I Ate Rat Poison Today

Physician! Heal thyself! I ate rat poison today.

Drastic measure...not from depression, burnout, or rodent dysphoria. It’s 2 weeks until a big event. A few days ago I got an ominous text on my phone. “You have a 1:00 appointment Wednesday at the Coumadin Clinic”. As I looked at the screen in the darkness of my bedroom and soul I sighed deeply. Coumadin aka warfarin...a drug urologists hate. As a potent blood thinner, it causes bleeding...sometimes a LOT of bleeding and now I’m staring at the warfarin tablet in my hand and bringing it to my mouth, and...it’s so difficult to swallow on so many levels. I am not a warfarin patient, yet I am. Earlier in the day, I checked into the Coumadin clinic at 12:45. I was the only one in the waiting room.

Within minutes, a parade of my fellow clinic patients started filing in, some using walkers, others canes, or leaning heavily on their spouse’s arm. They were old, most with swollen purple legs, some with oxygen tanks. As their names were called, they needed heroic efforts to get out of their chair into a standing position. Once they caught their breath, they stumbled toward the nurse that called their name. Lord, please take me now. I considered running out of the waiting room and heading back to my office to see the 21 patients waiting for me. As I rose to leave, the clinic door opened and a nurse called out...“Dr. Thill?!” Busted. Head down, I walked past her into the “prick” room, got my blood examined, and was on my way back to the clinic to see my patients. Driving home, I listened to an audiobook to take my mind off what I needed to do when I got home.

An unopened prescription bottle awaited me. Just after ingesting my first dose of warfarin, my wife presented me with dinner she had prepared starting with a salad of chopped broccoli and cabbage slaw with Sir Kensington mayo and white wine dressing. I shrieked like a rat in a trap...”I can’t eat that! I’m on warfarin!” A little bit of background is in order. First warfarin and then me. By 1955, doctors decided to give warfarin to President Eisenhower after his heart attack but didn’t tell him it was also used to poison rats. In 1988, when I started my urology training, warfarin was basically the only blood thinner other than heparin and aspirin. Blood clot...warfarin. Stroke...warfarin. Poor circulation...warfarin. Heart attack...warfarin. Heart arrhythmia...warfarin. Stat consult...patient on warfarin. A patient on warfarin needs surgery....cardiologist says no. I HATE warfarin!

Now I’m ingesting the drug that has got me out of bed in the middle of the night numerous times in my career to deal with life-threatening urologic bleeding. Hippa alert! I am about to share some medical information about myself.  I don’t get sick...as in perfect attendance in high school and never sick in college other than a weekend lip abscess. Skipped a couple of classes to spend time in bed but not due to illness...wink wink. Med school..missed a Tuesday to be with my wife during her C-section but reviewed lecture notes the next day and aced the Physiology test on Friday. Residency...perfect again 5 years straight but to this day regret that I should have called in sick to be with my wife who was bedridden with strep throat and a 3 yr old to take care of. Not my best moment as she has reminded me countless times since. 

Since July 1, 1993, when I started my urology practice I have made it to every clinic and operation and call duty. During a bout of diverticulitis in 2011, I had 10 outpatient surgeries to do one day and had my nurses give me IV fluids and IV antibiotics in-between cases. One week later I ran the Boston Marathon in under 4 hours. Common sense escaped me. I have run all world major marathons in Chicago, Berlin, London, New York, and Boston. I gave up running in 2013 because I was running injured more than I was running healthy and I always had to have an aisle seat in airplanes and theaters so I could straighten my trick knee.

In 2017, my heart started tapping my subconscious, rarely than more frequently. I’ve always had benign skipped beats and a very low resting heart rate. Bigeminy and bradycardia. No biggees. One evening while reclining and watching True Blood I felt weird...anxious, palpitations, and feeling faint. Hoping it was due to the Sookie and Bill's scene on the TV, I ignored it. After a while my inner voice said “don’t be stupid” and I asked my wife to drive me to the ER so I could get an EKG and bloodwork and be back home shortly.

The EKG looked fine to me and I texted an image of it to my cardiologist friend who said it looked fine. As I started to get dressed the attending ER doc came in and said my labs were ok but my EKG was slightly abnormal and I needed to be admitted for further testing. My 3 am lab work came back normal so I left AMA at 6:00 am so I could make it to my office where 20 patients waited. Whew! Perfect record is still intact! I had no abnormal beats in 2018. In early 2019, my occasional skipped beats seemed to change. They were more intense and I wondered if I was having panic attacks as both my parents occasionally had. Enter the Amazon Prime app. There was a special on a device called Kardia that pairs with the iPhone to read and diagnose your heart rhythm via your fingertips. Just as I was about to press the “Buy now” button I heard a familiar inner voice...”don’t be stupid”.

So I called a cardiologist instead to make an appointment. At my appointment, the cardiologist took a detailed history, performed an EKG (normal of course), and listened to my heart..also normal. Unsolicited he said “you should buy this device called Kardia. It’s on special at Amazon.” 2 days later my Kardia arrived and I waited for my heart to sputter and heave. There! Now! I put my fingertips on the pads and watched the tracing on my iPhone screen. I knew it. After 30 secs on the device, the screen said “possible atrial fibrillation 156 beats per minute”.  I emailed the tracing to my cardiologist. He responded back “Cool! You were right. You have paroxysmal atrial fibrillation”. Being right in this situation is quite a different feeling from answering a final Jeopardy question correctly. But I did advance to the next round: another cardiologist specializing in atrial fibrillation.

Our first meeting was optimistic and upbeat-pun intended. He said afib was quite manageable with medications and lifestyle changes. He wrote me a script for the same heart medication my mother took in her 80s. Lifestyle changes needed were described without emotion. No caffeine. No alcohol. No activity that increases heart rate. So I stopped caffeine and the occasional glass of wine or beer and quit going to the gym. My weight increased as did the episodes of afib. At our next visit, a new medication was added....a powerful heart-stopper with a rare chance of speeding things up. The new medication worked! No bad beats for 2 weeks! One Sunday in August 2019, I was on call, and in between emergency cases I ran up a couple of flights of stairs to see an inpatient consult.

WHAM! My heart was beating out of my chest and I was starting to faint and getting very short of breath. Steady now....your next case is moving into the operating room. I braced myself and put my fingertips on the Kardia. The tracing looked like the working end of a lumberjack’s saw. “Possible tachycardia 220 beats per minute” Possible? Thank you Captain Kardia Obvious! The OR called. “We’re ready for you!” I kept my fingers on the Kardia and watched the beat decrease to 170. Paroxysmal means sudden recurrence of symptoms so I figured I would snap out of it in a few minutes like I usually do and would have a normal rate by the time I got to the OR. No such luck. The case was a quickie common procedure that any urologist can do in their sleep. I was just hoping I would not have to do it on my back.

After writing orders and talking to family and rounding on a few patients I’m still clicking away at 170. I was exhausted. It has been 90 min since the stairs launched me into this new rhythm...atrial flutter. I call my cardiologist. He says go home and if my heart is still racing at 6 pm go to the ER and he will meet me there. This happens to be the weekend my 2 most important and needed women are vacationing together in Montana. I call my wife and nurse practitioner and relay what’s going on. They are very worried. At 6 pm I walk into my ER and tell the charge nurse similar to an AA meet and greet “Hi! I’m Dr. Thill and I have atrial flutter.” She whisked me into a room, made me undress, and started an IV. She barked for a stat EKG and chest x-ray and labs. As she taped the IV in place and started placing 12 soft sticky pads on my chest and legs she whispered “now we can register you and get your billing information”. Thank you, Florence.

For the next hour, an IV drip to slow my heart was maxed out and I was given a potent blood thinner. The cardiologist arrived with some paddles and asked if I had any questions as the staff placed large pads on my back and over my heart. The drip bottle was switched to a white liquid...Michael Jackson’s sleep medication. I asked, “Can I be the one to yell ‘CLEAR!’?” Wait! I’m on call! I text one of my partners to see if he can cover me for the rest of the evening. The shock of the 40-plus-year streak of not missing class or work ending is worse than the shock that restores my heart to a normal rhythm. I am unwell in so many ways. After my cardioversion I am put on 2 additional medications, one costs 584$a month and the other is $682 a month. I am horrified looking at my medicine cabinet and the number of pill bottles crowding the shelves.

These are meds for octagenarians. My old frail patients are taking these meds. The irregular beats continue. Maybe my heart is telling me something. Frustrated, I go back to the gym in the mornings and walk for one hour every evening. The heart mocks me with bursts of palpitations. I feel it in my throat. I am awakened at night. The paroxysmal beat goes on. I am failing medical therapy. I resign myself and agree to the next step...a cardiac ablation...a 3-day hospital stay with a minor followed by a major than another minor procedure. I am starting to listen to my heart. Finally, I realize what it has been trying to tell me. The procedures were completed and the message was clear. I had been fighting back against and ignoring the pleas from my heart and soul. My decision was made before the ablation. March 31, 2020, was my last day as a practicing urologist. I retired to Big Sky Country to live out my day's flyfishing and monitoring trail cams. 

My retirement coincided with Covid. The fish seemed to be wearing masks too and would rarely take my flies. My nurse practitioner called me and made me an offer I couldn’t refuse. A no-call, no-surgery, office-based practice in The Villages Florida. In late 2020, I went back to work on days my wife was on the tennis courts. It’s a perfect job for me at this point in my career. I no longer have atrial fibrillation and am on no medications. With 30 years of performing routine and complex surgery under my belt, I know how to keep my patients out of the ER and the OR. I have a large network of practicing urologic surgeons in Florida that whom I can refer patients who need inpatient surgery.