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If
you've never had major surgery before there's the cool part after they've got
you all scrubbed and prepped in pre-op, and inserted IVs in your veins, and
you're ready to rock and roll with whatever's on the program. I'm familiar
with this routine. It's the only part of the surgery your apt to remember.
Then they start pumping fentanyl and versed (midazolam) into you and things
get extremely pleasant instantly. You're riding a gurney, a rolling taxicab,
through the maze of subterranean hospital hallways and everyone's wearing the
same outfit: green scrubs with a big puffy beret, and there's a party going
on exactly where you're headed: the room where they disassemble you and put
you back together.
I
was in for a minimally invasive cervical decompression on March 4. They were
going to thread some arthoscopic instruments into
the spaces around my neckbones - the cervical
vertebrae - and grind down some bone spurs and fix some other crap that was
pressing on my spinal cord and giving me grief. I was goofing with the
anesthesiologists as I rolled into the OR, doing an old routine from a Samuel
Beckett novel, Molloy, that I'd memorized
back in college called The Story of the Stones ... "I took advantage
of being at the seaside to lay in a store of sucking-stones. They were
pebbles but I called them stones. Yes on this occasion I laid in a
considerable store...." It's a great piece, goes on for pages and
pages of absolutely absurd poetic drivel, and the chief anesthesiologist
(Albany Med is a teaching hospital) was an Irishman like Beckett so I thought
he'd appreciate it.
They'd
just given me the final chemical push into dreamyland
and inserted the breathing tube when the EKG unit that my heart was hooked up
to started reporting strange activity. The waveform looked bad. My blood
pressure shot way up. They stopped the operation. I don't know this on my
own, but I'm told that as they yanked the breathing tube out I seamlessly
resumed The Story of the Stones "...I distributed them equally among
my four pockets and sucked them turn and turn about.
This raised a problem which I first solved in the following way...."
In
the commotion I assumed that that operation had concluded and all was well. I
was then informed what actually happened, wheeled off to some post-op holding
pen, and left to stew in drugged mystification and disappointment for a
while. Eventually, they wheeled me up to a neurosurgery recovery ward to cool
my jets until some new order of business was lined up.
The
next two days I had heart tests. First was the common stress test. You get a
dose of radioactive fluid, wait an hour watching Honey Boo Boo videos until it penetrates your tissues, and then
get a set of fancy pictures of your heart taken under this big revolving drum
of a camera. Then they put you on the treadmill to study how your heart
performs under a controlled strain. Turned out the treadmill interface with
the EKG was on the fritz, so they took me off and opted for the
"hot-shot" instead. The hot shot is a dose of some chemical that
fools your heart into thinking it had just run the 100 yard dash. Meanwhile
you're hooked up to an EKG readout. It was like a
chemically-induced anxiety attack. The EKG on me produced a strange wave
form. The pictures, on the other hand, showed nothing conclusive.
The
next day I went to the angiogram lab. It's a subterranean room chilled like a
walk-in-fridge because all the computer equipment stuffed into it doesn't
like to get warm. I got another IV "cocktail" down there while they
shaved my groin and threaded a catheter wire into my femoral artery up toward
my heart. There were at least eight technicians roistering around in there
including the cardiologist who ran the lab. Some kind of Star Wars
type of "music" filled the room, and the ambience was rather like a
dance club around two o'clock in the morning, minus super-models. The upshot
of the test was that I had a 90 percent blockage of the Left Main coronary
artery, the "widow-maker." The other coronary vessels were clear.
It
had to get fixed. The next step was to decide whether they would fix it with
a stent or a bypass surgery. The stent is a little wire basket inserted with
a catheter. They have two kinds: 1) plain; 2) coated with anti-clotting
chemicals. It will hold a blocked artery open, but it has its limitations.
You have to stay on blood-thinner drugs practically forever and the stent can
just fail. The heart-surgeons and their cardiologist office-mates came around
to talk it over with me and we all decided that a bypass was the way to go.
I
spent the next six days as a hostage waiting for a surgery slot. The doctors
didn't want to cut me loose because the widow-maker might take me out just
lifting a bag of onions in the supermarket, and I suppose there were
liability issues - like: this guy's heirs and assigns will sue us if we let
him go for a few days and something happens. I had visitors, and my
girlfriend kept me company for big chunks of the day, and I read a biography
of Stalin - a much more interesting chap than I'd previously understood him
to be - and, of course, I enjoyed the fabulous hospital cuisine. Oh, I wrote
last week's blog somewhere in there, too, on my iPad.
Tuesday
morning it was back to pre-op. This time, I didn't feel as frisky as the last
when I performed Beckett. The anesthesiologist resident was a whip-smart
Asian beauty with a jaunty head-rag and a droll sense of humor, and that was
good enough. I don't even remember them shaving my chest, let alone sawing
through my sternum and retracting the ribs to reveal all the marvelous pulsing
wet gunk inside. The operation lasted about five hours. For about four of
them, my heart was stopped and my lungs collapsed (on purpose, to get them
out of the way). My blood and oxygen circulated through a machine. That was
my "Kurzweil" moment. I don't remember dreaming up any avatar
super-model sex partners in the process.
The
surgeon "harvested" a couple of blood vessels from around my
pectoral muscles to use as grafts. They used to go straight for the leg
veins, but the chest veins are stronger and more flexible. They ran two
bypasses around the blocked Left Main coronary vessel. The Left Main provides
nourishment and oxygen for the whole left side of the heart, so you want to
make sure that the bypasses deliver a lot of flow. They left three drainage hoses
and a temporary pacemaker wire in my thoracic cavity, wired the sternum back
together, and called it a day.
I
came to, partially anyway, in the post-op with the breathing tube jammed in
my craw and, quite possibly, the most unpleasant range of sensations I'd ever
felt. A nurse or patient assistant sat nearby and I tried to communicate that
the breathing tube was killing me, but he just said he couldn't understand
me. So, I tried writing it out on my forearm with my index finger. He
remained perplexed. Finally, I wrote it upside down and backwards, and he
said, "Oh, 'gagging.' Yeah. Don't worry, it's
normal."
The
next 48 hours in the cardio intensive care unit amounted to a diminishing set
of ghastly sensations. I was wired up to several machines and the hoses were
dumping liters of accumulated fluid. Sleep was out of the question, such a
racket of beeps and gurgling surrounded me. They got me sitting in a chair
and then walking around the unit within a day of surgery. The other people on
the ward were amazingly old, it seemed to me, pale, shriveled, grub-like
creatures, like the nematodes you find digging up a
patch of lawn. It was a stretch to imagine them surviving this.
The
doctors came by now and again to check in with me. They mostly gave you the
impression that they wanted to be somewhere else, and were impatient to get
there. But since they came by in the evening, and still wore the scrubs they
put on at seven in the morning, you got the feeling that they were horribly
overworked, too. After two days in the ICU, they sent me upstairs for one
more night, and then I came home.
The
feeling of having been hit by a truck and then having had my brains pulled
out of my head through my nostrils is beginning to dissipate. A few
provisional conclusions. 1) I was lucky to find out I had a blocked artery in
the way I did. 2) I was lucky to get it fixed, pronto. 3) Unlike many of my
boomer friends in these later innings of life, I know exactly what the
condition of my heart is now. 4.) I didn't have a heart attack at any point
in the ordeal, and the muscle is actually quite strong, so I will be here to
torment my adversaries and auditors for quite a while.
I
now await the cavalcade of bills. It was impressive to see how hermetically
sealed off the "care-givers" (doctors, nurses, etc)
are from the business side of the hospital. At no point in the ordeal was the
cost of anything discussed. Therefore, apart from the great benefit of
staying alive, one is firmly in the grip of what amounts to an outrageous and
indecent hostage racket. I'll keep you posted on how that unravels in the
weeks ahead, when I'm not running my mouth in other directions.
Apart
from that, too, I'm grateful to the doctors and nurses whose skills allowed
me to stay on board the mystery train and see how Ben Bernanke's grand
experiment works out, among other temporal melodramas. And thanks to many
readers who sent emails of support and concern.
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