Janet

Angina

Open heart surgery – the good, the bad and the stressful

Janet never even suspected there was something wrong with her heart. And now, she still ponders if all the treatment was worth it. This is her account of what came to be.

Who, me? Not possible, not the proactive diet-conscious health nut and the fittest in the bay. Not the line dancer, aerobics guru, compulsive gardener, leisure marcher, avid walker. Can’t be, wrong number.

Three months earlier my medical practice nurse had told me to do a heart risk assessment test. My result was below 10% and my cholesterol was okay. Haha, you can’t catch me.

Yet there I was walking along Pōhara esplanade while two of my favourite blokes were out fishing, and I get this very subtle tightening in my chest so I take a small rest then I’m off again. This happens a couple of times so I decide to turn around towards home – never giving my heart a thought as this is not what I expect angina to feel like. It must be indigestion or maybe I’ve twigged a little muscle in my chest.

But since this becomes a daily occurrence I decide to visit my doctor with what I think is a small glitch in the works.

“Janet,” she says, “I would like you to go over to A&E for an ECG and bloods.”

“What, now?”

“Yes, now.”

And so we do. Three hours later, bloods are fine and the ECG is perfect. We are sent home with the good news that I am not about to have a heart attack any time soon.

How could they get it so wrong?

Two weeks later, not feeling great, I return to my doctor who says, “Janet that’s not good enough, you need a treadmill test. Have you got insurance?”

“No, but I’m happy to pay.”

“Okay, I will sort out an appointment for you.”

Wednesday 30^th April I step on the treadmill: 2 minutes 53 seconds and $685 later, he calls out “STOP. And lie down”. It’s not a good result he informs me and tells me he’ll make an appointment for me tomorrow to have an angiogram...

I’m back the next day, and prepped to go, when my nurse tells me the doctor has had a family crisis so all is cancelled. She tells me to go home and that she’ll contact me later. She rings early the next morning for me to be there by 10am. The doctor meets me and apologises for his absence.

So we finally get started, with the doctor explaining to me the process and that if I need a stent he will do the job at the same time. Not a problem with me, I say, feeling confident that a couple of stents will sort everything out.

On waking from the dream of dreams I am told that we need a family meeting.

“Really, what for?”

“You need to go to Wellington for a triple bypass. You have one artery 95% stenosis (critical) and two others of 85% and 80% (severe).”

I had been living on the edge and not knowing it, and now I’m being put on the urgent list in Wellington.

I’m sent home to get my affairs in order. We feel like stunned mullets. How could this be? OMG, shock, anger, this is huge, answers please?

I have a chat with my family telling them that if things don’t go according to plan and if I come out of it only half the person I am, just to let it go. They understand my wishes. And so the journey begins. After reading all the available literature and watching a CABG (coronary artery bypass graft) on YouTube we trot off to Wellington to be admitted on Wednesday 14^th May at 1pm.

This is a day of blood tests, x-rays, ECG, the inside of my right leg shaved from groin to mid-calf, where they’re to harvest the saphenous vein  to be used for two of the grafts. For the third, they’ll use the internal mammary artery.

I’m visited by both the surgeon and anaesthetist who I discuss my wishes with, explaining that the family are okay with these too. They assure me I’m the perfect candidate – fit and healthy – and that they’re confident all will be well. There’s also general question and answer time.

The morning of Thursday 15^th rears its ugly head and my roommate Debbie is wheeled out at 7.30am – she’s to have two valves repaired which she informs me have become very noisy and are flapping around.

I am next, depending on how Debs goes. It’s toast for breakfast and my wedding ring is cut off. I have a shower with antibacterial solution and the hospital gown goes on. I look like I’m going to a fancy dress party, but it’s not to be. A very long morning looms and they start to prep me around 11.30am – nice sedative I must admit.

I go into theatre around lunchtime, though can’t remember this part. After surgery I’m transferred to the ICU unit. Apparently my husband and daughter come to see me after surgery, but I don’t remember this or anything much about the rest of the day.

At some stage I wake up to all these bright lights and noises feeling like I’ve been run over by a bus and very confused. My nurse speaks gently to me and tells me what’s going on and where I am, but not a lot makes sense. I spend two days here and only remember my family’s faces and trying to stay focused while they are here. I do remember some of my visitors, but it really is a blur, especially the where and when of their visits.

On the third day I’m transferred to the SDU (step down unit) .This is a six-bedroom, where they continue to monitor us closely. After two days I am transferred to the ward cubicle and am back with my roommate Debbie. We are pleased to see one another again and to see how each other has fared.

My memories of hospital

I have so many memories of happenings, some humorous, some sad, and some very hard and stressful.

1. My worst experience was hallucinations from the morphine. Fluro-coloured squiggles and shapes in sky blue, pink and lime green were my constant companions for about four days. It must’ve started in ICU. Every time I closed my eyes these little rotund green men with stick arms and legs were sitting on the windowsill watching me – they never gave up keeping vigil day and night. It took me a couple of days after being at home to get them out of my head, they were so real.
2. Nausea, constant dry mouth, and an aching back plagued me for the first four days. This was a battle and very stressful. They must have twigged a muscle in my back during surgery as I understand we are spread out like an animal at the taxidermist. With my back requiring more pain relief, this added to the nausea, dry mouth and little green men. It was a fine balancing act but the nurses were great and did their best to get me comfy and pain-free.
3. The same question every time they gave out medication or were to undertake some procedure on my poor body: “What’s your name and date of birth?” I felt like a cracked record.
4. Tablets: I didn’t know there could be so many. It started off at 7am with a morning cocktail before breakfast, continued throughout the day, finishing at 10pm with a night cap. How they all found their way to the right task they were required to do, I’ll never know. Sadly after a while I started to have trouble taking them and keeping them down and dreaded the sheer sight of them arriving. The nurse was again great and tried to find as many soluble types as possible.
5. We had a self-administrating pain relief line and we could press the button every five minutes, if required, and it would give us a little top-up. It was monitored to only allow a measured amount with each push of the button. We were told we couldn’t overdose ourselves so this was a real comfort as it kept the worst pain at bay. We were encouraged to use this, because – we were told – the stress of pain slowed down the healing process.
6. The constant attention was very stressful: 24/7 we were subjected to a grand variety of activities; BP hourly, temperature, pulse, lines flushed through, lines injected with whatever their job was, injections in the stomach, what must have been pints of blood extracted, so many ECGs I lost count, and a trip to the toilet frequently once our catheters were out as we were fed fluid-retention medication. I certainly needed this as my hands and feet were very swollen. There was also constant heart monitoring via the computer and as I had fibrillation on several occasions they were always administering or adjusting something. I carried a monitor around my neck wherever I went – it was full of batteries and quite heavy. Oxygen was put on and off depending on what my heart was up to. One night I couldn’t sleep so I decided to go for a walk around 2am. The next thing I heard was “Where’s Janet?” “I’m down here,” I replied as I was halfway way down the corridor. “Get back to bed now – we need to get your heart regulated and some oxygen on.” Buggered if I knew, I told them – if we didn’t exercise we were told to get A into G and if we did we were told to rest. Can’t win.
7. The surgeon visited every day and as this is a training hospital, he would have half a dozen or so trainees tagging along. I enjoyed this as one young man was so enthusiastic he was always at the front, knew the answers and had his notes open and pen at the ready. I was really pleased when I left as he was the one to find me in the lounge and explain my discharge papers and wish me well. I wished him all the best and I’m sure he will make a great doctor.
8. I had the same roommate most of the time and we looked after each other. Debbie went home a day before me, but by then we had the hospital running at a profit by firing middle management and making the other half work twice as fast. Debs was good value and bought me many cups of tea – she could walk a lot further than me (didn’t have her leg slashed) so would go down to the tea room and come back with her own brew that her husband had brought in for her – very nice.
9. Meals – I didn’t eat for four days as I had nausea. Some of the meals were quite tasty – small but adequate. The desserts were terrible as I couldn’t eat anything sweet and they seemed very keen on jelly and ice-cream which I’m sure had a lot of extra sweetener in it.
10. Noises in the night – yet another challenge. As I’ve said, the wards were divided into cubicles mainly by curtains, sort of open plan design. This was tastefully done and colour-schemed accordingly: we were the green ward. As you can imagine you could hear everything in the night when it was generally quieter. In between having oneself poked and prodded, the nights were filled with a bit of everything: Snoring that sounded like chainsaws, someone crying out in their sleep, crying out with pain, coughing, one guy talked so much I nearly knew his life’s history, one guy demanding his rights weren’t being met (you can’t please them all), call bells going off and general hurrying of nurses. The nights were very long.
11. One night during one of my many trips to the toilet and I was washing my hands I looked up into the mirror and my mother was looking back at me. OMG I didn’t realise I looked so much like her. I checked her out several times, gave her a wink and returned to my bed.
12. My young physiotherapist was lovely and had six months to go before her finals – she had her last hospital placement at Wellington before returning to Dunedin in November. We learnt how to breathe deeply, huff and puff (I felt like one of the three little pigs) and cough while supporting our very sore chests. We did shoulder and feet exercises and we moaned a lot. These are a lot harder than you imagine when in our condition, but very necessary for prevention of pneumonia and blood clots: every hour on the hour we had to do them – hard work.
13. On the day before my discharge she had to check that I could do stairs. “You are kidding?” I said. “We have a downstairs flat at home, I will live down there.” “Sorry Janet, still have to pass the test,” she said. So off we went. Part of the safety rules were she had to have another person to help her on the stairs. She spotted one of the active laundry ladies and politely asked her if she could give her only five minutes to assist her with this exercise. The active laundry lady promptly said, “No, I’m going to lunch.” I was shocked at her attitude but the physio quietly moved on and we came across yet another lovely nurse who came to our rescue willingly. Another firing for me and Debs.
14. I met one male nurse who impressed greatly. A young Indian man and full of enthusiasm. He was eager to learn and listened to the head nurse diligently. As I have said, this is a training hospital and she allowed him to do several procedures on me which he did with confidence. He was gentle and kind and we would chat often. He told me he had six months left of his training. He said that training here had changed his life forever and his outlook on life would never be the same. Whether he was to return to India or stay here, I do not know but he would be a valued asset to any medical team.

Looking back, one month later

Would I do this again? I’m not sure. Had you asked me in the first two weeks the answer would be no.

It was the most traumatic, stressful and emotional week of my life (except for when we lost our daughter).

I will have to wait and see the end result which is several months away. I feel it all happened so fast I wasn’t prepared for how hard it would be, especially where they slashed my leg from the groin to the mid-calf to do their harvesting.

Now that I do know, as the saying goes, a little knowledge is a dangerous thing – and I wonder if I would have the courage to play the game again. I would have to consider where my family was at, as thinking of my grandchildren fills me with pride and gives me the inspiration to go on.

And my husband and I have become so close over this hiccup that we realise we need each other in our older years. I won’t say ‘old age’ but it has certainly made us think where we are in our life and that time is running out.

I feel at this stage, one month on, that I need some counselling to understand just how this could have happened – all the balls were in my court – my symptoms subtle but my condition very serious. I had been assessed and sent home from A&E. I am still struggling to come to terms with this.

Thoughts, six weeks later

My routine check-up at the cardiac clinic showed that my breast bone was where it should be with regards to the healing process and that I was progressing well.

The x-ray also showed a collapsed vertebrae in my spine. I discussed this with the nurse and she agreed that it may have been possible that this was done in surgery, which would explain the back pain that I had not experienced before. This was reassuring to me as I knew something was amiss at the time but the team couldn’t come up with the answers, much to their dismay, as they tried everything to help me through those early days.

My thoughts, nine months later

I am fit and well again and living the life I thought I had lost. I have worked hard over this time to get my life back on track and I feel I have accomplished this.

I will forever be grateful to my GP at the time, and the doctor from Nelson Hospital who sorted me out and got me into Wellington urgently, and the Wellington Cardiac Team who I can’t thank enough – amazing group of people. They have given me the time to spend with my family and hopefully watch my grandies grow up.

The same question – would I do it again? I think the answer is no, as getting too old is not for me. I need to be active and productive so when that is no longer possible I’ll be happy to say FAREWELL.

I will finish by thanking my family for giving me the permission to bequeath my body to the Department of Anatomy, Otago School of Medical Sciences.

I only have one query still: is medical intervention at my age worth it? Should I have just fallen over instead of forever wondering what’s around the corner? Time will tell, but I’m having fun at the moment.

Shared November 2016