Serious As A Heart Attack: Epilogue

Home at last. Home, where I can lie in my own bed, eat food of my liking, sleep in front of my cheesy old movies and relax while my body knits itself back together. At last I can truly heal, because I am home. At least that is what I thought. The reality however is that I have never before had my chest split open and sewn back up and been put on blood pressure and antiarrhythmic medications, so I really had no basis for expecting anything. And the unexpected is exactly what I got.

My appetite and enjoyment of the taste of food did not return right away, and although I ate much more than I did while in the hospital, and ate much better stuff, there was little joy in it. A persistent light headedness continued and continues to make walking difficult, and the slightest hill of any sort will exhaust me almost instantly. The combination of less food and a lower sodium intake than before my surgery, plus my various medicines, led to dehydration which for one night put me back into the hospital. What a scare that was, as one of the possible causes of my problem could have led me back into the operating room to be opened up again. I think I would have preferred to slip into God’s arms rather than to do that. Fortunately for me, my problem did not need to be addressed in that manner, and I will always be grateful for that fact.

One thing that I mentioned earlier was the threat of constipation, the result of anesthesia plus pain medication plus heart medications. I ate salads and veggies galore and other high fiber foods, drank a lot of water, and still fell afoul of constipation. To a great many people that seems like a minor problem, a humorous side-note, a potty joke. It was none of those things. Constipation is a vastly painful condition which is exacerbated when in the context of major surgery, which left me in agony for at least six hours and almost sent me back to the Emergency Department, so awful was it. I feel constrained not to describe my pain or the difficult and messy manner by which my constipation was resolved because I believe that the story should be told in detail with proper prefaces so that the reader will understand from the very beginning that there is nothing in that story meant to be funny or gross or shocking or anything else. If I ever write that story it will be because I hope that at least one person will read it and take it to heart so that they never have to go through what I went through that day.

And then there’s the sweating. I would wake up in the middle of the night with bedclothes, sheets and pillows drenched in a cold sweat. I assume all of the medications I had taken plus the anesthesia had to work their way out of me, and also my improved eating which replaced what was already a fairly good diet was probably liberating toxins stored up in fat cells which were now melting away. I have lost nearly fifteen pounds since my surgery and the junk stored in those fat cells has to get out one way or another. My wife was kept busy washing clothes and sheets and pillow covers every morning for much of the first week that I was home. This has now subsided and I hope is at an end, although I deep protective coverings over my bed just in case.

Still, there have been many things at home that have lived up to my hopes. I cannot go into my garden but I can see it from the deck or a window, and I can eat out of it. I would love to pull the weeds creeping amongst my rows and beds and lift the drooping tomato plant branches and support them with cloth slings tied to wooden frames that I have build around the plants, but that is not to be for now. Instead I can watch my wife and my son water and tend and harvest my vegetables, and that counts for a lot.

So it’s been two steps forward and one step back; one step forward and one step back, and so on. My recovery is very likely to take the whole three months that I have been given off from work, and I still wonder if I will have the energy to return to what can be a physically demanding job. I’m not overly concerned about that as we could probably do all right if I was to retire, but I did not want to do that yet and it would be a hardship of sorts if I should have to. I will continue to pray for healing and be comforted to know that I have family and many good friends praying for that end as well.

Now it’s time to tell other tales and lighten the mood. No matter what happens from this point on, my life has still been an interesting one, to me at least, with many stories to write and hopefully many laughs to share with my readers. And from now on when I am tempted to respond to somebody’s question of ‘seriously?’ by saying “I’m serious as a heart attack”, I believe that I will catch myself and ask “was I really that serious?” My guess is that the answer will be that I am not quite that serious after all.

Serious As A Heart Attack, Part VI

“Good morning Glenn. How are you feeling today?” Kim, my new daytime nurse, was smiling and active, even perky. Nothing could have been more diametrically opposite of how I felt. I had been awakened two or three times the night before by a nurse taking vital signs or a phlebotomist drawing blood or somebody sticking a needle into my belly injecting something, insulin I think. I still felt light headed, as I had since I awoke from surgery, and I was still without any appetite at all.

“Today we are going to walk a little, and if you want you can take a shower. Your urinal is in the bathroom; if you need it, call and we’ll help you walk to it. Your breakfast will be here in a few minutes. Is there anything else I can do for you now?” I assured Kim that I was all right for the moment and she left to perform other duties, leaving me in bed to ponder my new stage of recovery. I did not feel at all like eating OR walking, and even though I knew that both would be good for me my body recoiled at the thought of it. As Kim had promised, my breakfast did arrive within minutes of her departure.

Diane, a nurse assistant, brought in my breakfast tray and set it on a bedside table. “Come on, Mr. Durden. It’s time to get into the chair.” I grudgingly complied, grasping a pillow against my sundered sternum and allowing Diane to get her arms around me so that she could help me up to a sitting position on the side of the bed. Using my own arms to push myself upright was forbidden, as the muscles of the arms are leveraged against the muscles of the chest which attach, among other places, to the sternum. I did not need the muscles attached to either side of my sternum pulling in opposite directions, separating that bone which was now cut into two pieces and wired back together. One surgery was enough; I had no need of another to rewire my sternum.

“Up we go.” And up we went. I sat on the edge of the bed for a minute or two, getting my balance, and then stood up, once again using my legs instead of my arms to push me erect. The chair was only a few steps away and I carefully sat down in it, still pressing my stiff pillow tightly against my chest. “There you go” said Diane. “Now lets see what we have for breakfast.” What we had was oatmeal with raisins, a small fruit bowl, a cup of cranberry juice and something else, the memory of which escapes me now. I looked upon my feast with a relish approaching that with which a taxpayer looks upon the approach of an IRS auditor.

“You have to eat to get your strength Mr. Durden” said Diane, and I knew that she was right. So I lifted my spoon and began first to work on the chunks of canned peach and pear and a few bits of melon which might have been fresh, and washed it down with my juice. That didn’t amount to much but it added up to more than I really wanted. Now I dipped my spoon into the oatmeal and began to mechanically chew. It was like asking a T-Rex to eat tofu. I rolled each spoonful from one side of my mouth to another, chewing and chewing and finally swallowing, just to get rid of the noisome stuff. I probably ate no more than a quarter of the bowl and then pushed the button that would alert my caregiver that I was finished. Diane quickly arrived and swept away my tray.

“I’d like to get back into bed now” I said. “Since you’re already up, why don’t we get your weight and take a little walk” Diane replied. I groaned but nodded my approval. Clutching my pillow I once again arose and walked unsteadily about ten feet to where a large scales awaited me. I stepped onto it, Diane recorded my weight, and then we headed out of the doorway and into the hall. I really didn’t want to do this and so I set out to get it done as quickly as possible. I probably went thirty feet down the hall, and at a faster rate than I should. I turned around to make my return trip and the distance to my room looked like miles to me, so I quickly pushed on, wanting to get this ordeal over with and back into my bed.

At last I did get to my bed and carefully fell back into it. I could feel my heart pounding with the exertion and my nurse quickly made an appearance. Kim took my vital signs, felt pulses, listened to heart and lungs and then disappeared for a few minutes. When she returned she injected a medication into the central line that was still in my neck. It turned out that the exertion caused my heart rhythm to go into atrial fibrillation, and the result of that was a new medication taken each day to ensure that my heart stayed in what is called a ‘normal sinus rhythm’. I still take that pill every day and will probably continue to do so for another month or two to come.

This pattern of activity dominated the rest of that day and the next two and a half days to come. I finally got my shower the next day, and not a minute too soon. I had worked and hurt and sweat for four days by then and I could draw my fingernails across the back of my neck and scrape up an opaque bit of dirty oil underneath them. A chair was placed in the shower and I sat on it while I sprayed myself with a hand held shower nozzle. I have never felt better than when I emerged from that shower.

Thursday and Friday were a monotonous progression of walks and meals (which nearly made me throw up) and blood draws and finger pricks and belly injections and attempts to have a bowel movement. Anesthesia, pain medication, and even some of the heart meds that I was taking have the unpleasant side effect of causing constipation, and when you have had your chest cloven in two any sort of straining is to be discouraged. My central line was removed from my neck (a very strange sensation if I do say so myself) and a final few wires in my chest were extracted. It felt good to finally be free of all technologies which had invaded my badly beaten-up body. Friday was proposed for my discharge, but my doctors, nurse, and ultimately I felt like one more day would do the trick.

Saturday arrived and I initiated my final round of unappealing meals and walks around the hallways of the sixth floor. I took another shower and brushed my hair, and for the first time in a week and a half put my baseball cap on my head. My wife appeared at about ten thirty and we waited as a depressing series of doctors and pharmacists and dietitians made their final interviews with me. Finally a cardiologist cam into my room, spoke with me for a few minutes, and pronounced me ready to go home.

Words are inadequate to express how I felt as I rode in my wheelchair down that elevator to the first floor. My wife had moved our car to the front entrance and we rolled out to it. I rose up out of my chair, sat carefully in the back seat, said my goodbye to Diane, and my wife fired the car up and rolled away from the hospital and out onto the street. I relished seeing the blue sky and the familiar houses as we crossed the five blocks or so which separate my house from the hospital. People were out working in their yards and at one house a small child played at it’s dad’s feet while dad puttered around the garage. The beauty and rhythm of the life I watched as we drove home were healing medicines all by themselves.

In a very few minutes we rolled in front of our house. My wife pulled slowly up the driveway and I looked out of the window at the abelia and hyssop that I had planted years ago. I saw that the white, pink and coral flowers were crawling with bees, and it looked good and natural. I also saw that the hyssop needed water. Hyssop has more shallow roots than abelia and must be watered more frequently. “That’s OK” I said to myself. “It’s all right now. Daddy’s home.”

Serious As A Heart Attack, Part V

Day number three after open heart surgery dawned in a fog, much as day number two had ended. My nurse had configured my bed in such a way that I was semi-upright all night, and for some reason that helped to control the pain which had run riot in my body the day before. As always I slept most soundly in the later morning period, so I slumbered pretty much right up until breakfast arrived. I was transferred to my chair and waited for my breakfast tray to be brought over to me.

I don’t remember what it was that was brought to me for breakfast but I do remember my response; I grabbed the nearest plastic bucket – they kept one within my reach at all times – and threw up explosively into it. I had hardly anything in my stomach so the volume was low, and I felt a good deal better when that was done. I had no interest in breakfast however and asked them to remove it from me. It would be several days before I would have any desire to eat again.

Nobody had arrived to visit with me yet and so I remained in my chair for a while with my eyes aimed in the direction of the television screen but with no real recognition of what channel it was on or what they were saying. Time passed in this manner as people slipped into and out of my room, some to draw blood from the central line in my neck, others to poke my fingers to monitor sugar, and still others to give me some kind of injection into the fat around my belly. Most merciful was the nurse who came in to push another syringe full of Dilaudid into my central line. More than that is only a blur and I would not be able to accurately describe it.

As the morning wore on the various doctors taking care of me stopped in to check on me. First was the Family Medicine general practitioners, usually consisting a trio of Dr. Manning and two residents who are not yet licensed to practice on their own. Dr. Manning and I have known each other for years and he is a lover of history as I am, so we usually ended his visits by giving each other a history challenge question. “What was the Beatles’ album which changed the course of rock music?” (Answer: Sergeant Pepper’s Lonely Hearts Club Band), or “Which WW II battle took place in May of 1942 and changed the course of the war?” (Answer: Battle of Midway), and so on. On this day I was in no kind of shape for such banter and Dr. Manning could sense that. A brief examination by the residents ensued and I was returned to my bed because my exhaustion was now becoming more of an issue than the pain.

My wife appeared at this point and took up her position by the bed, stroking my forehead or brushing my shoulder, completely unable to reduce the pain but communicating clearly that she would do anything in the world if she could to take it away, and there was comfort in that. We passed an hour or so I think in that way until the next group of doctors made their appearance.

Dr. Willis is with the surgical group of which Dr. Grossing, my surgeon, is a partner. He was checking on me that day along with Rachel Lenz, the physician’s assistant who was involved with my actual surgery. They examined the incision site on my chest and declared it to be infection free so far and healing nicely, and then they knelt down by the bubbling canister at the foot of my bed. “Take a breath and bear down on it Mr. Durden” said Ms. Lenz. I drew a breath and bore down on it as much as my stoned stomach muscles and screaming chest would allow. “That looks good Mr. Durden. How would you like to have your chest tubes out?”

I had been told that the tubes draining grunk from my chest could be a major source of the pain I had been experiencing for the last day and half so I jumped at the opportunity. In a flash the tubes were gone and after a little puttering around on my chest, which probably represented suturing the holes where the tubes had been, I was finally free of the tubes and the urinary catheter which they removed at the same time.

The improvement in my pain situation was almost instantaneous. There was still pain aplenty but the Dilaudid was more than adequate to keep that down to an acceptable level. I could finally lie in my bed and enjoy my wife and son, who appeared a short time after one in the afternoon, and carry on a conversation with them between naps which tended to remain on point more or less. I would describe that afternoon as pleasant, at least as pleasant as one could expect it to be under the circumstances.

A big change occurred at about five o’clock however. A gurney appeared and it was time for me to leave the CVICU and transfer to the sixth floor where less critical patients continued their recovery. I knew right away that I would miss the staff in CVICU. They had been very kind and attentive and I felt very well taken care of. I want to visit them very much when the time comes that I can walk and move about with more ease than is currently the case.

The sixth floor was an entirely different place with an entirely different mission. Once deposited (lovingly) like a sack of potatoes in my bed in room 6102 I was in the care of people who’s mission was to get me ready to function at home again. Because I arrived in the afternoon, rather close to shift change, I had a grace period where I could lie quietly in bed with my thoughts and narcotic dreams. My new nurse and her team of two assistants introduced themselves and then that was all that I saw of them that night unless somebody had to take vitals, take blood, give me pain meds or empty my urinal. The evening was passed in broken sleep, but the morning came soon enough and my new recovery plan took off in a big way.

Serious As A Heart Attack Part IV

The second day of recovery began when I emerged lazily and with some difficulty out of a fog of anesthesia, narcotic pain killers and sleep. My wife was beside me, as she almost always was, and as the fog cleared she was asking if I wanted to sip some chicken broth. The doctors had explained that it was important that I resume eating and drinking in order to speed up my recovery. There was nothing I wanted more than a speedy recovery, so I was eager to comply.

The broth was listed as low fat, low sodium. I guess that this is standard for hypertensive cardiac patients, but I thought that low taste, low interest would have been a good deal more accurate. Still, an order is an order, so down the hatch it went. I drank a cup of cranberry juice as a chaser and relaxed back into my bed to continue my nascent healing process.

I knew that my urine was draining out from my bladder through a catheter and found the convenience of that arrangement comforting. All of the peeing in a urinal that I had been doing before my surgery had now been taken out of the picture, and I didn’t miss it. I was actually mildly disappointed when the catheter was removed the next day, which will illustrate as clearly as possible what a lazy man I truly am. I also had one or two surgical tubes protruding from my chest and coursing into a bubbling container. Why the container bubbled is a mystery to me. Those tubes were draining blood or air or anything else which might be in my chest post-surgically but didn’t belong there. I was practically unaware of those tubes at first, but that would change.

My nurse, who was one more wonderful person in a parade of wonderful people, was constantly flitting in and out of my room taking vital signs, checking IV fluids, and generally making me feel as comfortable as possible, and the latter duty involved administering periodic doses of a pain killer called Dilaudid. The dose was prescribed to be given every three hours as needed through a catheter threaded into a vein in my right neck.

My son made his first post-surgical appearance that day and I greatly enjoyed chatting with him, although the pain killer had the exceedingly weird effect of loosening my grip on reality. I have an active if somewhat shallow mind and it is not at all difficult for me to slip in and out of a daydream at any time. Under the deluge of Dilauded which was pouring down my central line I was no longer slipping into daydreams; I was now jack booting down the door and commandeering the residence.

A conversation might go something like this. WILL: “I’m going to go to the house tomorrow and water your garden. Are there any special instructions that you have for me?” ME: “Yes. Use the sprinkler on the onions and just lay the hose at the base of the tomatoes. Don’t worry about the dog (author’s note: I don’t have a dog), he stays in the shade and will fix the bicycle tire himself if you have a…. Wait a minute, that didn’t make sense, did it?” WILL: “Some of it, Dad. You told me to sprinkle the onions and just put the hose in the tomato beds.” ME: “Yes, that will work. Do the same with the cucumbers and squash and don’t worry about the asparagus because they take care of themselves since they moved out of the house and haven’t had much trouble except that one time that the police….” It was like that all day.

As morning moved into noon the pain in my belly began to grow and by lunch had come to dominate my consciousness. Hospitals like to use a pain scale of zero to ten, with zero being no pain and ten being agony. Those scales are highly subjective of course, and for me skinning my right foot and plunging the raw flesh into salt would be about a three. By noon I was at five or six. I sat up in my chair and tried to eat, and the pain seemed to subside a bit, but I was not able to eat much and soon returned to my bed.

The pain began again to cresendo and soon I was begging for more of the pain medications with the result that I became even more stoned but not one bit less in pain. I had maxed out my Dilauded dose and still I was crawling up to an eight-and-a-half. My nurse was truly sorry for my pain and tried anything she could think of to bring it down, including exchanging morphine for Dilaudid a couple of times, but nothing worked.

The nurse’s instructions were to get me up in a chair as much as possible so that the changed position would keep fluids moving and allow me to inhale as deeply as I could on a device designed to help me gain greater expansion of my lungs. I groused about having to move in my pain but complied. It slowly began to register with me that I really did feel somewhat pain-diminished when I was sitting up. Not pain free by any stretch of the imagination, but pain-tolerable. My nurse noticed this as well, and I stayed in my chair until it was time for visitors to go home and for me to try to get some sleep.

“There’s no way that I will be able to sleep if I lay down” I told my nurse. “I know” she replied. “That’s why I’m going to turn your bed into more of a chair.” With that she began to fiddle with buttons and my bed began to move like a Transformer. The head began to raise up almost like the back of a chair and the foot of the bed dropped down towards the floor, leaving me a shelf to be seated on with feet dependent and head upright, then she tilted the whole thing back so that I was reasonably in a kick-back mode. In that bed I passed through the night. The pain level stayed down at a four or so and sleep, with the help of the Dilauded and a benedryl capsule, stole over me and I enjoyed something which approached acceptable comfort the rest of the night.

That second day was one of the worst of my life. I have suffered physical and emotional pain before and this day stands out from all of the others by a long shot. The pain in my belly felt like the larval stage of “The Alien” was eating his way up from my intestines through my liver and diaphragn and into my chest. It was hard to breathe and I performed very poorly on the device through which I inhaled in order to expand my lungs. The pain was almost like a physical entity; a beaked, taloned and tentacled monster from one of the ‘B’ sci fi movies of the 19650′s that I loved so much as a kid

Only there was no love here on this day. The tentacles embraced me with a power which refused my lungs the ability to inflate. The talons dug into my flesh and denied me the opportunity to shake my monster off in any way. The beak ripped and tore through bone and cartilage and muscle to feast on the crying organs at my core. This monster came to stay, and none of the tricks and devices which became available at the end of the ‘B’ movies to enable the humans threatened with destruction to escape the final victory of the monster was becoming available to me. I was the captive of PAIN. I would remain that way. Tough luck, Kiddo.

The pain meds, which no doubt prevented me from shrieking at the top of my under inflated lungs even if they seemed to not be working at all, also kept my mind in the fog that I mentioned earlier. It was a humorous side note to the day when I would prattle on to my family and then stop, both of us knowing that I was not speaking of anything real at all. But there were those times when I was not speaking, when I stared vacantly at the television or at the ceiling or simply into the pain which gnawed at my belly, and they were not humorous. They were dead, or at least deadening. They robbed me of what is peculiarly me and replaced my me-ness with a stoned, mentally wandering imitation of me.

I am not a narcissist by any measure, but I have grown over the years to like myself. I am glad to know that I have some good points and I can clearly see the bad ones and work towards their correction without self-loathing. I have managed with the help of God to be a blessing – a mixed one to be sure – to a wife of thirty seven years, two children whom I adore and three grandchildren. I short, as the saying goes, I’m ‘comfortable being in my skin’. The drugs blurred my self awareness and I became ever so slightly not me. The sensation lasted most of a day and a half and never came to wholly dominate the real me. It tried however and it was not pleasant, and I was eager to cut down on the narcotics as quickly as the pain would let me, which I am told was a great deal more quickly than most people who have undergone my surgery have done. That process would become easier by the events of the next day, which will have to wait for my next post.

Serious As A Heart Attack, Part III

“Good morning, time to get up.” Sandra, my nurse for the Big Morning, had actually let me sleep for a half hour longer than the plan had called for, but now it was time to get the ball rolling and she was all business. My surgery was the first case of the day and if anything delayed me, the whole rest of the day would be thrown off as well. “Let’s get you unplugged and into the shower.”

Sandra removed my IV lines and covered both sites with plastic to keep them dry, and snatched off a half dozen EKG patches, removing a little bit more of what hair I had left. She then led me to a large shower where I scrubbed down from head to toe with some kind of special soap. After toweling off and re-gowning I was led back to my bed where more blood was drawn, more pinpricks were made in my fingertips to assess glucose, and both IV sites were declared to be too old to risk going to surgery with. I did not realize that IV sites had a useful lifespan, but it turnes out that they do and mine had outlived theirs thanks to my prolonged wait through the Forth of July holiday. In a flash both of those sites were removed and a new plastic needle, but thankfully only one of them, was inserted into one of the few veins on my arms that remained at that point untouched.

That accomplished, my new site was again covered with plastic and once again I was in the shower scrubbing myself down with the anti-microbial soap. And once again I was toweled off and re-gowned and led back to my room to await the transporters who would move me to the Operating Room. The wait wasn’t long. After double and triple checking of my name and surgical procedure I slid sideways from my bed onto the gurney.

I can’t really tell you what I thought as I rolled through those unfamiliar halls. Wait a minute: Unfamiliar? How could that be? For 26 years I had passed through those halls, looking at the linoleum or carpet, the artwork on the walls, the co-workers whom I would pass and acknowledge. This time however it was very different. This time I was looking up at the sound-deadening ceiling tiles interspersed with banks of florescent lights that passed monotonously by my vision. I probably thought of the life that I had lived up to this point, the highs and the lows, and I probably thought about what life would be like afterward, although I had no way of knowing what life would be like afterward and I knew it. One thing was clear. I have assisted with open heart surgery before and I knew exactly what that would be like, and therefore made the choice to not think about that at all.

We entered the O.R. and I did a repeat of what I had done in the cath lab four days earlier. Same freezing room, same process of identification of patient and procedure, same slide onto a hard table and same wraith-like gowned, masked, and hatted doctors and nurses and techs puttering around the room preparing their instruments and equipment for the surgery that was imminent. Soon the anesthesiologist was injecting some fluid into my IV and soon I was once again somewhere out in deep space. Somebody else was occupying that space between Alpha and Proxima Centauri so I sped by them to take a gander at what was happening out near Sirius.

My next twelve hours are pretty much lost. Surgery lasted about three hours and at some point I was rolled into my new room with my breathing still controlled by a respirator and with more tubes and hoses sticking out of me than an automobile engine. I remember very little of the rest of that day, but two events stand out. With a big, fat tube running into my lungs communication became a challenge, but I still wanted to express myself to my wife and there were several instances when I successfully did that. Two occasions which I actually remember of accomplishing that feat went this way. By engaging in creative hand signs I asked my wife not to cry, and later asked her to pray for me which she did. Shortly after that event my body remembered how to breath on its own and that really nasty tube was removed from down my throat.

The rest of the evening I can barely remember. My wife was there the whole time and my daughter arrived at near 7 PM. I don’t remember the daughter’s visit more than as a shadow but I do remember the visit by her husband which followed. He had been reading about the early Christian Church leaders and their relationship with the Roman Empire. He rattled on about Ambrose of Milan in the West and John Chrysostom in the East, and their beef with the Emperor Theodocius and so on. This is the stuff we both like to talk about, but my participation this evening was sketchy at best. I was later told that I would drift off, then return with a comment which was actually pertinent to the topic, and then drift off again. The presence of my son in law and wife, and their familiar chatter, were immensely comforting and it was around 11 PM that they left and I finally lapsed into an exhaustion and drug assisted sleep.

This concludes Part III of my story. It is a short segment because there was so little that I was consciously aware of. There has been much told to me which would flesh out my story but my interest here is to record my own sensations and perceptions. I did not live the other stuff, even if I was involved in it. My true recovery did not begin until the next day, and that tale deserves a Part IV all by itself.

Serious As A Heart Attack, Part II

“Good morning Mr. Durd— oh, Glenn! What are you doing here?” Serena was in my room to pick up the next patient for the cardiovascular catheterization Lab and had no idea that the patient in question was me. We had worked in close proximity for years and were friends, but she had never learned my last name. It’s all right, really. I don’t know her last name either. “I was bored so I thought I’d come visit you guys” I replied, and after being disconnected from my bedside I.V. and monitors. I climbed aboard the gurney where I was reattached to portable monitors and was whisked away to the prep area in the Cardiovascular Observation Unit.

Prep for a catheterization procedure, or simply a ‘cath’ as we medical types call it, does not permit a patient any modesty. Human hair is about as dirty an item as one can get and the prevention of infection will be almost obsessive-compulsive in any hospital worth going to. Therefore, the hair had to go and Serena, with a coolness and professionalism that helped to diminish the awkwardness of the moment, exposed my altogether naked groin and gave the family jewels a buzz cut. The duration of my stay in CVO was short and I was glad that I had no visitors. Because of the Privacy Act hospital workers must be very careful to respect the privacy of patients, and since I have worked at the same hospital which was now taking care of me for 26 years I know almost everyone there at least a little. The close association and familiarity bred comfort and discomfort in equal measures, and I was glad to be left alone while I awaited my procedure.

I did not have to wait for long. Hardly a few minutes passed by before my escorts reappeared to roll me into the cath lab itself. I noted instantly as I rolled into the room that it was cold as a tomb. Hospitals usually seem cold but I went from snug to shiver in about 30 seconds. After exchanging greetings with the staff I slid over onto the table and issued my first complaint as a patient about how cold it was. I knew that my complaint would do no good but it seemed obligatory that I should register it, and so register it I did. A technologist placed a thin drape over me and the anesthesiologist injected a fluid into my IV. I felt nothing different and in a moment the cardiologist appeared and briefly reaffirmed what she would try to do; an angiogram, of course, and a stent if the problem was found and could be repaired in that manner. I agreed once again and the masked, hatted face of the anesthesiologist reappeared. With what seemed to be wrinkles of smile about the corners of his eyes he said “goodbye”.

Goodbye wasn’t the half of it. “Enjoy your de-existence” or “happy annihilation” would have been closer to the truth. In what seemed like an instant of time a catheter was inserted into my right femoral artery, threaded through my heart, and to the origins of the arteries which supply blood to the heart muscle itself. The dye was injected, the narrowing was found, the possibility of a stent rejected and the catheter withdrawn, all while I blissfully spun somewhere out between Alpha and Proxima Centauri. At some point I awoke sufficiently for the cardiologist to show me the images and explain that surgery would be needed, and then I was rolled back to CVICU to await my date with the knife.

This is the point at which my timing comes seriously into question. I had my heart attack on Tuesday July 1, went to the ER Wednesday July 2, and had my cath on Thursday July 3. Can you guess what comes next? July 4! National holiday! Emergency procedures only. My condition was very emergent to me but in the grand scheme of things I was considered stable. I couldn’t go home I was told but instead would await the next normal working day for my surgery, and that day was four long days in the future. I asked my wife to bring me books and writing utensils, and settled in to wait out what, except for the four-a-day blood draws, was one of the most boring 96 hours of my life.

Of course I got a lot of reading done, wrote several letters (I love snail mail) and wrote the vast majority of “Serious As A Heart Attack, Part I”. I also entertained visitors. I especially enjoyed the latter. All of my nearby family came and stayed for hours at a time with me, as did friends from church and work and a reading group of which we’ve been a part for 15 years. I loved those visits and, although there are people who would rather not be bothered with excessive human contact if they were in the same position as I was, I think that visiting friends who are confined in the hospital is one of the kindest things that a person can do.

I did have one scare during my wait for surgery. On the day after my angio I got tired of using a plastic urinal while lying in bed and asked if I could walk into the bathroom and pee like a normal man. It was more than 24 hours after my procedure and all looked well so Nick, my nurse for that day, agreed to affix all of my medical accoutrement to a mobile IV pole so that I could accomplish that task. The first effort went flawlessly and I shortly arose to do it again. While I was standing before the toilet in midstream however I began to feel a twinge in my right groin which grew rapidly into a nice burn. I instantly knew what that could possibly be and hobbled back to my bed so that I could call Nick. Upon his arrival he immediately put pressure on the bulge which had popped up under the bandage over the site where the catheter had been inserted the day before.

What I had feared is called a pseudo aneurysm. When an artery is punctured it is necessary to put a great deal of pressure at the puncture site for a good long time to be sure that the small hole left behind clots off. Doctors and technologists and nurses are good at making this happen but sometimes the hole in the artery wall pops open again and blood flows out of a narrow channel through the muscle tissue, forced by the pressure of arterial blood, and ends in a sort of pouch or balloon farther out in that same muscle tissue. These hurt very much and usually are repaired by advancing a needle under ultrasound guidance into the neck of the pseudo aneurysm and injecting a substance to cause the blood swirling in the pouch to clot off. The trick or course is to place the needle in the pseudo aneurysm and not in the femoral artery, as injecting the clotting agent into the main artery of one’s leg, well, isn’t usually regarded as a good thing. I have guided many of these procedures myself and had no interest in being on the receiving end of one, and the prompt intervention of my nurse prevented what was almost certainly the beginning of a pseudo aneurysm from happening. I spent the rest of that day and all of the next two flat upon my back, gratefully peeing in the plastic urinal and counting my blessings.

At last the final visitor who was probably my wife, an angle sent to this planet solely for the purpose of getting me through this ordeal (and helping me make a couple of wonderful kids and a few other things too), kissed me good night and it became time to prep me for the next day’s surgery. The surgeon had earlier counseled me that I might want to shorten my beard as it drooped down into the area that soon would be open like the hatch on the old space shuttle. It seemed as if he had gotten resistance on this idea from previous patients but I told him “It’s not spiritual, Doc. It’s a beard. Whup it off”. The idea of an infection in an incision extending from the surface of my chest to my very heart was entirely without appeal to me, so off it came and off I went to sleep until they would come for me at five thirty AM the next morning to begin my march to the next leg of this medical drama.

Serious as a heart attack, Part I

“Mr. Durden, you’ve had a heart attack”. Dr. Stone, whom I had known for decades, gave me the fish eye as he shared this little item of information with me. Part of me was stunned as I received this verdict but part of me was not. I had been dealing with chest pain for years and now, at last, I knew why. That might sound odd to a rational person; three years of chest pain which came on with exertion should be enough to alert anyone to a cardiac problem. The problem with that analysis however is that A. None of us, or at least very, very few of us are entirely rational, and B. Human bodies are just not at all as predictable as we would like to believe. But let me begin at the beginning.

Three years ago, while helping friends move from their condominium to a rental house where they would live while looking for a house to buy, I felt great as I hauled tables and lamps and boxes of all sizes down a flight of stairs and loaded them into a truck. I was happy and perhaps a little bit proud to be able to hold my own at 63 years of age with guys half that old. We emptied the condo and unloaded our cargo into a storage unit where it would rest for a few weeks until the rental was clean and empty and ready to be reoccupied. When those few weeks were up the call came to reverse the process and move my friends into their new nest. A crowd of us duly showed up and the work of transferring the household goods back into trucks and then into the new house began in earnest.

But something was different this time. After carrying, or helping to carry, several items I felt a distinctly uncomfortable pressure in my chest. I tried to ignore it, but the pressure was not to be ignored and so I sat down several times to let it subside before resuming my labors. At the end of the day I forgot about it and proceeded to go on with my life as I always had done before. But the intermittent pressure was not interested in going away. Climbing stairs, walking up a hill or carrying heavy loads would trigger the pressure which I was finally beginning to call pain, and at last I went to see my naturopath.

My naturopath, Dr. Marsh, is a very smart guy. He knows that there is much that can mimic heart disease and conducted or ordered tests to evaluate for food allergies and sensitivities, a chest x-ray, and ultrasound of the gallbladder and a few more diagnostics and concluded that he could not rule out a cardiac problem. I was then referred to a naturopathic cardiologist who ordered a stress EKG. That test came up positive for the heart as a likely source of the problem. The doctor suggested that I get an angiogram to confirm that I had a blockage or one or more of my coronary arteries before proceeding to fix the problem with surgery.

I didn’t like that news at all. Other than minor dental work I have never had surgery of any type and had no interest in doing so now. Also, the thought of doctors threading a catheter up an artery from my groin into my heart and squirting dye into my coronary arteries to make them light up under X-ray to demonstrate a blockage did not sound like a stroll in the part either, so I began looking around for an alternative and found it in the form of a Thallium Stress Test. This test is performed by injecting into a vein a radioactive isotope which likes to find it’s way into heart muscle, and then walking the patient at a nice clip on a treadmill to get the heart pumping at a higher rate than usual. Then, after resting for a while to allow the isotope to settle in the heart muscle I was laid on a table under a very special camera which detects that isotope. The result: no defect in perfusion of my heart muscle with the blood it needs to remain healthy.

A clean bill of heart health was exactly what I wanted to hear, and I concluded that whatever my problem was it was not heart and I would just have to work through it, so I took long walks, climbed hills, and tried to condition myself so that I could shake the uncomfortable pressure out of my life and get on with being a senior citizen superman. The plan worked, sort of but during the last year some other changes began to show up, and even though I continued to refuse to add two and two together the signs were there if I had chosen to read them.

First and most significantly, my energy level began to drop. I have always been an active guy and the barest hint of some activity to engage in with friends was all that I needed to launch me full tilt into chopping wood or playing frisbee or hauling sound equipment at my church from the theater where we meet to an upstairs office down the street where it rested during the week. A bad shoulder which is the result of thirty years of performing ultrasound exams was the primary indicator which ended my church tear down activities but I certainly didn’t mind avoiding the chest pain which inevitably accompanied that activity as well. Slowly I came to accept that there were activities that I simply could no longer do, ascribed it to my age, and settled down to learn to live with it.

More worrisome to me than my decrease in energy was my decrease in interest. I still continued to read and walk and meet with friends, but the verve was greatly diminished. Walking three or four miles in Hawai’i on a vacation was still a pleasure, but walking the same distance on the familiar streets of my own hometown was no longer tempting enough to draw me out of my chair and onto the pavement. There was always a good excuse; the weather was bad, work had been tough that day, or I had already done enough extracurricular activities that week. But the weather was no different than it had been the previous thirty years that I had lived here, my work was in fact easier than it had ever been, and my other extracurricular activities had never slowed me down before. Slowly I came to enjoy sitting in my chair reading a book on history or theology or philosophy more than sitting in a chair at a pub discussing those topics with friends.

This progression of changes finally came to a head on a Wednesday a little less than one week ago as I write these words. I had eaten on Tuesday night at about seven and after finishing dinner went outside to water the front lawn and pull some weeds in my vegetable garden in the back. Upon returning to the house I felt the old familiar pressure and expected it to quickly go away.

Throughout the night I would awaken and go to the bathroom or get a drink of water and it would not go away. Upon rising in the morning I got dressed and walked to work, and it did not go away. I came home and helped prepare to go to a picnic with friends and it did not go away. While chatting with those friends I was invited to throw a football, fling a frisbee, roll some lawn bowling balls but I declined; I just didn’t feel like doing any kind of activity and the pressure would not go away. At one point several people walked up a hill at about a 20% incline to a field above us and I looked at that small hill with the absolute certainty that I could make it up there but had no interest whatever in paying the price in pain that it would require to do it. Turning to my wife I said “I’m tired, let’s go home so that I can get some sleep.” And still the pressure would not go away.

We arrived home and I brought in a few items from the picnic. I began to walk down the hallway towards the bedroom and bathroom and the realization hit me all at once: I was not going to lie in bed one more night with my chest hurting. Halfway down the hall I wheeled around and said “I think you had better take me to the E.R.” “Would you rather go to an urgency care clinic” asked my wife who knows how little I like being a patient. “No”, I replied, “I know that they would just send me to the E.R. (probably in an ambulance I thought, but didn’t articulate that vision). Let’s just cut to the chase”. I grabbed a book and put a few supplies in my book bag and we rolled down the driveway and up the street towards the hospital only a few locks away.

When we arrived at the Emergency Department main entrance we could see that the little parking lot was full. My wife let me out and went to park somewhere further away. There was a small line of people in front of me who presented with a variety of issues. They were asked all the right questions and were duly processed and went to take a seat in the waiting room where they would await their turn to be seen. At last I stood in front of the open window. “What’s going on with you tonight sir?” asked the the young woman sitting behind the counter. “Chest Pain” I replied, and before another sixty seconds passed I was ordered – and I do mean ordered – to sit in a wheelchair which almost magically appeared behind me. Sixty more seconds and I had a blood pressure cuff inflating on my arm and an EKG tech awaiting his turn at me.

In ten minutes’ time I was lying on a bed in room 71 hooked up to a variety of monitors with a phlebotomist waiting her turn to draw a few tubes of blood. The blood draw completed I now had two needles the caliber of the Alaska pipeline inserted into my veins, one in each arm. What followed was a ritual dance of X-rays, more blood work, and waiting while calls were made, and finally Dr. Stone appeared from behind a curtain and said to me “Mr. Durden, you’ve had a heart attack. It was a small one, the EKG was read by the machine as normal but some of the waves just don’t look right to me. And the blood test confirms it. The cardiac enzymes level indicates that you’ve had a small heart attack. You’re going to be going to the cardiovascular intensive care unit tonight, and then tomorrow morning you will have an angiogram. If they find the problem perhaps they can put a stent in the vessel to open it up and you can go home. We can hope so anyway.”

After a gathering up of stuff I was rolled out of Room 71 on a gurney and taken to the fourth floor where a big, soft bed and a bank of glittering and beeping monitoring devices awaited me. I made the transfer to my new bed, was introduced the the night RN, George, and soon was alone in a darkened room with a couple of IV pumps pushing fluids and medicines into my veins and wondering how in hell I ever got here and where my life would lead next.