A Small Matter of the Heart, Part 2

Finding a hospital may sound like a trivial task, but it was not. On the evening of February 8th, 2005, I first drove to one of the Baptist hospitals, primarily because my General Practitioner (GP) worked with the system. Being the righteous, caring people that they are, the kind folks at the Baptist hospital wanted me to first give them $6000 before they would give me permission to be admitted. You see, the Baptist system is not in my insurance plan, and they wanted to make sure that they didn't lose any money.

I promptly about-faced and drove straight to the Methodist hospital closest to my house. Unfortunately, they were completely full and suggested that I take a room in the ER unit (for two or three days) until something became available. It began to feel as though I decided to get sick at the wrong time of the year.

Finally, after talking with someone at my insurance company, I discovered that the Saint Francis hospital was in the plan. And better still: the cardiologist that Debbie insisted I see (she worked with him years ago) also worked at that hospital. So, off I went. I was admitted without incident. Ironically enough, however, the hospital called the next morning, asking me how much of the decudtable I could pay immediately.

Nonetheless, I stayed on the cardiac floor in one wing of the building (I can't remember what they called it). On Monday morning, Dr Akins -- the créme de la créme of cardiologists -- performed his incredibly thorough examination of my heart via the stethoscope. Now, up to this point, I have had four or five medically-oriented people (including the "you have a virus" GP) tell me: "Yep. You have a murmur, dude." Dr. Akins, on the other hand, took a long time listening to various parts of my chest and then quite matter-of-factly said: "Well, he definitely has AI."

So, I took this like a real mature adult. I smiled, nodded my head, and said something really dumb like: "Cool beans, doc. What's next?" I definitely gave everyone the impression that I no idea what was just said. Debbie turned to me and offered an explanation.

AI, she said, stands for aortic insufficiency. Generally, it meant that my heart was unable to pump the blood through my body properly because my aortic valve was not acting properly. Dr. Akins suggested an echocardiogram. I was then scheduled for the test on Wednesday.

The test went well, considering the fact that it was totally painless and incredibly awesome to watch a grainy video of my heart pumping in real time. Unfortunately, we heard late that afternoon that the video wasn't quite what Dr. Akins wanted to see, so I was scheduled for another type of cardiogram -- the infamous transesophageal echocardiogram (TEE). The information you find in medical books doesn't quite give justice to what the procedure is like, so I will explain it from the patient's point of view.

Once I was wheeled into the procedure room, I was told to lie somewhat on my left side, so that my mouth would be pointed in the correct direction. The assissting nurse told me more than once that I would receive a small dose of a very relaxing drug in order to make me relax. It was after her third reassurance that I began to wonder why she was so concerned. Much later, I would come to the conclusion that she was probably more nervous than I had been.

Which brings me to a side note. Debbie began her career in the medical industry as a nurse many years ago. She worked different areas in different hospitals, and so she was able to get a very good understanding of the ups and downs in the life of your average nurse. Since hospitals run tight budgets, they try to get away with as much as they can with as few people as possible. In total-quality management circles, this is the corporate modus operandi. In a hospital, it has always proved disasterous to both the patients and the nurses. The nurses are the backbone of the medical industry. They are required to work shifts that no one in their right minds would ever agree to do in any other industry. Not only is it common for nurses to work twelve to sixteen hours in a shift, but they are exposed to everything that is bad for people. They care for the sick, alongside the injured. They have got to be one of the most underappreciated class of citizens ever. The attending nurse's nervousness could have been the result of just about anything, but she succeeded in making me comfortable, and she was incredibly professional -- something I believe all medical people should practice at all times.

Not that all nurses necessarily deserve such appreciation -- some don't. For example, I shall tell you of "Nocturnal Nurse the Ripper." During one of the first few nights at the hospital, I was awakened by a nurse at 3:00 a.m. to get some blood drawn. I expected it, so I was not surprised, but I fully expected the usual quick jab-and-patch routine I normally experienced. (My blood was drawn two or three times each day.) However, this nurse had a weird problem with the veins in my left hand -- she couldn't find one to give her blood.

Most people can see the veins under the skin on the top of their hands. Mine are nice and plump. These veins, however, move around a lot and are sometimes difficult to stick properly. This nurse went far beyond difficult, and took to making the attempt three times on one hand. On the last attempt, she had to chase down the vein by digging around with the needle under my skin until she finally punctured the vein. It hurt. I didn't sleep any more that night.

One other thing I must mention here is this: Debbie stayed with me throughout my entire time at the hospital. From that, two things emerged. First, Debbie saw firsthand what patients with heart conditions actually go through during their stays at the hospital. Second, I witnessed firsthand a totally selfless act of kindness from Debbie. When she was in the room with me, she made absolutely sure that things went as smoothly as possible. It was the second time in my entire life where someone pushed their entire life to the side in order to take care of me. The first time was shortly after I was born and my mother coddled me.

My mother, by the way, flew into town shortly after I was admitted. Debbie called her, urged her to make the trip, and even paid for the airfare. The wisdom in that move revealed itself later, after I went home.

At any rate, I was there in the TEE lab, waiting for things to begin. By this time, I had been in the hospital long enough to have one catheter in each arm. They were used only to pump liquids into me, and never to draw blood. Just like vampires, they wanted fresh holes for their blood samples. So, there I was, lying on my side, looking at an array of instruments and tools, the uses of which I was blissfully ignorant, when in walks Dr. Akins and one of his partners, another doctor. I forget her name, but I remember she was recently married and some people had trouble remembering her new last name. Let's call her Dr. Barbara.

Dr. Barbara was all business. I do not recall seeing her smile or hearing her joke about. This was a doctor on a mission, I told myself. She explained the procedure, gave the nurse instructions on my sedation, and sprayed my throat with a numbing substance (so I wouldn't gag on the tube). She did it in stages. First, she said I should taste the stuff, so she sprayed a tiny bit on my tongue. It was very bitter, and everything the nurse said it would be. So, Dr. Barbara sprayed some more at the back of my throat. I acked and said it had a weird taste. In fact, it was apparently banana-flavored. No banana I ate ever tasted like this. Finally, the good doctor sprayed a lot of this stuff in my throat. I dutifully swallowed. The sedation was beginning to take effect, because I began mumbling something about the odd banana-like taste.

Dr. Barbara would have none of this. She poked the back of my throat with a swab and asked if I could feel it. I didn't. All I had was a nasty bitter taste in my throat. More sedation was injected into my blood stream, and things began to get a bit fuzzy.

I remember feeling the probe being pushed down my throat, but I was so giddy and numb that I hardly reacted. What followed was 20 minutes or so of examination and doctor talk. I really cannot recall many details, yet I was fully awake. Man, those drugs are cool.

I regained composure and awareness sometime after I was wheeled back to the room. Debbie told me that the doctors said I was a "very good patient." I think that meant I was completely submissive and followed instructions. The next day, Dr. Akins returned and said that the TEE showed a much better picture of the valve. The pictures indicated a really bad problem. My aortic valve, which is supposed to have three leaflets, appeared to be working more like a bicuspid valve. Furthermore, it never seemed to completely close. In a word, my valve was toast. It was not working any more. Something bad happened to the valve and it was damaged beyond repair.

Still, rather stupidly I might admit, I didn't quite get the gist of Dr. Akins' message. I only wanted to get on with the fixing and get it over with as soon as possible. Debbie was deeply troubled by the news because she knew that I needed to have the valve replaced. What was worse, was that she had seen not only successful outcomes to this exact kind of problem, but she also had the displeasure of witnessing problems after surgery or even surgical procedures that went awry. I was blissfully ignorant and I felt no apprehension whatsoever.

Dr. Akins also wanted one more test. He wanted me to have a cath procedure done. After all, while my chest is cracked open, why not fix any other problems that may exist? It sounded logical to us all. The cath was scheduled for Monday, the 13th of February. On the night before, I had to shave the groin area so that there would be no chance of a hair sneaking into my circulatory system and creating all sorts of havoc.

I remember being wheeled into a very cold operating room. A nurse scrubbed the groin areas on my left and right legs. Usually, only one leg is required unless something goes wrong and the doctor has to open up the other vein. So, I was scrubbed and dried. I had a cloth drape hanging near my chin, so I wasn't able to see anything that the medical people did. I felt it, though. Dr. Akins came in, explained the procedure, and then numbed me up with a couple shots of lidocaine. The sedation wasn't as strong as what I had for the TEE, so I was lucid enough to comprehend what I was able to see on the monitor screens. At one point, I had to be stuck with a second catheter in the same location, so I needed a bit more lidocaine. There was some stinging, the dye injection felt weird: a warmth that exploded in my chest and moved quickly into my arms and legs before quietly disappearing. I saw the cardiac arteries turn dark and slowly fade into the rest of the white background on one of the monitors.

Later, while I was lying very still in my bed, Dr. Akins and our surgeon, Dr. Robbins, visited with great news: my cardiac arteries were in perfect condition and the surgery was scheduled for Tuesday morning.

In the late afternoon, a nurse came in and shaved my entire chest and abdomen, including my armpits. I slept normally that night, after having been wakened by more than one nurse requesting blood samples and such, but I suspect that Debbie had a very difficult time doing so. She was worried. I was about to undergo a very difficult procedure, and the future was looking very bleak.

The morning came as it usually does, and I was soon wheeled into the operating room. It was another cold room, but I only felt it for a minute at most. The anesthesiologist said he would give me a sedative and that I would probably feel a bit sleepy. One moment of my time later, I was in the critical care unit, many hours after I was initially transported to the O.R.