The Silent Visitors

Patient M, a 38-year-old female, presented with intermittent palpitations and dizziness over the past two months. Her last episode of palpitations was the night before her consultation. The episodes are sporadic and do not follow any known triggers. During the same period, the patient complained of increased fatigue and loss of sleep. There is no prior history of heart or respiratory diseases or diabetes. During the consultation, her blood pressure was 108/66 mm Hg, and her heart rate was 74 bpm and irregular. Peripheral pulses were slightly weak. Respirations were steady at 22 breaths per minute. Lung fields were clear to auscultation—no cardiac murmurs or clicks. A 12-lead ECG was normal. The patient lives alone in a remote location, far from medical facilities, so a Holter ECG was prescribed for the next 24 hours to diagnose any rhythm issues. After obtaining consent, the patient was fitted with the ECG leads and given instructions about the test. She was advised to continue her daily activities and keep a written track of her symptoms, activities and other relevant events. Follow-up was scheduled for the next day at 16:45. 

*

She walked back into my office the next day wearing the same clothes. I only noticed because she wore an old, faded shirt from the local library. Growing up, I had a shirt like that. I remember that the library made and gave away shirts to all its members one summer to increase membership. It might have been better if they had used the money to buy more books, but the shirts were fun. I couldn’t believe someone still kept those shirts. As the ECG technician was peeling off the leads and asking her if she had any skin reactions to the adhesives, I looked at her 24-hour reading. Gaps. Her readings were full of gaps.

“I see you have removed the device multiple times last night. Unfortunately, we will have to repeat the test. Please refrain from tampering with the machine this time.”

“I didn’t touch the machine or the things stuck on my chest,” she informed as she pulled down her “Read, Return, Repeat” shirt. 

Maybe the leads were displaced while she slept. Perhaps she was a restless sleeper. This happens quite often, but the ECG technician answered this before I could ask. “The adhesives on the leads looked fine. They held on very well.” With that, he left the room. He didn’t care that the woman before him had flatlined multiple times last night; he had other priorities.

“I'm sorry, Ms. M. We have to repeat this test. There must have been a malfunction. The machine did not record your heart for a significant amount of time.”

“That’s alright; I was expecting something like that.” She leaned back in her chair before she continued, “ Would you have some time now for my complete case history? I was told on my way in that I was your last patient of the day.”

They had conveniently forgotten that I was on the night call today. Not that it mattered. The hospital was too small and too far into the mountains, so night calls were usually event-free. The only stipulation was that the on-call doctors and nurses had to sleep in the hotel nearby so they could respond immediately. The hospital was too small to have rooms for night-duty staff, and the hotel didn’t mind keeping the ground-floor rooms for hospital personnel—a perfect symbiosis between a half-empty hospital and a nearly empty hotel.

“I guess you still think I took the machine off last night,” she said with a smile. 

“Well, if I don’t believe that or that the machine broke down, then you died several times last night.” 

Sometimes, I wondered why I became a doctor. I hated talking to new people. My bedside manner was often described as cold and mechanical, and I got annoyed when patients rambled. I guess curiosity drove me to this. I wanted to know how the human body worked. Better still, how it broke down and how it could be fixed. Studying medicine was fantastic, but the patients came along and ruined it. 

"As you know, I live alone," she began. "High up in the mountains, in a cabin my grandmother left for me. She liked the quiet, just as I do," she paused, "and just as they do."

I didn’t have the energy for this. “Ms. M, are you worried you will faint while you are alone up there? That’s why we must repeat the…”

“I only agreed to the test because I wanted you to take me seriously. I thought you would be the type that needed scientific evidence for everything. Me, I am the simple type. I let things be. I didn’t give them a name because they didn’t need it. They came looking for quiet, and they found it with me. I hardly go out, and I don’t keep any pets. I don’t encourage birds, and my windows are all double-paned. When I shut the doors and get into my bed, all I hear is my heart and an occasional breath. If these were something I could still, I would. They could, so they did, and I didn’t mind.”

“Who are ‘they’?”

“I don’t know. I didn’t need to know. They first came to me when I moved into an apartment by myself. The first Sunday afternoon after the move, they came as I lay on the floor, warm in the sun.”

What now! Ghosts? Spirits? “I’m afraid I don’t know anything about these matters. Would you like to talk to someone else?” Maybe it was time for a psych eval.

“No, I don’t like talking, and in any case, they told me to talk to you.”

“Do they talk a lot with you?”

“No, like I said, they visit me for the silence. There’s no point in that if we talk. They only spoke to me once, two days ago, to tell me about you.”

“They know me?” I smiled.

"The only thing they know is that you like quiet too, and working here, you must have a lot of it. They visit during quiet hours, usually at night but sometimes during the day. They come when it is the quietest. They still the heart and steal your breath to deepen their silence. But only for a little while. They mean no harm. We all have a finite number of breaths we draw in this life. These pauses they provide might make you live longer.” She laughed.

“Well, Ms. M, all of this is very interesting, even though I don’t have any interest in the supernatural. The only thing I need to know is how we plan to proceed with your diagnosis. Shall we repeat the test at home, or would you like to stay over at the hospital so we can monitor you?”

“Neither; I am going back home to finish packing. I am moving in with my girlfriend tomorrow. She is chatty, and I think that’s why they are agitated. I like the quiet, but I love my girlfriend. So, if you could just say yes to having them visit you instead, I’ll be on my way.”

“What if I say no?”

“Aren’t you curious? You are the doctor; don’t you want to know how this is possible? In the back of your mind, you know I am not lying. This machine of yours would have thrown an error message if I had taken it out, and your technician would have mentioned if there was anything wrong with the one you gave me.”

“And what happens if I say yes?”

“Nothing, for now. You just wait.”

“Fine. ‘They’ can do as they please. Now, can we get back to your diagnosis?”

“That won’t be necessary, doctor. I am fine. I am sure it was just the stress of packing and new relationships. You would understand as a fellow introvert. In any case, I will get going now. Thank you for all your help. Take care of yourself, and don’t try too hard to understand them. Just let them be, and everything will be fine. Feel free to call me if you feel anything odd.”

“That’s my line,” I said as she went to the door.

She turned around, winked, and gently closed the door.

I struggled to finish her case notes. “Ghosts occasionally stop her heart” was not something I would put down on paper. After a few minutes, I gave up and went to pick up a Holter ECG machine and an oximeter. This might be ridiculous, but who would even have to know? The technician had left a long time ago, and I could always say I was testing out machines after seeing what they did last night. I packed everything up, signed my name into the night duty register, and went to the hotel. 

They gave me the usual room, the one with a view of the empty parking lot. I set up the machines and struggled to crawl into the tightly tucked sheets. Everything stilled and slowed as I waited. Sleep was threatening to take over when the first one arrived. As I slipped further into the deep, I felt more and more of them take over, and just before the silence, I heard a single, faint whisper, “Thank you. I wish we could stay here forever.”