fokke Obbema.Beeld Jitske Schols

My weekly visits to a haptonomist helped me to release the tension from my body. By the end of June, after being home from work for three months, I jokingly said to her: 'I really need a holiday'. To my surprise, she took that seriously. 'That's only natural, you've worked so hard to cope with your cardiac arrest. It's absolutely tiring, so it makes sense.' I had not seen it in this way. I used her statement to calm down the Calvinist in me, who found that I was profiting from the paper by receiving a salary without working for it.

The company doctor suggested getting back to work slowly after the summer, in September. I was actually thinking of January, as by now, every thought of work stifled me. Work was now at odds with survival. The link between work stress and the cardiac arrest had penetrated deeply into my body and mind. The company doctor, however, did not find it wise to agree on six months of inactivity. It will only make the step of going back to work bigger', she reasoned. That sounded fair, so I agreed with starting with two half-days a week, with the book editors. So now I first had to get through the summer holidays.

As soon as we drove off to France, I already broke into a cold sweat. 'My God, we have to get petrol', I suddenly realised, just outside of Amsterdam. I had prepared for our trip meticulously – times, campsites and chambres d’hôtes were all booked, meaning that, in theory, we only had to relax and enjoy ourselves. But no matter how relaxed everything seemed to be, and how much my loved ones took my condition into account, the stress was enormous. 'Why didn't I stay at home?' I asked myself repeatedly.

Focus on your breathing and let all your thoughts be for what they are, I told myself. Try to live in the here and now, and don't take all these ruminations so seriously. Experience your senses. The environment helped as we were at the Dechen Chöling Buddhist retreat, near Limoges, where Carine and the children spend a week each summer. Meditation in the morning, a joint lunch with understanding people, lying in the hammock in the afternoon or going for a ride on my bike, and a joint dinner. I was surprised to feel the stress ebbing away.

Until we had to leave this protective environment and I had to show my own responsibilities. Despite all the meditation, it immediately went wrong. From a chambre d’hôte I wrote to my friend Dr Witte: 'I have the feeling as if the shock about the cardiac arrest that I never felt or have been able to feel is truly hitting me right in the face, right now. I get stressed about the smallest things – the route to the restaurant, the groceries for lunch, you name it. I actually don't want to do anything, so I can just keep some control over my life. A panic attack is lurking. This morning, I even considered taking a train home'.

He immediately texted me back, and explained that we 'usually resist our fear of dying with the daily routine and familiar rituals and structure of our own home and routine activities'. When this falls away, for example when we go on holiday, then 'tough nights filled with anxieties' are not uncommon, he knew as a psychiatrist. 'Just as with women having contractions, you can think: this contraction is never coming back. There is a reason why 'grieving' is called Trauerarbeit in German.’

It was a line that I would take to heart many times during that holiday. I got through it, partly thanks to Carine who endured my suffering and kept commenting on my stress with wise words. But the highlight, for me, was when we drove back into Amsterdam again. When I got out of the car, I felt a huge weight being lifted off my shoulders.

That relief was short-lived. I still felt that coping with my cardiac arrest was a huge challenge. The film of events I hadn't lived through consciously still kept on playing in my head endlessly. As if they held some hidden clue, which should suddenly make it crystal clear to me what the core of the problem had been; the deeper meaning I had to pursue and after which everything would turn out right. I was now ready to learn all the lessons there were, as long as this worrying would stop. My psychologist advised meditation and mindfulness.

This helped somewhat, but it still haunted me too often: the incomprehensible mystery of death which had grabbed me for just a moment (clinical death, it is called, a term that had already fascinated me as a child, and now I thought I knew why); the feeling that everything that seems to be important means nothing at all compared to that one big event at the end; the feeling of futility that always followed that observation; the money worries I saw looming ahead.

But I also started to see some positive signs. Better than before, I was able to pay attention to the so-called small things in life, and to enjoy them. I realised that they were not intermediate steps en-route to the really important issues. When I threw a party for my birthday in October (for the first time in my life I felt that I had 'made it to' a certain age), I explained these things to my friends and family. That I had joined a choir, liked to cook, meditated every day, and that I enjoyed writing about books more than writing about attacks. And how surprised I was about my interest in the local newspaper, which was miles away from the book that I had written about China and Europe. I experienced my happiness about life and existence itself, something we tend to take for granted far too often. And that Carine now finds me 'less aloof' and even 'more fun to be with', seems to be the blessing in disguise. 'So in some ways, a cardiac arrest can be something to recommend', I said rather bravely.

Of course, I didn't manage to hold on to this degree of lightheartedness. Also in the following months, I would crash repeatedly. But there was still a recovery process going on – small steps at a time. It felt like learning to walk, noticing that the ground beneath your feet is not sinking away, and moving on. The words of my friend Pieter, someone who knows about physical difficulties, were encouraging. 'Even though the physical recovery is more or less a linear process, the mental recovery is erratic', he said. 'We can even ask ourselves if we should use the word 'recovery', it is more about surviving while having good and bad days.'

That contemplation was a great help when I had a horrible nightmare in December. I suddenly sat up straight, sweating, while feeling for my furiously beating heart. 'Here we go again' was the first thing I thought. It took me a while before I understood that calling 112 was necessary this time – the shock was not caused by a physical failure, but by my own anxieties. It took me nearly a week to recover from this. Shortly after, it was Carine's turn to be scared as I looked deathly pale. My repeated assurance that I felt quite alright did not impress her ('the last time, you also thought that you were fine'), so I went to the A&E at the OLVG. Within minutes, I was lying on a bed so they could do an electrocardiogram – a near-death experience gives some privileges. 'You can go home, everything is fine', the assistant physician assured me a few hours later. To which his supervisor added: 'Warranty until the front door'. I chose not to share that last remark at home.

Later that month, my fellow journalist Joost Karhof, presenter of Nieuwsuur and a few years younger than me, died unexpectedly. On Boxing Day, unfortunately, his wife was not with him when he went to lay down for a moment. I was enormously upset: why did he have to die and could I move on? Inconceivable. Before that, I had been greatly distressed by what happened to the Ajax football player Nouri. He still lives after his cardiac arrest, but do not ask in what state. Did they have bad luck, and had I been lucky? Absolutely. But that explanation is nothing more than a banality.

There is no satisfying explanation, and there probably never will be. I wanted to regain the illusion of having control over my life by knowing what happened to me and why. But, ultimately, I learned very little. I can accept that now. I no longer see the stress of the past year as a result of my work, but as a result of my cardiac arrest. I was surprised by death during my sleep – no wonder that I felt stressed by only the slightest issue after that.

Having less control over my existence than I would have wanted – I felt that very tangibly, but it is the same for us all. We move forward, groping in the dark, while we pretend that our path is shining brightly. We protect ourselves against a fundamental part of our existence, as much as we can – I'm talking about death. We prefer not to think about it, as if our lives will last forever.

I now have a different relationship with it – not of my own choice, for sure, but nevertheless not less valuable. Over the past year, death took up a disproportional part of my life. First, I believed I had to push it back to the edges of my consciousness. But that feeling changed gradually, and I also learned to appreciate it. It is the finite nature of ourselves which gives us insight into what is important and where our priorities lie. Death can help us sharpen the view we have on life.

With that insight also came the surprise about how little attention we tend to give it. That is a thing of all times. As early as in the 16th century, the French philosopher Michel de Montaigne criticised this denial. According to him, acceptance was the solution, as described in his Essays: 'We must acquaint ourselves with death, to get used to it and to think of nothing else as much as death', he advised.

That may be overstating it a bit. But it won't hurt us to reflect a bit more on death. And then, not to get used to it, as Montaigne had in mind, but most of all to try to grasp what life is actually about: what is its meaning, and does everything have a meaning after all? You don't need to have gone through a near-death experience in order to struggle with these existential questions. But I do hope that you would like to accompany me on the journey to find some answers.

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