Resuming the story

Up until July 8, I talked about my experiences anticipating heart surgery. The posts that followed were updates of progress but not descriptions of the experience. It is Monday morning, July 13. I was discharged yesterday and am sitting in bed, with my laptop, and ready to tell the story. I'll try to recount, as accurately as I can, what has transpired over the last few days.

I felt fairly buoyed on Tuesday, throughout the day, following our meeting with Dr. Rosenbloom. The fact that I would not get a mechanical valve, with lifelong Coumadin, and click, click, click, relieved me a great deal.

I got up on Wednesday morning, at about 4 am, after sleeping much better than I thought I would. Part of my pre-surgical prep involved a shower using a special soap on those areas where they were going to cut. Maryka, Matt and I arrived at the hospital at 5:15 am and were in the surgical section by 5:30. Things moved quite quickly from that point on. Accustomed to seeing doctors in busy waiting rooms, where not everyone knows what is going on, I was comforted by how organized they were. The nurse, who greeted me, was extremely well versed on my entire medical history. She reviewed that history, conducted a quick examination, and double-checked my preparations, and what medications I recently took. She told me to strip naked and put on hospital gown and surgical cap. Maryka, who was similarly donned with gown and hair cap, barring the requirement to be naked underneath. She followed me as I got wheeled down the hall to the surgical prep room. Adhering to a strict rule allowing just one family member to come that far, Matt stayed behind in the waiting area.

I was quickly moved to a stretcher, so that my wheelchair escort could proceed with my shave. A pleasant and comforting man, he showed no hesitation holding my genitals to the side, as he rendered, hairless, the necessary locations.

From there, my memory gets vague. I believe I had visits from Dr. Rosenbloom and the anesthesiologist. I remember seeing Maryka sitting off in the distance, wearing her unflattering hospital gear. Maryka tells me that we spoke for a moment after these preparations were done, but I don't recall that conversation at all.

I next remember lying in a room with a tube down my throat. I could see a clock, and registered that it was near the top of the hour, although I can't recall whether that was 2 or 3 pm. There was a window to the left. I was aware that there was a nurse watching me, as her position would sporadically move in and out of my view. I felt a post nasal drip and was quite concerned that the fluids would choke me as they filled up my lungs. I kept trying to cough it up, but with little success. I tried to lift my hands, to let the nurse know I was ready for her to take the tube out. It was excruciatingly difficult, trying to move my hands up. I had particular difficulty raising my right arm, which was extremely numb. Although it is getting better, the numbness in that hand continues to be a problem. I believe that my hand movements were interpreted as an effort to pull out my tube, but my true intent was to get the nurse's attention. I wanted her to know that I could breathe on my own, and more importantly, that I might die from the fluids which were entering my lungs. I believe this went on for about an hour, since it seemed the clock was again at the top of the hour, when she finally removed the tube. I recall Maryka, Matt, my mother, and Beth, Maryka's long term best friend, in the room with me.

What transpired next was totally unexpected, and would land me a spot on Comedy Central, if I could do my routine out of a post-anesthetic state. I launched into a stand-up (or I should say lie-down) routine. I recall only two of my jokes, but I was quite aware of being purposefully funny. After asking for water and being told it was too soon since my tube was just removed, I quipped, "If they took it out when they should have, I'd be drinking a damn martini by now." When someone commented about my efforts to raise my hands to pull out the tube, I told them "I was doing the Atlanta Braves tomahawk chop."

I stayed in ICU for that day and the next. Both days, I was moved to a chair. The room was quite large with a couch, one or two other chairs, a commode and medical equipment. Each day, my nurse would comb my hair. The chair they would move me to was designed to allow a number of different positions. I found it grossly uncomfortable, and would have strongly preferred to sit on the couch. I was completely unable to move without help. At one point, a medical technician came into my room. I don't recall what he did, but I asked him to place my chair in its most prone position. In the process, he separated me from my nurse's call button. I did not like this position at all, but I stayed there, helpless, until my nurse reentered the room.

On the second day, the process of removing my tubes began. Until then, I was tethered to several devices through tubes in my body. There was catheter in my penis, three wires to my heart, two tubes in my chest, and a direct line through my neck to my vena cava, allowing the administration of drugs directly into my heart. I also sported a monitor for my heart, a blood pressure cuff, and a device on my finger which measured blood oxygen level. The burden of moving with this equipment severely limited my mobility in my much weakened state.

The catheter for urine was the first to come out. I was glad to have a female nurse handle that task, and mentioned to her my belief that no man, regardless of maturity, education, and clinical experience, would fail to make a mental comparison of size while performing this task. She chuckled at my comment, understanding I was right. I asked her if it was going to hurt, and she said it would not. As much as I wanted to have all these devices removed, I was quite concerned about what pain would be involved. I remember at ten years old during my first heart operation, when they removed my chest tube, I was told it would not hurt, when in fact, it did. There was some pain as the catheter came out, although certainly nothing large enough for my to worry about. I was also struck by how painless it was all the time the catheter was in, and how freeing it felt to effortlessly pee, whenever required.

Later that day, a physician's assistant came to check my temporary pacemaker. He decided it was time to turn the device off, while leaving the leads in just case it was needed again. The PA was a jovial man, causing me to suddenly feel worried about the decision he had made. In a rare moment of challenging someone's credentials, I told him I needed a doctor, not a PA, to make that decision. He handled my request with apparent understanding. Shortly, a cardiology resident came into my room, assessed the situation, and made the same decision.

Despite my tethering to equipment, the second day brought my first attempt at a bowel movement. Although I never minded using the urinal, a bedpan exceeds what I am willing to do. So with great planning and care, my nurse disconnected some of my equipment so she could lead me to the commode, and reattach what was necessary before my bowel movement. Although it was still too early for fully solid stools, I had some success, and felt like a two year old who had just crossed a threshold in the rites of potty training.

On day two, Howard and Jane visited me. I was touched by their kindness, and it has helped me throughout to go through this together, with Howard, who had a similar operation a few weeks ago.

One point that was frequently made in my pre-surgical reading materials, was to not let myself suffer with pain. I had further read that one benefit of minimally invasive surgery, which I could not have, was that there was less pain. I was often told in the hospital not to hesitate in asking for pain medication. Yet, I experienced virtually no pain. The one exception came from the chest tubes, which would cause my left lung to hurt, each time I breathed. Although I did not consider this enough pain to require treatment, I nevertheless decided to try the pain medication. The oxycodone made me tired, and possibly a bit loopy. I recall lying in my bed with Matt and Maryka sitting on each side, holding my hands, keeping up a conversation, as I seemed to go in and out.

In the evening after the medication wore off, and Maryka and Matt had left, I felt like reading and reached with my numbed right hand to pick up my Kindle. The Kindle fell, creating instant panic that I had damaged my highly prized item, which I intended to use through the course of my recovery. I looked for my nurse call button, but could not find it. Unable to move around on my own volition, I lay there waiting for someone to come in. A technician arrived, and I asked her to pick up my Kindle from the floor. I was greatly relieved to see that it still worked.

On the third day, Saturday, the rest of my tubes were scheduled to come out, the assignment given to the PA I had rejected the day before. He was just as chipper as he had been before, and I felt confident that my challenge had not caused any offense. Again, I questioned whether there would be pain with different answers for the various attachments. The heart wires came out first, two to the atria, one to the ventricle. These came out easily without any problem. The tube to my vena cava was fairly painful, with the pain continuing for an additional few days (although never at a level where I would ask for pain medication). The tubes in my chest reminded me of how I felt at ten years of age. Although it hurt slightly, it was just for a moment.

Without this apparatus, the decision was made to move me from ICU to the cardiac ward, a much more tightly cramped room. The move was made on Friday.

I think that's a lot for my first out-of-hospital post, so I'll wait until tomorrow to pick up on my story. In fact, it is 5:00 pm and I just finished my morning post. Obviously, I am working more slowly than I normally do, but that's okay, I just had open heart surgery.