Monday, January 30, 2012

cardiac surgery etc

Allow me a moment of slobbering sentimentality. I've just spent two weeks penned up in the hospital and am so grateful to be home and in my room again... a large room with wide plank pine floors as they were built in 1901; the recycled oak boardroom table I use as a desk; a futon sofa to loll on (futon because that was all we could get up the narrow curve of the staircase); bookcases along one wall; favourite photos; printer; big dictionaries; writerly paraphernalia. The double sash window looks onto the ad hoc cornices of Point St. Charles. They're simply carved as befits a working-class neighbhourhood, crazily painted as befits the taste of the inhabitants. Two-tone peacock blue and white, matte black, chalk grey, red. Above the flat roofs, the sunlit branches of an enormous oak against a clear sky.
Heart surgery turned out to be the easy part. Yes, your chest is sawn open, your heart stopped, your lungs collapsed, but for the surgeons this is all fairly routine. People have their hearts stopped and valves replaced all the time. Pick a hospital with a cardiac surgery department, look at the OR list, count how many valve surgeries are done per week and do the math to get a round number for the year.
How many mortalities on the table? Bah. None. Certainly not for a youngish woman (I'm talking hearts, not bathing suits) like myself. Statistically, I was pretty safe.
The surgery lasted approximately six hours. I remember being wheeled into the corridor outside the operating theater. It was cold. I thought of refrigerated flesh. People were walking around in surgical greens, caps, and masks.
The next thing I recall was the ICU nurse telling me that my sister had called. Since my sister is dead, I assumed I was dead too. We were now in the same realm. I'd forgotten that a friend had said she was going to call for updates on my condition by claiming that she was my sister. Bad timing, bad joke. I didn't want to be dead and tried to tell the nurse that I didn't have a sister, but I had a tube down my throat. Don't try to talk, she said.
Consciousness wafted on and off. I had nightmarish dreams that I was going to have my chest cut open. Then I opened my eyes to the swimming ICU environment--I wasn't wearing my glasses--and realized ohmygod IT WAS TRUE. Yet I felt no pain because I was medicated.
R squeezed my hand a lot. I remember that--perhaps because he has such large warm hands. Or because he stood by me for hours squeezing.
Dear friends came too, but I have only vague recollections of their silhouettes against the bright ceiling lights. I suppose it's not fair to expect my memory to be stronger than the pharmaceuticals that kept me from shrieking against the pain of just having had scalpels root around in my chest. In any case, what I remember with my mind doesn't matter. Being a sewn-up sack of flesh is the perfect situation to examine the mind-body split. Your mind is anaesthetized, all talk of free will, personality, belief systems useless. Your body is a wounded animal craving solace. My body knew friends had come to bear witness and was comforted by their presence. That's all that matters in the ICU--that your body survives this moment, then the next, then the next. Whatever makes you feel safe, get it. I wanted people, though I know it couldn't have been pleasant to see me intubated, bloated with IV fluids, and unable to speak. Thank you Kathleen, Jean, Saleema, Lina, Matthew, Ahmed and Badar for coming. Thank you most of all to Robert who never left.
The first time I had to roll to the side for the orderly and the nurse to change the bed, I thought my chest would crack. Yet the next day I was sitting up by myself. The body is amazing for what it can withstand.
I was transferred to an intermediate unit for a day, and from there to the ward. I had an IV pump I had to wheel around with me, which required more acrobatics than seemed doable in the middle of the night when I had to go to the toilet. All those wires--one dangling from an IV in my arm, another hooked on the bed rail, another snagged on the bedside table, the pump itself plugged into the wall. Of course, I could have called the nurse or an orderly for help, but I was stubborn. The sooner I was independent, the sooner I would be able to go home. The pump and I did war in the limited space between my bed and the chair where the patient in the next bed (a retired mafioso with a sullen profile) had propped his swollen purple foot. Every time I drew the curtain between our beds for some privacy, he swiped the curtain aside with his cane. He wanted to see the hallway so he could bellow at his nurse whenever she walked past. Poor nurse.
I avoided looking at my scar. I've seen it since of course. It's more crooked than the one I got in '83. Yet it also looks smoother. At the very top, just under the collarbone, there's a protrusion--like a widow's hump, except that it's on my breastbone. Damn. I can't tell yet if that's how the bones beneath have been sewn together or if it's swollen flesh--if the lump will get smaller.
Half of my left hand--my fourth and fifth fingers and that side of my palm--are numb, which is apparently a common complication of  cardiac surgery. Something to do with the placement of your left arm over your head during the surgery. The nurses told me the feeling would come back in a few months. A FEW MONTHS??? I'm left-handed. So I'm trying to relearn how to type with two dead fingers. I can't use a pen. Toothpaste flies as I try to brush with my right hand.
Because the breastbone and ribs are a stable cage that enclose the heart, the pain of cardiac surgery isn't at all like an abdominal or even a neck incision where the muscles pull each time you move. I took only Tylenol while I was in the hospital. I was offered morphine and Oxycodone. I  preferred to withstand the iron corset feeling and not take the stronger stuff because it made me nauseated.
Nausea was by far my biggest concern. However, I recalled being nauseated from the last time I had valve surgery and wasn't surprised. Nor was the hospital food in the least appetizing. Hot meals were gluey and colourless. Sandwiches came in a choice of yellow, beige, or darker beige: egg, chicken, or tuna. Even the drinking water stank of hospital sanitizer. R brought my favourite foods but I wouldn't even let him unzip his knapsack. Just the idea of food made my guts curdle. I told the nurses that I was nauseated+++++. But they, too, were familiar with the nausea that commonly follows cardiac surgery, and didn't suspect that I had trouble brewing.
One day I had a long run of atrial fibrillation that wouldn't stop. My heart fluttered high and hard in my throat for hours. It was exhausting. Well, yes, at a heart rate of 150, I might as well have been jogging all that time without stop. But apparently a-fib post-op day 2 is common. I was put back in the step-down unit and given a drip that stabilized my thundering rhythm.
Back on the ward again, I did my best to get ready to be discharged within the 5-7 day time frame I'd been given for post-op stay after cardiac surgery. Who wants to stay in the hospital an instant longer than they have to? I walked in the hallway shoving my unwieldy pump. I coughed as I was supposed to. I still couldn't eat. All I could tolerate was ice. Before mealtimes I asked for anti-nausea medication, but it didn't really help and made me sleepy. Nausea, nausea.... I just wanted to get home.
My chest tubes were removed--fat slithery worms that had stopped draining fluid from my chest cavity. How were they removed? They were pulled. One, two, three, take a deep breath. Ewwwwww. R asked the nurse if my insides weren't going to ooze out the holes. She looked a bit shocked--didn't realize he was joking. Though maybe he wasn't.
The pacemaker wires were tugged out. One was sewn to my heart, the other a ground. The nurse took care to make sure they weren't tangled. Though they were only wires--much thinner than chest tubes--removing them pinched more since they'd started to fuse with my flesh.
My blood thinner had finally hit the target mark for mechanical valves, so the IV pump was removed. I could take a shower! The next day I could go home, and would surely get my appetite back when I was eating proper food again. I was determined to get out.
But that's not what happened. I ended up spending another full week in the hospital, much of it in the ICU. But that will wait for another post.

Tuesday, January 10, 2012

midsternal line

Here, where the skin is smooth—below the collarbone, above the breasts—press your hand flat, slide it down to where the diaphragm starts. Trace the line, almost faded, made by the surgeon in Toronto 30 yrs ago. Do it now before the flesh is cut again.