If I didn't say it before, I'll say it now: Debbie is a saint. She told her boss that she had to stay with me while I was in the hospital. She literally stayed with me at least 20 hours each day for the two weeks I spent there. I did not comprehend the relevance of her selfless act until after I was released and went home. I owe my life to the doctors and nurses who made sure that the surgery went without complication, but I owe my sanity and my quick recovery to Debbie. Perhaps it was due in part to the fact that I never experienced that kind of act of love; perhaps my alarming proximity to death and the trauma of the operation gave me a different perspective. In any event, I found myself loving her more than I thought I could.
I have some really great friends and co-workers who visited me, sent me flowers and cards, and even gave me books and lent me games so that I could keep myself occupied during my recouperation. My children, who live many hundreds of miles north of me, sent me flowers and cards, and called me. Two very good and life-long friends of mine from the old country (Denver) called and offered to help us in any way possible. I was truly humbled.
On the other hand, there were people who I thought were friends who did not call, did not send cards or flowers, or even offer a sincere "hope you get better" when I talked to them. In the space of two weeks, I discovered exactly who my real friends were, and those who couldn't or wouldn't give a damn. It's a pity that I had to undergo open heart surgery in order to make this distinction.
One friend of mine asked if I underwent a life-changing metamorphosis, having come close to death and all. I told him that I didn't, but, upon reflection, I think that I did. The changes were subtle and difficult to measure, yet they are there nonetheless. Part of it was the way I came to love Debbie more than ever. Some of it lay in the changes to my senses of smell and taste. The rest have to do with the way I see my life.
There are a few things that I have been postponing during the past decade or two. These things will no longer be ignored. Debbie and I are going to become official husband and wife in July. And I am going to seek a few changes in my current employment. None of these things are sudden or alarming -- they're just finally getting the attention they deserve.
The week in the hospital following the surgery was routine. I often exercised my lungs with the spirometer, which usually led to the expulsion of mucus from them as I ever-so-gently coughed. My appetite grew to the usual gargantuan proportions. I slowly gained the strength to stand, and then walk, and then walk around the ward a couple of times each day.
The worst problem I had was sleeping. Since I have sleep apnea, I require a CPAP to attain the proper REM sleep at night. But, because my chest and lungs wouldn't allow any sort of effective expansion (deep breathing), I couldn't use the CPAP. So, I slept fitfully, often awaking with the feeling that I was gasping for air or suffocating. After a few restless nights, the pulmonary folks were able to get me set up with an APAP. This helped, but it wasn't perfect. Finally, a couple of days before I was discharged, I was able to use the CPAP without an accompanying stinging pain in my chest.
The process of splitting the breastbone and prying open the ribcage to expose the heart leaves one with a couple of issues. First, the splitting requires a reconnection. Second, the prying action forces the ribs to move in ways that cause back and side pain for months. When the operation is completed, the breastbone is stiched back together using wire. Simply, wire is wrapped around the bone, fed between the ribs, and twisted together very tightly. The muscle is sewn together with absorbable sutures. Lastly, the skin is held together by sutures or staples. In my case, the surgeon used staples.
The staples look weird. They reminded me of a zipper. There couldn't be a more fitting comparison. The ends of the staples did not turn back like stapels I use to hold together papers. They curved inward just a little bit. They stayed in for a full week and then were removed painlessly in an examination room at the surgeon's office by a very young and somewhat inexperienced nurse. Once they were removed, I was able to scrub the incision area while showering.
Other than that, I only need to remind myself not to do stupid things like lift something really heavy or wrestle with the neighbor's Great Dane. In a few months, I will only have a scar as a reminder, although the reverberations of the selfless acts of my friends will remain.
Note: I saw the doctor and I will be going back to work April 4th. Bummer.
Wednesday, March 30, 2005
Friday, March 25, 2005
A Small Matter of the Heart, Part 3
Before I get to the after-surgery drama, I should mention the sub-plot that kept showing up every other day or so. When I visited the emergency room on the week prior to going to the hospital, the obvious conclusion to my symptoms was that I had an infection somewhere in my body. I had the chills and fevers which doctors refer to as "classic" symptoms. The one wrench in this assumption, however, was that the hospital lab was unable to grow a bacterial culture from blood samples.
This bizarre contradiction presents itself to doctors occasionally. Their explanation is that there wasn't enough bacteria in the blood when it was taken in order to return a positive culture. For this reason, patients sometimes have to go through several "draining" events which are used to create an array of potential cultures -- usually during the course of two or three days.
The optimal time, of course, is when the patient's temperature begins rising. It is then that the body is reacting to the problematic bacteria, and the time when the bacteria is at its highest concentration in the blood.
For me, unfortunately, the hallowed growth never occurred.
The Infectious Disease people talked a bit about performing a culture series, but I only had mild fevers while in the hospital before the operation. Furthermore, I took a strong antibiotic after my first ER visit, which may have reduced the bacterial level in my body considerably. Whatever the cause, the result was inescapeable: my aortic valve was screwed.
So, the operation went rather well -- or so I heard. When I was finally given the anesthetic, I retained about 20 seconds of memory. One instant later, I found myself waking up in the critical care unit (CCU).
My first sensations were fuzzy. Not only was I recovering from anesthesia, but I was really doped up on morphine in order to mask the pain from the surgery. I recall feeling the breathing tube in my mouth and down my throat. I had enough sense to quell any panic and I concentrated on other things, valiantly ignoring the weird sensation of breathing without effort.
Debbie and mom were probably in the room, but I was far too groggy to do much more than recognize the fact that I was out of surgery. At some point -- and this too seemed to me to be moments -- I heard a voice telling me that the tube was coming out of my throat and that I shouldn't worry. It slid out without a problem. Thank the gods for morphine.
Full consciousness occurred sometime during the night after the operation. It was probably the longest night in my history. Several things kept me from having a good night's sleep:
After a surgical procedure that requires the use of a heart-lung machine, patients often report small changes in their senses of taste and smell which last for a month or two. They also often have depressive episodes. I had none of these symptoms while in the CCU. My guess is that I was too busy with the post-surgical pain and breathing problems to worry about such trivial matters.
While in the CCU, I was given water to drink. Thank the gods for water. Nearly six weeks after the surgery, I still drink mostly water at home. I will drink diet soda when we go out to eat, but I haven't had a sip of soda since I had the operation.
At any rate, the night led to morning, and I was then visited by saints Debbie and Mom. The surgeon's nurse also appeared and helped the nurse assisst me with climbing out of bed and sitting in a chair.
Yes, only hours after the operation and they had me perform the nearly-impossible feat of planting my arse in a chair and remaining somewhat upright for a few minutes. Since my chest was freshly sewn together, I couldn't begin to lift myself. The tubes in my stomach, bladder, and arms proved to be annoying obstacles as I moved between bed and chair -- and eventually from chair back to bed.
Everyone praised me on my ability to sit. "Wow. You're really doing great," the nurse would say. "Gee. You're moving about sooner than we expected," another would quip.
In my mind, I just wanted to do whatever it took to get me:
Saints Debbie and Mom hung around during the visiting hours, talking with me and expressing their deep relief that I came through fine. I was not there in the waiting room while the minutes passed agonizingly slow, not knowing whether or not the surgery was going well. I could, however, see their relief in their eyes and hear it in their voices. It was incredibly comforting.
Pat the nurse came into the unit before I was transfered to the cardio floor. He pulled the tubes out of my abdomen.
Now, saying the words "pulled the tubes" recalls the painful event for me in extreme clarity. For anyone who has not had drainage tubes pulled from their body, I will attempt to explain the pain that this entails. First, you must realize that one tube is in the left lung cavity, one tube in the right, and the third in the cavity surrounding the heart. They are about sixteen inches in length. They are also inserted during surgery by cutting three small holes completely through the abdominal muscles and then snaking them into their proper places. "Pulling them out" sounds so very benign, so matter-of-fact.
The nurse warned me of the pain, but I was blissfully unaware of what he meant. When he pulled them out, I experienced approximately four seconds of a deep, wrenching sensation that was quite unlike anything I had ever experienced. Days later, I would tell Debbie that the feeling was probably as close to a stabbing that I would (hopefully) ever get. I could not breath for those four seconds, and I yelled out loud at the end of it -- something I rarely do.
Well, as if that wasn't enough, the on-duty nurse at the CCU then proceeded to pull the catheters out of my body. One was in my left arm, one was in the right side of my neck, and one was in my penis. Each was handled with no care and apparently with the full intent of making sure that I would have a really bad day.
Debbie was furious, but kept quiet lest the nurse respond with something more unspeakable. Mom turned pale and probably wished she were somewhere quite different. The nurse, I learned as she wheeled me to my new room, was on her last day in her current position and was happy as could be that she would start her new job in some unknown place, most likely conducting training exercises in torture. As I bid adieu to her, I wondered how many other patients that day would get bladder catheters ripped out of their bodies and arterial holes improperly serviced so that massive subdural hemorrhaging in their forearms would result.
Debbie and my mother spent the next week basically performing most of the ill-forgotten chores of the nurses that were supposed to comfort and aid me.
This bizarre contradiction presents itself to doctors occasionally. Their explanation is that there wasn't enough bacteria in the blood when it was taken in order to return a positive culture. For this reason, patients sometimes have to go through several "draining" events which are used to create an array of potential cultures -- usually during the course of two or three days.
The optimal time, of course, is when the patient's temperature begins rising. It is then that the body is reacting to the problematic bacteria, and the time when the bacteria is at its highest concentration in the blood.
For me, unfortunately, the hallowed growth never occurred.
The Infectious Disease people talked a bit about performing a culture series, but I only had mild fevers while in the hospital before the operation. Furthermore, I took a strong antibiotic after my first ER visit, which may have reduced the bacterial level in my body considerably. Whatever the cause, the result was inescapeable: my aortic valve was screwed.
So, the operation went rather well -- or so I heard. When I was finally given the anesthetic, I retained about 20 seconds of memory. One instant later, I found myself waking up in the critical care unit (CCU).
My first sensations were fuzzy. Not only was I recovering from anesthesia, but I was really doped up on morphine in order to mask the pain from the surgery. I recall feeling the breathing tube in my mouth and down my throat. I had enough sense to quell any panic and I concentrated on other things, valiantly ignoring the weird sensation of breathing without effort.
Debbie and mom were probably in the room, but I was far too groggy to do much more than recognize the fact that I was out of surgery. At some point -- and this too seemed to me to be moments -- I heard a voice telling me that the tube was coming out of my throat and that I shouldn't worry. It slid out without a problem. Thank the gods for morphine.
Full consciousness occurred sometime during the night after the operation. It was probably the longest night in my history. Several things kept me from having a good night's sleep:
- I just had my breastplate sawed apart, my ribcage spread beyond normal expectations, and my heart cut open in order to fix the valve problem;
- The hospital administers only very minimal amounts of morphine, which takes care of the pain just long enough to ensure the return of all the pain at the same time that you are able to relax enough to fall asleep;
- The nurses on duty in the CCU are always taking care of more patients than you, and there was a patient who flatlined at some point during the night, eliciting all sorts of action -- and noise -- from the nurses;
- I had trouble breathing because there was a lot of gunk in my lungs;
- I had three large tubes inserted into my body via three holes cut through my abdomen approximately one inch below my breastplate which on the other end were connected to a large machine on the floor that made loud sucking and slurping noises;
- I had a catheter which helped me to empty my bladder;
- I was facing a large clock on the wall which made loud ticking noises all night long;
- I could hear my new valve clicking open and shut.
After a surgical procedure that requires the use of a heart-lung machine, patients often report small changes in their senses of taste and smell which last for a month or two. They also often have depressive episodes. I had none of these symptoms while in the CCU. My guess is that I was too busy with the post-surgical pain and breathing problems to worry about such trivial matters.
While in the CCU, I was given water to drink. Thank the gods for water. Nearly six weeks after the surgery, I still drink mostly water at home. I will drink diet soda when we go out to eat, but I haven't had a sip of soda since I had the operation.
At any rate, the night led to morning, and I was then visited by saints Debbie and Mom. The surgeon's nurse also appeared and helped the nurse assisst me with climbing out of bed and sitting in a chair.
Yes, only hours after the operation and they had me perform the nearly-impossible feat of planting my arse in a chair and remaining somewhat upright for a few minutes. Since my chest was freshly sewn together, I couldn't begin to lift myself. The tubes in my stomach, bladder, and arms proved to be annoying obstacles as I moved between bed and chair -- and eventually from chair back to bed.
Everyone praised me on my ability to sit. "Wow. You're really doing great," the nurse would say. "Gee. You're moving about sooner than we expected," another would quip.
In my mind, I just wanted to do whatever it took to get me:
- Out of the CCU, and
- Out of the hospital.
Saints Debbie and Mom hung around during the visiting hours, talking with me and expressing their deep relief that I came through fine. I was not there in the waiting room while the minutes passed agonizingly slow, not knowing whether or not the surgery was going well. I could, however, see their relief in their eyes and hear it in their voices. It was incredibly comforting.
Pat the nurse came into the unit before I was transfered to the cardio floor. He pulled the tubes out of my abdomen.
Now, saying the words "pulled the tubes" recalls the painful event for me in extreme clarity. For anyone who has not had drainage tubes pulled from their body, I will attempt to explain the pain that this entails. First, you must realize that one tube is in the left lung cavity, one tube in the right, and the third in the cavity surrounding the heart. They are about sixteen inches in length. They are also inserted during surgery by cutting three small holes completely through the abdominal muscles and then snaking them into their proper places. "Pulling them out" sounds so very benign, so matter-of-fact.
The nurse warned me of the pain, but I was blissfully unaware of what he meant. When he pulled them out, I experienced approximately four seconds of a deep, wrenching sensation that was quite unlike anything I had ever experienced. Days later, I would tell Debbie that the feeling was probably as close to a stabbing that I would (hopefully) ever get. I could not breath for those four seconds, and I yelled out loud at the end of it -- something I rarely do.
Well, as if that wasn't enough, the on-duty nurse at the CCU then proceeded to pull the catheters out of my body. One was in my left arm, one was in the right side of my neck, and one was in my penis. Each was handled with no care and apparently with the full intent of making sure that I would have a really bad day.
Debbie was furious, but kept quiet lest the nurse respond with something more unspeakable. Mom turned pale and probably wished she were somewhere quite different. The nurse, I learned as she wheeled me to my new room, was on her last day in her current position and was happy as could be that she would start her new job in some unknown place, most likely conducting training exercises in torture. As I bid adieu to her, I wondered how many other patients that day would get bladder catheters ripped out of their bodies and arterial holes improperly serviced so that massive subdural hemorrhaging in their forearms would result.
Debbie and my mother spent the next week basically performing most of the ill-forgotten chores of the nurses that were supposed to comfort and aid me.
Monday, March 21, 2005
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.
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.
Sunday, March 06, 2005
A Small Matter of the Heart, Part 1
I recently underwent major surgery and I thought that the gory details would be of interest to someone. Considering the fact that this blog is about as well hidden and unread as anything could ever be, the "someones" who may find this interesting number somewhere between 1 and 2.
At any rate, I shall begin with a bit of my medical and family history. Strokes and heart attacks have been the cause of many untimely deaths throughout my ancestry. Even my father had a tough time battling heart disease. When I was a wee child, I was plagued with strep throat. After a good number of infections hit me in succession, my doctor sent me to the hospital because she suspected I might have contracted rheumatic fever.
Now, whenever I have my teeth cleaned (or have any kind of dental work performed), I take an antibiotic before the event. When I had an impacted wisdom tooth extracted in December of 2004, I both premedicated with Amoxicillin, and took a steroids following the operation. You see, the mouth of homo sapiens is filled with bacteria. This bacteria is continually released back into the body when we brush our teeth, get them scraped clean, or floss. It's not a big deal.
People who have had rheumatic fever, on the other hand, need to protect themselves a bit more because rheumatic fever often damages valves in the heart and this bacteria has a higher chance of sticking to the damaged valve, thereby causing some serious problems.
Well, all had been quite normal with my life until one dark night in the middle of January 2005. I went to bed and began shivering. After five minutes of this, it went away. At the time, I probably thought that the temperature in the house was a bit too low for me, so I did what guys apparently do best: I forgot about it.
Two days later, Deb and I went out to eat at a local retaurant. While sitting in the booth, I began to shiver. This lasted about twenty minutes, during which I tried my best to remain still by wearing my coat and drinking hot coffee. Deb was mystified and I was just a bit alarmed, but the shivering stopped and we went home.
The next day, Deb had to go out of town for work and I was home alone that night with the doggies. At approximately 6 p.m., I became extremely cold and my teeth began to chatter. Thinking that I most needed warmth, I got into bed, wrapped myself with all the blankets, and rode out the shivers that followed. This time, however, my entire body shook. This lasted about fifteen minutes, after which I realized that I felt feverish and thoroughly worn out.
This happened every night at about 6 p.m., with one exception wherein I woke up at 3 a.m. out of a dream, shivering in the dark. Deb was out of town most of the week. When she returned, she decided to do something about the shaking. For three nights, I went through the now-familiar routine of shaking, trying in vain to keep warm with blankets. On the third night, that being January 23rd, Deb took me to the hospital.
Let me explain why. Each night brought on a worse episode than the days preceeding. I would take medicine to bring down the fever, but the shaking began to get a bit out of control. By the time I began to calm down that sunday evening, my temperature had soared to 104.5 degrees (Fahrenheit). I also remember screaming in pain while the shaking was going on because, in addition to the chills, I was convulsing rather violently. Anyone who's experienced a high fever would understand the awful headaches and weakness that accompany the rise in temperature.
So, off we trotted to the emergency room. The nurses in attendance were very nice, but I had unfortunately broke the fever before we finally found ourselves in an examination room. The chills and fevers, we were told, were hallmarks of an infection and, because of this, they drew several vials of blood from me and sent it off to the lab for culturing. Meanwhile, the hospital contacted my doctor -- a general practitioner -- who in turn authorized a prescription for a very strong antibiotic (levaquin). We knew the blood cultures wouldn't show anything for several days, but the stuff I got was supposed to be very good at killing a wide range of bacteria.
During the next week, I saw my doctor a couple of times. I had a CT scan done on my chest, abdomen, and pelvis, just in case the problem had anything to do with lymphoma. And, the fevers sort of went away. I had no episode on monday, but I did every other day. The shaking never got as violent as it did the previous sunday, but my temperature rose every night, reliably, to somewhere around 102.
The CT scan showed a slightly enlarged spleen, which is consistent with infections, but it also showed nothing else of importance. Thus, cancer was ruled out. The lab results from the cultures, unfortunately, all turned up negative. This was really bizarre, because blood cultures are a very good means of identifying (and verifying) infections.
It was at this point, I believe, that my GP found himself outclassed. He had no idea what to do next, claiming that my condition was probably just a virus. The antibiotic that I was given lasted ten days. During that entire time, I was still getting nightly fevers, although they were not quite so dramatic as they had once become.
I also noticing something else: I was gradually becoming weaker. By the time the next weekend arrived, I had trouble standing for more than 30 minutes before I had to sit down. I noticed that my heart pounded harder than normal when I rested. I also noticed that I sometimes felt like something was in my throat when I went to bed, causing me to swallow over and over again until the feeling went away. We thought that it was probably due to the infection or the antibiotic.
On February 7th, Deb had to go out of town again for work. This was monday. I had been trying for several days to get my GP to suggest another test or try something else to see what was causing me to get the fevers and become so darn weak. Since he was clueless, he was very reluctant to see me.
On the eighth of February, Deb called the GP's office and basically told him that he was showing disturbing signs of negligence. This apparently caused some alarm, and I was in his office at 4 p.m. that afternoon. He asked me about my symptoms, blathered on about how bitchy my fiancee seemed to be, and gave me the impression that he wasn't much of a physician. Finally, as an afterthought, the good doctor decided to listen to my heart.
While I waited, I could practically see the blood drain from his face. He turned to me and said that I had a murmer. Furthermore, I was told to get my happy arse to a hospital.
Thus began the second phase of my ordeal.
At any rate, I shall begin with a bit of my medical and family history. Strokes and heart attacks have been the cause of many untimely deaths throughout my ancestry. Even my father had a tough time battling heart disease. When I was a wee child, I was plagued with strep throat. After a good number of infections hit me in succession, my doctor sent me to the hospital because she suspected I might have contracted rheumatic fever.
Now, whenever I have my teeth cleaned (or have any kind of dental work performed), I take an antibiotic before the event. When I had an impacted wisdom tooth extracted in December of 2004, I both premedicated with Amoxicillin, and took a steroids following the operation. You see, the mouth of homo sapiens is filled with bacteria. This bacteria is continually released back into the body when we brush our teeth, get them scraped clean, or floss. It's not a big deal.
People who have had rheumatic fever, on the other hand, need to protect themselves a bit more because rheumatic fever often damages valves in the heart and this bacteria has a higher chance of sticking to the damaged valve, thereby causing some serious problems.
Well, all had been quite normal with my life until one dark night in the middle of January 2005. I went to bed and began shivering. After five minutes of this, it went away. At the time, I probably thought that the temperature in the house was a bit too low for me, so I did what guys apparently do best: I forgot about it.
Two days later, Deb and I went out to eat at a local retaurant. While sitting in the booth, I began to shiver. This lasted about twenty minutes, during which I tried my best to remain still by wearing my coat and drinking hot coffee. Deb was mystified and I was just a bit alarmed, but the shivering stopped and we went home.
The next day, Deb had to go out of town for work and I was home alone that night with the doggies. At approximately 6 p.m., I became extremely cold and my teeth began to chatter. Thinking that I most needed warmth, I got into bed, wrapped myself with all the blankets, and rode out the shivers that followed. This time, however, my entire body shook. This lasted about fifteen minutes, after which I realized that I felt feverish and thoroughly worn out.
This happened every night at about 6 p.m., with one exception wherein I woke up at 3 a.m. out of a dream, shivering in the dark. Deb was out of town most of the week. When she returned, she decided to do something about the shaking. For three nights, I went through the now-familiar routine of shaking, trying in vain to keep warm with blankets. On the third night, that being January 23rd, Deb took me to the hospital.
Let me explain why. Each night brought on a worse episode than the days preceeding. I would take medicine to bring down the fever, but the shaking began to get a bit out of control. By the time I began to calm down that sunday evening, my temperature had soared to 104.5 degrees (Fahrenheit). I also remember screaming in pain while the shaking was going on because, in addition to the chills, I was convulsing rather violently. Anyone who's experienced a high fever would understand the awful headaches and weakness that accompany the rise in temperature.
So, off we trotted to the emergency room. The nurses in attendance were very nice, but I had unfortunately broke the fever before we finally found ourselves in an examination room. The chills and fevers, we were told, were hallmarks of an infection and, because of this, they drew several vials of blood from me and sent it off to the lab for culturing. Meanwhile, the hospital contacted my doctor -- a general practitioner -- who in turn authorized a prescription for a very strong antibiotic (levaquin). We knew the blood cultures wouldn't show anything for several days, but the stuff I got was supposed to be very good at killing a wide range of bacteria.
During the next week, I saw my doctor a couple of times. I had a CT scan done on my chest, abdomen, and pelvis, just in case the problem had anything to do with lymphoma. And, the fevers sort of went away. I had no episode on monday, but I did every other day. The shaking never got as violent as it did the previous sunday, but my temperature rose every night, reliably, to somewhere around 102.
The CT scan showed a slightly enlarged spleen, which is consistent with infections, but it also showed nothing else of importance. Thus, cancer was ruled out. The lab results from the cultures, unfortunately, all turned up negative. This was really bizarre, because blood cultures are a very good means of identifying (and verifying) infections.
It was at this point, I believe, that my GP found himself outclassed. He had no idea what to do next, claiming that my condition was probably just a virus. The antibiotic that I was given lasted ten days. During that entire time, I was still getting nightly fevers, although they were not quite so dramatic as they had once become.
I also noticing something else: I was gradually becoming weaker. By the time the next weekend arrived, I had trouble standing for more than 30 minutes before I had to sit down. I noticed that my heart pounded harder than normal when I rested. I also noticed that I sometimes felt like something was in my throat when I went to bed, causing me to swallow over and over again until the feeling went away. We thought that it was probably due to the infection or the antibiotic.
On February 7th, Deb had to go out of town again for work. This was monday. I had been trying for several days to get my GP to suggest another test or try something else to see what was causing me to get the fevers and become so darn weak. Since he was clueless, he was very reluctant to see me.
On the eighth of February, Deb called the GP's office and basically told him that he was showing disturbing signs of negligence. This apparently caused some alarm, and I was in his office at 4 p.m. that afternoon. He asked me about my symptoms, blathered on about how bitchy my fiancee seemed to be, and gave me the impression that he wasn't much of a physician. Finally, as an afterthought, the good doctor decided to listen to my heart.
While I waited, I could practically see the blood drain from his face. He turned to me and said that I had a murmer. Furthermore, I was told to get my happy arse to a hospital.
Thus began the second phase of my ordeal.
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