Wanderings in the Negev Desert.
Tuesday, 1 June 2021
Monday, 24 May 2021
Christy Brown and Others.
Thursday, 6 May 2021
Cabbage Pt 3. The Nortel Pillow.
Cabbage 3 -Post Surgery.
Much of my discomfort came later and was due to a hyperesthesia (super-sensitivity) of the scar. So much so that even touching the area was painful.. The touch of clothes brushing over the hypersensitive scar tissue was more painful that some of the really big stuff that seemed relatively painless. How is it no one has ever thought of a little plastic cradle one could tape over the scar to prevent clothes from brushing against the hypersensitive skin? Maybe I need to invent such a gizmo? It would be relatively easy. I thought maybe I'd do it when I was better! Needless to say, I never did. Somehow, that night crept by, a nanosecond at a time, it is true, but a least I could see that the morning would come eventually.
Morning at last! Moved out of the ICU and to the step-down unit. I had been in the ICU for two days instead of one, not because I needed to be there, but because they had nowhere else to put me. Another day there and I’d really have been crazy, but now I had windows and daylight and could see the sky. Oh happy day!
My surgeon, the guy who was holding my heart in his hands just hours ago, was standing at the bottom of the bed, relaxed and easy.
“Everything went well; you’re good for another thirty years!”
I was glad to hear that.
Soon my family were sitting by the bed and had obviously seen a good deal more of me in the past 48 hours, than I had of them. They reassured me of how good I looked, and in fact I wasn’t feeling too bad as long as I was lying fairly still in the bed. But I knew that the therapists wouldn't let me lie in bed for too long and, after adequate numbing with narcotics, they had me walking a few steps later the same day.
The following day my surgeon came around to see how I was doing.
“You are good for another twenty years,” he smiled.
“Not so fast,” I threw at him, “yesterday you said thirty, so that’s thirty percent deterioration in one day.”
He laughed indulgently..
My main complaint, until now, had been nausea, and had been controlled mainly by living on juices and apple sauce and processed fruit, and sending my set meals back without even looking at them. Now I was ready to tackle something a little heartier. Normally, I am not a fussy eater. The meals came, as I found out later, from some central depot. Before taking the lid off, they looked like Air Canada meals (economy), which when I used to fly a lot were not too bad. I remember the choices – “fillet, chicken or fish?” Any resemblance finished on lifting the outer plastic cover. What took place under the cover defied description. Once the lids were whipped off these dishes any inclination to eat was gone. Irene took one look and vowed that my food would be coming from home! Subsequently it did.
The Nortel Pillow.
Nortel was a Canadian communications company in the days when Canada was a successful country. After an outstanding performance it went into a nosedive and a lot of people lost a lot of money. China (Huawei) denied that it had reverse engineered the product and destroyed Nortel. Most of us knew better. On post op day two I was moved to the step-down unit. Because post op breathing and coughing is important the physiotherapist gave us a pillow to clutch to take the tension off the scar when we coughed. Having taken a beating on my Nortel stock when that company went bankrupt I was more than a little surprised to see beautifully embroidered on the pillow 'with the compliments of Nortel Networks'. Nortel had cost me a lot of money and the irony of the situation left me uncertain of whether to laugh or to cry. I decided to laugh even though it hurt! (After all, I had my pillow to hug!) The guy in the bed next to me heard me laughing. We chatted a little. A healthy looking fifty -five year old, he had found his way into the cardiac unit as a result of forcefully pulling open his car door and hitting his subcutaneously implanted cardiac pacemaker so hard with the edge of the door that it was totally wrecked and needed immediate replacement.
"What's the joke?" he asked. I told him.
He examined his pillow. He laughed. "I guess I have the same twenty grand pillow!"
We laughed so much that the nurse came over to see what was wrong.
Thereafter we referred to the pillows as our twenty thousand dollar pillows, because that's about what they cost us. There are no free lunches!
On day three my surgeon popped in to make sure I was doing okay and my scar was okay.
"I have two important questions to ask you today. "
"Okay, fire away."
"One, when can I get out of here?" I asked.
"A couple of days."
"Maybe tomorrow?" I bargained. "If you look out of the window you can see my condo. I could be in emergency quicker from there than you can get me down from here." I was on a higher floor in the hospital so that statement was probably true.
"We'll see how you are tomorrow. The other question?"
"When can I have a martini?"
"As soon as you can get some to bring you one." he intoned, his Scottish accept a little more prominent than usual.
I love the Scots!
The next day he arrived after his operating list and I was ready for him.
"I think I'm ready to go home today," I said cheerily. I could see I was starting to wear him down.
He countered with, "You can go as soon as you have had a bowel movement." Sometimes the bowels are a little slow to start functioning after major surgery,
" I've just been," said I triumphantly.
And that's how I managed to go home on the fourth day after my quintuple bypass!
Some post surgery thoughts:
A bath! Oh, what a pleasure, oh what a joy! And, oh, how much muscle power it takes to get in, wash yourself and to get out! Amazing how much leverage, torsion and other forces involved in just sitting up, pushing yourself on to your feet, while praying that your feet don't slip away from under you, cracking your cracked thorax on the side of the tub, and ending back at the hospital. And where does all that disgusting dirt in the water come from anyway, when you haven't been out of your house and barely out of your bed since the last bath? Anyway, it confirms that the simple joys are great!
Note to Friend on Dec 2. (while still under the influence of medication!)
Apropos of nothing, but in the light of some of our recent discussions, I thought you might be interested in this paragraph I just read in the NY Times Review of Books, from the review of the book by Harold Bloom entitled " Where Shall Wisdom be Found?"
"It reminds me of the experience of a friend years ago,” he wrote, “when, awakening from major surgery, she heard in the recovery room a faint voice reciting the Easter soliloquy in which Goethe's Faust comes back from the brink of suicide to the joy of life. Through her anesthetic haze, she wondered to whom the voice belonged until she recognized it as her own; speaking a poem she had known by heart since childhood and somehow retrieved from deep memory during induced sleep."
Oh, what strange things we store in that three pounds of jelly in our skull!
Finally, A colleague phoned and was pressing me for information about the pain and pinning me down for some descriptors. My bottom line and I knew him well enough to know he would understand the simile, “ - like coming home hungover, getting into a fight and having your chest and ribs kicked in!” Not very eloquent, but I think more accurate than described in any medical text!
Tuesday, 27 April 2021
Cabbage. Pt 2.'Cabbage' medical jargon for Coronary Artery Bypass Surgery
When I sprung it on relatives, colleagues and friends that I was planning to have bypass surgery, the first response tended to be reassurances as to how healthy I looked, and questions as to how long I was ill. Funny, because I never considered myself ill at all. After all, all I had experienced was a bit of breathlessness and a little tightness in my chest when I exerted myself. I could swim laps indefinitely, as long as I used commonsense and didn’t try to break records. And after all, I was sixty-nine, no spring chicken in anyone’s language. How was that to be equated with illness? I was never ill a day in my life. Never missed a day of school or university or work. Ill indeed, I thought indignantly! In fact, quite honestly, I was really only proceeding with surgery prophylactically, because the genetic scales were so heavily weighted against me. Was I just going to sit around and wait for those obstructed coronaries that I had looked at on the angiogram to totally plug and kill a huge chunk of my myocardium, or even me. I was determined to get those obstructed coronaries before they got me. So I carried on going to work every day, waiting to hear from my surgeon’s office as to when I would be having my surgery. Meanwhile, I was daily fielding a litany of phone calls from relatives and other well wishers, including dutiful nephews and nieces who no doubt were responding to their parents exhortations gracefully and did their duty. I could tell they were impressed when in response to their questions I told them I was having a quintuple bypass. That was rare at the time - the only other case of a 'quintuple' that I knew of was Bill Clinton!
Thursday - the day before Surgery. After a fairly normal day at work during which the objective was to keep as busy as possible, and to keep my mind off the following days ordeal, I headed home. At least, I consoled myself, as I manipulated my Honda along the dark, wet slippery country road, against a continuous steam of giant SUVS, nothing I was going to encounter in the next few days was going to be more dangerous than this. A serious martini and a light supper followed by a sleepless night, rounded off the day.
The nineteenth of Nov 2004 - day Zero! Up at 5 am and son David picked us up at 5.30 for our morning appointment. I remember, in a gentler more civilized era when patients were admitted the night before surgery, rested, worked up, sedated and assured of a good night's sleep . In the olden days, we used to think that getting the patient as relaxed and stress free as possible had some bearing on the patient’s subsequent progress. But that was before we had a Health Care Industry. Getting the patient up at 5 am is hardly conducive to survival, let alone surgery.
At 6 am I was through the admitting area, hardly noting all those other poor souls with their problems small and great, but none I was sure, as great as mine.
A kiss goodbye; a word of encouragement from Irene and David; clothes deposited in a plastic bag and on to the OR . Although over the years, I had spent many hours in operating theatres, this one seemed so small and so crowded with people and equipment that I wondered if there was enough room for me.
The Anesthesiologist greeted me as I was wheeled in the door.
"So you're Dr. Smith?'' He smiled, effortlessly sliding the IV needle into a vein.
"Yes, that's me,” I tried to smile back and think up a clever witticism I could throw out.
The lights went out.
I opened my eyes. The anesthesiologist was gone; it was all over, and I was surprised at how little pain I had. Just like my niece had said of her anesthetic - 'light off, light on. Like flicking a switch!” She had also added that it had made her a little less fearful of dying, and as I reflected on that particular piece of philosophy, I found I was in agreement with it.
Now I had to get the damn tube out of my throat. My God, I couldn't talk! I made as much noise as I could to attract attention and look as though I was really suffering - maybe that way I could get rid of it! The Nurse leaned over me.
“Are you having a lot of pain?” she asked sympathetically.
I shook my head - no, but harrumphed and coughed as much as I could to make it quite clear I wanted this damn tube out of my throat. Maybe if I coughed enough I'd manage to propel the thing across the room.
I could hear the machine behind me, but couldn't see anything. Where was I anyway? Alive, at least, and no sign of any stroke or paralysis or anything else horrible as far as I could determine. I seemed as sharp as ever! I tried to cough up the tube. The nurse injected something into the IV tubing in my arm and I drifted into some pleasant place.
I woke up with vague pain everywhere, and a horrible nauseated feeling. The lCU nurse slouched by. “Something for the pain?” she said, pulling her drooping sweater up around her shoulders. She deftly deposited a little cardboard container with two pills in it, in my hand, and propelled them into my mouth. I swallowed them and soon dozed off again.
“Are you on these pills too?” I politely asked the woman just to the right of my shoulder. I couldn't figure out why she was wearing a pretty bonnet right there, in the ICU. I managed to twist my neck around, to get a better look at her and saw this was an electric fan somehow managing to look like a woman's face, framed in a bonnet. I gave a little chuckle to myself, as I realized what I had done- no wonder the poor old geriatrics got wingy after a few days on narcotics. I had at least one other similar encounter and resolved I’d have to cut back on the pain pills. I looked at the clock, 11.10, but was it night or morning?. I drifted off to sleep again, and had a long deep sleep. I woke up again, thought I had slept for hours, and looked at the clock. 11.20! I couldn't decide if I had slept right around the clock and it was 11.20 twelve hours later, or just ten minutes had gone by. Then I noticed people all hustling around and going somewhere! Something was wrong, I was going to watch what was going on very, very carefully It looked like some sort of a set from the movies, something funny was going on here. Everyone seemed to be leaving. My last thought before drifting off to sleep again was that they really needed to have windows in these places, or everyone would end up disoriented and crazy.
Someone woke me up and was offering me pills again.
“I think I'm going to throw up,” I said.
“Hold on a minute,” the nurse said, a large basin appearing from nowhere.
I felt horrible, retched and threw up a large amount. The relief was immediate and wonderful. I closed my eyes and drifted into a deep sleep. When I looked at the clock a long time later, it was only 11.30 pm.
I was watching the Iraqi war on the television. A bullet in the chest. Must feel something like having your chest cracked open, I thought.
“Rate the pain with a number" a nurse asked. "if 1 is very mild pain and 10 is the worst pain you’ve ever had."
What does that mean? Depends on who you are and how much pain you have experienced. Where is 10 if you’re lucky enough to never to have had much pain? I rated my current pain at 5 - a nice median number!
"There's a button attached to your IV that will give you a pre-set dose of morphine whenever you press it to relieve the pain if you need it."
"Thanks," I said. I used it about twice and it made me feel worse than the pain! At least I don't have to worry about becoming a morphine addict!
Monday, 19 April 2021
Cabbage. Pt 1.
Have a Heart!!Its seventeen years now since I had my coronary artery bypass surgery. Just a short time ago, a friend of mine who was booked for an angiogram and may be having a bypass 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 about it 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 angiogra a procedure that involves passing a catheter into a groin artery and threading it right up into the coronary arteries, injecting dye and estimating the amount of blockage.
Bypass. Pt 1. The Angiogram.
I stared straight upward at the big overhead scanner, that would be photographing my coronary arteries soon. I was rationalizing the risks 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 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 shaving 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. No locker, 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 the wait is okay, I haven't anything else to do today,"
All of a sudden, a masked pirate, swung into the cath lab. At least that's what he looked like! He wore a red floral bandanna, 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.
"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."
He had told me last week that the rare complications of the procedure included hemorrhage, stroke and cardiac arrest, to name the most severe. "If you hemorrhage we might have to do some surgery to stop it, if you stroke out, there's not much we can do, but if you arrest we can defibrillate you on the table," he said benignly,.
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, I didn't expect.
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.
He brandished the sleek cardiac catheter like a rapier.
"Now I just take a run at you with this!" He laughed., holding up the catheter.
The nurse bent over and she whispered reassuringly into my ear, "he's just kidding", and even though I knew it was joking, I wondered how many times I myself might have 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."he said.
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.
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 maintain pressure to prevent 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 from the gurney 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.
Too impatient to wait for orderlies or porter, one fist applying pressure to the puncture wound, he wheeled me straight down to the ICU. Irene was waiting outside the Cath Lab.
"Are you alright?" she asked me, we 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 - with a strange sense of humour," said I, "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 to try not to start up any bleeding from the puncture wound. 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 rudely.
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 myself 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.