My "Sudden" Open-Heart Surgery
I was in preoperative testing for a knee replacement. My knees had been bothering me for years and my doctor was ready to take positive action about it. I was excited at the thought of finally getting them fixed, but terrified at the process to get there. In the preop, a nurse listening with a stethoscope said the ominous words ”you have a significant heart murmur”. So ends the knee surgery and begins visits to the cardiologist…
After extensive testing by the cardiologist, to include shoving an ultrasound transducer down my throat, the “team” of doctors declared that my Aortic valve was so crusted with calcium that my condition was “critical” and the valve would have to be replaced very soon to prevent my imminent death.
The only health issue that hadn't plagued me up to this point was my heart. I have extensive family background of heart problems, so was tested often for cholesterol, and heart-related issues. Up until now...nothing. Then why this sudden valve problem? Cancer treatments 20 years ago!! Apparently radiation to the heart causes this type of calcification decades after the radiation treatment. This occurred 17 years after my radiation and occurred very quickly and suddenly.
There are 2 main ways to replace this valve: Old-fashioned open-heart surgery where they cut through your breastbone and cut their way to the actual heart, cut the old valve out, and sew a new valve in…or an intra-catheter method where they feed a new valve through an artery to the valve location, then expand the new valve inside the old, forcing the old out of the way, effectively replacing it. Sadly, after extensive testing, the doctors discovered I had too much calcification of the entire heart. If they fed the replacement valve through the arteries into my heart, they feared they would dislodge calcium into my blood stream causing a stroke. At least there were a couple advantages to doing the open-heart: the open-heart method allowed my surgeon to clean that calcification out of my heart precluding later damage, and by cutting the old valve out and sewing a new one in, the shape is perfect for a catheter replacement when I need the next replacement valve.
I spent quite a bit of time deciding whether to do this surgery: I would rather have 12 to 18 months of my current lifestyle, than 10 more years as a weak invalid. It was a tough decision, but ultimately the desire to have some brief period of retirement made my decision for me.
Surgery day arrived. I walked into the hospital at 5:30 to prepare for a 7:30 surgery. They dressed me in a gown, established a couple of IV lines, shaved my chest, asked me a ton of questions about my health and the purpose of the surgery, and wheeled me into the surgery room. It was all white gloss tile filled with people and equipment. They strapped my arms down on either side of the “table”, and that’s when I passed out. They must have given me the fentanyl without my noticing.
I woke up with the breathing tube still in me. I had a very hard time breathing with it in, and no way to communicate that to anyone. They had my hands strapped down so I had no means of telling anyone I couldn’t breathe. Luckily, my wife was holding one of my hands so I could focus my communication attempts on her. I slowly “tickled” the palm of her hand. Then I started tapping Morse code into the palm of her hand. By then, she was catching on that I was awake and actually said “I don’t know Morse Code”. She then took control of the situation and started telling me to do things: “Squeeze my hand, open your eyes, wiggle your toes, cross your legs”. After a series of these exercises, the hospital staff finally believed I was awake and unstrapped my hands. At that point I motioned for a pen and paper so I could communicate. The first words I wrote were “I can’t breathe”. It solicited no positive response to my distress, but at least they understood I was aware. Then, I wrote “Cough, cough, cough!”. I wanted that fucking tube out of me so I could inhale enough to clear my throat. They didn’t understand and instead shoved a suction tube into my mouth (hurting my gums with the hard plastic tube). I inhaled as much as I was able and weakly coughed; it was excruciatingly painful, but it cleared my throat enough so I could breathe a bit easier. They finally explained that they had some things to do before they could remove the tube and it would be a while longer. I drifted off for a while and awoke to them finally removing that damned tube from me.
Tube or not, I had a very hard time breathing. If I inhaled anything more than a tiny pant, the pain was excruciating. I couldn’t fully catch my breath and was reduced to about 10% breathing capacity for the following 3 days. Also, the breathing tube left my mouth and throat VERY dry. It felt like my mouth and throat were coated in tar. Every chance I got to drink water was a heavenly moment in relief! Sadly, very few of the nurses actually provided water to me and I was left parched for days as well.
I ultimately discovered that I was unable to breathe well because of 3 large drainage tubes located in my chest. They were each about 3/8” to ½” thick and snaked between my heart and my lungs; filling my chest cavity such that there was no room for my lungs to expand when I tried to breathe. Once those tubes were out, my breathing issues nearly disappeared immediately.
The next 2 days were spent re-learning to sit, walk, cough and eat. I wasn’t allowed to use my arms for much, so I had to learn new ways to do everything. All the while, I was awakened every 90 minutes round the clock for meds, blood tests, readings, teaching. It was a harrowing experience with little opportunity to heal. Throughout, I hade a half-dozen tubes or wires protruding form me, so I couldn’t move very easily and when I did, I was in constant fear of disconnecting something.
Finally, on the third day after surgery, they removed my drainage tubes and almost immediately wheeled me to a less-intensive ward. This was, apparently, where I was supposed to heal and rest for my return to my life. Sadly, that didn’t turn out to be the case.
The second ward was understaffed and very noisy. I slept in quick 45-minute periods. By the time I left there about 96 hours later, I was exhausted. The dressing that covered the drainage tubes hadn’t been inspected nor changed since I got it. I demanded they change it before I left the hospital and they grudgingly did. Unfortunately, they didn’t know how to cover it and left it under a waterproof dressing. I also didn’t know how to dress it, so every time I changed the dressing afterward, I also covered it in waterproof dressing. After several day of draining without healing, I finally called my doctor’s office to discover that it was supposed to be exposed to air or it would never heal; it would just keep draining!
Also, on that ward, they kept skipping the meds I was supposed to receive. I reminded them of those that I knew, but was constantly worried they were missing meds I didn’t know I should be taking.
5 days after the surgery, they finally released me. To add insult to injury, they told me I wasn’t allowed to walk out of the hospital by myself; I had to be wheeled out on a wheel-chair. My wife sat outside the hospital in a hot car in August heat for 35 minutes while I waited. I finally told the nurse I was leaving to which she responded “You can’t leave, I won’t let you!” which elicited from me “Stop Me!”. The nurse stormed off angry and lo and behold, a wheelchair suddenly appeared. Thank God I didn’t have to get into it with a security guard over something as trivial as how I was leaving!!
It took three days after being released for me to finally ask my doctor’s office how I was allowed to sleep. Until then, I’d been flat on my back all night long. After a couple hours of discomfort, I’d get up, walk around the house for 20 minutes to stretch the kinks out, and get back into bed. I was exhausted from simple lack of sleep! They told me to lay however was comfortable for me. Hallelujah!!
On the third night of release, I slept 10 hours straight. I got the best sleep I’d had in 2 weeks. It was awesome…but…
That morning, while reading e-mails,. I began to feel shaky and slightly nauseous. I checked my blood pressure and it was quite low (85 over 55), and the machine told me my pulse was over 150. I tried to manually check my pulse but couldn’t feel It beating consistently. The feeling lasted all morning until I finally called the doctor’s office again. The nurse told me to find somewhere to get an EKG. After several phone calls, I got into a cardiologist’s office for the EKG. They hooked me up, ran about 12” of paper, and took that paper to the doctor. Within seconds, he was back in the exam room telling me he’d just called an ambulance and alerted the hospital emergency room to expect me: I was in Rapid Atrial Afibrillation.
I spent the next 24 hours in the hospital getting “Stabilized”…more like them trying a variety of chemicals that all accomplished nothing…until they performed a “Cardio-version” on me. That procedure is a strong electric shock through the heart to establish normal rhythm. Luckily, I was asleep during the process. Within 2 hours of the shock, I was again discharged.
That brings me to now. I’m nearly weeks out and don’t feel all that bad. I’ve seen both the surgeon’s Nurse practitioner and my cardiologist, and between the two of them received very conflicting instructions. The nurse is very strict and “by the book”. She tells me not to use my arms or exert in any way for the next 6 weeks. If I do, I will rebreak the sternum, it will get infected, and I risk death. The cardiologist on the other hand, at the 2-week mark, said to go ahead to do anything I want and let pain be my guide; if it hurts, stop doing it.
I am taking an approach between the two: slowly increasing my exertion, avoiding excessive use of my arms, but trying to re-build my strength until about 5 weeks from now I should be back to fairly normal.