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My heart attack, Part 6: Coming out of surgeryBY: Bob Levin 05.19.2012
“Only one-third of all patients improve,” the surgeon told us after the operation. No one had dropped that statistic on us beforehand.
We are the 33%BOB LEVIN
Sixth in a series of articles about the author’s heart attacks.
“A happy surgery,” Dr. G called it. He hadn’t needed to replace my valve with a pig’s; he had fixed the one God gave me. He had performed a single bypass, not two. His 83 minutes had low-balled the over/under by seven.
“You can see him in two hours,” he told my wife. “Go back to the hotel. Relax, nap, take a shower.”
Adele returned to the hospital after an hour and a half. The board didn’t show me in Intensive Care. It didn’t show me in Recovery. It still had me in Surgery. She couldn’t reach Dr. G for an explanation. Hospital personnel said only that I was “being worked on.”
She waited four hours without another word before an exhausted and ravaged Dr. E, the associate whom Dr. G had left to close me, told her I was fine.
Which proved an exaggeration.
The problem had been that my resistance to the usual-and-customary blood thinner, Plavix, had placed me on its alternative, Effient. I was fortunate that an alternative even existed, since it had been developed just a few years earlier. But I was unfortunate that its existence had been too brief for doctors to understand its workings. They took patients off Plavix a week before surgery. I came off Effient ten days before mine. Which proved insufficient.
I had bled and bled. They had coded me, an intensive care nurse informed me the following evening.
“You mean like Code Blue?” I asked.
Maybe she had meant Code Grey, which summons security when a patient attacks a doctor, and I had been in no condition for that. Maybe she had meant Code Pink, used when someone swipes an infant from Pediatrics, for which I had no inclination.
“Dr. E saved your life,” the nurse said.
Scars and sores
I had a 12-inch scar down the middle of my chest and, below that, what looked like a second belly button where a tube had pierced me. I had a five-inch scar on the inner aspect of each lower leg where veins had been harvested for my bypass. My right shoulder ached from a muscle that had been pulled when they had spread me apart for better viewing. The breathing tube had scratched my throat, so eating, drinking and taking pills triggered fits of coughing.
(All of this would hurt less than the bedsore I developed on my butt over the next several days from being forced to lie in one position.)
My biggest problem was being forbidden to put pressure on the wires that knitted my chest together. I couldn’t use my arms to lift or steady myself when I got in or out of bed or sat on or rose from a chair. I couldn’t reach behind myself to pull a T-shirt on or off or to wash or dry my back. I couldn’t lift more than a newspaper.
With Dr. G occupied elsewhere and Dr. M (my cardiologist) on vacation, Dr. E attended me. His surgical skills were superb, but he struck me as being about as drawn to the sunny side of life as Barnabas Collins.
He cemented this assessment the moment he told Adele and me that it would be six months before we’d know if the surgery had done any good. “Only one-third of all patients improve,” he said. “One-third remain the same, and one-third become worse.”
Now he tells us. No one had dropped that statistic on us before. We welcomed the news the way a birthday balloon would welcome a porcupine.
On the other hand, Adele said, I looked “beautiful. Totally healthy, peaceful, with good color.”
A truck on my chest
My room in Recovery held one bed and a chair. Its window’s view was limited to a slice of park and its TV’s reception unaugmented by cable.
Once again, nurses, techs and one therapist after another impinged upon me. I was bled, X-rayed and scanned. My blood pressure, temperature and pulse were measured. The restrictions I had been under in Intensive Care still held. To expand the range I might roam depended on the will I could muster. Dr. G had warned at our initial consultation I would feel like a truck had hit me. Now I had to hoist that truck from my chest.
Weeks of cardio-rehab had strengthened my legs, making it easier to handle “Look, ma, no hands” maneuvers. I rose and sat. I walked the halls and climbed stairs. I did the recommended exercises and requested license to do more. If my blood pressure registered too low for me to be allowed out of bed, I exercised while lying down and, now primed, had the nurse take it again.
Dr. G, the surgeon, visited five days after my operation, just as I was exercising my lungs. Every hour I drew air through a tube, forcing a marker toward the top of a clear plastic cylinder. “Squirrels could do that,” he said jocularly.
He snatched the tube, wiped it clean and rang the cylinder’s gong. I was prepared to hear that in his spare time he sang tenor for the San Francisco Opera. Instead, Dr. G elated us by announcing that I would be discharged the following morning, one day earlier than expected.
Our elation didn’t survive the afternoon. An echocardiogram, whose results Dr. G hadn’t seen, had shown that my heart was functioning too poorly to expel the ten pounds of fluid sluiced into me during surgery. (In fact, we learned by eavesdropping on residents making rounds, my heart might be so damaged that it would never be capable of properly oxygenating my arms and legs and brain.)
I was not discharged. Instead I was returned to Intensive Care so I could be monitored while IVs fed me medication to strengthen my heart and help me void. It was frightening to be back in the ICU. It was frightening not to know how long I would be there.
The medications worked so well, though, that I wet my bed twice.
I continued to rise and walk and exercise. I resisted temptations to use my arms. On the occasions when confidence and macho daring pushed me on, I re-trenched as soon as Adele caught me.
My appetite was good; I watched snippets of ball games; phone conversations with friends cheered me. Adele and I brightened my free time by reading to each other from the most recent Jackson Brodie mystery. Once she sneaked me a double espresso, which lifted my spirits further— and set my left leg jiggling uncontrollably.
My second weekend as an in-patient, I had a visit from Dr. M, my cardiologist. On her return from vacation, she’d found Dr. G’s uncorrected message that he’d discharged me. Only after being unable to reach me at home had she inquired further.
Dr. M was her usual warming, ebullient self. She reassured us that there was no reason to believe the surgery had failed. It was natural that the shock from it would traumatize my heart, but recovery was equally likely. Even if I became no better than I’d been before the operation, other options were available to me.
She even managed to find one certainty that had been realized: “Everyone agrees that, if it comes to it, you’ve proved yourself a good candidate for a transplant.”
That wasn’t exactly “I’ll see you again in five years,” but it was something.
I came up with a second reason for hope. For six months I’d teetered along the high wire of not knowing if I would need surgery. Now I had put that concern behind me.
Two days and one improved echocardiogram after Dr. M’s visit, I was home, ready to learn toward what heights that base would launch me.♦
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