I was lying in critical care.

After five hours under the cardiac surgeon’s care, I have to say it was bliss in intensive care. The pain drugs flowed freely though the multiple number of lines entering into

Let’s see…this one leads to the…ummm…..ummmm

my neck and wrist.  Forget that my bed space and the area around my body looked the back of my High Definition TV set and home theatre. There were cables and lines and diodes everywhere…pain killers and beta-blockers and blood thinners and catheters and heart telemetry and blood pressure cuffs and pace maker wires and saline drips and chest drainage tubes, and who knows what else, were exiting and entering my body through a Medusa-like tangle.

I was wired for sound and without exaggeration, it took my nurse almost 20 minutes to untangle and create order from the plastic and rubber kitten’s ball of hoses and tubes. And honestly, I could care less,  I was as high as a  red-faced Metropolitan Mayor!

But eventually, Nurse Judy fought through the tangled mass and treated me to a wonderful bird bath, getting rid of the pinkish disinfectant – and the odd dried blood spot – that I was slathered with during the op.  I took stock of the 35 cm incision from collarbone to sternum and the 25cm incision down my left forearm, the IV in my neck and I chilled – a kind of Lucy in the Sky with Diamonds chill – which was okay, because as you remember, Ringo Starr was supposed to be one of my surgeons (see Act VI).

I had visitors…my wife, my brother, and my Mom and Dad came to see me and spent some time chatting. At least that is what it sounded like in my brain. I have no idea what came out of my lips…gobbledygook for all I know. But it’s okay, they had a babel fish with them – or at least they smiled at the right times. I think I lasted about 7 minutes before I was too tired to form any semblance of words. My body was telling me to shut up. And rest. So I did.

But don’t worry; even after everyone left I was never alone.  I had a new friend that I had to carry 24 and 7, and that I never wanted to be without.

No – not morphine or other opiates

I was Linus van Pelt. I had my new security blanket. It was (and still is) my chest pillow.  I hugged my “chest pillow”… a heavy flannel sheet that was folded and folded and folded and folded like an origami swan, and then tucked into a pillow case. Hugging that pillow with every ounce of my strength was the only thing that stopped me from feeling like my chest was splitting wide open when I moved, which was rare, or when I coughed – which unfortunately wasn’t as rare as I would hope.  Moving I could control. But the cough…unexpectedly and inconveniently, I coughed the weak cough of the injured, as my lungs tried to take over responsibility for providing me air and getting rid of the phlegm in my lungs – an unfortunate side

I love my pillow…

effect of intubation and having a machine breathe for you for over 5 hours.

I enjoyed my private room and around-the-clock care. I even had a great chat with one of the Veterans of the Battle of the Bypass… a blue vested cardiac volunteer (obviously wearing the smock prepares one for a future career as a Walmart Greeter).  Funnily enough, we had served together in the past and he had just recently celebrated his Depart with Dignity ceremony from the Canadian Forces – a medical release due to the operation. I had not even considered how this whole episode would likely end my Army career. Eeeek!

We talked briefly, once he overcame his shock over the fact I was a fellow member for the Zipper Club at 48 years of age. As I would find out later, once you become part of the Club, it is like you learn the “secret handshake” – there are just so many of “The Bypassed” out there. Every time I turned around, there was someone else telling me how they had blocked arteries and that a bypass had changed their lives.

Great news.  I just wish I wasn’t 20 years younger than them.

I was pretty content in my little drug-infused hamster ball.  But, sadly, nothing lasts forever – not even the super-drugged up nirvana of post-surgery opiates. And despite the wisps of hope that I would stay in Intensive Care because the cardiac post –op ward was full, it was not to be. A bed came free in “general population”’; I hope it was because someone was discharged, but no one could tell me.

So I was moved from my deluxe single accommodation to a semi-private room.

Now I have not written much about the several room-mates I had over the course of my almost two weeks in the hospital. For the record, I had five with a joint age of 324…the youngest at 45 and the oldest clocking in at 84. And save for one, the average stay together was for almost three days at a time.

I tell you, if you want to learn about people – hang around with someone who is scared to death but tries not to show it. I learned a lot about the human condition of those who face the prospect of open heart surgery. Yes it is routine – but it is complex and there are risks. And apparently you want to get a lot of your chest (no pun intended)

Firstly, there are no inhibitions or privacy…the flimsy little cotton curtain between bed spaces is not very sound proof. Whether you want to or not, you learn a lot about bodily functions, diagnoses, prognoses, family, lifestyle and a host of other things that you would never, ever, ever care to share with a stranger – unless you are a stranger sharing a hospital room and something critical in your body is not working properly.

I learned about my roomies’ relationships – as couples, with their children, with their families, with their friends. I learned about regrets and a few things that would change when the operation was all over.  I might have even shared a few thoughts myself…though I am more of a listener than a talker. It is amazing how a few well placed “tsks, tsks” and some reflective listening will calm the soul.

But back to post-operative care…

Being in general population sucked. I went from one-on-one care to one nurse caring for 8-12 patients. And at night, the ratio got worse. Funnily enough, CBC carried a

Noise…noise…noise…

news-piece just after I was discharged reporting on the noise levels in a hospital ward. They reported it was terrible; hardly conducive to rest or sleep or recovery.  I can tell you it is brutal – day or night. Between alarms, call buttons, PA announcements, jovial staff, the food carts, cleaning staff, patients in pain, it was a wonder I slept at all. Add to that the sad and unnerving coughing of the post-operative smoker trying to rid their lungs of cigarette goo in their lungs, it was absolutely hellish.

I slept on and off – more a series of three-hour cat naps between the oral doses of pain killers. Unfortunately the pain killers came every four hours. It is funny – actually, sad – how your body knows it is time for another dose. I can only imagine the pain of the junkie as the glow wears off; I became a clock-watcher – especially at night. For the last hour, I slept in fifteen minute bursts hoping for the nurse to magically appear with the little plastic pill cup that contained another three hours of pain-free sleep. During that last 45 minutes of hell, I tried shifting into a comfortable position, by raising my back, or lowering my legs, or shifting on to my side, or arching  – but as I was weak and in pain, I could not even manage that to get relief. Several times I had to call the nurses to untangle me from the absolutely tortuous positions I had managed to slide into.  I tried to be brave, but I have to tell you, it pushed me to the limit. I tried to hold out as long as I could and wait for the nurses to help me, but more often I gave in, and pushed the call-button forl help and relief. I did not feel empowered or healthier or stronger. I felt weak and vulnerable and unhappy.  And I was a young, fit, robust fellow. I can only imagine how my elder room mates were fairing.But over time, things got better. My sense of humour never left me – it thought about being snarky and mean – but that is not me.  Plus, no sense in pissing off the pain relievers! As I got better, I learned to enjoy the little things in life: peeing without a catheter, orange Jell-O, a shower, clean socks, sweatpants and a hoodie. And I walked…first just to the toilet; then 10 m, then 40, and finally being able to walk to the nurses’ station to grab an apple juice and make toast.  Like I said, the simple things – smelling burnt toast without having a seizure – made every day better.

I often thought that I was not ready to go home – I had pain, my chest bone was still healing, coughing hurt like no one’s business, I had 60cm of stitches, and I had three holes in my diaphragm from various removed hoses that were trying to patch themselves up. I couldn’t imagine being without my meds and staff to move me.  But after 72 hours in general population, I was ready. I could not stand being there – eating steamed food that tasted like cardboard, sitting among the sick and injured, listening to the pain and agony, and trying to keep up a happy face. I wanted to be in my house, with my wife and my stuff. So after showing the staff that I could climb up and down and a flight of stairs, I was granted parole.

Hallelujah!  A quick visit by my Surgeon and I was sprung free. With discharge instructions that included restrictions on how much I could do, how much I could lift, how much I should eat, I was allowed to leave. My wife helped me out of the hospital, and as I waited in the hospital lobby while she went collect the car, I was dazzled by the sheer volume of noise and activity around me: conversations and food line ups and questions to the Info Desk; the smells of Tim Horton’s coffee and muffins. Though my life had been on hold for over two weeks, for everyone else the game of Life had gone on. I was like a country farm-hand in the Big City, marvelling at the chaos and cacophony. I was no longer a patient, I was just a guy.

And off we went into uncharted territory. Armed with only a few manuals, some well-intended verbal advice, a couple of 8.5×11 sheets on post-operative issues and pain management techniques, we headed off. The ride home was nerve-wracking for both my wife and me – I had the resiliency of a raw egg. The only thing between my breast bone and the seatbelt was my “issue heart pillow/security blanket” – a cheerful, red, overstuffed pillow the size of a kids’ rugby ball, snuggled firmly in place to absorb any jostling, bumps, sighs, sneezes or coughs. I hugged that pillow like it was toilet paper from the Carnival cruise-liner Triumph.

And that was the tone for the first few days of recovery: angst, hesitation, worry…every ache and palpitation, every heavy heart beat, every sharp pain, every perceived redness or soreness around an incision was a siren call to my internal hypochondriac. I imagined misaligned grafts and an over-taxed heart or rampant infection. I was not that strong mentally or physically, despite what my external face said.

But that did not last forever. With the strong support – physically and mentally and emotionally – of my wife, my kids, my parents, my brother and sister, and the multitude of friends far and wide who sent me positive energy, I moved through the yucky bit and beyond.

And now, here I am at Surgery plus 16 days: full of vim and vigour and appetite. The strength has returned and so has the humour. I walked almost 2km today. And I am getting better.

And with that, I will sum up the Coronary Chronicles.

It has been a wild ride. I hope that my exercise in self-indulgence has entertained you as much as it has helped me. I also hope that I have been a cautionary tale for some of you – especially for you guys out there who are in my age bracket. Alpha male or not, recognise we are not invincible and immortal. Many of us have been ridden hard and put away wet.

Listen to your body…get things tested…check for bumps and discoloured moles.  Early warning will increase the odds; go into hand with pocket Kings and show the House that it can be beaten.

And now on to bigger and better things…when I write again, I will be just be a regular simple fellow…albeit a little more battle-scarred.

Later,

ASF

Ground Control to Mister Pal…

During heart surgery, the beating of the heart is temporarily stopped and life is maintained through a cardiopulmonary bypass (also called CPB or the heart-lung machine). The heart is stopped either through decreasing its temperature or through the injection of a preservative. The heart-lung machine then keeps the blood pumping through the body, adding the necessary oxygen and nutrients.

I guess, if you consider a beating heart as a necessity for life, I was technically dead for a few hours. I suppose my brain was alive; but if you asked me what happened between the hours of 10am and about 3pm on 2 November – I could not tell you. Those five hours did not exist for me.

But as for the hours surrounding that…

Having just been bumped due to a higher priority heart emergency on 1 November, at about 10pm I had enough of Friday. I brushed my teeth, and readied myself for bed hoping that tomorrow they would fix my heart. I was still nervous. I was also very tired. Almost 24 hours of mental preparation for the postponed operation had left me fatigued.  And though I had a verbal promissory note that Saturday would be the day, as I had experienced today, there were no guarantees when it came to affairs of the heart.

So after asking for a sleep aid – as I figured sleep might be a bit elusive otherwise –  I toddled off into bed after an iodine scrub shower, feeling very pink and very shiny.  And I slept.

I’m here for the surgery…

I dreamed that night…and while I do not recall all the details, I do remember that it had a surreal quality to it. Sort of a Beatles animated movie

Clickety-clikey

feel or a Tim Burton feel – alternating between Ringo Starr and Edward Scissorhands as my surgeon. Freaky…

I must have slept well because promptly at 0600 hrs, it was vital signs’ time  and the start of The Wait Part Deux. It was dark and the rest of the ward had not woken up yet. There was a sombre, suspenseful feel to the air  – I can only describe it as that slow motion period in The Terminator when you know Arnold Schwarzenegger is going to come around the hospital corner into the shot, but the frame continues to be empty. I knew what was coming, but I was dreading it slightly.

I contemplated what would happen next – trying to create a mental image of the words I had read and the steps that would happen, much like we are taught to mentally rehearse our actions for specific drills to prepare ourselves for the task at hand. Adding to the surrealism,  I could hear the occasional snort from my roommate who was having a lie-in. He was not on until Monday.

And soon I heard footsteps in the hallway. And no, it was not Arnold.  It’s funny, when you lie in a hospital bed for long enough, you get pretty good at discerning who is who based on their footsteps. Their gait, their strike, their pace, their footwear, the noise of the equipment they are pushing or pulling, are great clues as to whether it is the floor nurse, the ECG technician, the blood work technician, the food lady or the cleaner. In this case, it was neither. First it was my daughter, then the comforting clack-clack-clack was my wife’s, accompanied by my parents and my brother. They made it in at 0630 hrs if I was whisked off promptly at 0700 hrs.

I am glad they made it in. I can imagine nothing worse than not being able to say, “Good luck. See you later. I love you,” as you arrive too late and are faced with an empty hospital bed.

But that wasn’t the case as we settled in to wait the last call for the surgery. Before too long, Dr Payne arrived, offered his good mornings and told me that he had a quick procedure to do first and that I was on for 0930 hrs. I smiled wanly, I had heard this refrain before. But I also saw a determination in his eyes that he had no wish to leave me twisting in the wind. So we waited.

There were no new skills learned overnight that made the wait any more bearable. It was still tense and uncomfortable. We all knew it was risky and invasive. We all knew what could go wrong. But we also knew, as we did the day before, you gotta start before you can finish.

And at about 0900 hrs, a stretcher rolled down the hallway, flanked by the cardiac surgical nurse. My chariot had arrived. I had a nervous pre-game pee, and then said my

Mom and Dad…18 hours after surgery. Benefits of a good drug program…

bye-byes to my family. Now while I am an affectionate fellow, the family has demonstrated various degrees of physical affection depending on the circumstances.

Sometimes the hugs can be in short supply.

But on this day, the hugs, kisses and “I love you”s were not held in reserve. I could see worry on my parents’ face, my daughter’s, my brother’s and most sadly, on my

wife’s. They were all being brave. We all know that not showing your fear and worries is the Unwritten Rule in such cases.  I climbed onto the gurney, ass flapping in the breeze, and after another quick round of farewells, I was wheeled to the Operating Theatres, flanked by my wife.

Now a hospital is a maze at the best of times, but I remember thinking, I hope my wife is leaving a trail of bread crumbs, because I have no idea of how to get back. And selfishly I added a personal post-script – “I don’t need to, because I’ll be out of it when I head back this way.”

As we continued the long trek into the bowels of the 2^nd floor operating theatres, I couldn’t help but look at the passing fluorescent ceiling lights and hear the clickety-click of the gurney without thinking I was in some cheap grainy made-in-Canada TV special. It was like I was watching a bad movie.

We arrived in the operating waiting room and I was greeted by the Chief Surgical Nurse, Tammy, who checked my identification and files and bracelets and asked me questions to determine if I was of sound mind and right body, and briefly explained that in a few minutes we would head off to the operating room and meet the remainder of the team. When she had finished reviewing the huge red binder that was my hospital life, she left my wife and me alone for a few minutes to say bye. There were no violins, no tears – at least that I could see or feel – and with a hug and a kiss, off she went.   I hoped she could find her way back to the Family safely.

And I began another four-minute roll to the operating room where my heart would see the light of day – or at least the fluorescent lights of KGH OR.

The next five minutes were a dizzying flurry. In a rapid series of staccato 5-second introductions I met the anaesthetist, the heart-lung machine maestro, the artery harvester, the surgical resident, the head surgical nurse, the second assistant and a couple more people who I have no idea about. I was asked rapid fire questions about my health and my weight and some other general questions. I was befuddled – who do I answer first? Let me think, dammit!

We’re reaaaaaaaadyyyyyy…

All these questions!

I was asked to move from the gurney to the operating table – which let me tell you – is not built for people with girth like mine. I felt like I was going to fall off at any moment. Soon my arms moved to my side in the crucifix position and I felt pokes and prods and pushes. Checklists on bodily function, equipment readings, drug solutions, IVs, telemetry outputs were being read out confidently and rapidly, and confirmed and repeated by assistants. Soon a confident reassuring voice, probably coming through a smile if I could see past the surgical mask, said,

“Pal…it is time. We’re ready. Are you?”

In that five minutes it had taken for the team to get everything ready, they had overwhelmed me and stunned me into mental paralysis. Between the sedatives to ease the anxiety, and the questions to keep me distracted, I had not even thought of what was going to happen now – man, they are going to harvest arteries from my arm, then cut my chest open, then saw through my breastbone, then crank open my ribs, then retract my chest to open the cavity, then transfer all my breathing and blood circulation to a machine, then stop my heart and then sew things to it, and then close me up. I had not had one negative thought or forgiving during that entire time that I had entered the operating room to the moment that I was going to be rendered unconscious. Man they were good!

And with a last look at those cheery eyes, I went under the knife.

Now I could jump to the post-operation recovery, but that would not be fair to my family, who had to find ways to occupy the better part of 5 hours. Thankfully it was early, so they all could while away a few hours eating a Fat-Boy special breakfast. And that they did. They also walked around Queen’s looking at preparations for the Science Formal that my daughter and her boyfriend would attend later that day. Apparently the 3-story castle the Engineer students built inside the Hall was magnificent.  But even after that they waited over another three hours…reading…napping…drinking bad coffee…making lame jokes…and mostly worrying and worrying. As for how they felt, you will have to ask them. I cannot imagine it was positive energy.

And then I surfaced. So I am told. I was wheeled into critical care, past my family, who depending on their personal desires, wanted to see me right away, or wanted to wait until I was looking more human and less machine.  My wife and my brother came in right away – I do remember playing charades, unable to talk through the intubation – and mimicking I was cold. My reward was a nice pair of winter socks. They felt grand.

Still freaks me out…

And then I fell under the spell of the anaesthetic and the pain  killers, and drifted in and out of consciousness. I vaguely remember the intubation being removed, I foggily remember my Mom kissing my forehead, my Dad looking stunned and pleased at the same time. But these could be just things I made up because like David in the minivan, I was not sure it this was real. But, as I was in for a long day and night of slipping in and out of consciousness, the family had a last word with the Surgeon before calling it a night.

Dr Payne was extremely pleased with the surgery – it went very well – despite my stubbornness in allowing him access to my harvested artery (which he apparently had to dig for like gold) and that my rib cage was tighter than a drum. Thank goodness he was a strong man, he needed every bit of his anaerobic strength to crack me open like a walnut! And while we had known that I needed a double bypass, in the end, he decided to add 50% free, just to save us the pain of cracking me open again in 10 or 15 years.

I was good to go again, completely re-tooled with clean hoses and valves, enjoying one-on-one nursing in a quiet, clean and calm intensive care hospital room with calm lighting. One little whimper, and the nurse was at my side with pain killing support and a reassuring word.

All that was left was the recovery. And thought at the moment, life was beautiful. I should have enjoyed it more.

Because, in less than 24 hours I was going to fall off my nice, soft, fluffy cloud and realise just what trauma my body had experienced…

End of Act Six

Later,

ASF

(Note: First post-surgery blog. Your patience is requested today, I don’t really care how well I am spelling or using grammar; save for omitting the Oxford Comma – when it comes to that, “misuse is abuse”.)

Also, despite my personal story, Please spare a moment to remember on November 11th, and always. https://asimplefellow.com/2012/11/08/the-11-hour-of-11-november/

At the end of the last installment of The Coronary Chronicles, (queue Newsworld Theme Music here…fade away from stock footage of Toronto’s Mayor’s latest media rant and inebriated stupor…), I had decided that I was All In. I had thrown all my chips against the House, holding a pair of Kings.  I am sure the more confident amongst you would say, “C’mon, it was Pocket Bullets” – taking into consideration my fitness, my age, a good surgeon, and how quickly we had caught the heart disease.

But, even Bullets can lose a hand of Texas Hold’em.  And, seriously, I was not a “poker-thlete”, playing for one of those bling WPT bracelets.

So after signing the permission papers for surgery, for transfusions, for medications, emergency measures AND donor card, etcetera, I left my fate to my very capable surgeon, the ironically named Dr. Payne, and the Hospital functionaries. And before long, I was scheduled for CABG on Friday 1 November.

My roommate, who despite his age, was holding a good pair of cards too, was also scheduled for Friday.

And with the practicalities now taken care, of, I entered in to the High Stakes World of Cardiac Arterial Bypass Surgery. Indulge me while I continue the sporty analogy –  the 1 and 2 of November (for those that have followed my case) were exactly like betting games.  Though this was 21^st century medicine, my fears, my decisions, my concerns, my rationalisations were all like trying to figure out the best horses for the Trifecta, or figuring out the betting line on the NFL.

Let me explain:

So my roommate, aged 68, and I were both scheduled for Friday: one of us at 0800

OK gents, first one there gets new arteries…

and the other at 1300 hrs. So how do we, when asked by the Surgeon, decide who goes when? Do we arm wrestle, do we run to the operating room at the sound of the starter’s pistol, do we draw straws, cut a deck? There’s no real protocol in these instances.

My internal Good Samaritan said, “Do the right thing…”

Others, good Samaritans themselves, but more pragmatic than me, would say, “Go as early as you can, mate. Timetables change.”

Now the right thing and the smart thing are not necessarily exclusive, but I was loathe to lunge out with, “I’ll go at 8, thanks.” It seemed unsporting…

But more than that…was it smart?

I mean, was the Doc at his best at 8am? Did he do better after a warm-up patient, like a baseball pitcher throwing a few fastballs before first inning, or a goalie after the pre-game warm up. I don’t know. Or would he be sharper, more fit, less tired at 8am? I needed a racing program to make an informed decision. I had no clue whether Dr. Payne was a “mudder” or “a sprinter.”

Booo!

And while I knew that none of these points were relevant – as I already knew he was a brilliant surgeon with a great ability to blend fact and tact –  my mind was not there. It was in that “throw-salt-over-the shoulder”, is the “bogey-man-behind-me frame” kind of space.

Regardless of the Flop, it was decided that I would be first, with my roommate batting cleanup. For me, I’d be lying in Critical Care, sipping Demerol margaritas by noon on Friday.

It was like being told you were in the starting lineup for this week’s big game. Time for the psyche.

First went the calls to family, and then to friends, and then workmates – which in the military is like one big mixed up group. The jungle drums quickly passed the news. And as before, well wishes came from many corners of the globe – the benefits a military career.

And as  the operation marched closer, I prepared myself. I knew enough about the operation; I was not into watching You Tube videos or Google Images of actual operations. That was just too macabre. I’ll leave that to the Walking Dead fans,

I was preparing, by staying away. I did all the proper stuff – perhaps just as macabre – but necessary. I called the bank lady, and talked finances with my wife. It was unpleasant – the actual act of explaining where our money was, where it would come from if the pocket kings weren’t good enough, and how it should be dispensed so she wouldn’t be homeless or future-less – was accepting that I could lose. An unpleasant thought,  but far less unpleasant that the thought of her trying to sort it out by herself while grieving and dealing with frozen accounts as my Estate was dissolved and distributed.

And I relaxed – as best as I could knowing that I as soon going to look like a stunt-double for the movie Alien.

And then it was Friday. I was expecting to be collected at 0715hrs, so the family could make it in, congregated in my room to wish me luck. And we waited. How do you describe that feeling? Well for those in the military, it is the 4 hours you spend in the waiting area of the Base Gym or Training Facility, waiting for the bus to carry away your loved one to a deployment. For those in the military, it is the uneasy mix of wanting to spend as much time as you can with someone because sometimes Fate is cruel, and wanting it to start as soon as possible  – because it can’t end if it does not start.

And at 0800 hrs the doctor told me had an emergency case. I was not off the roster, but I was second. And my roommate third. Chances of two surgeries on Friday – good. Of three? Poor. I commiserated with him. That was a kick in the jewels – but at least he could mentally stand-down. I still had to maintain game form and keep the stiff upper lip. And I could see the strain on my loved one faces, despite the smiles and the positive words that it’ll be soon.

And the hours dragged on…1200. No word from the Operating Room. 1300 nothing. At 1330 hours, I was told that if it did not start by 1600 hrs, that my surgery would be cancelled. But this time, my sportsman’s mine started to kick in. If I was at 1600 hrs, my man would have completed almost 8 hours of complicated heart surgery. And if the surgery had been successful, he would have been lauding a couple of game –changers that he and his team executed – but he would have to have been exhausted, mentally and physically. And if it had gone poorly, would he be reliving The Sports’ Network Turning Point as he was executing mine. Rationally I knew that answer, but as a patient waiting to undergo what would probably be the biggest procedure of his life, I was not rational.

And disappointingly, but mercifully, at 1430 hrs, they waved me off. My surgery was postponed. To when, who knew. His next window was Thursday – six days away.

I was dashed, but after a chalk-talk with my family, I knew it was for the best. I want it done – but I wanted my Surgeon at his best too.

And so I waited to go through the whole thing again, when at about 2230 hrs that night, the Nurse walked into my room. “Dr. Payne” wants you to start fasting at midnight.”

I guess the game was back on…

End of Act V

Later,

ASF

(Note: Surgery did not happen when planned; a sicker heart had priority and occupied my Surgeon for 8 hours.  Bad news: I was bumped. Good news: I can still wipe my own bottom.)

As I left you faithful reader, I had just learned that my heart was sick and that despite my age, outward appearance, physical activity, and general good health (at least compared to the others on the cardiac floor…) I had heart disease. Whether it was lifestyle or bad habits or a predisposition to generating plaque were irrelevant to the situation at hand –  my heart arteries were in need of some cardiac liquid plumber.

The angiogram was still a bit of a mystery, but the diagnosis was clear:

• My main heavy-lifting arteries were pristine, clear and showing no distress whatsoever
• A series of secondary arteries, that wrapped the heart, were bunged up; substantially, and for some length. In some places the arteries only had 15% capacity – that’s a shit-load of gunk lining the artery walls. Further constriction and the possibility of the plaque destabilising and completely blocking the artery were real concerns.

And the prognosis was clear: sort this out, STAT before it sorted me out.

But the question was how? The location, length and thickness of the blockages meant that the “Master AngioPlaster” would have her work cut out for her. This fix would need a lot of stents and in some uniquely, weird locations. And because some were near junctions of arteries and veins, the Doctor was unclear of second and third order effects on the major flow patterns. It was not a simple case of one, or two, or even three stents removing the pea from under the mattress. If it was angioplasty and shoring with the mesh stents, this was going to be the equivalent of a cardiac Chunnel.

This required a major cardiac huddle between the Interventionist and the Artery Plumbers to discuss options.

And so, with that, my femoral artery was closed up and I was wheeled back to my room and my wife.

Now it is not easy to look someone you love in the eye and deliver the emotional equivalent of throwing them in a pool of ice water. But I figured, since my face said it all already, it was best to take the Band-Aid off in one quick and rapid motion.

“It’s not good. I have several blockages that need more than a simple stent.  We’re here for a while.”

And with that, we entered a whole new realm.

A bypass?

Jesus.

I had heard about those. I knew that they opened your chest and stopped your heart and sewed some stuff on. And I had heard about singles and doubles and triples and quadruples. It sounded desperate and complicated and scary.  But honestly, I knew nothing. I only had notions.

There is a lot of good reading on the topic of heart health and heart disease, on heart maintenance and heart repair. And over the next 12 hours, between moments of sheer disbelief and bitter acceptance, I read a lot.  I read about angioplasty and stents; about all those drugs I was taking and all about coronary artery bypass grafts. I read about probabilities and risks and success rates and quality of life after.

And I thought. And then I though some more.

I asked myself is this all my doing. Did I just ruin the most important thing that I have been given; my heart. Did I ruin because I like eating the fatty bits of the medium rare prime rib? That I enjoy my fine scotches and craft beers? Love my occasional bag of potato chips? Cream cheese? M&Ms?

I have always believed that you can live a Wilde life: everything in moderation, including moderation. But maybe I was wrong. But how can this be? I just ran a half marathon five weeks ago. I quit smoking over 4 years ago. I dropped 30lbs from my heaviest in 2004. I was not exactly a poster child for the healthy heart foundation, but I definitely wasn’t a poster child for heart disease either.

And I brooded and worried and became stressed. In hindsight I expended a lot of energy wondering how I got here. It made me a bit of an angry man. I was experiencing all the stages of loss. I had moved through denial and was now working through the anger. I was bitter that this had happened to me. There were fatter and very idle people out there…how come they weren’t having heart attacks? Why were they out enjoying the weekend sucking on their cancer sticks, drinking Kilkenny’s, and scoffing down large bowls of gravy and cheese curd laden poutine while I had to decide between Cardiac Curtain Number One or Curtain Number Two. It just wasn’t f*cking fair.

But I am not by nature an angry man.  I like to think am rationale and at times I am a fatalist.  Que sera, sera. My mom always told me that things happen for a reason. We just don’t see it until later. And after a day or two, I started seeing it. It sorted came at me like a ship through the mist. Maybe this was an opportunity.

I talked to the specialists. As we all know, I could have helped myself by being a little lighter, by making a few smarter eating choices, but overall I understood and ensure that I got the necessary OMEGA-3s and grains and greens and vegetables and fruit and proteins. I was not a fast-food junkie or a cola addict. I ran and rode my bike. And though I enjoyed life and its finer things, I was doing all the things you need to do to be good to my heart – not dogmatically, but sufficiently I thought.

The only joker in the deck was my ancestry.

I am not blaming anyone, but you cannot run from genes. High blood pressure, diabetes, and stroke are part of my ancestral family medical history. But there is so much that is unknown – in pre 1960s India, people died and no one knew or cared why. There was grief. And then there was land to be divided. Who knew whether it was heart disease or not?  All I know is that I have heart disease. My body produces cholesterol and plaque and my body will continue to produce cholesterol long after my arteries are repaired.

Maybe, this episode, this minor heart attack, this signal, was the chance to start over again. To take stock, and assess the devil-may care attitude, and perceived invincibility of my youth and early middle-agedness, and decide if I could keep up that pace forever. And I could…if forever was 49 years. But in my vision, forever was much longer than that. Yes there would be moments of craziness, but I needed to make sure that “Crazy ASF” understood that in the future there would be some cheques he shouldn’t write – his heart may not be able to cash them.

So eventually, after a day to think about, I chatted with the cardiac surgeon. And I was ready. I had three options:

• If I was an 80-year-old man, who was unable to stand the rigours of surgery, and who was going to sit on his butt and do nothing but stare out the windows at the pigeons, then perhaps we could go with medications to control pressure and flow and rates and stuff…meds would buy the time for something else to fail catastrophically, like my liver

• If I was a relatively inactive fellow who was willing to live a relatively sedentary life of long walks in the rain, and wanted to always watch what I eat while taking a very large daily medical cocktail of anti-rejection drugs, cholesterol pills and a host of other heart regulating agents, then the stents would be perfect. Upside? Less intrusive, quick recovery. Downside? Second guessing every tweak and pain as I tried to live my life as I wanted would cause me mental distress. And anyway, a stint was like paving a pothole. Effective, but eventually you have to pay the piper and replace the road.
• And the granddaddy of the option, the coronary artery bypass graft (CABG). A complete new superhighway for my heart akin to replacing Montreal’s crumbling turnpikes. The downside? My chest would be displayed to the world as a machine kept me alive. Risks include stroke and infection and just bad luck. The upside? After convalescence, I would be the old me – minus a few bad habits. I would be able to run, to dance. I could even swim the dolphins if I wanted. I would be on a less strict regimen of heart pills, but I would be me again. Plus I would have a pretty wicked scar to show off as part of the Zipper Club

Go for it!

For those that know me, I am pretty sure you could guess which I would choose. Being active and full of life, being who I am, there were no half measures. As a young lad, with great prospects at recovery, and with a robust immune system, I was sure. And I decided.

CABG it was. I knew what I had to do.

End of Act Four…

Later,

ASF