Things had been going very well, although a couple of weeks ago, I felt like I overdid things. My heart rate went up and became irregular. I thought I might be in atrial fibrillation, having had that in 1990 when I had endocarditis, although this irregularity was not as bad as it had been then. I thought of calling my doctor, although I wasn't too worried. I am aware that there is some stroke risk, however, I am on coumadin, so I knew I was protected from that possibility. By the weekend, my heart beat seemed to resolve, although I did take note that it still was fast. This was not something I could tell by myself, but when I took my pulse, it was clearly holding at 120 beats per minute. So, I called my cardiologist and was told to come in.
Dr. Ginzburg was on vacation, but I saw one of his partners who told me I was having atrial flutter. He changed my atenolol to metaprolol, and told me to come back the next day. I saw a different cardiologist, who ordered an echocardiogram, but otherwise did not seem alarmed. By the end of the week, they called Dr. Ginzburg (apparently on the golf course). He upped the medication further, and said he would see me the next week. I saw him on Friday and, after two weeks of an unrelenting flutter, he decided it was time for cardioversion (shocking my heart back to a regular beat).
This does not lead to pleasant thoughts. But, I did what he ordered and, on Monday, had a combination transesphoghial echocardiogram and cardioversion. I felt like I was on death row, as the nurse attached the electrodes to my chest and back. They assured me I would be sedated. They did the TEE first, to make sure there were no blood clots, which might get dislodged when I was shocked. I remember the tube going down my throat. From that point on, everything goes blank.
The procedure worked and, whatever they gave me, it was not your ordinary anesthetic. It wiped out my memory. Not only don't I recall getting shocked, I don't recall leaving the hospital and riding home. Everything is a blur. Even though I went to work the next day, I felt in a fog.
Anyway, it was a good thing they did what they did. This morning, when I got up, I could truly feel the difference. My heart is beating about 60 times a minute. It is completely steady (which it has not been in a long time). I feel very good, to the point that I think, I'm almost normal again. So, a minor glitch. Otherwise, everything seems to be going very well.
Thursday, August 13, 2009
Friday, July 24, 2009
Update
It's over a week since my last post, and 16 days after the operation. Last week, I went into the office to see one patient, someone I was particularly concerned about. I won't start seeing people regularly until Aug 3, my original plan. At the time, I said I would be working part-time until Labor Day, but at this point, I'm not sure why. Yesterday, something clicked. I had been getting better in a gradual way since being discharged from the hospital, but yesterday, I felt a strikingly new level of energy. I had an appointment with an orthopaedic surgeon, to deal with a nagging problem I have with my left shoulder, but have delayed doing anything about until after my heart surgery. He referred me for PT, but delayed on either anti-inflammatory medication (since I'm on Coumadin right now), or an injection (which he did not think I should have, due to my recent surgery). Afterward, Maryka and I spent the day at home, reading and playing Scrabble, before we went to Chili's for dinner. The thing that caught my attention, the click I referred to above, is that I felt perfectly normal. Today, I woke up and realized that, except for some minor issues -- not yet allowed to drive, cautious about lifting anything heavy, waiting to play tennis again -- I feel almost fully recovered. I think, if I needed to, I could return to work next week, not part-time, but full-time. It's really hard for me to see why I can't resume a completely normal life, right now. I will take care. After all, I had open heart surgery just two weeks ago. Still, it does not feel as if I did.
Wednesday, July 15, 2009
Finally home
It's Wednesday, July 15, 9:27 am. Seven days ago, I was lying on a table, anesthetized, as Dr. Rosenbloom and his team did their surgical magic. I've been home for the last three days, and am about to publish my last (at least for a while) and probably most bizarre post: the story of what has happened since I got home.
Following some last minute scares, my EKG in the middle of the night, and an early morning blood test of my Coumadin level(the nurses had overlooked the order, so I had to wait for those results to come in), Drs. Ginsburg, Bowen, and South Africa came to my room to tell me I was going home. Maryka commented on how well I was recovering, and Dr. Ginsburg responded, as he had the day before, that Dr. Rosenbloom and his team do a very good job. This time, after a pause, he gave credit to the healing powers of the patient.
After getting my discharge instructions, we left the hospital and stopped at CVS, where Matt and I filled my prescriptions, while Maryka bought lox and bagels for my first not-Heart-Healthy meal in days. I got home where BB, who had not come to the hospital, gave me a hug. I saw Sasha, who had driven in the night before, and had visited me briefly in the hospital as well. We all played some games of rummy before Sasha and Matt had to leave. Since then, Maryka and I have enjoyed our time together. We'll see my mother today. She is coming over for lunch. On Saturday, I am hoping to drop by the tennis court and say hello to the members of my tennis group (no actual play for a few months). Matt thought I should dress in tennis wear, and walk to the court carrying my racquet. I'll visit my mother on Saturday, following our routine of breakfast in her apartment, every Saturday morning. Sunday, I plan to go to church. Next Monday, I hope to start completing some reports (there were ten I could not get to before my surgical break). Now, here's what is bizarre. This whole operation feels like no big deal. When Dr. Rosenbloom first told me he could not do minimally invasive surgery because he would be working on two valves, I asked if it would be better to do two separate operations. He responded by asking if I knew anyone who had had heart surgery, the implication that you don't want to do this twice. Now, I think his response should have been, Why? I'll have you out in a jiffy.
I feel quite well. Just one week after the operation, I have very few problems. The numbness in my right hand persists. I can't lift anything heavy (when we went to LabCorp yesterday for my blood work, Maryka opened the somewhat heavy door for me). I get a bit more tired doing ordinary things (yesterday, I walked from the bedroom to the dining room, but kept forgetting things I needed -- the back and forth trips a bit wearing). I'm not supposed to drive. All that notwithstanding, I feel good. In fact, I have no doubt that, if I had to, I could return to work today. My plan is to go back on August 3, and work two hours a day. I could do that now. I'm not going to. I'm sticking to my plan. But, that's still the truth.
Before my operation, I talked to others, Tom Leacock, who had previously had heart valve surgery at a much younger age, as well as Howard. I conferred with my doctors to see what to expect. Dale Matthews, a doctor and Maryka's nephew, has always been helpful with information and advice. I bought a book, "The Patient's Guide to Heart Valve Surgery," written by a former double valve replacement patient. Nothing I learned could have possibly predicted the response I have had.
Note, I said bought, not read, The Patient's Guide. It was an ominous book, which I put down quickly. It predicted serious pain, risk of opiate addiction, and months of a slow and difficult recovery. The author advised setting up a "support team" for 24 hour care when you return from the hospital. You will need a bell to summon help, as it will be too painful pulling yourself out of bed. It took him three months to return to work. One week? Inconceivable!
I feel good. I feel better today than I did at this juncture when I went to the hospital in February. Then, I was drained. Dale and Demetra dropped by that Sunday. I enjoyed their short visit, but had to go to bed before they left.
Although I may update this blog, as things transpire, this will be my last regular post. I have other things to do. I will still stay home until August 3, but there is some other writing I have wanted to do, but never have had the time. So rather than post to this blog (unless something significant comes up), I'll put my writing time into that project instead. For all who have followed, thank you for your interest and support. It has certainly helped to know there are people who care.
Following some last minute scares, my EKG in the middle of the night, and an early morning blood test of my Coumadin level(the nurses had overlooked the order, so I had to wait for those results to come in), Drs. Ginsburg, Bowen, and South Africa came to my room to tell me I was going home. Maryka commented on how well I was recovering, and Dr. Ginsburg responded, as he had the day before, that Dr. Rosenbloom and his team do a very good job. This time, after a pause, he gave credit to the healing powers of the patient.
After getting my discharge instructions, we left the hospital and stopped at CVS, where Matt and I filled my prescriptions, while Maryka bought lox and bagels for my first not-Heart-Healthy meal in days. I got home where BB, who had not come to the hospital, gave me a hug. I saw Sasha, who had driven in the night before, and had visited me briefly in the hospital as well. We all played some games of rummy before Sasha and Matt had to leave. Since then, Maryka and I have enjoyed our time together. We'll see my mother today. She is coming over for lunch. On Saturday, I am hoping to drop by the tennis court and say hello to the members of my tennis group (no actual play for a few months). Matt thought I should dress in tennis wear, and walk to the court carrying my racquet. I'll visit my mother on Saturday, following our routine of breakfast in her apartment, every Saturday morning. Sunday, I plan to go to church. Next Monday, I hope to start completing some reports (there were ten I could not get to before my surgical break). Now, here's what is bizarre. This whole operation feels like no big deal. When Dr. Rosenbloom first told me he could not do minimally invasive surgery because he would be working on two valves, I asked if it would be better to do two separate operations. He responded by asking if I knew anyone who had had heart surgery, the implication that you don't want to do this twice. Now, I think his response should have been, Why? I'll have you out in a jiffy.
I feel quite well. Just one week after the operation, I have very few problems. The numbness in my right hand persists. I can't lift anything heavy (when we went to LabCorp yesterday for my blood work, Maryka opened the somewhat heavy door for me). I get a bit more tired doing ordinary things (yesterday, I walked from the bedroom to the dining room, but kept forgetting things I needed -- the back and forth trips a bit wearing). I'm not supposed to drive. All that notwithstanding, I feel good. In fact, I have no doubt that, if I had to, I could return to work today. My plan is to go back on August 3, and work two hours a day. I could do that now. I'm not going to. I'm sticking to my plan. But, that's still the truth.
Before my operation, I talked to others, Tom Leacock, who had previously had heart valve surgery at a much younger age, as well as Howard. I conferred with my doctors to see what to expect. Dale Matthews, a doctor and Maryka's nephew, has always been helpful with information and advice. I bought a book, "The Patient's Guide to Heart Valve Surgery," written by a former double valve replacement patient. Nothing I learned could have possibly predicted the response I have had.
Note, I said bought, not read, The Patient's Guide. It was an ominous book, which I put down quickly. It predicted serious pain, risk of opiate addiction, and months of a slow and difficult recovery. The author advised setting up a "support team" for 24 hour care when you return from the hospital. You will need a bell to summon help, as it will be too painful pulling yourself out of bed. It took him three months to return to work. One week? Inconceivable!
I feel good. I feel better today than I did at this juncture when I went to the hospital in February. Then, I was drained. Dale and Demetra dropped by that Sunday. I enjoyed their short visit, but had to go to bed before they left.
Although I may update this blog, as things transpire, this will be my last regular post. I have other things to do. I will still stay home until August 3, but there is some other writing I have wanted to do, but never have had the time. So rather than post to this blog (unless something significant comes up), I'll put my writing time into that project instead. For all who have followed, thank you for your interest and support. It has certainly helped to know there are people who care.
Tuesday, July 14, 2009
My new room
On Friday, I was transferred from the ICU to the cardiac ward. Cooper wants to be the premiere heart (and general medical) facility in the Philadelphia area, a daunting task given the other fine hospitals around. They built a modern, new wing where my surgery took place and where the ICU is located. They still use their older building, so my transfer involved an elevator ride down to the basement, over to the older wing, and up to the 7th floor. I immediately recognized the place from my prior stay, last February. It's an odd layout, the rooms extremely cramped, and the staff reflecting South Jersey's cultural schism. When I was there before, I had a paranoid roommate who was obviously neurologically impaired from years of alcohol abuse. He talked on and on about some events that took place, in St. Louis, twenty or thirty years ago. He had an altercation with the police or some other men. Two techs were sent in to calm him down. As soon as they heard him, they went on for ten minutes, talking to each other, showing more empathy than I could, for his view of the world. "Know what you mean ... can't stand that shit ... they're gonna hurt you ..." going on and specifically recounting of their own grievances against the police, their neighbors, and society in general.
I recognized one of my former nurses, whom I liked quite a lot, and Toni, the hip hopping tech, who would say whatever crossed her mind. I don't recall the specifics, but she made some highly offensive and inappropriate remarks to me the last time. This stay, she was pleasant, upbeat, and playful, but nevertheless, inappropriate. She came into the room to see Maryka sitting on the side of my bed, holding my hand. She immediately admonished her for climbing all over me, suggesting we could display more sexual self control. She had actually come to take my blood sugar. After getting an unexpectedly low reading using a finger on my left hand, she tried again, using my right hand. When this number showed a higher, more expected reading, she tried to link difference to sugar in the hand that Maryka was holding.
Once in my room, I was placed on a heart monitor, this time one that broadcast the results, without tethering me to a physical device. I was given oxygen, this time at half the volume of what I had on the ICU before. The oxygen was now my only impediment, outside my physical strength, to getting around. This led to discussions between the nurse and me regarding how I should handle my bathroom needs. She left it up to me, whether to use a bed bound option or disconnect for a brief amount of time. She suggested she might be able to get me a mobile O2 tank. She then left the room, to return shortly with more oxygen tubing. She jury rigged two pieces of tubing to create an, which reached the bathroom. It proved long enough, so when I returned, she tried to tape these two tubes together. Her efforts proved futile, as she could not get the tubes to permanently stay together. Further, there was too much loss of pressure to get me the oxygen I might truly need. The next day, this nurse led me in a walk on the floor, monitoring my oxygen level along the way. I was extremely touched by how vigilant she was.
There is a dramatic difference in the quality of hospital beds between the ICU and the my present ward. There was also a noise which continuously came from a vent in the ceiling, which was far more disturbing than a mechanical valve could have been. I did not sleep either night in that room. Still, it gave me a change to get to know my roommate.
Except for one night, I had a room entirely to myself. I was glad, since my prior experiences with hospital roommates is not very good. In February, I had two hospitalizations, one at Cooper, one at Kennedy. My roommate in Kennedy was not much better than the one at Cooper. He was an active alcoholic, not as neurologically impaired, as the Cooper chap. Whatever got him to the hospital, he was clearly itching to get himself out. I similarly disturbed roommates during my 1990 hospitalization for endocarditis.
Jack was admitted to my room shortly after I arrived. My anxieties went up from the very beginning, when he asked the nurse if he could have a drink. When his request for alcohol did not pan out, he got the tech to go downstairs, to the coffee shop, for some real (non-hospital) coffee. My initial about Jack were soon allayed when I realize that he was a friendly and jovial man.
I got to know Jack late that night, while I was wide awake, unable to sleep. I had just returned to my room after walking in the hall, when Jack also came ambling back. I did not realize he was having trouble, too. Jack and I sustained a conversation for a good half hour, until we both went back to sleep.
Jack had open heart surgery about nine years ago, at Deborah. His surgeon had completed 10,000 operations with the implication that he was the best around. Following a mental "my surgeon's better than yours," I lamely found a way to interject that Dr. Rosenbloom was recently cited in the Top Docs edition of Philadelphia Magazine. Jack did not seem impressed, and went on to tell me that he came to Cooper because he needed a pacemaker, and Cooper is closer to when he lives (with the implication he would have gone to Deborah if he needed more serious, open heart surgery). Following this brief round playground banter, we got engaged in more conversation, about ourselves, about politics and the world. Although Jack had been a blue collar worker from the boon docks of Cumberland County, I found that many of our beliefs, were truly shared.
On Saturday morning I was seen by one of the cardiology residents (or fellows, I'm not quite sure about the difference) who examined me before Dr. Ginsberg arrived. I don't recall this doctor's name, but my immediate response once he opened his mouth was to inquire, "You're from South Africa?" He held his response until completing the examination, and then told me I was right and asked how I knew. He shared that it bothers him that people often think he came from London or Australia. I told him that my grandfather was South African, and that his speech mimicked exactly sounds I heard from relatives of mine. This seem to seed a closer than doctor-patient relationship. He later asked my advice about how his mother-in-law, who is a psychoanalyst in Johannesburg, could get licensed, if she moved to New Jersey.
Jack was discharged on Saturday, so I had the room to myself that night. I still could not sleep, and got increasingly impatient to get out of there. On Saturday, I had spoken to three different doctors, Dr. South African, Dr. Ginsburg, and Dr. Bowen (Dr. Rosenbloom's associate). They all disagreed on the day of my release, respectively Saturday, Sunday, and Monday.
In the middle of that night, my nurse came into my room, to do an EKG. The technician was worried by something that appeared on her telemetry screen. The nurse tried to assure me that it was nothing to raise concern, and that the telemetry technician was just doing her job. The blip that she saw, had already been seen and ruled out as a problem by Dr. Ginsburg earlier in the day.
I've known for years that there is a blip on my EKG. It reads as if I have had a heart attack. Years ago, when I worked at South Amboy Hospital, I was given an examination and told I had such a prior attack. I went immediately to Dr. Ginsburg who repeated the test, and then assured me that this was not the case. The blip was either an idiosycratically delayed beat, or a misreading caused by my prior heart surgery. Despite my nurse's efforts to reassure me, this raised my anxieties that I would not go home.
In the middle of the night, my nurse rolls in a portable EKG machine to begin the test. Something goes wrong, and the machine spits out graphs with large black lines, causing me to wonder if I were in cardiac arrest. She told me there was something wrong with the leads (reminding of the movie, Glen Garry Glen Ross). After considerable effort on her part, she finally got a reading, which she could use. She told me that nothing had changed, and despite my worries, I felt certain I would have seen a doctor that night, if something had.
I got up in the morning, following a poor night's sleep, waiting for Dr. Ginsburg to arrive. He had told me, the day before, that he would be here at 10 am. I decided to sit in my chair and read the Sunday Times on my Kindle. At some point, Dr. South Africa came in to do an examination. He told me that it was his understanding that I would be going home today. We had a friendly and cordial chat. He left, and I picked up my Kindle, to find its screen had frozen on that page. No matter what buttons I pushed, I had no way to get it working again, leaving me feeling quite panicked that this prized possession would never work again.
The Kindle has a special place for me. I don't care for TV (with the exception of surreal court shows -- The People's Court, etc). When I was in the hospital back in February, I mentioned to Maryka that I was getting very bored with the TV on. The message appears to have gotten back to Matt, so for my birthday (which is February 18), he sent me a Kindle. I certainly did not expect such a lavish gift, and was touched by his sensitivity to my plight. It also happens to be that Matt works for Amazon, and is involved on the Kindle project. So, this adds a special connection to him associated with this gift, and considerable concerns if I were not to have it.
Before I got the Kindle, I did not actually read very much. Although many know of me as a writer, I am actually a handicapped reader with a clear learning disability. The learning disability is a consequence of my operation when I was ten years old. Before that, I was an avid reader. Many of the historical facts I know today come from children's books I read before I was ten. I mentioned before that Dr. Gross had a worldwide reputation as a pediatric heart surgeon. One reason for his success is that he was able to do surgery at a rapid clip. Without today's technology, there is significant interruption of blood flow during the operation I had. The damage that is done may depend on how long. Although my operation was successful, my loss of reading skills was dramatic.
This has actually played a very central role in my development as a clinical psychologist. I was trained in New York which was heavily influenced by the psychoanalytic approach. I assumed that there were Oedipal themes and castration anxieties, associated with the fact that I suddenly stopped reading after my operation. My mother stayed in Boston during my surgical stay, while my father had to stay home to work. Undoubtedly, I feared going blind at my father's hand for sharing this intimate time with her. This, and other misguided notions about a whole range of health and emotional reactions, have significantly altered my views on psychoanalysis, and play a major role in the psychology I currently practice.
Coming back to the Kindle, I found it not just a thoughtful gift, but a remarkable device. It's small screen combined with its options to control the size of the letters, has dramatically increased my capacity to read. Whereas for most of my adult life, I have read just one book a year, on my annual summer vacation, I've read four since February, along with my daily New York Times subscription. The loss of my Kindle would be a devastating blow.
I tried to comfort myself, knowing that it had a one year warranty, but I also thought back to that time, shortly after surgery, when I dropped my Kindle, reaching for in with my numbed right hand. Would that invalidate the warranty? I looked over my Kinder for signs of damage, and shockingly found that some were there. There was a slight separation in the integrity of the seal between the front and back covers. Undoubtedly, it had separated when it had dropped.
With some difficulty, I was able to snap the pieces back in place, still unclear about whether I would be protected. It didn't fail after the fall. But there may have been phsyical damage to kicked in later on. After continuing to push the buttons, I figured my only option was to use the power cord. I did not have it with me, and would have to wait to get home.
I put this out of my mind until Sunday evening while Maryka drove Matt to the airport. Unfortunately, I had to wait for her return, she she had been carrying the cord in her purse. I told her of my plight, and she questioned why I didn't share this with Matt, who could have taken the device back with him, if it did not work. I did not want him to feel bad, and also figured that I could settle the problem easily from home. Anyway, I plugged the Kindle in which caused the frozen screen to be immediately replaced with one that indicated, it needed to be charged. I believe the charge ran down during that day. Within a few minutes, my Kindle was working again.
It's interesting how, during a period of vulnerability, small things take on major levels of importance. Certainly, the worst that would happen is that I'd have to buy a new one. I can certainly afford a $300 item, knowing Blue Cross Blue Shield is handling my quarter million dollar operation. But this was a very special gift.
The other, unexpectedly special gift is Sir Koff-A-Lot. Before going into surgery, I was given a device called a incentive spirometer. I was instructed to use this ten times an hour, and continue to use it after I got home. This is done to prevent pneumonia, and will induce coughing if there are fluids in the lungs. Before of the cracked sternum, it is helpful to hold one's chest while coughing. Although a blanket would do, Sir Koff-A-Lot is a specially manufactured Teddy Bear, indistinguishable from his Teddy Bear cousins, except for his straighter back. This explanation is clearly described on Sir Koff-A-Lot's tags. Not quite ready to read when the bear first arrived, it nevertheless proved to be a comforting pal. I truly enjoy having Sir Koff-A-Lott around, who is currently napping in my bed. I guess surgery creates a throwback to a more primitive time, depending on others, and experiencing pride in using the potty the first time. Sir Koff-A-Lot has earned a permanent place in my heart.
I recognized one of my former nurses, whom I liked quite a lot, and Toni, the hip hopping tech, who would say whatever crossed her mind. I don't recall the specifics, but she made some highly offensive and inappropriate remarks to me the last time. This stay, she was pleasant, upbeat, and playful, but nevertheless, inappropriate. She came into the room to see Maryka sitting on the side of my bed, holding my hand. She immediately admonished her for climbing all over me, suggesting we could display more sexual self control. She had actually come to take my blood sugar. After getting an unexpectedly low reading using a finger on my left hand, she tried again, using my right hand. When this number showed a higher, more expected reading, she tried to link difference to sugar in the hand that Maryka was holding.
Once in my room, I was placed on a heart monitor, this time one that broadcast the results, without tethering me to a physical device. I was given oxygen, this time at half the volume of what I had on the ICU before. The oxygen was now my only impediment, outside my physical strength, to getting around. This led to discussions between the nurse and me regarding how I should handle my bathroom needs. She left it up to me, whether to use a bed bound option or disconnect for a brief amount of time. She suggested she might be able to get me a mobile O2 tank. She then left the room, to return shortly with more oxygen tubing. She jury rigged two pieces of tubing to create an, which reached the bathroom. It proved long enough, so when I returned, she tried to tape these two tubes together. Her efforts proved futile, as she could not get the tubes to permanently stay together. Further, there was too much loss of pressure to get me the oxygen I might truly need. The next day, this nurse led me in a walk on the floor, monitoring my oxygen level along the way. I was extremely touched by how vigilant she was.
There is a dramatic difference in the quality of hospital beds between the ICU and the my present ward. There was also a noise which continuously came from a vent in the ceiling, which was far more disturbing than a mechanical valve could have been. I did not sleep either night in that room. Still, it gave me a change to get to know my roommate.
Except for one night, I had a room entirely to myself. I was glad, since my prior experiences with hospital roommates is not very good. In February, I had two hospitalizations, one at Cooper, one at Kennedy. My roommate in Kennedy was not much better than the one at Cooper. He was an active alcoholic, not as neurologically impaired, as the Cooper chap. Whatever got him to the hospital, he was clearly itching to get himself out. I similarly disturbed roommates during my 1990 hospitalization for endocarditis.
Jack was admitted to my room shortly after I arrived. My anxieties went up from the very beginning, when he asked the nurse if he could have a drink. When his request for alcohol did not pan out, he got the tech to go downstairs, to the coffee shop, for some real (non-hospital) coffee. My initial about Jack were soon allayed when I realize that he was a friendly and jovial man.
I got to know Jack late that night, while I was wide awake, unable to sleep. I had just returned to my room after walking in the hall, when Jack also came ambling back. I did not realize he was having trouble, too. Jack and I sustained a conversation for a good half hour, until we both went back to sleep.
Jack had open heart surgery about nine years ago, at Deborah. His surgeon had completed 10,000 operations with the implication that he was the best around. Following a mental "my surgeon's better than yours," I lamely found a way to interject that Dr. Rosenbloom was recently cited in the Top Docs edition of Philadelphia Magazine. Jack did not seem impressed, and went on to tell me that he came to Cooper because he needed a pacemaker, and Cooper is closer to when he lives (with the implication he would have gone to Deborah if he needed more serious, open heart surgery). Following this brief round playground banter, we got engaged in more conversation, about ourselves, about politics and the world. Although Jack had been a blue collar worker from the boon docks of Cumberland County, I found that many of our beliefs, were truly shared.
On Saturday morning I was seen by one of the cardiology residents (or fellows, I'm not quite sure about the difference) who examined me before Dr. Ginsberg arrived. I don't recall this doctor's name, but my immediate response once he opened his mouth was to inquire, "You're from South Africa?" He held his response until completing the examination, and then told me I was right and asked how I knew. He shared that it bothers him that people often think he came from London or Australia. I told him that my grandfather was South African, and that his speech mimicked exactly sounds I heard from relatives of mine. This seem to seed a closer than doctor-patient relationship. He later asked my advice about how his mother-in-law, who is a psychoanalyst in Johannesburg, could get licensed, if she moved to New Jersey.
Jack was discharged on Saturday, so I had the room to myself that night. I still could not sleep, and got increasingly impatient to get out of there. On Saturday, I had spoken to three different doctors, Dr. South African, Dr. Ginsburg, and Dr. Bowen (Dr. Rosenbloom's associate). They all disagreed on the day of my release, respectively Saturday, Sunday, and Monday.
In the middle of that night, my nurse came into my room, to do an EKG. The technician was worried by something that appeared on her telemetry screen. The nurse tried to assure me that it was nothing to raise concern, and that the telemetry technician was just doing her job. The blip that she saw, had already been seen and ruled out as a problem by Dr. Ginsburg earlier in the day.
I've known for years that there is a blip on my EKG. It reads as if I have had a heart attack. Years ago, when I worked at South Amboy Hospital, I was given an examination and told I had such a prior attack. I went immediately to Dr. Ginsburg who repeated the test, and then assured me that this was not the case. The blip was either an idiosycratically delayed beat, or a misreading caused by my prior heart surgery. Despite my nurse's efforts to reassure me, this raised my anxieties that I would not go home.
In the middle of the night, my nurse rolls in a portable EKG machine to begin the test. Something goes wrong, and the machine spits out graphs with large black lines, causing me to wonder if I were in cardiac arrest. She told me there was something wrong with the leads (reminding of the movie, Glen Garry Glen Ross). After considerable effort on her part, she finally got a reading, which she could use. She told me that nothing had changed, and despite my worries, I felt certain I would have seen a doctor that night, if something had.
I got up in the morning, following a poor night's sleep, waiting for Dr. Ginsburg to arrive. He had told me, the day before, that he would be here at 10 am. I decided to sit in my chair and read the Sunday Times on my Kindle. At some point, Dr. South Africa came in to do an examination. He told me that it was his understanding that I would be going home today. We had a friendly and cordial chat. He left, and I picked up my Kindle, to find its screen had frozen on that page. No matter what buttons I pushed, I had no way to get it working again, leaving me feeling quite panicked that this prized possession would never work again.
The Kindle has a special place for me. I don't care for TV (with the exception of surreal court shows -- The People's Court, etc). When I was in the hospital back in February, I mentioned to Maryka that I was getting very bored with the TV on. The message appears to have gotten back to Matt, so for my birthday (which is February 18), he sent me a Kindle. I certainly did not expect such a lavish gift, and was touched by his sensitivity to my plight. It also happens to be that Matt works for Amazon, and is involved on the Kindle project. So, this adds a special connection to him associated with this gift, and considerable concerns if I were not to have it.
Before I got the Kindle, I did not actually read very much. Although many know of me as a writer, I am actually a handicapped reader with a clear learning disability. The learning disability is a consequence of my operation when I was ten years old. Before that, I was an avid reader. Many of the historical facts I know today come from children's books I read before I was ten. I mentioned before that Dr. Gross had a worldwide reputation as a pediatric heart surgeon. One reason for his success is that he was able to do surgery at a rapid clip. Without today's technology, there is significant interruption of blood flow during the operation I had. The damage that is done may depend on how long. Although my operation was successful, my loss of reading skills was dramatic.
This has actually played a very central role in my development as a clinical psychologist. I was trained in New York which was heavily influenced by the psychoanalytic approach. I assumed that there were Oedipal themes and castration anxieties, associated with the fact that I suddenly stopped reading after my operation. My mother stayed in Boston during my surgical stay, while my father had to stay home to work. Undoubtedly, I feared going blind at my father's hand for sharing this intimate time with her. This, and other misguided notions about a whole range of health and emotional reactions, have significantly altered my views on psychoanalysis, and play a major role in the psychology I currently practice.
Coming back to the Kindle, I found it not just a thoughtful gift, but a remarkable device. It's small screen combined with its options to control the size of the letters, has dramatically increased my capacity to read. Whereas for most of my adult life, I have read just one book a year, on my annual summer vacation, I've read four since February, along with my daily New York Times subscription. The loss of my Kindle would be a devastating blow.
I tried to comfort myself, knowing that it had a one year warranty, but I also thought back to that time, shortly after surgery, when I dropped my Kindle, reaching for in with my numbed right hand. Would that invalidate the warranty? I looked over my Kinder for signs of damage, and shockingly found that some were there. There was a slight separation in the integrity of the seal between the front and back covers. Undoubtedly, it had separated when it had dropped.
With some difficulty, I was able to snap the pieces back in place, still unclear about whether I would be protected. It didn't fail after the fall. But there may have been phsyical damage to kicked in later on. After continuing to push the buttons, I figured my only option was to use the power cord. I did not have it with me, and would have to wait to get home.
I put this out of my mind until Sunday evening while Maryka drove Matt to the airport. Unfortunately, I had to wait for her return, she she had been carrying the cord in her purse. I told her of my plight, and she questioned why I didn't share this with Matt, who could have taken the device back with him, if it did not work. I did not want him to feel bad, and also figured that I could settle the problem easily from home. Anyway, I plugged the Kindle in which caused the frozen screen to be immediately replaced with one that indicated, it needed to be charged. I believe the charge ran down during that day. Within a few minutes, my Kindle was working again.
It's interesting how, during a period of vulnerability, small things take on major levels of importance. Certainly, the worst that would happen is that I'd have to buy a new one. I can certainly afford a $300 item, knowing Blue Cross Blue Shield is handling my quarter million dollar operation. But this was a very special gift.
The other, unexpectedly special gift is Sir Koff-A-Lot. Before going into surgery, I was given a device called a incentive spirometer. I was instructed to use this ten times an hour, and continue to use it after I got home. This is done to prevent pneumonia, and will induce coughing if there are fluids in the lungs. Before of the cracked sternum, it is helpful to hold one's chest while coughing. Although a blanket would do, Sir Koff-A-Lot is a specially manufactured Teddy Bear, indistinguishable from his Teddy Bear cousins, except for his straighter back. This explanation is clearly described on Sir Koff-A-Lot's tags. Not quite ready to read when the bear first arrived, it nevertheless proved to be a comforting pal. I truly enjoy having Sir Koff-A-Lott around, who is currently napping in my bed. I guess surgery creates a throwback to a more primitive time, depending on others, and experiencing pride in using the potty the first time. Sir Koff-A-Lot has earned a permanent place in my heart.
Monday, July 13, 2009
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.
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.
Saturday, July 11, 2009
Almost went home
It's Saturday evening, and I almost thought I was going to go home A cardiology resident saw me early in the morning. His statement was highly unexpected, and turned to be untrue. Shortly, thereafter, a doctor from the surgical group saw me and suggested I might be here until Monday or Tuesday. Then, Dr. Ginzburg, my cardiologist, came by later and told me I'm going home tomorrow. There aren't many reasons for me to stay here. I feel well and can walk around. I get tired and take a nap, all things I can do at home. I've told them that I'd like to go home, but if there is a medical reason for me to stay, I will. The issue appears to be Coumadin. Even though I have a tissue valve and will not need it lifelong, I have to be on it for about two months, for my mitral valve. They put a plastic ring around the mitral valve when doing the repair. Some scar tissue is expected to develop around the ring, so they have to inhibit clotting while that happens.
Otherwise, things are going very well. My heart is pumping regularly. I've been off oxygen today. I'm certainly getting better much more quickly than I would have predicted.
Please excuse any typos in this post. I'm not quite up to proofreading what I wrote, as I usually do.
Otherwise, things are going very well. My heart is pumping regularly. I've been off oxygen today. I'm certainly getting better much more quickly than I would have predicted.
Please excuse any typos in this post. I'm not quite up to proofreading what I wrote, as I usually do.
Thursday, July 9, 2009
First Post After Surgery
It's the day after my surgery and I'm dictating this blog to Matt who is handling the technical aspects of my blogging for a while.
The operation went well. They replaced one valve and fixed the other. And for the first time in my life, I don't have a heart murmur. It also seems that I've got a career in stand up comedy as long as I make sure I come out on anesthesia. I've generally felt good except for some pain today. And I did just have my first solid food.
More to come when I am more active.
The operation went well. They replaced one valve and fixed the other. And for the first time in my life, I don't have a heart murmur. It also seems that I've got a career in stand up comedy as long as I make sure I come out on anesthesia. I've generally felt good except for some pain today. And I did just have my first solid food.
More to come when I am more active.
Subscribe to:
Posts (Atom)
