I’m an emergency-medicine resident in Philadelphia. Last fall I got sick and almost died. As a result, unfortunately — or fortunately, depending on how you look at it — I now know exactly what my sickest patients go through.

I know that asking them how they’re feeling, right before they crash, has no value. Their mind is elsewhere, their feelings blurred. (I shudder when I think of the times I shouted, “Can you hear me? How are you feeling?” while rubbing a patient’s sternum.) They have no idea what’s going on. Their body is focused only on dying. Their head is focused only on staying alive.

I know the strong, piercing pain of a chest tube entering the body. And so I will say, “This is going to hurt, and I apologize for that” instead of what I used to say, which was, “This may hurt a bit, a little sting, no problem, please stay still.”

Alin Gragossian, 31, had a heart transplant in January after she went into heart failure due to a genetic heart condition. She has since started a blog chronicling her transplant journey.
Courtesy Alin Gragossian
Alin Gragossian, 31, had a heart transplant in January after she went into heart failure due to a genetic heart condition. She has since started a blog chronicling her transplant journey.

I know how important their visitors are. They’re vital to my patients’ course in the hospital, and they shouldn’t be casually dismissed. So I no longer ask them to step out of the room, or to please limit the number of visitors in the patient’s room that day.

I also know that those who fight are fighting to live, that fighting will help them overcome this untimely disaster. They will fight with the ventilator, with the nurse about medications, with me about wanting their breathing tube out. I promise that I will let them fight.

Exactly why do I now know all of this?

Just a code

Last fall, I had a terrible cough — for two months. Like a good doctor, I did nothing about it. Toward the end of December, I became short of breath, even at rest. And any time I tried to breathe, I coughed. Finally, I decided to get a chest X-ray, and walked to our emergency department.

My X-ray looked terrible. It was unclear what was going on, possibly pneumonia, maybe something else. The attending physician said, “You are sick, Alin. You look really sick,” and I reluctantly consented to be admitted to a medical floor for further tests.

Just a few hours later, I began feeling uneasy. Nauseated. Cold. Sweaty. I looked up at my monitor and noticed that my heart rate was falling into the 50s, then the 40s. A normal rate is between 60 to 100 beats per minute.

My boyfriend, an orthopedic surgeon, was with me and he ran out of the room, yelling, “RAPID RESPONSE RIGHT NOW!” The nurses rushed in. I looked at my monitor. My heart rate was now in the 30s.

There was ringing in my ears, and I couldn’t understand anything that was being said around me. More people descended. Someone tried to put external pads on my chest to help my heart beat faster. Someone else asked if this episode should “just" be turned into a Code Blue, like I was about to meet my demise.

Just.

And that’s the last thing I remember. I was subsequently intubated and put into a medically induced coma.

An Urgent Transplant

It turned out that I had a genetic form of heart disease that had gone undiagnosed since birth. My failing heart had tried to work for months, maybe years (I suspect it had my stubborn personality). Until that cough and all it unleashed, I’d never known anything was wrong.

I had worked hard. Exercised. Went out with friends. In every aspect of my life — socially, academically, career-wise — I was so happy. I had just matched into a prestigious critical-care-medicine fellowship program and was getting ready to move out of Philadelphia to start a new chapter in my 30-year-old life. Everything had been perfect until the night my heart gave out on me.

When I woke from my near-death experience, I learned that I needed a heart transplant, urgently. My heart was pumping — barely — only because of medications. My blood pressure was persistently low. I became anemic. During those early weeks, I came close to death a few times. I barely had enough strength to write out a living will and advanced directives. Try doing that at the prime of your young life, while tethered by tubes and wires to an ICU bed.

Third-year emergency medicine resident Alin Gragossian, who underwent a heart transplant in January 2019.
Alin Gragossian
Third-year emergency medicine resident Alin Gragossian, who underwent a heart transplant in January 2019.

While waiting for a heart, I had some bad days and became angry and sad about what was happening. My illness had stopped the final year of my residency in its tracks, along with the fellowship I’d been so excited about. For the most part, though, I stayed positive (with a lot of dark humor). I read many good books and launched a blog — “A Change of Heart” — to keep friends and family updated about my medical odyssey.

In mid-January, I underwent a heart transplant. Six months later I returned to work at Hahnemann Hospital, where I’d been a resident, just as its closure was announced. I was shocked, disappointed, and terribly worried about my patients. But, in a moment of clarity, I also felt grateful to be alive to feel those feelings, all because of a donor’s gift.

Positive worth

During the depths of my illness, I came across actor Rock Hudson’s final words when he was dying of AIDS. “I am not happy that I am sick. I am not happy that I have AIDS. But if that is helping others, I can at least know that my own misfortune has had some positive worth.” I decided that my own misfortune would have some positive worth, too. I knew that good things would come out of this. They already have.

The first good thing? I am now able to truly empathize with my patients. No more being ignorant about what is and isn’t going to hurt.

The second? Early screening for my family. My disorder was genetic, and my family members now know to get their hearts checked. I wrote down my diagnosis for them to take to their primary-care doctors. “Tell them that I have this, OK?” I told my brother.

What else? I’ve learned that the human spirit is capable of great resiliency — we carry resilience in our blood. But it’s our choice whether to use its power to overcome the toughest moments in life.

When something bad happens, you can hate yourself, yell at your parents, blame any god in whom you believe, and ask yourself, “Why me?” But that won’t change anything. So you may as well change your mind-set, become resilient and strong, learn from the misfortune, grow from the experiences, and continue your insanely beautiful life. I promise that it is a very beautiful life you’re living.

In the future, I don’t know how I’m going to explain all of this to skeptical colleagues or questioning supervisors. But at least I can tell them that I will be very empathetic with my patients and that I have lived a complicated but interesting 31 years on this earth. I carry many lessons with me.

Most importantly, though, I can tell them that I will never take a day off from work unless I am literally on my deathbed.

Dr. Alin Gragossian will soon resume her training at a Philadelphia-area hospital. An expanded version of this article originally appeared in Emergency Medical News and was edited for The UpSide with permission.