Well, after run of almost eleven years heart happiness I’m having another heart-health event of the bad kind. It is also Week 5 of COVID quarantining in downtown Reno! So there are two immediate, distinct things that could kill me any week now. Awesome!
The heart is such a complicated organ. It does so much, with so many moving parts, all (hopefully) in sync. I learned a lot about it in the aftermath of my 2009 heart surgery, when it turned out that each of the three aspects – mechanical, plumbing and electrical – required a significant procedure to get them right again.
- The symptom that caused me to be in an Istanbul operating room in the first place was a mechanical malfunction – a poorly functioning mitral valve.
- Pre-op showed that I also needed a plumbing fix: a single bypass that Dr Cicek threw in for free as part of my one-price-fits-all visit!
- The EKGs from Reno showed that I also had electrical timing problems in the form of atrial fibrillation. I liken this to the distributor in your car engine. Gotta keep those pistons firing in order! They did something called an ablation to fix this. Here’s a cheerful description of afib:
During atrial fibrillation, the heart’s two upper chambers (the atria) beat chaotically and irregularly — out of coordination with the two lower chambers (the ventricles) of the heart
from Mayo Clinic
The fixes to my mechanical and plumbing problems have held up pretty well for the last eleven years, but the final one, my electrical timing is starting to mess up again.
The beta blocker I take for hypertension is slowing my heart down so much it forgets to beat sometimes. Hence the pacemaker, to stimulate the heart muscle to keep the beat.
Beta blockers are the optimal “swiss army knife” for distressed hearts in many cases because they just mellow out the stress. The downside is that it does such a good job of mellowing the heart out that it forgets to beat sometimes. At some point your heart may slow down so much you just pass out or gulp, it stops altogether.
Dr Kedia has mentioned the pacemaker probability on my last couple of visits. She’s had me take home a Holter monitor a few times. It gives her non-stop electrical activity readings over a few days. After this one, she say’s it’s pacemaker time. sigh…
Tuesday – Pacemaker eve
It’s Tuesday night, I go in tomorrow for the operation. I am apprehensive. Will it go well? What will life be like afterwards?
And how much does any of it matter if we’re all in quarantine forever anyway?
Wednesday – Admission
11:45 am. My good friend Ed picks me up and drives me to the main, non-emergency St Mary’s entrance and drops me off at the drop-off. I walk up to the sliding glass doors. They open for hospital employees coming and going, but they don’t open for me. I get the hint and stand aside.
A minute later clipboard girl comes outside, asks my business and tells me to take a seat. There’s a ole fat dude without a mask plopped on the only bench, so I do NOT take a seat.
In a few minutes a masked woman appears at a previously unnoticed side door and invites me inside for pre-screening. She writes on her own clipboard, issues me a mask and tells me to proceed to the main desk, … the place I would have walked directly to in the Before Days.
The next few steps are standard hospital stuff. Wait for awhile, get called into a room where someone takes all your billing info and asks a bunch of questions. Then you are led off to whatever your visit is about.
I was taken to the second floor to get all hooked up and prepared.
- Take off my clothes,
- Put on a gown.
- Get the inevitable IV shoved into my arm.
- Get a little blood taken for some reason.
- Get a visit from the Medtronics rep who shows me what my pacemaker looks like.
- Have a little Q&A session with everybody.
The best news out of this is that it is indeed possible to get the gadget installed on the right side instead of the left! This is a big deal to left-handed me.
My gown is a nice yellow with pinstripe plaid patterns. Very stylish, would make a great summer shirt in fact. They gave me some matching yellow hospital socks to keep the ole toes warm. I complemented the nurse on the color coordination, she told me that yellow gown means “danger of falling”. I was probably just as happy not knowing that.
Anyway, now I’m ready for the main event! They put my clothes in a bag under the bed, and wheel me down the hall through the double doors to … the operation room – scary!
The Operation
The room is cold, and quite large. There are 5-6 people in there bustling about. They ask me to wiggle off the bed and onto the operating table, and we get the process going!
Shave my chest with a little electric razor – both sides in case the right side thing doesn’t work out.(*) They explain a little more about that. Since the heart is on the left side, fishing in the leads from the from the right is a tiny bit more complex. Also, I have had open heart surgery so my whole chest has been ripped open down the middle which could possibly complicate things. Spoiler alert, everything was fine with no problems!https://whufu.com/wptest/wp-admin/plugins.php
(*) Not like back in Istanbul where a local barber showed up in my hospital room and went at it old-school with a straight razor and shaving cream.
Both here and in the pre-op area, everybody remarks on my scar, noting that I’ve already had heart surgery. This is a grand excuse to wow them with the story of my Istanbul adventure. Everybody is suitably impressed. Valve repair plus a bypass plus two weeks on the hospital for a flat $18,000 is the talk of the operating room there while I’m flat on my back and not yet sedated. The other story of paying for a follow-up trip to Istanbul for the price of a ultrasound is also a crowd pleaser.
They a little curtain rod thingie over my head between my head and my chest. I asked if it was to not gross me out by the gore. They said no it was to prevent me from breathing germs onto the wound. That makes a lot more sense.
At some point they start the anesthetic drip into my IV and I start fading away. A face looms over me and says “hi, I’m Dr. Correa”. That’s the last thing I remember.
I do remember an impression I have of somebody pressing pretty hard on my shoulder area. I guess that was shoving the device into my chest. The way my shoulder felt and looked the next day, it was pretty physical.
Observation
Back to good ole Room 504, my home for the night. They wheel in lunch. I get the orderly to fetch my phone charger and the clever fellow finds a way to plug in the charger behind me and look the cord over the top of the bed. I can’t quite charge it while using it, but I can charge it. I think I slept on top of it most of the night.
I try watching tv (nothing on – no new sports, no interesting news – it’s the pandemic). Eventually dinner comes. Talk to the nurse(*) and then have a really hard time sleeping that night. They had prescribed Ambien for me. I chose in the moment not to take it. In the middle of the night I wished I had.
(*) This reminds me of one of the BIGGER drawbacks of overseas surgery, namely that you can’t chat with the nurses and techs and orderlies, because almost none speak English.
Thursday – Being observed
It was an uncomfortable night, but it passed well enough. I was in a half-conscious haze for most of it, so when the Medtronics crew showed up around 8 AM I didn’t even mind! It was the nice Asian fellow from yesterday plus an impressive-looking black woman. She seemed to be the alpha dog. She passed a device over me to make sure everything is working. We chant and they leave, and I go back to wondering when breakfast arrives.
Breakfast! Coffee at last! It turned out it was decaf, but I got bit of a a placebo buzz just from the joy of it being coffee!
The rest of the stay was routine. My cute daytime nurse showed me how to dress myself, which sounds way more exciting than it was. Really all she did was impress upon me the importance of not sticking my right arm straight up in the air when putting on a tee shirt (duh). While we were doing that I got my official discharge visit from an official doctor, which turned out to be the biggest bummer of the whole event.
I will give her the benefit of the doubt and infer that she was suffering from COVID stress, but whatever, she was was rude and unpleasant and an all around asshole to me. I would have been much happier and no more informed with no doctor visit at all. Around 11:30 they escorted me downstairs, and my new Pacemaker life begins.
Home- Pacemaker life begins
Well, that was an interesting, exhausting and intermittently awful 24 hours!
It is great to be home, but I feel pretty beat up and pretty depressed. I hope things are better tomorrow when I’ve had some sleep. Maybe regaining control over my life will mellow me out.
Losing control of your life sucks. This was my first overnight in an American hospital, and I did not like it at all. It’s a preview of what nursing home life must be like. Laying in your bed and watching tv and pressing the Call button and waiting for the orderly to show up.
Friday
Yes, I do feel better today! I think was more beat up than I realized.
Medtronics called and set me up with their iPhone app. Apparently as long as my phone and pacemaker are within Bluetooth range of each other my heart vitals are being recorded. Pretty cool.
A small factual detail is that I will never need a Holter monitor again, because the pacemaker records all that stuff all the time forever!
I am really down in the dumps. I think the no shower thing is getting me down also. A washcloth bath on the body works ok, but trying to wash your hair at the sink with one hand and a bad foot and a wound you have to keep dry on your shoulder is pretty fucking complicated.
The bad foot part needs some explaining. It went from minor annoyance to a Big Fucking Deal in a matter of a few days, and is indeed the subject of the next post.
Wednesday
I drive, park, and hobble to the cardiologist’s office for the first follow-up visit with the “device nurse”. She affirms that things are working just fine. She removes the bandage, clips off the staples, and re-covers it with little gauzy strips which had a cute name I can’t remember! The big deal for me is that I can take a shower when I get home!
I talk to the nurse practitioner about how they want me to start taking a blood thinner, but I don’t want to start taking a blood thinner. We knock that around for a few minutes and put it off till my next appointment with Dr. Kedia.
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