Possible (part III)

This is the final chapter (for now) concerning my recent scary and unexpected adventures in the medical world. If you haven't read the first part please start there.

It took the surgeons approximately 90 minutes to scrub me down, stick in all the various catheters, extra IV's, central lines, get me under full anesthesia, and set up the respirator before the actual incisions began at 2:45pm. Julia was given a pager for updates and she wandered down to the main lobby to wait out the long hours. I'm not going to disclose the full details of the operation itself because I was in la-la land and have no idea. I kind of like it that way. [ update - actually I got the exceptionally complex full op report and it's kind of cool to see exactly what was done. See it all here) Suffice it to say a lot of messy and uncomfortable things were happening to my body over the next 6-7 hours. However Julia has two brothers on the east coast who are doctors and she kept them updated via text messages over the next 14 hours as I went from surgery to recovery:

2:48 PM [ Julia was paged that the surgery was underway ]
3:56 PM (family) Is ben's aortic valve bicuspid?
3:57 PM (Julia) Yep. Rick says that often causes an aneurysm.
3:58 PM (family) Oh. I was wondering why he would develop an aneurysm because he has always seemed so healthy and interested in diet and exercise
4:00 PM (Julia) He was born with it. Over time the pressure of the flow causes the tear.
4:11 PM (family) Yes. I was thinking it was like getting struck by lightning. At least there is an explanation.
4:14 PM (family) Do u have an idea of how long the surgery will take?
4:14 PM (Julia) 4 to six hours. Started 2:48

By 8:08pm, the procedure itself was complete and I was taken off the bypass so they could restart my heart and check for any leaks (just like any good plumber should do). Julia was paged accordingly and she returned to the CICU lounge to wait for Dr Kirker and his update.

8:08 PM (Julia) Off bypass. Should hear soon from md

About an hour later Dr Kirker came out of OR and spoke to Julia about the operation. Which in a nut shell was a huge success - most especially because he was able to repair my valve  (it's still a bicuspid, but now a working one, yeah!). Julia asked him how he did that and he responded that it was too complex to explain.  He also told her that I didn't need any extra blood during the entire operation, which is highly unusual for such a long and complex open heart procedure.

9:31 PM - (Julia) Out of or. Md saved his valve, replaced ascending and placed stent into descending. Next step: check for bleeding. Get him to wake up. I'll see him soon.

About an hour after this Boyd, the CICU nurse, brought Julia to see me in my room. I was still on a ventilator and occasionally shivering from the after effects of the anesthesia. Julia spoke in my ear and gave me a million kisses. Boyd pointed out that I had lots of movements, such as in my arms and legs and once I tried to get something out of my eye (there was antibiotic gel in them) and these were very encouraging cognitive signs for a good recovery.   My catheter was constantly dripping which meant my kidney's were going good.  Everything was as positive as it could be at this point.

Julia then returned to the CICU lounge and tried to sleep while Boyd continued to bring me slowly out of anesthesia and back into the real world. This process continued into the morning.  Around 5:30am Boyd spotted Julia in the hall and gave her a signal to come into the CICU.  He was smiling.

My first memories occurred around this time. There must have been a period where I was semi-conscious and that time frame seems like a vague dream. But I clearly recall seeing Julia come into my room.   I smiled and said "Hi Baby!".  I was so happy to see her!  I then remember asking if they saved my valve and she told me yes.  This is like waking up on Christmas morning and immediately finding the two most important gifts that you wanted so bad right in your hands.  Julia said I was almost euphoric.  And hungry. So very hungry!

By this time, around 6:30am,  I was propped up in my chair and Julia fed me two bowls of jello and a sorbet, constantly warning me not to eat too fast.  But they were so good! I joked that there must be a secret ingredient in the jello that makes you want more - a line from the movie "So I married an Axe Murderer" that Julia and I often quote. After this I started to feel some pain so the new nurse, Marie, gave me a shot so I could sleep. Julia gave her family an update.

8:25 AM - (Julia) Tubes coming out! He's eating jello and loving it
8:26 AM - (family) Amazing!! Great news
8:27 AM - Some pain when he transferred from chair to bed, so he got meds 
8:29 AM - (family) Of course that is hard. But out of bed, eatng, breathing on his own, hungry, all good signs! 

Julia also sent an email to my sibs with similar news: Breathing tube out!  He's up in a chair!  Hungry!  Amazing!  Thank God"

At this point my recovery began in earnest.  Various tubes were pulled out starting with the catheter.  I ate soup.  Later Dr Kirker visited and said I was doing great and that he was impressed.  By the afternoon I was able to transfer out of CICU and walked on my own to the new room.  Turkey and gravy for dinner.  I remember thinking that could have been my last meal ever and was so glad it wasn't.

On Thursday Dr Kirker visited again and thought that, due to the 40% leakage which I had before, it was entirely possible I might feel stronger once I was fully healed.  He also suggested that I might be discharged as early as Friday which would be some kind of record, but I preferred Saturday because my pain meds were still pretty heavy.  He thought that made better sense and was still plenty fast for any open heart recovery.  He had another interesting comment for me.  I wasn't the youngest patient who had had this surgery, but I was definitely the fittest.  Before leaving he told me he was soon headed east for vacation and would out for a few weeks.  I recall thinking how lucky I was that all this occurred while he was still in Oregon. Just a few days can make such a difference in your life.  I don't believe in fate, but....

On Friday Julia's brother -  the cardiologist in New England - told her that I had officially become a boring cardiac case.  I was able to walk up and down stairs without much difficulty.  In fact one of Dr Kirker's partners, Dr Ott, had to catch me in the stairwell and joked that he was now tired.  He warned me that my greatest challenge was not to push myself too hard in the next few weeks.  My sternum was still split in half and required 6-8 weeks to fully heal.  I had to be very careful not to lift anything over 8 pounds.  And he had one further warning.  Many patients experience major depression after returning home from heart surgery as they deal with new physical limitations and their bodies cope with the stress of such a large healing process.  Hormones are reduced and protein is redirected from the exoskeleton to areas that are healing.  He wasn't the first person to tell me this and I was willing to believe this could very well happen.  Though as of right now every day has only been better, sometimes way better, than the last. And I intend to keep it that way!

I had one minor set back Friday afternoon, though looking back it was kind of funny how it went down.  All cardiac surgery patients are wired to heart monitors and there's a room with technicians who keep an eye around the clock for any funky heart business.  Our first visitors had just left and I was munching on a sandwich while our nurse was in the room chatting with us.  I swallowed a bite and was talking when I felt my heart take a few noticeably harder beats, but it didn't seem too concerning.  At that moment the nurse got a page - "is room 42 OK?"  That was my room!  The nurse replied she was there and everything seemed fine.  She walked over and listened to my chest and said "hey your heart is beating a bit fast".  Her pager beeped a second time "room 42 is in A-fib!!". Julia and I looked at each other in shock and surprise. I suddenly felt very tense and now I really did feel my heart pounding!  At nearly the same time we heard steps running down the hall and approaching our room.  I half expected a team of doctors to rush in with large needles and a defibrillator charging up ready to give me the big shock.  Instead a lady pushing a food cart flew by our room - running a little late on the lunch delivery I guess?

Meanwhile our nurse didn't seem too concerned.  An A-fib (Atrial fibrillation)  is a paricular type of cardiac arrhythmia that is very common after open heart surgery or whenever the heart has been cut or traumatized.  In fact they always have anti-A-fib medication (protocol) ready to go in these cases as it's practically standard procedure to occur once ot twice during post-op.  So I moved to my bed and took some calming breaths while she hooked up a bag of anti-A-fib juice into my IV drip. My heart already seemed slower and about ten minutes later our nurse was paged that I was out of A-fib. Whew!  I was worried that this might impact our Saturday discharge but everything was good from there on.

Early Saturday afternoon I walked out of the hospital and  into Julia's waiting arms.  We high-fived and hugged each other.  I could not believe that only four days ago I was facing such an uncertain and scary future. We drove back to Hood River and once there I recalled riding my bike up to HRM last Monday so certain I would be back in just an hour. In our waiting mail was the Netflix rental "Soul Surfer".  Funny - that has been in our queue all summer and it just shows up now. Weird coincidence (cue Twilight Zone theme). Every surfer probably knows the story - Bethany Hamilton has her arm bitten off by a shark while surfing her home waters in Kauai.  Later in the movie she tells her dad she wants to not just surf  again but also compete.  He tells her "honey, it's not going to be easy".  And she replies, "Dad, I don't want easy, I just want possible."  Possible is all I can ask for as well.