Straight from the Heart :
The
Story of My Tryst With My Heart Ailment
|
Straight from the Heart (1) : The Story of My Tryst With My Heart Ailment
Straight from the Heart (2) : “Rational” Thinking, Irrational Acts
Straight from the Heart (3) : When the Unthinkable Happened : Angioplasty, 1999
Straight from the Heart (4) : Back to Life as Usual, with a Minor Throwback
Straight from the Heart (5) : Déjà vu
Straight from the Heart (6) : Opening Up to Open-Heart Surgery (CABG)
Straight from the Heart (7) : Post-Operational Recovery
Straight from the Heart (8) : One Year After
Part-VI of VIII
CABG
______________________________________________________________________
Opening Up to Open-Heart Surgery (CABG)
Not Angioplasty; Open-Heart Surgery
Dr Wani advised me around 12.30 pm on Thursday, 3 July 2014
after Angiography that in view of my 5 blockages between 85% to 100%, including
the one in the Left Anterior Descending coronary artery (LAD: 100% blockage) where
during the Angioplasty in 1999 a stent was put, Angioplasty on me was not
possible.
I felt disheartened that the only heartening remedy for me
was Open-Heart Surgery (CABG)—and
sooner the better.
Like Edward de Bono explains in Lateral Thinking, we tend to put boundaries on possibilities. My
outer-most boundary was Angioplasty. Open-Heart
Surgery was something I had never even once considered as a possibility. But, now
it brutally stared me in the face. How what you never expect happens?
I not only had to come to terms with the looming possibility
of soon being at the receiving end of CABG, I had to take a decision fast; for
Dr Wani had stressed “sooner the better”, and that was backed up through an SMS
to my wife from Dr Sejao, who had been apprised of the Angiography results by
Dr Wani.
Which Surgeon? When?
If CABG had to be done, then in which hospital, and by whom?
That was the next logical question.
“Who does open-heart surgery here [in that hospital—KDAH: Kokilaben Dhirubhai Ambani Hospital]?” I asked Dr Wani on 3 July
2014, when he recommended CABG.
“Dr Lad,” he informed, “Dr Vidyadhar Lad.”
“How’s he?” I instinctively let out an unnecessary query.
“Good!” responded Dr Wani.
“Can I meet him?” I asked, sitting in hospital-bed in a
reclining position with my right thigh heavily and tightly bandaged and not
allowed to move, and still some hours away from being discharged.
“Yes, sure. The sister here would see to it. I would
instruct her,” said Dr Wani.
Shortly afterwards my wife and the two daughters were
permitted to meet me, and came over to my bed. I told them to do a fast
research on the web on their tablets on Dr Lad and on the other renowned heart
surgeons in Mumbai in other hospitals; and further check-up information on Dr Lad
in KDAH itself. Their short visit-duration over, they were requested to wait
outside.
After over an hour I saw one young, smiling gentleman
walking towards me along with my wife and my elder daughter, Manasi. He
extended his right hand towards me for handshake and just said, “Dr Lad.”
“Oh, Dr Lad. Glad to see you. But, I thought you were a
friend of my daughter, and had come along after knowing I was in the hospital.
You look so young!” I said.
“No, no. I am not that young. I am 44. I have just studied
your angiography and other test reports, and was coming to meet you,” he
responded laughing.
“Can you please explain briefly all the relevant stuff about this
open-heart surgery, including the cost,” I queried.
Dr Lad gave an overview. The cost seemed reasonable, considering the quality of services and the facilities available.
“Dr Wani has advised that CABG be done as soon as possible.
So, what is the earliest it can be done here?" I queried.
“We can schedule it next week. But, before that you have to
be off blood-thinners—those medicines that you have been taking have to be
stopped," Dr Lad informed.
We told him we would take a final decision in a day or two
and would inform him accordingly—we thought we would check up with other
renowned doctors too in other Mumbai hospitals.
Dr Lad went over to a table across and began looking at my
file and the medicines I had been taking.
“Dr Lad,” I interrupted his study of the file, “what is the
risk percentage of CABG?”
“About or rather less than one percent,” he informed.
“However,” he continued, “looking to your state of health, that risk is zero
percent for you!”
“Zero percent!” I repeated after him.
“Yes,” he confirmed with quiet assurance.
That swung the scales. Later, after Dr Lad had left, and my
wife and daughters filled me in with their local enquiries and their research
on the web on Dr Lad and others, our views converged—Dr Lad was the right
person; we need not go anywhere else; and we must finalise date of CABG that
day itself before leaving the hospital.
As I was still in bed, and not allowed to walk, I asked my
wife and daughters to seek an appointment with Dr Lad, meet him, and settle the earliest possible date for CABG. They sent an SMS to Dr Lad, and as is Dr Lad’s
excellent habit, they received his prompt reply: appointment was scheduled after about an hour.
They met him. He explained to them the details on “Beating-Heart CABG”
(technical details covered in Part-I of this blog-post) that would be performed
on me. The date of the operation was fixed for the earliest possible
date—Wednesday, 9 July 2014. For the purpose, I was to get admitted at the
hospital late evening by 8pm on Monday, 7 July 2014; and was to remain off
blood-thinners starting that day itself—Thursday, 3 July 2014.
After discharge, we all left the hospital by about 5.30 pm
on Thursday, 3 July 2014.
My younger daughter, Manini, who divides her time between
Germany and India, being director in two companies, one in Germany and the
other in Pune, left for official work in Pune on the morning of Friday, 4 July 2014. However,
the elder one, Manasi, who works in Oracle-Hyderabad stayed back. It was after
a long long time she was spending so many days with us. We watched
Football World Cup 2014 quarter-finals between France and Germany on Friday, 4
July 2014. Germany, of course, won, but by only 1 goal. On the 5th
and 6th too we watched the quarter-finals.
____________________________________________________________
Back to KDAH for CABG
Then came the D-day. On Monday, 7 July 2014, I packed up. My
wife Debu, Manasi and I left for the hospital in the evening at about 6.30pm.
We were now familiar with the registration process. We filled-in the forms,
paid and registered at the ground floor.
The Ward
A twin-sharing room was allocated on the 13th
floor: room number 13033. We moved to the room by about 8pm. The room was neat,
clean, spacious and well-lighted, and was centrally air-conditioned. It had an
attached toilet. My bed overlooked the metro-line, and one could watch through
the large, wide windows beautiful multi-coloured metro-trains going to-and-fro.
Early next morning I noticed the sea visible through the window in far off distance. My area was
separated from the area of the other patient by curtains.
There was a side-sofa along the window for visitors, and for
the person accompanying the patient (guest) to sleep in the night. They
provided bed-sheets and blanket for the guest too.
The first thing I was required to do was to change into the
hospital-provided patient’s clothes. I did so, and although I was then quite
normal, I started feeling depressingly like a patient.
Soon after hot soup brought in thermos was served, followed
by dinner. The fare was healthy and good.
Manasi and Debu went down to the ground-floor restaurant for
dinner. They were back by 9.30 pm, accompanied by Manini, who had come over
straight from Pune. Later Debu and Manini left for home, leaving Manasi to give
me company.
The room was equipped with a cable-connected 32” LED-TV facing
each bed. That is, there were two TVs, one for each bed. I just checked the TV
functioned well, and listened to the news. There was no World Cup match either
on the 7th or on the 8th July.
Good mood turns sour
On the first day, or rather night, there was none in the
other bed, and hence no TV noise.
However, as they say, ‘good times don’t last’! And, next day
early morning saw the entry of a patient who was to occupy the other bed in the
twin-sharing room. No sooner was he in, his TV started blaring out. He switched
among various Hindi movie channels and seemed happy watching atrocious movies
at high volume. I requested for ‘some mercy’, to which he readily responded by
decreasing the volume temporarily, and then reverting to his ways after
some time.
I started cursing the facility of providing TV. If it had to
be provided, then head-phones too should be made available, so that others are
not forced to listen. Besides, there should be an instruction/request displayed
prominently beside each TV: “Please don’t disturb your neighbour. Play at low
volume: use head-phone if your neighbour feels disturbed.” I found it difficult
either to focus on my iPad or to sleep.
I had to
be operated the next day, and my hitherto good mood—thanks to the cleanliness
and excellent ambience of KDAH, fine view from my wide window, and admirable,
empathetic behaviour of hospital staff, besides palatable healthy food—began to
turn sour.
Helpless with regard to the neighbour’s TV, I, contrary to my nature, went silent, and began to brood—something
which I had not indulged in at all. “If only I had never smoked—giving it up 14
years back was not enough—I would not have been in this health/heart-mess. Had
I not been in this mess, I would not need to be operated upon. Had the
operation been not necessary, I would not be in KDAH. Had I not been in KDAH, I
would not have been in this bed 13033. And, had I not been in this bed, I would
not have had this neighbour! So, the fault is mine and mine alone!!”
My younger daughter, Manini, later remarked I had gone rather silent a day before the operation. Well, the reasons were what I just described. Once I had decided to go in for the operation knowing that the alternatives to it were much worse, where was the question of shying away from the requirements or being scared of what lay ahead. In fact, rather than being apprehensive, I was hopefully looking forward to my forthcoming birthday on the 29th July by when I expected to be in a much better shape—like it is said by/of Narendra Modi and his government: “Achchhe din aane wale hai [Good days are about to come)!!”
My younger daughter, Manini, later remarked I had gone rather silent a day before the operation. Well, the reasons were what I just described. Once I had decided to go in for the operation knowing that the alternatives to it were much worse, where was the question of shying away from the requirements or being scared of what lay ahead. In fact, rather than being apprehensive, I was hopefully looking forward to my forthcoming birthday on the 29th July by when I expected to be in a much better shape—like it is said by/of Narendra Modi and his government: “Achchhe din aane wale hai [Good days are about to come)!!”
______________________________________________________
Pre-Operative Tests
Blood/Urine Tests, Chest X-Ray, ECG & 2D-Echo
They took blood and urine samples for various tests.
Then a member of the hospital staff came over with a
wheel-chair to take me to the X-ray room on the first-floor for my chest x-ray.
I asked him if I could walk with him, rather than going in a wheel-chair—it
felt so embarrassing. He didn’t mind, so I walked with him.
Later, a wheel-chair came to carry me for ECG and 2D-Echo
test. I again walked with the hospital-staff, ignoring the chair.
Tests Relating to Radial Artery
For the next test, in the late afternoon, the hospital-staff
did not agree to my walking along (what if someone complained?), and I allowed myself to be wheeled, avoiding
eye-contact with all. I found the test rather queer. The concerned doctor was
running a probe on my left-hand forearm and wrist, and watching a monitor.
Unable to understand the purpose, I queried him. The following is the gist of
what he informed and what I gathered from other sources:
Arteries
harvested for CABG
For the purpose of Coronary Artery Bypass Graft (CABG), that
is, Open-Heart Surgery (OHS), arteries from the body of the patient are used
for bypass graft. Which arteries are used?
Usage of great saphenous vein (GSV) of the leg used to be
common, but is no longer so.
The arteries often used/harvested are the radial artery and
that from the chest.
Radial
Artery (RA)
The usage of radial artery for coronary artery bypass
grafting has gained growing popularity among cardiac surgeons on account of its
superior pre-operative and post-operative course compared to saphenous vein
grafts from the leg. It is much preferred over femoral approach due to better
accessibility, hemostasis (surgical procedure of stopping the flow of
blood) and shorter hospital stay. Radial arteries are the conduit graft of
choice after internal thoracic arteries because they are relatively easy to
harvest and have a larger diameter than other arterial grafts.
Further, the forearm is less prone to infection compared to
the leg because of better vascular supply. Local neurological complications are
infrequent and can be minimized if anatomic relations with the artery are
respected and cauterization near nerves is avoided. Harvesting usually involves
an incision extending longitudinally throughout the forearm that is not
cosmetically appealing. In my case, as it turned out later, they did something
better: rather than incision extending longitudinally throughout the forearm,
they made only three cuts of about an inch each, which they then used to
harvest the artery.
When harvesting the radial artery, typically the
non-dominant arm is used: in my case, the left-hand.
The test was done on my left-hand radial artery to evaluate
if it could be harvested. The test results, as the concerned doctor told me,
were negative. However, prior to operation, the test was re-conducted—as Dr Lad
obviously preferred the better option of harvesting radial artery—and the
re-test showed that my left-hand’s radial artery could be safely used. The same
was done.
Left Internal Thoracic/Mammary Artery (LITA/LIMA)
Harvesting of LITA/LIMA has gained popularity for CABG, and
has advantages over other methods.
In my case, both RA (Radial Artery of the left-hand) and
LITA/LIMA were
harvested for grafting.
LITA is the cardiac
surgeon's blood vessel of choice for CABG as it has superior long-term patency
to saphenous vein grafts from the leg and other arterial grafts like RA, when
grafted to the LAD (Left Anterior Descending coronary artery) which clinically
is generally the most important vessel to revascularize.
I don’t recall any pre-operative test done for LITA.
______________________________________________________
Pre-Operative Preparations
In the evening of Tuesday, 8 July 2014, a hospital staff
came over to remove my body hair from neck down. He didn’t have to do much, as
the same had been done about 6 days back, prior to Angiography.
I was asked to take dinner early, and to have a bath after a
gap of two hours, thoroughly and liberally applying Bactoscrub (an antiseptic,
anti-bacterial medicated liquid soap) from head to foot. Around 9pm on 8 July
2014 I had a bath with hot-water and applied Bactoscrub. After I had dried
myself, a hospital staff came over and applied Betadine neck-down all over my
body, turning its colour to yellow. After it dried up, I wore fresh hospital-clothes.
“You would need to wake up at 4am tomorrow morning,” I was
told. Thankfully, the nurse woke me up only at 4.30am. After a cup of hot-tea
and two biscuits, I went through my morning ablutions.
A hot-water bath, using Bactoscrub from head to foot,
followed. That had a collateral advantage. I had been feeling slightly scratchy
on my head, although I had no dandruff. All that disappeared with Bactoscrub.
Later, upon discharge, I bought two bottles of Bactoscrub, and have been
regularly using it.
After the bath, a hospital-staff again came over to paint my
whole body neck-down with Betadine, turning it yellow. After Betadine dried up,
I wore fresh hospital-clothes.
Funnily, my neighbour in my twin-sharing ward had also woken
up by 5am, and had started his racket of watching aloud a Hindi movie. I was to anyway move out for operation after some time, clearing out the ward; with a
hope to return to some other ward, after operation and a stint at ICU.
Operation began to seem a desirable option to run away from the TV and the ward.
After the operation, and before being shifted from the ICU to ward, I actually requested Dr Lad if I could be shifted to a general ward, rather than a twin-sharing room, thinking the general ward would not have TVs. "Why?" he asked perplexed. "I can't stand TV," I told him and narrated my experience. "But, the general ward has five beds and five TVs, one for each bed," he responded laughing. "Even we sometimes find it difficult while we go for visits, with all those five TVs blaring!"
After the operation, and before being shifted from the ICU to ward, I actually requested Dr Lad if I could be shifted to a general ward, rather than a twin-sharing room, thinking the general ward would not have TVs. "Why?" he asked perplexed. "I can't stand TV," I told him and narrated my experience. "But, the general ward has five beds and five TVs, one for each bed," he responded laughing. "Even we sometimes find it difficult while we go for visits, with all those five TVs blaring!"
______________________________________________________
To Operation Theatre
My wife, Debu, and my
younger daughter, Manini, had slept in the ward itself overnight. My elder
daughter, Manasi, my son-in-law, Arun, also working in Oracle, who had since
arrived from Hyderabad, and my younger sister, Poornima, who had come over from
Nagpur, landed at the ward at about 7am in the morning.
At about 7.30am I was wheeled out on a bed to be taken down
to the CABG Operation Theatre on the third-floor. The group—Debu, Manasi,
Manini, Arun, Poornima—followed me. We went down the lift to the third-floor.
As I was moved towards the operation theatre, we parted company. They all
wished me, and I put my thumbs up as we parted.
God,
Religion & Minimising Anxiety
I didn’t feel nervous or anxious or anything. Like I had
done while undergoing Angiography (which I have described in Part-V of this
blog-post) on 3 July 2014, I began repeating a long string of names of gods and
goddesses, and lost myself in it. That’s the advantage of belonging to a
polytheist religion like Hinduism. You may take names of a dozen or a score or
several score gods and goddesses—even over a million, if you know the names and
have the time! Fortunately, polytheist religions like Hinduism are genuinely the religions of peace, as they are tolerant, respect all faiths, and believe there are many ways to God, and all paths deserve to be respected. Not having the arrogance to declare itself as the only true religion, or its gods as the only gods worth worshipping, and believing in the principle of "live, and let live”, Hinduism respected and absorbed different groups worshipping different gods and goddesses, leading to multiple gods and goddesses and multiple prayer practices and rituals.
However, what is truly unique about Hinduism is its large-heartedness and democratic spirit. You may adopt different methods of prayer, different rituals, and pray to different gods—yet, you remain a Hindu. You may not even pray or ever go to temples, yet you are a Hindu. You may not even believe in God, may be an atheist, and yet you are a Hindu. In Sanskrit, atheism is called nirisvaravada—doctrine of godlessness—and an atheist is called a nastik. Hindu atheists live by Hindu values and traditions, and for them Hinduism is a "way of life", not a religion, and they do not accept the existence of God. Among the six schools of Astika—theist—Hindu philosophy themselves, two do not accept God: the Samkhya and the early Mimamsa school. Both reject creator-God. Apart from this, there is an explicit atheistschool of Hindu
However, what is truly unique about Hinduism is its large-heartedness and democratic spirit. You may adopt different methods of prayer, different rituals, and pray to different gods—yet, you remain a Hindu. You may not even pray or ever go to temples, yet you are a Hindu. You may not even believe in God, may be an atheist, and yet you are a Hindu. In Sanskrit, atheism is called nirisvaravada—doctrine of godlessness—and an atheist is called a nastik. Hindu atheists live by Hindu values and traditions, and for them Hinduism is a "way of life", not a religion, and they do not accept the existence of God. Among the six schools of Astika—theist—Hindu philosophy themselves, two do not accept God: the Samkhya and the early Mimamsa school. Both reject creator-God. Apart from this, there is an explicit atheist
In Jainism, propagated by Lord Mahavira, there is no place
for personal or impersonal God as the creator or sustainer of the universe, and
there is no notion of outside force regulating reward and punishment.
Buddhism is more a spiritual philosophy and a "way of life" than a religion. It
rejects the notion of creator-God. Here is what Buddha said:
Believe nothing.
No matter where you read it,
Or who said it,
Even if I have said it,
Unless it agrees with your own reason
And your own common sense.
Another good thing about Hinduism is that you can flip
between being a believer, an agnostic and an atheist as often as you wish and
any number of times—neither Hinduism nor the Hindu gods nor the Hindu goddesses mind!
Yet another notable thing about Hinduism is that a Hindu need give NO weightage
to any Hindu Dharm Guru (equivalent of a Pastor, Mullah or Pope) or to his or
her diktat. That is, a Hindu is directed by NO religious head. A Hindu need not
care what a Hindu religious head says or directs, nor need he care about what
the scriptures/religious books say or direct. A Hindu knows that things change
with time, what was said or written centuries ago may be wrong, and he or she
must go by his or her own choice and reason, in keeping with the changing times.
One thing worth-noting about all those who founded new religions is that they were actually irreligious! Irreligious in the sense that they rebelled against the religion they were born into, and founded new religion. What one must learn from them is the rebellious spirit, the guts to question one's belief and that of the religion one is born into, and go in for change and fresh thinking. All religions are old and outdated and out of sync with the reality. True religion is to be a good person (tolerant of others, behaving well with all, to be good to all, to change rationally with the requirements of changing times, and so on); and NOT to stick to outdated, age-old practices or to observe some set rituals or to wear certain kind of dress or to pray in a given way. A good person who is irreligious or atheist is far superior to a devout, religious person who is otherwise.
______________________________________________________
In the Operation Theatre
As a first-step, the anaesthetists introduced themselves to
me, told they would give injection on my thigh, and did so as gently as
possible. I only recalled Dr Lad telling me the day before that when I begin to
regain my consciousness in the ICU after the operation I would find tubes in my
mouth and would be unable to speak, but that I should not worry—the tubes would
be withdrawn after about two hours, and I would find my voice to be hoarse
initially. Even as I considered all this, I imperceptibly lost my
consciousness.
Certain technical details of the Beating Open-Heart Surgery
I have already covered in part-I of this blog-post.
Briefly, the other
particulars, to the extent I could gather, are as under (As I was
unconscious during the operation, I can’t vouch for anything. I would be happy
to stand corrected on any point):
After anaesthesia, a breathing (endotracheal) tube is
inserted and secured by the anaesthetist.
A tracheal tube is a catheter that is inserted into the
trachea for the primary purpose of establishing and maintaining a patent airway
and to ensure adequate exchange of oxygen and carbon dioxide.
The chest is opened via a median sternotomy. This procedure
provides access to the heart and lungs for surgical procedures.
In median sternotomy a vertical inline incision is made
along the sternum (breast-bone) from the suprasternal notch (top of the
sternum, after the large, visible dip below the neck) to below the xiphoid
process (the cartilaginous section at the lower end of the sternum). The
sternum is then cut with a sternal-saw (bone-cutter). The cut halves of the sternum are then slowly spread apart with a retractor, something similar to a brace. This allows physical access to heart. Closure requires reunion of the sternum with stainless steel
sutures (thread).
Sternum saw that cuts open the sternum (breast-bone)
The bypass grafts are harvested. A CABG involves taking a blood vessel from another part of the body – usually the chest, leg or arm – and attaching one end to the aorta and the other end is sewn on to the coronary arteries beyond the blockages (please see diagrams in Part-I of this series of blog-post). This new blood vessel is known as a graft. In my case the internal thoracic artery and the radial artery of the left-hand were harvested and used as five grafts for my five blockages.
As mine was a beating-heart, off-pump CABG, devices must
have been placed to stabilize the heart.
Once the grafting is over, chest tubes are placed in the
mediastinal (space between right and left lung) and pleural space to drain
blood from around the heart and lungs. In my case, there were three tubes—two
inserted in the two sides of the chest, and one at the top of the stomach,
below the sternum. The chest tube is inserted through a 1-inch cut in the skin
between your ribs. The tube is connected to a special canister kept on the
ground. Gravity allows draining out the blood. A stitch (suture) and tape keep
the tube in place.
Chest tubes are used to treat conditions that can cause lung
to collapse: after surgery/trauma in the chest; air leaks from inside the lung into
the chest; fluid build-up in the chest (pleural effusion) due to bleeding into
the chest.
My left-hand forearm from which radial artery was harvested
was also bandaged, and a tube was placed in the forearm under the bandage to
drain blood.
Thus, there were 4 tubes—three into the chest and stomach,
and one in the forearm—inserted in my body to drain blood. The other end of the
tubes went into a receptacle into which blood was collected.
The sternum (breast-bone) that had been cut to gain physical
access to heart was wired together with steel wires, and the incision, which
was about nine inches long, was closed with suture (thread of catgut, silk or
wire used by surgeons to stitch a wound).
______________________________________________________
Out of the Operation Theatre
I could hear some sounds, some commotion, but unable to open
my eyes, I could not make out much.
After a while I heard someone say aloud the operation was
successfully over and I was in ICU, and I could open my eyes. I believe I heard
some clapping too. I desperately attempted opening my eyes, but all I could
make out through the microscopically-opened slit of my eyes were splashes of
yellow. Had I gone blind?—I wondered. I again tried, but failed. About to give
up, I made out splashes of red too. Am I going to see paintings of yellow and
red for the rest of my life?—I thought, horrified. No, I must not lose heart, I
must try, I told myself. Then my eye-slit became a little larger, and I could
notice some shapes. That gave me hope. I put all my effort on both my eyes to
open to the full. Gradually, it happened. I saw hospital-staff around. Someone
said everything had gone fine. Perhaps it was Dr Lad (I don’t fully recall). I
made a gesture to thank him. I could not speak, as I noticed tubes jutting out
of my mouth.
After a while, one by one, my wife, daughters, sister and
son-in-law came over to see me from a distance (lest any infection be
transmitted) and wished me quick recovery.
I later learnt the
following from my wife and daughters:
Tense and anxious, they were all—Debu, Manasi, Manini,
Poornima, Arun—waiting outside the operation theatre in the waiting area. The
operation was to last several hours, and as none of them had eaten since the
morning, they took turns going to the ground-floor restaurant both to eat and
to relieve tension.
Apparently, around an hour and a half went by in initial
preparations. I was re-painted with Betadine. Radial artery test was redone.
Other things were set.
I understand that the actual operation commenced at about
9.30am. The operation lasted about 4 hours and finished around 1.30pm. After
post-operation observation, I was reportedly brought to the ICU at about
2.15pm. I regained consciousness in the ICU at about 3.30pm.
In between, when one of the doctors from the team doing the operation came out for a while, my wife, tense with what might have been happening, rushed to him to enquire. "Things are going fine. He is stable. Three grafts have already been done. Two more to follow," he informed. That brought some cheer to my wife and others.
In between, when one of the doctors from the team doing the operation came out for a while, my wife, tense with what might have been happening, rushed to him to enquire. "Things are going fine. He is stable. Three grafts have already been done. Two more to follow," he informed. That brought some cheer to my wife and others.
______________________________________________________
In the ICU
My
body and the attachments
Till then, I had not really attempted to take stock of my
own body. Like I had mentioned in an earlier post in the context of the
Angiography, I felt as if my body stood leased out to the hospital for a
temporary period, and I had lost my rights over it. I was rather reluctant to
do a self-check afraid I would be violating some unwritten terms of lease.
Leaving apart the mental block, even otherwise, the physical
position that I was in made it difficult to take stock of self.
I was lying on my back, covered with pieces of blue-coloured
thick cotton sheets. The purpose of pieces was to expose specific portions of my
body when warranted, without disturbing the other parts.
There was an IV-fixture jutting out of my neck, making head
movement difficult. Another IV- fixture was on the wrist of my right hand.
My left hand was in bandage, with a tube coming out, and
going into a receptacle—to drain blood. That was thanks to the radial artery
harvested from my forearm. A finger of my left hand was caught in a probe
measuring my pulse on an ongoing basis, and displaying it on a monitor kept
on a rack to the left of my bed, behind my head. These two almost immobilised
my left hand.
A wire inserted into my femoral artery of the leg through a hole in the groin, through which the Angiography
catheter had been inserted, measured my femoral blood pressure on a continual basis, and displayed it on an monitor kept on the rack behind. This partially
immobilised my right leg.
A single ventricular pacing wire was placed inside my chest,
going into the heart.
The nine-inches vertical wound on my chest, where the
sternum (breastbone) was cut, was bandaged.
Three tubes, meant to drain blood out, jutted out from my
chest and stomach. Their other end went into a bottle kept on the ground for collecting blood.
Thanks to urine catheter, yet another tube carried urine into a bottle kept on the
ground below, because there was no question of my sitting up, walking and using
toilet.
There were thus a total of 5 tubes coming out of my body.
I mostly lay flat on my back. Nurses did recline it to allow me a semi-sitting position when I had
to consume juice or tea through a straw, or had to meet visitors. It was not
possible to turn on my side to the right because of the IV-fixture jutting out of
my neck. However, the nurses helped me turn marginally to my left, when tired
lying in the same position, by pushing some sheets under me from the right-side.
The
routine
Despite the above, I must admit I was not in much pain—at
worst I was uncomfortable. However, I slept well. In fact, when the nurses used
to wake me up between 5.30 to 6.00 am in the morning, I used
to get irritated for being woken up at that unearthly (as per my
habit/definition) hour. They helped me brush my teeth. However, they didn’t have much to clean or bathe me except dab me
with a wet cloth (sponge bath) a little on the legs and on the exposed portions of my hands
and neck. But, I liked the wet-tissues (wet with eau-de-cologne) on the
face—that dramatically freshened me up.
After that little wet-wipe, I eagerly looked forward to the
morning tea, taken through straw for the first two days. It was liquid diet for the
first two days. Soft, solid food was served from the third day, and regular
food from the day I was shifted to the ward.
Nurses had 8-hour shifts, and hence 3 nurses in turn helped
you out during the 24-hour period. All
nurses took good care, were invariably well-behaved and very helpful.
I came to ICU in the afternoon of Wednesday, 9 July 2014,
after operation, and remained there for three days till the afternoon of
Saturday, 12 July 2014.
After a day in the ICU I desperately looked forward to using
my iPAD and/or reading newspapers, periodicals and books. But, those were
barred in my own interest—lest I get infected. That made passing time a little
difficult. What do you do? Either just sleep or look around. Fortunately, my
bed was near a large window through which I could watch the rains—it had been raining
heavily.
Disinfection
Another noticeable things was the frequent thorough
cleaning/disinfecting of the ICU. The concerned staff would wipe with
disinfectant-soaked cloth practically everything in the ICU: bed-frame, bed
from below, chairs from top to legs, cupboards, racks, windows, window-sill,
and even walls and ceiling! And, not just once in a day. About every three
hours they would repeat the process. An inspector would come checking each
thing with a fresh paper-tissue in hand for any evidence of dirt.
Gradual
detachment of attachments
My position in the ICU remained normal, and fortunately
there were no anxious moments. All instruments generally showed normal
readings.
On the afternoon of
Friday, 11 July 2014, a day before discharge from the ICU, the process of
detaching the attachments commenced.
The first was removal of the wire through a hole in my groin
into the femoral artery meant to measure femoral arterial blood pressure. Such
blood pressure measurement is more accurate than that through the normal
non-invasive method. A lady doctor came and told me it would be painful and she
would therefore inject local anaesthesia in my thigh. She did that quite
gently. She then removed the wire and the attachment and told me she would have
to keep the perforation pressed with her hands—and it would pain—for at least
15 to 20 minutes lest the blood should spurt out. She did that skilfully. She
then tightly bandaged the perforation and the thigh, and kept a heavy slab
on it. Lest the blood should ooze out, don’t move your leg for 4 hours and let
it remain under this heavy slab—she told me. I thanked her and complied.
In lieu of the wire in the groin, a wire was placed inside
my right-hand forearm artery (to measure radial blood pressure) through the
hole that had been earlier made for Angiography.
Next day morning, that is, on Saturday, 12 July 2014, the
tube from the left forearm was removed. Then the urine catheter was removed.
Meanwhile, I heard cries from a bed in the ICU some distance
away. I asked the doctor, who then was near my bed, what it was. “That’s on account of
removal of chest tubes. It pains. Patients cry out and shout at us,” he
informed. “Oh!” I said thoughtfully as I looked down anxiously upon my own
chest tubes. “We would shortly take out your tubes too,” said the doctor. “But,
don’t worry, we would do it as gently as possible.” I got busy internally
reciting my long string of names of gods and goddesses. Presently, the three
tubes were pulled out one by one. It was exceedingly painful, but I only contorted
my face without crying out even as I continued reciting names of gods. The
three wounds/holes where the tubes had been inserted were bandaged.
The IV-fixture of my neck was removed.
After an hour, another doctor came and removed the single
ventricular pacing wire embedded in my chest. It gave a stinging burning
sensation upon removal, but thankfully only for a few seconds. The doctor told
me to not move for two hours.
Lastly, the wire inserted in my right-hand wrist and the
IV-fixture of my right-hand were removed.
Once free of all attachments, I was wheeled out of the ICU.
______________________________________________________
In the Ward
I was shifted out of the ICU on the third-floor to a
twin-sharing, centrally-airconditioned ward on the thirteenth-floor on
Saturday, 12 July 2014, at about 1pm. The new bed-number was 13069. My bed was
near a huge window that provided an excellent view.
Free of attachments, I could then move around. Of course,
bandages on the chest and left-hand remained, preventing me from having a bath.
Among the first things I did was to shave, and then to ask my daughter, Manasi,
to shampoo my hair even as I bent down my head into the wash-basin. I then
washed myself stomach-down, and dabbed the non-bandaged portions of the rest of
my body with eau-de-cologne soaked towel. That made me feel better. Used to at
least two baths a day—morning and evening—I had been feeling terribly unclean.
Later on the day of my arrival in the ward, an occupant for
the other bed in my twin-sharing room (with area of each partitioned by
curtains) arrived. He was a Bengali gentleman from Tezpur, Assam who had
undergone Angiography that day, and was scheduled for Angioplasty after two
days. His was a very gentle, non-intrusive family who watched TV only at very
low volumes. Having undergone Angiography (which is done without anaesthesia),
he was genuinely mortally scared of Angioplasty, which too is done without anaesthesia.
I gave him courage saying I had undergone the same in 1999, and that it was not
really a big deal at all. But, he remained un-reassured. “Why can’t they make
you unconscious and then do what they like? Why torture you when you are wide
awake? Such primitive methods!”—said he, wondering at the lack of empathy in
such operative procedures. After Angioplasty he was shifted to another ward,
but his relative met my daughter and informed that all went well. Thanks to
him, and with his permission, my daughter, Manasi, and I watched on TV in our
area at low volume both the 12th July world cup football match for
the third place between Brazil and Netherlands, and the final between Germany
and Argentina on the 13th July.
I was allowed to use mobile and iPad in the ward. That
helped me pass time. There have been arrogant, incompetent critics, but I have
always admired the unmatched ease of writing of RK Narayan. I consider him as a
natural writer close to ground and without pretence, who can make even humdrum
interesting and engrossing. Reading his novels or short-stories submerges you.
I re-read, after a very long gap, his “Guide” and “Painter of Signs” on the iPAD and felt
as engrossed reading them as I had felt when I first read them.
The fare of early morning hot-tea and biscuits, breakfast,
pre-lunch soup, lunch, evening tea with snacks, pre-dinner soup followed by
dinner, and bed-time hot-milk was healthy and palatable. I found my hunger had
grown, and unlike the pre-operation days, I eagerly looked forward to each meal,
cleaning up all offered.
My chest x-ray was taken to check if things were normal.
Looking to my faster than normal recovery, Dr Lad allowed my
discharge by Tuesday, 15 July 2014.
In preparation of the discharge, physiotherapists visited me
and advised me of the exercises to be done, especially breathing and
chest-expansion exercises. I was provided with an Incentive
Spirometer and taught its usage to help improve functioning of the lungs.
Diabetes specialist came over to advise me on the dosages of
insulin to be injected prior to each meal. I was required to be on insulin for
a month. As I didn’t know how to inject myself, I was asked to acquire insulin
pen (please see picture below), which makes it a child’s play to inject oneself.
I was also provided with a chest ster-grip ( a broad belt)
that was to be tightly worn around the chest for about 2 months.
Completion of all formalities for discharge was over by
about 2 pm on Tuesday, 15 July 2014, and readily surrendering my hospital outfit and donning my shirt
and trousers, I happily moved out.
Onward
to Post Surgery Recovery at home in the next (last) part (VII) of this blog-post...
* * * * *
Rajnikant Puranik
August 29, 2014
91-22-2854 2170, 91-98205 35232
rkpuranik@gmail.com
www.rkpbooks.com
http://rajnikantp.blogspot.in
https://twitter.com/Rajnikant_rkp
