Voices: Death by Tuna Sandwich?


The problem, I keep repeating as a mantra, is not with my heart. After every cardiac test in the book, my 52-year-old ticker is in perfect shape. It’s propelled me twice to the peak of Mt. Kilimanjaro, crossed the finish line of many a half-marathon, and survived the seemingly endless contractions of a 26-hour unmedicated labor.

The problem is actually with the vagus nerve — the longest nerve in the human body — which happens to control both heart rate and the swallow reflex, among other things.

For reasons that are not yet understood, people with swallow syncope sometimes get their vagus signals crossed. For me, swallowing something bulky, like a thick, dry tuna sandwich, seems to “stun” the vagus nerve: my esophagus constricts, my heart stops, and sight and sound recede.

Thankfully, the pacemaker now reboots my heart when that happens.

But life as a medical aberration remains daunting, because there is no instruction booklet for this orphan disorder. Nobody knows why my vagus nerve signals my heart to stop, or what this means for me down the road.

As a medical journalist, I had the immense honor of knowing and profiling David Colman, director of the Montreal Neurological Institute, in 2011. He inspired me with his offbeat curiosity and penchant for serendipity.

He quoted Louis Pasteur, “chance favors the prepared mind,” and wrote “we must also teach how to prepare the mind to accept the unexpected discovery, because most often, serendipity provides the real breakthroughs.”

His insight endures. It captures a philosophy that energized me in my search for a diagnosis, and nourishes those doctors who practice the true art of medicine.

Kate Johnson is a freelance medical journalist based in Montreal.


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