The following account of my open heart surgery may make some of you queasy due to the graphic depiction of some of the procedures. If so, please quit reading sometime before "The Angiogram."
To all of you, my sincere thanks for your many wellness-wishes, prayers, cards, faxes, and flowers.
Finally, if I failed to mention you, please forgive me. Perhaps my finishing this on the 20th, was prior to receiving your well wishes.
Wow, doesn't this guy have a good heart now - worrying about those who sent belated well-wishes and didn't get thanked...... awww gosh. Yes, it's me the little commando who barred all callers (and visitors) who wanted to "reach out and touch someone" - namely Mike. The motto for those two weeks was "keep your hands to yourself." And all of you did - for which we are both most grateful!To establish recuperation ground rules, I made up two signs for Mike's hospital door (but he had a roommate who might not share these sentiments).
The 1st sign read:
"People are in the hospital because they are sick - not lonesome!!!
Go home and send a card."The second sign read:
"If I did not invite you to my home....
do not show up in my hospital room!"
The cardiologist's assistant, a wonderfully sassy young nurse named Angie, thought the signs were so hysterical she took them with her. When I first showed them to Mike, he laughed (as much as he could, that is) and then said "show them to John" (his roommate). I thought better of it since he had four visitors (in addition to his wife) at the time. Later that night he had two uniformed police officers (who "serve and protect" under him) visiting so I, again, thought better of it. So I want to thank all of you who reversed your energies in order to honor my wishes for Mike and also myself..The surgery is a testimony to the finest of technologies, but the recovery is still fairly primitive and very, very slow and scary. To hear a phone ring, or see and smell (ala perfume) someone standing at your bedside could be more than a person can truly tolerate at that moment.... so I kept the only family I could (mine) away from him in order to save the visits for Mike's children, parents, and brother. Other than that I fought everyone off (including the hospital clergy) with a stick! I do believe because of everyone's respect for our wishes, Mike's recovery was faster than most. He and his roommate both left the hospital on the same day (the fifth day after surgery for Mike, but tenth day after surgery for John). Well-meaning calls and visits do take their toll on people trying to recover from this kind of surgery. At one point Mom said to me that she hoped the ban on calls and visits was really Mike's request and not just mine. I tried to reassure her that calling a person coming out of bypass surgery is like conducting a seance because you are in fact trying to commune with the dead!
Tired, Always Just Tired
In the beginning, I attributed it to just working too long, or too hard. Not years, but daily and weekly hours. It was just a little heavy breathing now and then. Yet, it seemed that I wasn't really working that hard as a truck driver. Hell, up until 4 years ago I rode my bicycle to work 7 miles each way, and walked 2 miles in 40 minutes during my lunch time, 5 days a week. And now after cranking the trailer landing gear, I'd have to rest a few minutes before finishing my pre-trip inspection.
After breaking my wrist on March 10, I had all the reason in the world to just sit around the house and `recuperate' from my injury, and I did.
Wednesday, April 3rd, Barbara and I decided to walk with the grandchildren to the video store to rent a few childrens' films. We got about a block away from the house, their little feet churning up the pavement at the flashing speed of 2 miles per hour, with me right behind them. It started with just a little huffing and puffing, but within a hundred yards or so, I began to feel a pounding in my chest, and a burning in my lungs. Nothing unusual, but a lot sooner than I had expected, especially at this slow pace. Suddenly, just a little `pinch' behind my left breastbone. I stopped walking, breathing heavily, and told Barbara we should probably take the car as I was running out of breath. (Never used the words `having a hard time breathing' or `pain in my chest'.) That's all there was to it. It went away, we had a great time with the kids and I decided it was time for me to do something.
So, I started to walk a little. Each day a little farther, a little harder...but not too hard, because I knew...something was not right. I was denying it, I knew I was denying it, and still I continued to deny it. Finally I called for an appointment to our HMO doctor, Derek Kelly, a few miles from the house.
Tuesday, April 30 10:30 a.m. after asking me a few questions, Dr. Kelly scheduled me for a stress test the very next morning at Swedish Covenant Galter Lifecenter.
Wednesday, May 1, 10:30 a.m. About 7 or 8 electrodes are plugged into sockets stuck onto various regions of my anatomy, and attached at the other end to an ordinary looking computer. It is the EKG or `electrocardiogram,' the machine that will register the electrical activity of my heart under both rest and stress conditions. They take my vital signs like blood pressure and pulse, then turn on the EKG to establish my `baseline', the reference against which subsequent readings will be measured. I'm told that the procedure will take as long as 1 hour, and I will be performing various exercises while the computer reads the electrical activity of my heart, and converts it into a printed chart. The first exercise is to start walking on a treadmill as they gradually increase the speed and then the slope. The attending Cardiologist, Dr. Nequin, took a great deal of time to explain beforehand that he would be reading the computer screen constantly, and would take my pulse and blood pressure every 60 seconds, while viewing the printed chart as it came out of the machine. It was all quite impressive. The treadmill started to move, I stepped onto it and began walking. Within a minute the speed had increased slightly and I was thinking to myself that this wasn't so bad. The slope increased slightly, and I began to breathe a little harder...then harder, all the while he was asking me how I felt and to relate it to a chart on the wall with scales of 1 to 20 for various sensations of breathing, effort, etc. At 3 minutes and 48 seconds Dr. Nequin said, "stop the test." At 4:30 pm I sat in the office of the Cardiologist, Dr. Vishnu Gaiha, at St. Francis Hospital in Evanston, the premiere Cardiac Center in the Midwest.
Pain
Mike called from the Galter Lifecenter and I could not believe what I was hearing. He asked me to come and pick him up (hmmmm, he had walked there on his own). When I met him at the door he broke down for just a brief second, then recovered quickly and said, "They scheduled me to see a cardiologist at 4:30 today." He gave me a handful of prescriptions which we filled immediately: A Nitroglycerin sustained-release `patch' to help his heart by dispensing medicine through the skin. A cholesterol-lowering pill. A coated aspirin to diminish the headache from the "patch" which dilates the vessels in the brain. And Nitro pills to be put under his tongue if he gets any indication of chest pain. What could have happened to this man in the short time he left the house and now? I felt as if I was courting explosives. Now I felt like crying but didn't know why because nothing had really happened yet - but the "nothing" seemed to be taking on very ominous tones.A few hours later in the West Tower of St. Frances' Professional Building, that's exactly what I said to Angie, Dr. Gaiha's intelligent young assistant when she finished examining Mike and detailed all the various options Mike would have as a result of the angiogram on Monday ("the absolute soonest they could get him in"). I said to her, "What you are describing sounds like we should feel the same as when we go through a red light but don't get hit." She nodded, smiled, and left Mike and I alone in the room. We were stunned and tried to figure out what was "important" to us yesterday....because today certainly changed all that. The weekend was spent cancelling existing plans and trying not to think too much beyond the moment.
I am such a literalist as to the point of madding. To me, `pain' is real hurt. It is not pressure, or squeezing or tightness. When the American Heart Association talks about heart pain however, they are really talking about ANY discomfort. And I don't mean indigestion or cramps in the stomach. Oh, to be sure, there may be real pain in a heart attack, but most often there is not, and I quote from a bulletin of the Cardiovascular Institute of the South which I downloaded on Barbara's computer from the Internet after coming home from the cardiologist's office.
Written by Dr. W. Ladd, M.D. it says in full:
"If you suffer chest pain, particularly while exercising, you will almost certainly wonder whether it might be heart-related - and well you should. Heart muscle pain - angina - is likely to be the first warning of blocked coronary arteries, the cause of most heart attacks."
"While there are no infallible guidelines about whether a chest pain is heart-related, it generally takes a particular form. Heart discomfort is rarely a sharp, stabbing pain. The textbook description of angina is a feeling of heaviness, pressure, tightness or aching in the chest usually accompanied by a shortness of breath. The pain generally goes away when you stop exerting yourself, and it frequently isn't especially severe - which is, perhaps, unfortunate. Even a heart attack may not be unbearably painful at first, permitting its victim to delay seeking treatment for as much as four to six hours after onset. By then, the heart may have suffered irreversible damage."
"It is not unknown for patients to drive themselves to the emergency rooms with what prove to be very serious and even fatal heart attacks!"
"Angina is a protest from the heart muscle that it isn't getting enough oxygen because of diminished blood supply. A heart attack is simply the most extreme state of oxygen deprivation, in which whole regions of heart muscle cells begin to die for lack of oxygen. If the blockage in the arteries serving the heart muscle can be cleared quickly enough - within the first few hours of the onset of the attack - the permanent damage can be held to a minimum."
"That's why it is so vital to seek medical attention quickly if you feel the sort of pressing pain or heaviness described above. There is a 90% probability that pain of this type is angina. And even if it goes away, the artery blockages that caused it are still there - and will grow progressively worse."
"Ignoring this sort of pain because it is not unbearable or because it goes away is the worst thing you can do. It is the only warning you are likely to get of a potentially lethal condition. Heed it! Consult a cardiologist immediately."
Well, that's it all right. I've had that heaviness/pressure feeling a dozen or more times in the last 18 months, and now I'm scheduled to go in for an angiogram on Monday, May 6 at 12:30 pm They're going to inject a detectable dye into my arteries to determine where I may have blockages that restrict blood flow to the heart muscle. In a way I'm excited to have the experience, but...more later.
He's excited? Having lost my father, age 43, to a fatal heart attack didn't give me good vibes about any of this. Many months ago Mike and I were walking home from breakfast and he said "hey, slow down!" Nobody in this whole world ever, ever had to tell me to slow down when it came to walking!!!!! I became immediately alarmed and knew from that moment on it would be a winding road going who knows where. On March 10, Mike fractured his wrist. On March 30, we were invited to my cousin Jon's for dinner. It was chilly outside and we parked 3 blocks from Jon's house. Mike had to stop several times to catch his breath. I wanted to cry because I knew whatever was wrong three months prior, had worsened.Less than a year ago we finally qualified for health care through Mike's employer J.B. Hunt Transport. We both looked through the Cigna Health Care book and each picked a name at random as our health care provider. The doctors (and their hospital) we both chose were in our neighborhood. When Mike slipped and fractured his wrist on March 10 he was the first to test out his choice: Dr. Derek Kelly. As it turned out, Swedish Covenant Emergency staff called Dr. Kelly (the accident happened at 2:00 p.m. on a Sunday). Dr. Kelly recommended an orthopaedic specialist so Mike still never met Dr. Kelly, but every time his name was mentioned it seemed to gather praise for his work and the speed with which he attended to a problem. Given such good press, I asked Mike to schedule a visit because whatever was wrong seemed to be getting `wronger.' Mike's choice of doctor seemed to indicate the fates were with him. I sincerely hoped his luck would hold out.
The Angiogram Monday, May 6
Barbara and I arrived at St. Francis Hospital in Evanston a little before 12:30, and were immediately escorted to the Galvin Heart Center. Since visiting the cardiologist on Wednesday, I had gone on the Internet and downloaded all I could find about heart disease. So, I was well prepared, but still nervous as hell. The only pain I felt was the local anesthetic injection, the rest was nothing. During the angiogram procedure, the attending nurse was describing everything that was being done, and I felt informed and part of the team.
The angiogram is a test involving the injection of an x-ray detectable dye into the bloodstream. A small incision is made in the femoral artery at the groin, and a catheter is inserted up to a point very near the main artery of the heart. Where the dye pools, it shows up on the x-ray as the blockage (in my case many blockages) in the arteries. Depending on the severity of the blockages, an angioplasty may be performed to free up the blood flow through the arteries. In my case however, I had a 99% blockage of the left main coronary artery, an 80% blockage of the anterior descending and numerous other blockages. Angioplasty would not be a viable alternative. I was a `walking time bomb.'
By late afternoon, I was admitted as an inpatient to the Surgical Heart Unit (SHU). The SHU is a wonder of modern technology. It is designed to care for up to 12 patients at one time. It is a U-shaped facility with four beds to each of the three sides surrounding a `control' center. Each patient has their own attending cardiac-skilled nurse for the first critical hours after surgery. The individual cubicles are defined by movable curtains (no walls) and every cubicle with it's attending electronic displays is visible from the control center. Dinner was served around 5:00 and I was fed Oriental Beef Casserole with a roll, Apple Cobbler, salad and fresh fruit and de cafe. Valium was given at 6:00 (a drug I highly recommend!) I was clean shaven from chin to ankle by 8:00, `gifted' with an enema at 8:30, which "kicked in" at 9:00 (and then again at 2:00 a.m. - served them right!).
It was my solemn understanding that Mike would be checked in, put on a table and have dye pumped through his veins. I would be able to watch the dye travel through the heart and witness the extent of the damage to his heart. Based on the amount of blockage it would be determined that Mike goes home with medications, or is scheduled for an angioplasty the next morning. Since I never ruled out pneumonia as his basic condition, I believed it might be possible that he would come home that afternoon. Possible, but not probable according to Mike. Okay, then he will be staying overnight and have the angioplasty tomorrow morning and after six or so hours I will bring him home. Based on the results of the angiogram I will call his daughters, Kathy and Susan, and tell them when to "send their energies" the next day.Instead of walking alongside the cart carrying Mike to the angiogram room I was told to wait in the ambulatory patient's lounge on some floor and given directions" - the doctor would talk to me there when it was over." I was shocked at not being able to go with Mike.
I found the lounge and sat way in the corner. The test was to take an hour. I looked at the clock. It was 1:45. I got a cup of coffee and prepared to wait. This is not what I was expecting.
After a few minutes the phone rang in the room and a volunteer hostess called to an older man sitting a few seats away from me. She said: "Mr. so and so, the doctor would like to see you downstairs." I thought how awful for him, it had to be bad news and that trip downstairs would be agonizing for him. The next call was for me - and I was right, the trip was agonizing. The fright of hearing my name called tweeked my bladder but I could not stop long enough to go - I must get to Mike, if there still is a Mike.
I was now back down in the little nook Mike and I waited in together just a little while ago. But now I was alone, except for the man who was called right before me. He started chatting about his life, and his wife, and his strife and I wanted to tell him to shut up, please just shut up. I sat for half an hour listening to him alternately gripe about and praise his wife. I tried to make the appropriate comments but my ears were straining for the sound of Mike's voice somewhere. Finally the doctor appeared and sat down next to me. There was nothing written on his face.
He began immediately: "He has 99% blockage in the main artery, 80% in ......." I felt ice in my veins and almost could not listen to anything more. The next wave of words said something about trying to locate this surgeon who would do surgery as soon as possible, hopefully first thing in the morning. Mike was, at least, still alive - but I got the idea that that could change any second since he said they left a balloon in his heart just in case. "Someone will come out and give you the details." I was desperate for something to hang on to and said like a fool "Will he be all right?" The response was "The odds are 98%. He has a strong heart." Then he shook his head and said "He's a truck driver...lifting a box could have..... boom (snapping his fingers), it would have been fatal with that kind of blockage. He's a walking time bomb." And with that he was gone. But thank goodness so was the gabby old man. I sat paralyzed for another maybe half hour until someone came to me and said "Your husband wants to see you." I wanted to run away and be hysterical for a while but she was taking me toward Mike's voice, and I didn't know what he knew.
When I saw him flat on his back on that wheeling table I tried to say something but my throat was swelling shut with emotion. I really wanted to be very casual about all of it since Mike was so frightened that morning at home. I think I said "I thought I'd be able to go in with you for the test." What followed told me Mike knew all along how serious this was. I said "This all seems to be moving too fast. Should I challenge any of this, ask to see the film or something?" He said he had read all about the symptoms, the doctors, the procedure, and the hospital. Everything so far fits perfectly into what his experience has been, and he knows all of this is right and necessary. He said "I am not afraid. I have all the confidence in the world in these people and this place." Hearing that was all that really mattered because at this point there was nothing I could do but get out of the way and let what was going to happen, happen.
They wheeled him up to the 2nd floor cardiac unit (with me running alongside) and again told me to wait outside until they got him ready. There was no one in the hall so I stood there and tried to compose myself. Every now and then I would get hysterical but only for a moment, then I would feel numb again. The hysteria only came when I thought about saying the words out loud to someone so I decided to make sure Mike was all right then get as far away as I could and start screaming until I felt sane again.
I pushed the metal wall plate that whooshed open the doors to the surgical heart unit and walked in. Five steps in I saw the center "hub" and realized this was serious business. I stood there again looking for Mike but saw only curtains and machines and people inside this glass hub. "We'll be done with him in a minute and then you can see him." I went back outside for a few more minutes and then returned. I heard him say "I'm here" and walked in the direction of the voice. The nurse was alternately giving and getting information. A food tray carrying his dinner arrived and he lifted the lid on the entreé. What was on that tray was food I would have never served to a person with clogged arteries! I thought it must be the "condemned man" menu. Mike, while laying flat on his back, tried to nibble at a big piece of beef using his fingers instead of a fork because his recently fractured left wrist was still not that functional. He said it was tasty and then decided to eat the dinner roll (which I also knew was loaded with butter and egg yolks). On to the apple cobbler, fruit plate, and coffee. By now I was ready to puke!
Instead, I went back out into the hall and looked for a phone and a washroom. I found the washroom and used it - I found the phone and did not. I could not form the words in my mind much less speak them without losing control - and I definitely did not want to create that kind of scene for Mike or the hospital staff. I wanted to stay by his side because the thought of him dying without me being there was devastating; yet I knew I had to begin the preparation process for all those who had no idea what was taking place.
Back in the surgical heart unit the nurse was briefing Mike on what would happen the rest of tonight and tomorrow morning. The minute she said he would be put into a "very deep sleep" so they can work on the heart I knew exactly what that meant. I also knew Mike. Much of our life is spent with him doing things my way so I don't get upset. I knew this time I would have to compromise. I realized Mike had everything he needed to survive: information, determination, confidence in the place and the people, a strong will to live, no fear of death, and a love of risk and adventure. He knew very shortly the drugs would take him out of the game so told me to do whatever I needed to survive my part of the experience.
Knowing Mike works best alone I decided to ask Kathy and Susan (Mike's daughters) to help me through the next day because I could not stand to wait alone. When the cardiologist appeared, I assumed to make sure Mike was okay after the angiogram, I asked how many bypasses there would be. He held up finger after finger: "three, four, five..... we won't know until we get in there." That was all I needed to hear to assure me that I would be uncontrollably hysterical within the next few minutes. I kept laughing out sentences mixed with gasps and tears, then apologizing. When I realized I would probably explode if I didn't release some of this emotion I asked the nurse if I could call later and find out when the surgery was scheduled. She said "the surgeon had a lung at 7:00 AM and a heart at 11:00 so it all depended on the doctor as to when and even if it would be tomorrow"....but "yes," I could get that information by calling the number she gave me.
She also said that patients do best when they can see their families before surgery. Mike, hearing that, said he did not need to see me - in fact he would feel awful to think I had to miss breakfast in order to be there early in the morning. Now I knew he had no idea what was going on in me ... for the past 14 years!
I left the cardiac unit and suddenly realized I had no idea where I was, where the parking lot was, where the car was within that parking lot, where the hospital was within the city. The only reason getting home became so important is that I promised myself as soon as I got there and made the necessary calls I could cry until I stopped hurting inside. I also knew that might be never.
Tuesday, May 7
I went in and out of sleep during the night, and at 5:00 a.m. I was wide awake but not nervous. Incredibly, Susan and Larry arose at 2:30 that morning to drive in from Hoffman Estates.. They picked up Kathy and Michael, then Barbara and all arrived by 4:30 or so to be with me (and Barbara) for the next 12 hours as it would turn out. My mother and brother flew in that morning from Arizona and together with my Dad also had a chance to wish me well before I was taken to surgery. There were many moments of anxiety on the part of my family, fearful of the surgery and the unknown after-effects (like death, I think.) For my own part, I had utmost confidence in the coming event, because St. Francis is the primo heart facility in the Midwest, and my surgeon Dr. Ali Shariatzadeh is a renowned Cardiothoracic surgeon who had performed hundreds of these procedures annually since 1973. Also, I was pretty well drugged up, and was feeling no pain.
The Surgery
Many thoracic surgeons are now exclusively cardiac surgeons. They perform heart transplants, bypass operations on the coronary arteries, implantations of cardiac pacemakers, replacements of diseased heart valves with artificial ones, surgical corrections of congenital heart and vessel defects, and surgery for diseases of the major blood vessels. Cardiac surgery is in many respects a model for the direction of modern surgery. The surgeon works as a member of a large team that includes cardiologists, catheterization teams, heart-lung pump teams, radiologists performing angiography (X-ray visualizations of the heart and blood vessels), echocardiography teams, and nursing teams, as well as the staff of the intensive care unit and a host of others.
A person wishing to become a thoracic surgeon must first complete training in general surgery and then spend two additional years devoted to thoracic surgery.
Before surgery could proceed I was to be weighed. The bed scale very closely resembles a rigid hammock. You are rolled to one side of the bed, the `hammock' is unfurled, then you are rolled over it to the other side of the bed, and the unfurling completed. A large electric motorized `sky-hook' type machine is brought over the bed, attached to the `hammock' and the whole assembly with me in it is raised a few inches to record my weight. The weighing would be used as a reference point after surgery to monitor if I was retaining water, an indication of possible onset of pneumonia, and other internal malfunctions. After being weighed, I was wheeled down the corridor at 7:00 am into the operating room. The operating room seemed very small, crowded with equipment and people, and was very cold. Heart surgery operating rooms however, are larger than most other types of operating rooms because of the amount of equipment and number of people involved in the surgery. I maneuvered myself from the gurney onto the smaller operating table. Above the table were three large chandeliers each containing 4 high intensity lamps which would provide a shadow-free light over the entire surgery region. The assistant Anesthesiologist, Dr. Lee, a young man, inserted an IV into my left forearm. I heard him ask the Anesthesiologist, Dr. Maureen Coleman (on staff since 1983) "how do you want this stitched, over or under?" and she replied it didn't matter, to which he replied, "this is my first heart." Upon hearing that, I asked him how he felt today, and he responded "OK", to which I replied "then let's do it." I felt a slight pinch in my arm where he started the first stitch...
After the patient has been put under, the sternum (breastbone) is sawn in half along the body axis, the chest cavity is opened, and the wizard performs his or her sorcery. At the same time, an assistant (often more than one) extracts veins from the leg or abdomen to be used for additional bypass material. The heart rate is reduced drastically by an ice-cold saline solution bath, lowering it's temperature to 70 degrees. The heart is then lifted slightly so a cardiac `jock-strap' can be wrapped around it to give it support and keep it still while the surgeon operates. The entire body and it's systems are cooled with ice packs and cooling pads to 86°, greatly reducing their need for blood. The blood is rerouted around the heart by a heart-lung pump. The pump exchanges carbon dioxide for oxygen and cools the blood, replacing the function of the lungs.
The term `bypass' does not specifically refer to the placement of veins and arteries. Rather, it comes from the fact that the heart is `bypassed' from performing the task of pumping blood. Likewise, the lungs are also bypassed from performing the exchange of carbon dioxide and oxygen during the actual surgery on the heart.
Since this was a triple bypass, the 1st bypass graft came from the left mammary artery which is already attached to one side of the aorta where the blood pumps out of the heart, and feeds the left breast and chest tissues. Mostly unneeded, (except by body builders, I guess), the mammary artery is cut at the chest side and flipped over to become the 1st bypass graft of the left main coronary artery where the largest blockage occurs. This bypass feeds the anterior descending (front center) artery on my heart. In addition my left leg was sliced open along the inner thigh from the groin to just at the knee joint, where some saphenous vein material was cut out (deeply as would be told to me later), to be used as additional bypass material. In my case the other two bypasses are also attached on one end to the aorta, then to the obtuse marginal (left-side to left-back) artery and the diagonals (left center.)
While all this was going on the rest of us "camped out" in the Surgical Unit Lounge, drank coffee, and tried to be calm. We were briefed by a volunteer hostesses what to expect for the rest of the day. "He will be in surgery for about four hours. If the waiting goes beyond what you can handle come to me and I will call and find out what is the status, so you will know how much longer it might be. When the surgery is over the doctor will come in here to see you. From that point it will be about two more hours until you can see him. The first time you see him it will be quite shocking because he will be pale, have several tubes coming out of various parts of his body, and will be on a breathing machine." Prior to this, a nurse had also informed us that we should not expect him to talk because with the tube in his throat he will only gag and cause more discomfort. We were also told that when he is allowed visitors it will be for only five minutes on the hour beginning with a half hour designation (like 12:30, then 1:30, etc.) Tomorrow he would be allowed visitors from 12 until 2 and then from 5 until 8 (but still only 2 visitors at a time). The room hostess also gave me a phone number to call to find out how he was doing if we could not be there.It felt like a very long wait, then suddenly this man appeared whom I had never met yet just a few minutes ago had Mike's heart (and life) in his hands. I recognized him only from a tiny photo in the directory Mike had taken when he went in for a visit to the cardiologist five days ago. The morning of the surgery I decided I wanted to know what this man looked like since he was about to be an integral part of our lives. When he walked through the door, I gasped and said "that's him!" He motioned to me to follow him and then went into one of the small `family rooms' off the main lounge. I invited the others in with me. He said "It was a triple bypass. He did very well. We had to go deep (I think that's what he said) for a vein because of the varicosity. You can see him in a little while." I had expected, because of the emergency nature thus far, that it would be far more severe, and I also believed Mike could die in the process. That he was alive, and that it was only a triple bypass brought a flood of tears and relief coupled with, believe it or not, great joy! Only a triple bypass, I could not believe the good fortune. The doctor's words were so reassuring I finally began to think "future" again. He left the room and I followed him out and to a phone to call my mom who was the control center of my family at that point. I told her the news and said we would not see him for two hours and then every hour after that for five minutes only. I called Mom every hour on the hour in the beginning. Having her do all the calling took the pressure off of me to keep others from having to worry needlessly. Mom came through in a pinch and did what Mom does best - keep people informed..
The Bright Light
Before I continue with post-operation and recovery, I will answer the big question. I do not recall going under, I saw no `light' at the end of any tunnel, there was absolutely no consciousness of anything, and all was solid black and totally void of any sound and movement. It seemed like one second after being knocked out, I heard the anesthesiologist say to me "Wake up Michael, the operation is over." In effect, I was awake - then I was awake again. The surgery had taken three hours. Immediately after surgery, I was taken to a temporary recovery room, where I was monitored very closely until my internal body temperature was brought to normal. I would be monitored by a nurse at my bedside for the next several hours.
Post Operation
After being returned to the SHU I became conscious of activity and sounds around. I could not `feel' any part of me. My hands and legs would not move. My lungs were breathing, but I wasn't making that happen. Gradually, I became aware of the tube (the endotracheal tube) in my throat from the respirator. It was very irritating, and I was unable to swallow because there was no room for my throat muscles to flex. I also felt no need to swallow because I had been given medication that had dried up my salivary glands. I could not speak until the tube was removed because it ran through my vocal chords. There was another tube running from my stomach and out of my nose to drain stomach acids. There were three more tubes, two from the chest area, and one from the heart area to drain fluids that accumulate normally during and after the surgery. In addition there were four pace-maker wires laying on the heart that protruded through the chest and were taped down, to be available `just in case.' Then there was the inevitable bladder catheter which was very irritating because of some tissue damage done when it was inserted into the urethra. I felt very cold for awhile. My body was shaking violently, so much so that I could hear the bed rattle. Eventually the shaking subsided as I grew warmer. I overheard someone say that when I could keep pace with the respirator, the tube would be removed. That became my immediate goal, and I soon learned to keep pace with and then finally master control over the respirator. I found that I could exhale against it's inhalation cycle causing it to stop. After I played around with it a few hours, it was removed - followed by the stomach drain - leaving me with a very sore throat and weak speech for the remainder of the day. I had to breathe using an oxygen mask, and was unable to talk without it. I still had two IV's, one in my right hand, and one in my right carotid artery at the neck. As time passed, I began to feel the presence of my hands and legs.
In spite of the briefing as to what you will be seeing, it still is shocking. Mike was white, except for his lips and fingers which were bluish. His whole body was convulsing slightly (like intense shivering). His chest seemed to be heaving up and down much more than it should. The sheet was not covering him completely and from underneath you could see tubes and dye, and blood and markings on his body. It was not pretty - but it was Mike! In spite of what we were seeing the nurse assured us he was doing just fine - quite well as a matter of fact. I was told that even though he is shivering, his internal temperature is normal - they have to raise the temperature slowly because during surgery everything is on ice so to speak.The next visit (one hour later) was a complete shock (for the good this time). His color was back, he was not shaking, his chest was not heaving. I could see an incredible improvement. In spite of all the tubes and machines hooked up to him, he actually looked better than he went out of there some 6 hours earlier. Each hour brought more improvement and another call to Mom who passed on the information. Apparently we had more information than he did because in the third hour's visit he indicated he wanted a pen and paper. He scribbled on it "What did Dr. say / do?"
Finally at 5:30 the tubes were taken out of his throat and he could speak. Susan was the first to approach him and asked how he felt. His first words: "I feel like shit, my throat is killing me." During all of this Mike seemed to communicate easiest and most with Susan - she was good at picking up all the little details like Mike nodding toward the breathing machine and then stopping it and giving her a little smile as if to say "I'm in charge here!" She also determined what Mike wanted when he could not speak and was trying to act things out for us. It was like a game of charades with us guessing and him shaking his head no. Finally when Susan said: "you want water sprayed in your mouth?" Mike nodded emphatically yes!!! I clapped my hands and cheered - but the nurse said "No." We were still very pleased with ourselves. Kathy also was able to approach her Dad and comfort him with her touch and just the right words. At one point when the girls were at both sides of his bed, holding his hands and bending over speaking reassuring words I just stood back and envied the parenting that enabled this wonderful moment. When Jim, my son, and I had our visit both of us stood a few feet from the bed and did not speak, except in whispered tones to one another "Man, he's fucked!" "Yeah, I know, let's get out of here." That's why I wanted Mike's two children there - it seemed the most loving thing I could do for him.
Go Past ICU
I began to recover quite rapidly, much to the surprise of the attending staff. My respirator had been removed within a remarkably short 6 hours after surgery, and all vital signs were responding well. I began to take liquids that evening, and by 2:00 PM Wednesday was removed to a room in the coronary care wing with just a monitor taped to my chest. They had decided to bypass the Intensive care unit altogether. I was put on a restricted liquid diet that evening.
Thursday started off with juice, tea, broth and jello. Lunch was much the same but included soup. Mid-morning I made my first tentative walk to the hallway and back to bed, assisted by the cardiac therapy nurses. Shaky, but rewarding. In the midst of all this I would be thoroughly exhausted from the slightest activity and would constantly reach for my oxygen mask.
Friday, they disconnected the IV, placed me on a regular cardiac diet with solids, and my life began anew. Early in the morning before breakfast, two nurses came in to remove the three drainage tubes protruding from my torso. Two nurses.....why did I have a sense of impending doom? Even my roommate a Sergeant in the Chicago Police Department fell into a quiet spell and drew the curtain separating our beds...uh oh! The nurse in charge said "look into my eyes and take deep breaths along with me. On one of your exhales I will pull out the drain tubes, and you must hold your breath while we apply a dressing to seal the holes." Oh, boy, am I in trouble! "Ready?" she asks. "IN!" (one), "Out", "IN!" (two) "Out", "IN!" (three) "Ou...." and with a mighty heave, eyes bulging, cheeks turning red, she pulls out what feels like 10 feet of coiled hawser, losing her balance and almost falling back against the wall as it comes slurping out of my body with a loud gurgling sound along with a low, sustained groan coming from deep within my throat. I held my collapsed lungs in place while the other nurse pushed a large dressing down over the gaping holes, maintaining great pressure with both hands as the first nurse applied many strips of tape... `slap, slap, slap' around the dressing. It was all very frantic, quick, and painless! I was told to lay still for one hour until the draining/bleeding stopped. Hell, I would have laid there like a stone all day if it was up to me...imagine, three holes the size of a fist! (Well, they turned out to be really small incisions after all.)
I was given a wonderful breakfast, but was too frightened to sit up to eat it! By lunch time, I was sitting in a chair and doing some deep breathing exercises. It was all very tentative, but it felt great to finally be doing something. Again the therapy nurses assisted me in my first walk down the hall 60 feet - what progress. I still needed oxygen for the slightest activity. However, Friday night I slept without the mask, and felt wonderfully free of it.
On Saturday, I was visited by Ned Strain. Ned is a volunteer in the nationwide organization "Mended Hearts." I will attend a meeting of these people when I am able, but for now I can say that they are all recovered Open Heart Surgery patients. It was a wonderful visit, because this gentle man knew exactly what I was going through, having gone through it himself. The visit wasn't very long, but it was quite rewarding, because it helped me to release the depression and anxiety that would have slowed my recovery.
What was I doing all this time? Sitting downstairs in the cafeteria in the warm sun that was streaming through the windows and looking at tulips blooming right outside the glass. Ah, it was like a vacation in the Bahamas! Except in between these moments I was alternately mud wrestling with two of Mike's visitors, and trying not to trip over any of the equipment in the room or shove his food tray onto his chest! I'm the one who walks into walls and can't ride a bike or roller skate so grace is not my forté! At one point Mike remembers looking at me struggling to get the top off one of his food items and then place it somewhere on the tray where he could comfortably reach it he was thinking, - "this person is so wonderful and yet look at her." I was always soooo relieved to leave his room every night and be able to trip over something if I had to. These heart patients were in grave danger with me around.On Saturday Mike asked his cardiologist if he could come home on Sunday. Sunday?! What is he thinking?! I went home that night and tried to determine how I would get this man who could not do more than 10 seconds worth of activity without having to catch his breath, from the hospital room into our home without the benefit of an oxygen mask, cardiac nurses, and a wheelchair.... using our 1977 Chevy Pick-Up truck with it's stiff suspension. Me, the one who finds every hole in the road, would now be transporting a guy whose chest was in two pieces and in between those two pieces was a heart that had not been road tested. As we drove down Ridge Avenue, with the sun shining, and classical music playing on the radio we both started crying. We looked at each other, started laughing, and decided to shut the damn radio off! Phew, what schmaltz! That was like the ending of some really sappy movie!
Throughout my stay in the hospital, I was attended by professional, informative and compassionate people. It was a satisfying experience for me, and while I would not recommend this type of procedure to everyone, if you must have it done I do recommend St. Francis Hospital of Evanston.
I must wholeheartedly agree. The experience was as trouble free and pleasant as it could be...from Inpatient Registration right up to our follow up visit, two weeks later, when I left the lights on in the truck and returned to find a dead battery. I asked for help and within five minutes time Security came, jumped the battery, and we were on our way home.