Thursday, January 31, 2008

Thank you for your thoughts and prayers and virtual flowers

I usually prefer not to write little vanity pieces in public spaces, but this is a special occasion. The purpose of this note is to (1) thank everyone very much for thinking of me as I went through surgery and (2) tell the whole story to everyone at one time so I can avoid telling it a few hundred times over the next few weeks.

This Wednesday, I underwent cardiac ablation to fix a problem know as supraventricular tachycardia. It's a not very fun but not fatal condition that causes ones heartbeat to jump into the high 190s to 200s, something that's happened to me twice in the last 6 months. It can be treated with drugs, but there are side effects; and it's something that may never happen again, but I didn't want to take a chance of being 6 hours into a 14 hour flight to Japan when my heart tried to leave my chest through my neck again.

For those who didn't follow the link above, SVT is caused when there is an extra electrical path between your atrium and ventricle (get out you old biology textbooks and look that up if you've forgotten). The only sure cure is to burn away the extra path. That's what I had done this week. It's really not as bad as it sounds - they go in through your legs - but it's not something I'd recommend you do for fun just to show off the scars.

I'll include lots of excruciating details of my day here because talking about blood makes me queasy and talking about my own blood is significantly worse. My reasoning is that if I put in too many details here it'll keep folks from asking me to relive the day ... which would not be fun for me or anyone in the immediate vicinity.

My parents came into town Tuesday evening to help out (something I appreciate more that I can tell them). On Wednesday morning, I sent the kids off to school in the carpoool and, as Tina prepared for a school meeting, my parents took me to St. Joseph's Hospital Outpatient Facility. All I took with me was my ID, my insurance card, and an emergency overnight bag just in case they needed to keep me. Although I had a cold I couldn't take any medicine, so I was sneezing and coughing a bit.

We arrived at the hospital at 8am, and there was some confusion about where to check in that was quickly resolved. On the second floor, very polite and professional attendants took my insurance information and had me sign 2,468 different papers with titles like "I Promise not to Sue" and "I Understand that Someone is Going to Hurt Me Today" and "I Came in with This List of Valuable Items and Would Like to Leave with This Subset of that List" and "I Really, Really Promise not to Sue". They asked me if I was diabetic, and I said no. Then I waited for a surprisingly short time before a nurse came and took me back to my own private waiting area (if you define private as "shared with dozens of other people, each separated about 70% of the time by some thin sheets on rails"). I had to leave behind all of my things, including removing my watch, so times are estimated for most of the rest of the story.

The nurse instructed me to remove everything except my boxers and put on a standard hospital issue "mooning gown", and closed the sheets o' privacy to allow me some vestiges of propriety These vestiges were to be quickly stripped away later, but at this point I was still in transition phase from "paying customer" to "compliant victim".

The nurse who handled me initially (I believe her name was "Laverne", but drugs have addled my brain a bit over the last few days) was very friendly, professional, and competent and kept me at ease, even as she announced that she had to shave my chest. I told her of my experiences with this procedure in the past, including the multiple lacerations received in an ambulance during the first SVT episode. She assured me that she wasn't planning to perform any ritual bloodletting and was, in fact, going to use an electric razor. The process felt ticklish and odd - cut hair is removed with a medical version of a lint sticky brush - and left me looking like a 13-year-old from the waist to the neck.

She then took my vitals (blood pressure very good, pulse a bit elevated), asked me if I was diabetic, and was finishing up when the lead nurse for my procedure came in and asked if she had also shaved my "groins". That's not a word that I'm used to hearing as a plural, so I was a bit worried about what was to come next. Think more in line with a "groin pull" than anything that would be featured in a Sharon Stone movie. Essentially, the tops of my thighs were denuded as well as my chest.

I was left just a thin bed sheet and set of privacy sheers away from becoming a fascinating story for the octogenarian across the hall to tell her friends about over tea.

A variety of other specialists came through and took EKGs, bloodwork, and my watch (just kidding, just kidding) and asked several more times if I was a diabetic. Someone asked if I was allergic to anything, and I could only think of pollen. They assured met that pollen was not expected to be present in the operating room.

The head nurse installed a fancy IV with three little tails. When she entered the room and asked how I was doing, I explained to her that so far everything had been pretty fun (the shaving was mentioned, I believe) and that I certainly didn't want her to change that by hurting me. She apologized and went about sticking a foot-long, inch-wide needle into my arm. That memory may also be somewhat exaggerated by time and pharmaceuticals.

Dr. Wilson stopped by as well to explain again what I would be undergoing and, fortunately, he approved my taking something for my cold. Instantly, my life and my outlook improved in direct inverse proportion to the number of tissues that I was employing.

The head nurse explained that another procedure was still finishing up, so I might have to wait a little while. She offered to bring me something to read, and I asked if she could bring in my book from the waiting room. Instead she brought back my parents and all of my things (which technically did include the book that I'd asked for). Actually, bringing back family was a better option, as talking was more distracting than reading would have been.

Around 10:30am, Tina arrived from her meeting and traded out with my dad. My doctor's assistant came by to let me know that he was taking a short break to eat and that I'd be up next. Less than a half hour later, I was being wheeled back into surgery.

The anesthesiologist and surgical assistants started out by asking me if I was a diabetic and then sticking circular and rectangular objects all over my barren chest and sides. This represented at least the third time that I'd had stickers attached to my body in the same general area in less than 4 hours. I mentioned that next time I'd ask for them to be permanently installed, and they explained that some machines have different numbers of leads, so each pattern is different. Plus, the leads that they were attaching in the O.R. had to be away from the heart area to allow a better view. Expressed in non-medical terms, this translated roughly as "shut up, we know what we're doing", but in a very polite and professional way.

I also told them that I still had a cold. I wanted to make sure that this wouldn't impact the surgery or the drugs. They both told me to be sure not to give the cold to them. I explained that largely depended on what they did to me while I was unconscious. To my relief, they laughed and didn't do one of those conspiratorial wink things that happen in bad Robin Cook movies.

It just occurred to me that everyone that I dealt with at St. Joseph's from the moment that I checked in until I was discharged was a woman - with the exception of my surgeon. Interesting that I didn't notice that at the time.

I was instructed to sit on the operating table while they attached the leads and some cold packs. They made comments about my not flinching from the cold packs, and I let them know that if that was the worst that they were going to do to me today I was in for an easy ride. They promised to make the rest of the day as close to that level of easy as possible.

The big surprise of the day was when they saw my shaved chest and said "why is your chest shaved?" Oops. Apparently that's not required for my kind of procedure. I'll be sure to remember that as I'm scratching at stubble for the next few weeks.

I was told to lie down and they started the cocktails flowing. The drugs used were "twilight" which meant that I wasn't completely out. In fact, during the procedure I remember distinctly thinking that I was awake the whole time. I remember pieces of conversation, I remember the sensation of something being injected or inserted, and I very distinctly remember a very uncomfortable feeling of something being threaded past my diaphragm. In reality, there's no way that I was conscious or even semi-conscious for most of the procedure, since it lasted over 2 hours.

I kept my eyes closed the whole time - even when I was more awake - since I wasn't all that interested in seeing what was going on. See the reference to blood in the first paragraph.

At one point, I heard comments about removing everything and felt things being taken away. I remember hearing something about "he's not going to be able to help" and at that point I asked if I needed to roll sideways. Someone told me not to, that they'd take care of it for me, so I just kept my eyes closed as instruments were pulled off, my body was rolled back and forth, and stickers were peeled away.

The only nearly unbearable part of the process came when they had to put pressure on the wounds to stop the bleeding. The hole on my right side had apparently bled under the skin, and someone was trying to push that out. The pressure was right on the local veigle nerve, which meant pain, nausea, and an urge to get far away from the offender as quickly as possible. I must have made some noises to that effect, because the pressure was eventually moved to another area (and the bruise was allowed to form).

I learned later that a total of 2 catheters had been used on my left side and 4 on my right. That's the main reason that my right side then - and now - is in worse shape.

Once the bleeding stopped, I was wheeled into recovery where I was to remain still for the next 4 hours. I arrived at 2pm, which meant no moving until 6. My parents had returned to our home by this time to take care of the kids, but Tina was with me for the rest of the evening.

I slept for much of the first 3 hours. Lunch was brought, but I didn't want to eat much without being able to get up. I drank some water and faded in and out.

After 3 hours of deliberately not moving, the main thing that I wanted to do was bend my knees. Try sitting extremely still for a long time - it helps if you're afraid you'll bleed to death if you move your legs - and see if you can make it 4 hours. It's not comfortable. At the end, I was willing to trade an overnight stay just to be able to turn my feet sideways for a few minutes. At 3 hours and 45 minutes, I snuck in a slight knee bend. It felt wonderful, and nothing broke loose.

Dr. Wilson came in for a few minutes early in the 4-hour wait and explained that the problem - the short between my atrium and ventricle - wasn't where he'd expected it to be. Based on my symptoms, he was 90% sure it was in one place, but it was actually in another. However, he did find it and did zap it. He also explained that there was a small chance that the surgery wouldn't take ("it might just be stunned"). Great - I'd really love to do this again. He asked me to schedule a follow-up in 2 weeks to see.

At around 6pm, dinner was brought and I was allowed to sit up and put my feet over the side of the bed if I wanted to. I chose to just flex my legs a bit until after I'd eaten. I hadn't eaten since dinner the night before. The Chicken Tetrazini was pretty good, as were the pears and salad on the side. It was certainly better than your standard-fare hospital-food punchline.

Then it was time to walk. I had to spend an hour walking a bit and resting a bit before I could be discharged. No one wanted me to get home and spring a leak. At a little after 7pm, I was wheeled out into a waiting car.

My instructions were to avoid stairs, not to pick up anything more than 10 pounds, not to squat down, and to be sure to get up and walk around occasionally to avoid blood clots. Stairs weren't going to happen anyway. Even now, two days later, stairs are a challenge to be met slowly and methodically.

Fortunately, our house has a drive-around driveway with a door to the basement. I went into the basement and collapsed onto the couch and watched TV while the cocktails worked their way out of my system. I wasn't feeling very chipper, and wasn't much of a conversationalist. Around 10pm, I shuffled into the basement bedroom and slept through the night.

The second day was a little better, and today is better still. I'm still very sore and have trouble going up or down stairs, sitting up straight, and standing for any long periods. My skin reacted to the adhesive on all of those attachments, so my torso looks like I've been nursemaid to a family of remoras. I didn't get any prescriptions for painkillers (although they were offered), but I will be taking an aspirin a day for the next 60 days to avoid blood clots.

Overall, it appears that everything went well, and I expect to recover quickly. Hopefully I'll be up to coming back to work on Monday, but maybe not for a full day. And I'll be taking the elevator to the second floor.

If I've missed anything in the story above, it's probably not significant and certainly not worth making me repeat the entire sordid tale in person, although I will try to be polite if anyone has questions. I do genuinely appreciate your concern - every one of you - and I look forward to getting back to my old, obnoxious self very soon.


Anonymous said...

so brother, you wear boxers??? glad to hear it :)

Glad to hear you also admit you are obnoxious.

I love your old obnoxious self..


your little sister Noel

Anonymous said...


Your eloquence in describing your experience should earn you a column in the next JAMA, if for no other reason that to warn future candidates of what's in store. :)
Glad to hear you are doing well.

Chris and Alan Cochran