Wednesday, February 1, 2012

possible complications post cardiac surgery

If anyone reading this is about to have heart surgery, bear in mind that what happened to me was unusual. Gastro-intestinal bleeding can follow the intense anaesthetic and heavy doses of anti-coagulants required to work on the heart during valve surgery, but GI bleeding more usually presents as a bout of bloody stools, ie farther down in the body.
The surgery itself had gone well and I was expecting to be released from the hospital next day. The nurse said I could take my first shower in a week--YAY!--and I was walking down the hallway with R to check out the facilities. I suddenly felt the urge to vomit and told him to grab a basin.
Now. I'd vomited that morning. It happened while I had a visitor, and in my embarrassment I quickly folded the piqué across the mess I'd made and gave it to the orderly. I didn't take a good look, but I'd noticed that it was black and grainy. I work in a hospital and had heard the term "coffee grounds" to describe vomit, though I never knew what it meant. I've since looked it up. Molecules in red blood cells become oxidized by gastric acid. Coffee ground vomit means that your stomach is bleeding. I knew that what I'd vomited didn't look right. I asked the orderly to keep the piqué to show the nurse. He didn't. She returned from her coffee break and gave me anti-nausea medication so I wouldn't vomit again. She didn't ask any questions and I was in no state to badger her. I fell asleep.
When I woke, I called the friends who planned to visit that afternoon and told them not to come. I didn't feel well and I was in a foul mood. Though that, in itself, was not so unusual that it was a marker.
Later in the afternoon, when I was looking for the shower, I vomited dark red blood. No mistaking what it was. Everyone reacted quickly. I was dropped onto a nearby commode, wheeled to my bed, and had a  tube crammed down my nose--ostensibly to drain my stomach. The procedure was extremely painful. I asked the doctor to freeze me; he said he had no time. A nurse commented that my narrow nostrils were pretty but made the insertion of a naso-gastric tube very complicated. Uh... thanks. I think. Was that a compliment or a reprimand?
I was rushed back into the step-down unit where I began vomiting fresh blood: bright red gobs of egg yolk consistency. I will never forget the texture of it coming up my throat and out my teeth. Carmine rich semi-coagulated blood.
I shouldn't have been vomiting at all with an NG tube in place, begging the question: was it in the right place? My anecdotal guess--merely present at the center of the mayhem--is that it wasn't, but I seem to have been the only one asking.
The surgeon came to see me. He wanted to know if I had a history of ulcers. No. Never. He explained that upper GI bleeding was a possible complication after valve surgery. He apologized that it had happened. I understood that it wasn't his fault. It was how my body had reacted.
The GI doctors wanted to do a gastroscopy to investigate. My heart rate was over 200. The ICU doctors wanted me shipped to the ICU, but first they had to free a bed.
I realized I wasn't stable. Again, because I work in a hospital, I recognized the language. An upper GI bleed is not a good thing. The fact that the large blue cart--the crash cart--had been pulled up next to my bed in preparation for a cardiac arrest was not a good thing. I had an IV pole over my head with a chandelier of blood products hanging. Bags of yellow platelets, yellow plasma, red packed cells. Also not a good thing. At one point there must have been more strange blood than my own blood circulating in my body. And still I kept spewing it out. The doctors were trying to counteract the anticoagulant I'd been taking to keep my valves functioning. That might help stop the bleeding, but might also clot my valves. I overheard the doctors discussing my case in heated Latinate syllables. The GI doctors insisted that they had to scope me. The ICU doctors weren't sure that my heart would withstand the added stress of a scope. Which was more likely? Bleeding or my heart stopping? No one used the word death. Doctors are superstitious too.
I thought I should say good bye to R and tell him I loved him, but I didn't want to jinx myself either.
A doctor arrived to place a central line in my chest to facilitate access to my bloodstream. The line would have three faucets which could be turned on and off. They would be used to draw blood, as well as give me blood and medication as I needed it. My heart was still racing wildly.
The doctor had unfolded a transparent plastic sheet over the top half of my body, including my face, to make a sterile environment. R was pacing the hallway, bunching his fists in his hair. A doctor friend, who'd stopped by to visit, undertook to keep me talking during the procedure, because I was supposed to stay awake. He began by assuring me that everything was fine. I told him to stop the fucking bullshit. NOTHING WAS FINE. He said, okay, what do you want to talk about? I was lying with my face covered by a blue plastic sheet. My subconscious was in free-fall. The whole while I'd been in the hospital, the nurses had kept giving me messages that my sister had called to inquire about my condition. I knew it was a friend who was calling, but all this talk about my sister--who's been dead for 30 yrs--was beginning to work its effect on me. I was lying with my face under blue plastic, wondering if I was going to bleed to death or have a heart attack. I started talking about this stupid shitty coincidence of lying there with a plastic sheet on my face, because the last thing my sister would have seen before she died was plastic. This doctor friend had no idea what I was talking about. He knew nothing about how my sister died. He didn't know if I had family. But he was very good-natured and kept me talking, even when I called him names.
Another doctor drew arterial blood. Do you know where your artery is? Deep in your wrist. Imagine someone digging around with a fat-gauge needle to find your artery. Why anyone thinks that slitting their  wrists is an easy way to commit suicide, I'll never know.
Finally a bed was ready for me in the ICU, but the transport orderlies couldn't be located. The effort to get me to the ICU would have been comic if I'd had the least thread of humour left.
The GI doctors were still waiting to do a gastroscopy. It was 1 a.m. Again--because I work in a hospital--I understood how dire my situation must be for a medical team to be willing to do a procedure in the small hours of the morning. Partway through, though, they had to stop because my heart rate was too erratic. The doctor said she couldn't stop the bleeding and would have to repeat the test the next day.
The next day my heart was still fluttering madly. I still had the dreaded blue crash cart next to the bed. The ICU doctors debated and decided to try a medication that would either slow or stop my heart. Oh, the suspense. Six doctors standing around the bed watching the monitor as another doctor fed the medication into my IV drip by drip. Guess what? It worked.
I had a second scope that afternoon. The bleeding in my stomach couldn't be stopped completely, but my anti-coagulants had been stopped. I hadn't vomited since 5 a.m. The surgeon felt I had a window of a couple of days during which my valves would continue to function and my stomach might heal itself.
I ended up spending three nights in the ICU. R stayed for all but the last night when I told him to go home, shower, eat real food, and sleep in a bed. A dear friend came to spell him. My friends were all supportive with visits, checking up, bringing food, sending messages. I felt surrounded by a net of goodwill and comforting thoughts--as heartful and helpful as the umpteen bags of blood. That includes the doctors and the nurses who took such good care of me.
When R got home, there were many messages on the answering machine asking about me. Among them was a cheerful voice congratulating me on having won first prize for the Prairie Fire 2011 Fiction Contest. What fantastic news! And what timing!

1 comment:

  1. Wow, congrats on winning the Fiction contest. And very happy to hear you are recovering...but what an ordeal. Take care of you, Alice.