Pens of Cherbourg
I was in the hospital for several days. It was my first time as a patient, staying overnight. I noticed some similarities between being in the hospital and walking the Shikoku pilgrimage. For example, I didn’t shower for days in both places. The meals I ate were microwaved and repetitive, and didn’t look anything like food I would prepare for myself. I slept uncomfortably, and dreamed of being in my own bed. There were daily rituals to perform, but in the hospital they were focused on pills instead of prayers. There was little to occupy my mind, other than a longing for the next chance encounter with another human being. Several times a day I went for a walk, but instead of 20 miles a day, I was excited to make it to the nurses’ station and back.
I had tubes everywhere. When I first woke up after surgery, there was one down my throat to help me breathe. There was one in the back of my hand for easy access to my blood, which they tapped every day. There was one in my neck to provide a convenient port for mainlining drugs. There was one near my right armpit for draining fluids from the surgical site. And there was a catheter, meaning I never had to get up to use the restroom. I could have used one of those in Shikoku, especially on cold nights in the tent.
My stay started in the Cardiovascular Intensive Care Unit. I was supposed to be there for a couple of days, then move to a less restrictive environment, but the hospital was packed full with flu patients, and there was nowhere for me to go. A couple of days became five. When a bed finally opened up, it was the middle of the night. I convinced the nurse that I was perfectly capable of walking the 100 yards or so to the new unit. About half way down the hall I became a little light-headed, and stopped to rest on a bench. After a few minutes I tried again, but only made it about 15 yards before admitting to myself that I'd run out of gas. My workout of the day was over. I spotted a rolling desk chair, and tried to fall into it before losing consciousness. I woke up for a brief moment and saw panic and beads of perspiration on my nurse’s face. She was flanked by a couple of her colleagues, and they were all doing their best to wheel me in the right direction while trying to keep me from sliding out of the chair. That incident probably cost me an extra day in the hospital.
My surgery was on a Thursday, and I was home the following Tuesday. The valve repair surgery that I had is often done through an opening in the center of the chest, through the sternum. In my case the surgeon used a less invasive approach called “port access” (although this was confusing because my scar is on the starboard side). This meant that many of the warnings and post-surgical considerations didn’t apply to me. “Let your body be your guide,” was my surgeon’s advice. But one thing that kept me in the hospital was my weight. My body was retaining fluids, as is expected after surgery, and I was a good ten pounds heavier after surgery than before. The doctor was waiting for my weight to come down before discharging me. They gave me diuretics to speed up the process. I pointed out to my doctor that both coffee and beer were diuretics. He laughed, although I didn't intend it as a joke. (Would you like to see a video of my surgery? Check it out.)
Being home was comforting. I could finally take a shower (albeit sitting on a chair), sleep in my own bed, and eat real food. My wife and daughter fawned over me. Doctor’s orders included walking at least three times a day, and my entourage was always there, ready to catch me if I dropped. I wasn’t supposed to bend over, so I didn’t even have to pick up the dog’s poop when he came along. I felt a little stronger and more capable each day. I went out for ice cream. Life was good.
Until it wasn’t. There were days when my body seemed to go back to square one, and I couldn’t do much of anything. Without fail, I woke up suddenly and completely every night around 2:30 in the morning, and often couldn’t get back to sleep. I battled with occasional depression, and the thought that compared to this, a leaky mitral valve didn’t seem so bad after all. I felt fragile. I remember my first post-surgical sneeze. In that micro-moment when I realized that there was no turning back, I wondered if the violent contraction might just rip open my heart stitches and kill me. Death by sneezing, how embarrassing would that be? I tried to write, but my head was foggy, and the process took more time and effort than I could muster. My keyboard accuracy was down. More than usual, I called things by the wrong name, like asking someone to hand me a pen but saying “umbrella” instead. I had trouble remembering names, and in the middle of well-established rituals, such as making morning coffee for Ann, I sometimes got confused about the sequence of steps.
When I first got home, I was taking around 15 prescription pills a day. Many of them were temporary. The scariest is probably the blood thinner. I will continue to take it for a total of three months. The medicine (Warfarin, or Coumadin) works by reducing the amount of Vitamin K in your blood. Vitamin K helps to clot your blood. The source of Vitamin K is dietary, and is especially abundant in green leafy vegetables. My job is not to eliminate sources of Vitamin K, but to keep them as consistent as possible. A little bit of green vegetables every day is fine. A giant green salad once in a while is potentially a problem. To insure that my medicine and my diet are in sync, I have to have a blood test every few days. For a while, these tests were performed by a home health nurse, saving me a trip to the hospital. It was comforting and reassuring having a medical professional visit me at home every few days. As an example, there was a scar on my groin, through which I was connected to a heart-lung machine during the surgery. The scar had become a little tender, and I asked the nurse to take a look. Seizing the opportunity to chastise me for what she thought was my tendency to do too much too soon, she said, “That’s right. Just keep doing what you’re doing, and you’ll probably open that thing up and just bleed out.”
One of the temporary medicines helped to regulate my heart’s rhythm. While in the hospital I had bouts of “afib,” an erratic and inefficient heart rhythm. Apparently that is not unusual after having your heart cut open. The medicine helped, but after discontinuing it a couple of weeks after surgery, I wound up back in the hospital emergency room with what the doctor called “atrial flutter.” I went back on the rhythm medicine for several weeks. The rhythm meds and the blood thinners don’t play well together, which meant my blood tests needed to be more frequent, and the potential side effects were more intimidating.
It is now almost exactly two months since my surgery. I’m able to function pretty much normally. I don’t think you’d be able to tell by looking at me that I had heart surgery. Yesterday I went in for my first post-surgical echocardiogram. This is a test to determine how well the surgeon fixed my valve. The technician, sensing my anxiety, told me that it takes three or four months for valve repair patients to start feeling good again. She also reminded me about my next appointment with my cardiologist, who would give me the results of the “echo.” I wanted to write down the information, so I asked if I could borrow her umbrella.