Jennifer

Aortic aneurysm

Arrhythmia

Atrial fibrillation

Carer’s story

Heart failure

Heart valve problems

Stress of husband’s heart condition disturbs wife’s own heart rhythm

After more than 15 years of postponing surgery for his aortic stenosis and aortic aneurysm, Jennifer’s husband collapsed in the hallway one evening after returning from a night out. When he came to, Jennifer had to beg him to let the ambulance staff take him to the hospital. The following is an excerpt from Jennifer’s book about the experience: ‘Across a Sea of Troubles’.

Whereas the events of the first part of that night are deeply etched in my memory, I have only the vaguest recollection of our next few hours in North Shore Hospital. I suppose I was too shocked and fatigued to take them in.

I know that Brian was examined by several doctors and had several tests carried out. The amiodarone drip started by the ambulance staff was continued, and his heart gradually slowed and returned to sinus rhythm. About 4 a.m. he was transferred to a single room in the Coronary Care Unit. Then I went home by taxi.

In my exhausted state it seemed like the last straw when I discovered the front door key was missing from my handbag; I must have dropped it inside the hall when Brian collapsed. Fortunately I remembered where he kept the spare key.  

Making plans in hospital

Brian’s clinical condition rapidly improved over the next few days, but investigations showed serious pathology: a 70% blockage of the stem of the left coronary artery, severe stenosis of the aortic valve, a hypertrophied left ventricle and a grossly dilated ascending aorta.

The level of the enzyme troponin was over 40,000 units, signifying damage to the heart muscle. The left ventricular ejection fraction of only 30‐35% indicated heart failure.

The consultant cardiologist advised Brian to have the aortic valve replaced, the aortic aneurysm repaired and the coronary artery grafted. There was a 20% risk that he would die from complications of this major surgical procedure. But if he went home without having it, he would be a cardiac invalid and probably die anyway within six months.

He was 82 years old, but fit apart from his heart. The consultant said, “Your brain is alright, your lungs are alright and your kidneys are alright,” adding with a smile, “if you were a member of my family I would order you to have the operation.”

Before making his decision, Brian discussed the situation with me. Without wanting to influence him unduly, I said I did not want to take him home only to watch him die. The surgery would offer a good chance of recovery and, even if he did prove to be among the 20% of patients who did not survive the procedure, at least everything would have been tried and his death probably quick and painless.

Brian agreed to the operation. He was given a choice about whether to have the valve replaced with a mechanical prosthesis made from metal, or with a biological one derived from a pig’s heart. The metal one would last longer, but require lifelong medication with anticoagulant drugs. Brian opted for the porcine valve, which would last about 10 years and not require long-term anticoagulants.

The operation could not be done at once. It would need to be carried out by a senior surgeon with experience of the complex procedures involved, and at a different hospital – Auckland City. There was a waiting list. Several times Brian was advised that he would be going to Auckland the next day, only to have the transfer cancelled at the last minute because emergencies had arisen overnight...

Brian remained remarkably calm and free of symptoms during the three weeks he stayed in Lakeside Cardiology, a modern wing of North Shore Hospital with fine views across Lake Pupuke to the sea. It was difficult to believe he was so seriously ill, and he asked to go back home while awaiting his operation, but was not even allowed to leave the ward in case he had a cardiac arrest.

He spent much of the day working on his laptop, writing his own obituary, and walking up and down to improve his fitness. Other patients came and went, often with sad but interesting stories to tell. The medical and nursing care was excellent.

Emotional stress builds up

Meanwhile I felt my own life and health were falling apart, with one thing after another going wrong in ways beyond my control. The emotional stress and the practical demands seemed overwhelming. Visiting Brian was top priority, but spending several hours at the hospital every day left little time to cope with the responsibilities of looking after our large house and garden and four cats, and assisting my aged mother next door; visiting lawyers and banks regarding Brian’s financial affairs; and dealing with the stream of inquiries from relatives and friends. I had to stay up late and get up early to fit everything in, but I was sleeping so badly anyway that this was not too hard to do.

I was tremendously grateful to everyone who helped during this period by bringing home‐made cakes and frozen dinners, inviting me to their houses for meals, offering lifts to the hospital, sending flowers or supportive emails and cards. There were many unexpected acts of kindness, for example my hairdresser came into the hospital on his day off to cut Brian’s hair before his operation, and refused any payment.

But the phone calls from well‐meaning friends, inevitably coming in when I was frantically trying to cope with something else, were less welcome. I could find no polite way of asking people not to ring, and could never leave the phone unanswered in case the call was about an emergency involving either Brian or my mother, a frail 91-year-old for whom I was the sole carer.

It was a few days after Brian’s collapse that I began to feel physically ill myself, with a constant feeling of tightness in the chest, palpitations and shortness of breath. Having a medical degree, I self‐diagnosed the somatic symptoms of an anxiety state and on 11 September consulted a GP who found my blood pressure was up to 172/89. He prescribed the beta blocker metoprolol, and the benzodiazepine lorazepam. These drugs seemed to help for a while.

Three days later, on 14 September, I had my first appointment at a gynecology clinic for what I had thought was a minor problem, but the doctor who examined me said that I probably had a form of cancer that would require extensive surgery and radiotherapy. She took three biopsies and arranged to review me after a fortnight with the results.

Next morning, as I was getting into the shower, I suddenly saw a burst of flashing lights and a large black floater in my left eye. Having yet another thing wrong with me seemed like a sort of sick joke of Fate. I managed to get an appointment with an optometrist at the end of the afternoon and was diagnosed with a vitreous hemorrhage, rather than the more serious condition of retinal detachment.

Over the following week my blood pressure came down to the satisfactory level of 134/70. The visual flashes and floater persisted, but gradually became less. The gynecological biopsies were painful and slow to heal, but the good news was that the pathology report showed the lesions to be benign.

Brian’s cardiac condition remained stable and on 23 September came the long‐awaited news that his operation was definitely scheduled for the next day. Accompanied by a nurse with a defibrillator, he was transferred by ambulance across the Harbour Bridge and admitted to a single room in Ward 42 at Auckland City Hospital.

As I sat at Brian’s bedside, aware that it might be our last evening together, I felt we should be having a significant conversation. But I don’t think either of us knew what to say, and in any case we were continually being interrupted by doctors and nurses coming in to make various preoperative checks. So I said goodnight and arranged to return first thing in the morning to see Brian before his surgery.

Brian’s Surgery

At 10 a.m. on 24 September Brian was taken to the operating theatre. He would be having a long and complex procedure: the diseased aortic valve replaced with tissue from a pig’s heart, the blocked coronary artery replaced with a vein graft from his leg, and the dilated ascending aorta replaced with synthetic material.

I followed behind as his bed was wheeled along by a porter and a nurse. At the end of the corridor Brian and I kissed farewell, the kind nurse gave me a hug, then they all disappeared through the swing doors and I was left alone. At this point, for the first time since it all began, I started to cry. I went down to sit in the hospital lobby and continued crying for the next half hour.

Then I went outside to the gates of Auckland Domain to meet a close woman friend, whom I had known for some years through my membership of a church choir. She had offered to take me for coffee while Brian was having his operation. She drove us through the park to a café in Parnell, where we stayed for an hour or so, and it was a great comfort to have her company and to be able to talk with her about all the recent traumas.

After that I returned home, ate a bit of lunch, and went upstairs to lie on the bed while I tried unsuccessfully to focus on listening to music while waiting for a call from the hospital.

At 3 p.m. the consultant surgeon rang to tell me that the operation had gone well. He said that Brian would remain unconscious for a while and suggested that I waited till about 6 p.m. before visiting him in the intensive care unit (ICU).

Buoyed up by this good news, I filled in the rest of the afternoon by catching the bus to Takapuna for a bit of shopping, then took two more buses to Auckland City Hospital, and rang the bell to request entry to the ICU.

It was a shock to be greeted by one of Brian’s three nieces, who works as a nurse in another part of the hospital, with a serious expression on her face. She told me that Brian had had “a stormy few hours”.

I was not allowed to see Brian immediately, because the ward area was temporarily closed to visitors while clinical procedures were being carried out. I would discover later that this is frequently the case in the ICU, and I understand that it is necessary, but it can be hard for worried relatives to endure. I had to sit in the waiting room for what seemed a very long time before being allowed into the four‐bedded room where Brian lay unconscious and still, with numerous machines attached to his body and a group of worried‐looking doctors and nurses standing around his bed. Blood‐stained liquid was draining out of the tube in his chest while fluids were being given through the drip in his arm.

Several hours passed. After the first niece had gone home to look after her children, one of her two sisters came in to sit with me. As I watched Brian’s blood continue to flow away, and heard the murmurs of concern as the staff discussed what to do, I began shaking. At last I was informed that the surgeon was returning to the hospital to reopen Brian’s chest and try to stop the hemorrhage. With an unsteady hand I signed the consent form. About midnight, Brian was taken back to the operating theatre, and my niece drove me home.

At 3 a.m. the surgeon phoned me, again sounding quite confident and cheerful. He said that no specific source of bleeding had been found, but he had “tidied things up” and Brian should be alright now.

Next morning I returned to the ICU, this time with the third of our nieces there to support me. Brian was still unconscious but no longer losing blood. A highly skilled nurse was continuously stationed at the foot of his bed, monitoring the readings on the various machines and adjusting the input of intravenous drugs and fluids accordingly.

At 11 a.m. she told us that Brian was ready to have his medication adjusted so that he would wake up. Some patients, she said, regained consciousness immediately but for others the process was much slower. I think it took about 10 minutes for Brian to open his eyes and utter the classic line, “Where am I?”

His recovery continued rapidly over the next few days, a testament to the near‐miraculous powers of modern medicine and surgery. But our troubles were not over.

Jennifer’s own heart problems

On 26 September Brian was moved out of the ICU into a four-bedded room on Ward 42. He was very weak. At meal times I cut up his food and helped him to eat. He was also uncharacteristically emotional, being easily moved to anger or tears. I understand this happens for many patients in the first few days after major cardiac surgery.

Between 1 and 3 p.m. daily, the ward was closed to visitors to allow patients to rest. Wanting to be with Brian as much as possible, but reluctant to spend two hours in the hospital waiting area when there was so much to be done at home, I took to coming in twice a day. Looking back this was too much, because it was quite a long journey by bus and ferry and I did not feel well enough to drive.

While visiting Brian in the afternoon of 29 September I began to feel ill in a way I could not define. Without telling him why, I left the hospital earlier than usual, and with an effort made my way back to Devonport.

Kind friends had invited me to have supper with them and I hoped the company and food would make me feel better, but I could hardly walk up the hill to their house, and when I got there I could hardly eat or drink. After the meal I excused myself and went home.

My chest felt tight and I could feel my heart beating too fast. I decided to switch off my phone overnight, the first time I had done so. I went to bed but the symptoms persisted and I slept only fitfully. In the morning I felt even worse and rang 111. I don’t know why it had not occurred to me to seek help before.

The ambulance arrived, and so did my neighbour from over the road. My blood pressure was up to 220/110, heart rate around 120 and the ECG showed atrial tachycardia. I was taken to North Shore Hospital. It was almost like a replay of what had happened with Brian a few weeks earlier.

I began to feel better on the journey, and switched on my phone to let Brian know what was happening. I was alarmed to see that there had been a missed call from him in the middle of the night. I rang him back and learned that he had gone back into atrial fibrillation after I left the ward, and felt very frightened. The fact that we had both developed cardiac arrhythmias about the same time is either a remarkable coincidence or evidence of communication between our energy fields.

By the time I was seen in the emergency department my blood pressure and heart rate had come down and the doctor did not think there was much cause for concern, but among other blood tests he took serial measures of my cardiac enzymes and they were found to have risen as the morning went on. After hearing the story of my husband’s recent illness he queried the “broken heart syndrome”.

I was moved from a low‐risk observation area to a monitored one, and there I stayed for the rest of the day. My ECG and a further blood test was satisfactory so I was allowed home, and advised to double the dose of metoprolol. Being still in my nightclothes, I much appreciated a lift from the husband of the niece who had been in to see me earlier on. I spent a quiet evening alone at home, having been unable to make my usual daily visits to Brian and to my mother, though I spoke to them both on the phone. I learned that Brian had just had another operation, though a more minor one, for insertion of a cardiac pacemaker…

For more of Jennifer and Brian’s story, please refer to Jennifer Barraclough’s book ‘Across A Sea Of Troubles’.

Shared March 2017