Tuesday, 12 June 2018

The Angiogram.

    Its fourteen years now since I had my coronary artery bypass surgery.   Just a few days ago, a friend of mine who is booked for an angiogram and may be having a similar procedure asked me about it and I responded as accurately as I could.  I mentioned to him I had taken notes at the time and that I had later published an article in a medical newspaper, The Medical Post describing the procedure.  Although I have yet to locate the article, I still have my post surgical notes that I offered to share with him.
   Here they are starting with the angiogram

Bypass.  Pt 1.   The Angiogram.

I stared straight upward at the overhead camera, a chagrined that I had asked what it was, when I should have known perfectly well what it was.  But I wasn't thinking clearly right then, I was rationalizing the risk statistics of the procedure and knew I took a bigger risk every time I took the freeway.   Cardiac arrest, well that was easy enough to deal with, a couple of good electrical shocks and it either started up again or it didn't.   And if it didn't, nothing too serious, you didn't even know about it.    No, I wasn't worried about that, or about a hemorrhage from the thigh artery; they can always fix that.   The only thing I was really worried about, was stroking out, ending up like a close friend, a helpless prisoner in his own body.   Death was a lot easier to handle.   Not that I wanted to die; I still had plans and ambitions.  Far more pressing than any of the above thoughts, was the itching and burning in my groins, despite the copious shaving cream and the fresh new razor I had used when following the instructions.   My sympathy for the poor metrosexuals, who shaved this area on a regular basis as a part of their daily ablutions had increased.   

 I had kissed my wife goodbye and walked toward the Cath Lab, double gowned.   Modern sensibilities and sensitivities ensured that patients no longer wandered hospital corridors with 'back to front gowns', their tails hanging out for general condemnation or admiration.   I'd been issued with two gowns, one opening at the front and one at the back, providing total coverage.  I held my clothes in a white plastic bag, in my right hand.
The Nurse introduced herself. 
"I'm sorry we're running a bit late," she said.   "What do you want us to call you?   Dr. Smith or Stan?"
"Stan will do," I said. "And that's okay, I haven't anything else to do today," I said, and I meant it.
All of a sudden, a masked pirate, swung into the cath lab.  
He wore a red floral bandana, with the collar of a bright red shirt peeping above the drab green of operating room attire.   Was this really the balding middle-aged doctor, with a rather peculiar sense of humour, that I had spent a half an hour with last week?   I guessed it was.   Whatever it was, I sensed a deep respect from the surrounding staff.
"He's got a rather peculiar sense of humour" warned the nurse whispering into my ear.
I smiled back weakly and nodded.
'Don't worry," the pirate said to me, "this won't be too bad."
"Very few things in this life are as bad - or as good as they are reputed to be", I replied, the homespun philosopher as usual.
The pirate pondered for a moment, and then said, "I think that sums up life pretty accurately."    A slight note of appreciation in his voice.
He had told me last week that the rare complications of the procedure included hemorrhage, stroke and cardiac arrest, just to name the most severe.   "If you hemorrhage we'll just have to do open surgery to stop it, if you stroke out, there's not much we can do, but if you arrest we can just defibrillate you on the table," he said benignly, making it clear that the latter was by far the most desirable of the choices.   Obviously, the one he would have chosen for himself, if he had to.  

Then, he went on to tell me that I would feel a strange warm feeling, when the dye was injected into the intravenous which had been set up right at the beginning of the procedure.
"You'll feel hot and wet all over, and might even feel as though you had lost control of your bladder, but don't worry, you won't and I'll be standing right there," he said with a strange sensitivity, as though that would help.
He injected the local anesthetic into my groin, and after a few moments I felt nothing, but the miraculous relief of the itching and burning of the razor burn.
Dr. Pirate brandished the sleek cardiac catheter like a rapier.
"Now I just take a run at you with this!" He laughed.
The nurse bent over and she whispered reassuringly into my ear, "he's just kidding", and even though I knew it was just joking, I wondered how many times I myself had caused a frisson of anxiety in a patient, with a light word, meant to be humorous and to reassure.
It surprised me that I felt nothing at all, as the catheter ran up through my femoral artery, up my aorta and into my heart.
"You can see it all there on the monitor," the male nurse said, "if you don't mind seeing that sort of thing."
I looked at the x ray of my heart beating.   I saw the thin line of the catheter thread its way into my coronary artery, like a wire coat hanger being threaded into a key hole.  I hoped it would leave enough room for the blood to get through.
"Take a deep breath and hold it," commanded the Pirate.  
I did as I was told, until it started to hurt, I waited a few moments. 
"It's starting to hurt," I said, knowing that was because he was depriving my poor myocardium of much needed blood.
"That's okay, it's supposed to.   You can let it out now."
The pain resolved quickly.  
Okay, now I'm learning how to play this game, I thought.
As soon as I started to feel some discomfort as the next coronary artery was being threaded, I didn't wait.   "It's starting to hurt".   Save my myocardium.
"Okay, you can breathe out."
Ah, now I've got it mastered, I thought, there's a solution to every problem.
The procedure was repeated a few more times, with little discomfort and the monitor show continued.
After a few more thrusts, peppered with light commentary, the show was coming to an end.   
"We are just about coming to the end of this, and I'm going to be thrusting my fist into your groin, to make sure there is no bleeding."  he said. "You just lie perfectly still and we will get these three big strong nurses to lift you over to the stretcher.
Two of the nurses were fairly slight young women and the other was a slight young man.   They picked up the stretcher sheet corners and whooshed me over on to the stretcher. 
No wonder they all have back pain, I thought, knowing that many of the patients they lifted were twice or three times my weight.
A fist was thrust into my groin, applying firm pressure.   The impatient Pirate took control of the gurney with his other hand and wheeled it quickly out into the corridor. 
A couple of words in my ear, "your right coronary is a hundred percent blocked, your left anterior descending about fifty percent blocked, and the obtuse marginal and posterolateral branch of the circumflex eighty to ninety percent.  I think you are a bypass candidate."   This guy didn't waste any time.
No time to wait for orderlies or porter, we headed straight down to the ICU.    Irene was waiting outside the Cath Lab. 
"Are you alright?" she asked me, the pirate pushed on.   "Are you……?" she directed her question to the pirate.
"I'm the orderly," interrupted the man with the strange sense of humour.
"He’s the doctor" said Stan, "this is Irene, my wife."
"Hello," said the Pirate, pushing right on for the ICU, where Irene wasn't allowed to follow.
"I'll see you as soon as they move you," she called out.
And there he stood with his fist pushing into my groin for the next ten minutes.
"Drink lots and wash out all that dye," he said, "and keep lying absolutely flat for the next hour or so.  I don't even want you to raise your head, then we'll move you to the observation ward."
Every few minutes the nurse solicitously bent over me, with a glass of water and a flexible straw.
I gulped greedily at first, but then started to think of the consequences of pushing the fluids too enthusiastically.    I didn't want to have to empty my bladder while I was lying flat on my back, and that was going to be at least the next hour.   Better to wash the dye out a little more slowly, and a little later when I could at least sit up, it might be easier.

A nurse I hadn't seen before breezed into the room.  
"I'm taking you down to the recovery unit," she said, wheeling the gurney out of the cubicle it had been occupying for the last hour.   She got almost out of the unit, when the Pirate swung in.
"Where are you taking him?" he barked.
I wondered if I had just been saved from a hijacking.
The unfortunate nurse flushed and said, "just to the recovery room."
"No one leaves here until they have been checked by me," he commanded gruffly.   "I have to make sure they are not bleeding."
He rolled the gurney back behind the curtain, pulled back the gown and looked into my groin, was satisfied and said quietly, "okay, you can go."
She rolled me to the West Wing, where I was deposited in a two bed ward, the other bed was empty.   Irene awaited anxiously.
“Are you okay?”
“Yes, everything feels numb right now,” I said.
The ward nurse was cheerful and pleasant.  
“You’ve got to drink lots of water," she said cheerily, "wash all that poison out of you.   And I bet you're starving.   What would you like to eat?"
"What's on the menu?" I hadn’t eaten since the day before.
"Sandwiches, cookies, whatever you'd like.   But you have to drink lots, juices, ginger ale, cranberry juice, whatever you fancy.   If you do real well, I'll let you stand out of the bed to pee." She smiled.
This was the best offer I'd had all day.   I gulped down a glass of cranberry juice through the flexible straw and ate a tuna sandwich.   It was a little easier to drink now that I had been promoted to sitting up a few degrees.   What was it that they'd said a few degrees every hour?   I was starting to want to pee. The nice nurse whisked by with the water.  
"Have a nice big drink now and I'll let you stand out at the side of the bed," she said.  
I thought that one over and decided it was a deal.   I sucked down a big gulp of water and looked over at the side of the bed to the bedside table, where amidst the debris of sandwiches and small juice containers, I saw the new, pristine, disposable urinal.   A far cry from the old stainless steel ones, which were handed out when I was a student.   I flipped off the lid and tried it on for size.   It seemed fine.   I swung my legs over the side of the bed, barely sitting on the edge of the bed.   I was lucky my weight was propped on the bed for as soon as I put some weight on the right leg, it collapsed under me.   I tried to feel it; it was completely numb.   Totally anesthetized!   I carefully propped himself against the edge of the bed, put the urinal in place, and was all ready to pee, when the commotion behind the drape that surrounded my bed distracted and inhibited me.   The nurse stuck her head through the drapes,
"You've got a new neighbor," she said,
Irene, who had stepped outside for a moment popped back in.
"Everything okay?" she asked.
"Yes," I sighed, giving up on the bottle, and swinging back into the bed.
Irene sat on a chair near the end of the bed.   The New Man's wife sat on a chair at the end of his bed.  They were nice friendly people; I had seen the New Man come into the intensive unit soon after me.   They started talking to Irene immediately.   I felt overwhelmed with a desire to sleep, so I kept eyes closed and didn't pull back the drape.
I heard them talking and Irene replying, and then I drifted to another place where I was lying on a chaise, on a beautiful sunny day dozing, before diving into David's pool to swim another twenty laps, just to show myself I could do it without any chest pain.
I woke up about half an hour later, and thought I ought to be more sociable.    Just as long as the New Man or Mrs. New Man didn't discover my occupation!  
"Hi," I said to Mr. and Mrs. New Man.
"Hi," said Mr. New Man, "have a nice sleep?"
"Yes, thanks," I answered.   Now I really wanted to go to the bathroom.
"What do you do, Stan?" asked Mr. New Man.
No, I thought, I'm the patient, today, I can’t tell him I’m a physician.
"I work in Mount Brydges," I answered, leaving it there.
Mr. New Man left it at that.
"Is your leg numb?" I asked.
"No, never was."
"Been to the bathroom yet?"
"Yes, the nurse let me go just before you woke up."
 I had a bit of feeling in my right leg now.   How come Mr. New Man had already been allowed the luxury of actually navigating to the lavatory on his own two feet?      Well, I was going to make my own way there.   I slid out of the bed, could feel my right leg ready to buckle when I tested it for weight, found I could stabilize it with my hand, and hobbled the few paces to the bathroom.    There was a convenient bar to hold on to, which made it easy.   Ahhhhh, heaven!
It was easy after that.   I joined in the conversation, checking for sensation in my leg at frequent intervals.  After all, I didn’t want to be in here a moment longer than necessary and the nurse said I would be able to go as soon as my leg would support me sufficiently to independently walk down the corridor and back.
And Sure enough another hour made all the difference and I could indeed walk down the corridor under the watchful eye of the nurse.    She whisked me into a wheelchair and out to the waiting car
"Good luck for your surgery " she called after me as I got into the car.  
Part 2, the Bypass Surgery- next week.

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