UT Cardio Vascular Institute

It’s hard to believe it, but it’s been about ten weeks since I’ve written anything about my heart issues and my recovery.  Mostly it’s been because I can’t imagine you being interested in hearing that “I went to the Cardio-Vascular Recovery Center again today.  As an athlete, I still suck, but I got a tiny, but noticeable bit better than last time,” over and over again.  But that’s what’s happened.  Since I completed my home-bound convalescence I have attended twenty one workouts over seven weeks, missing a total of five:  one because I over-scheduled myself that afternoon, and three because of various holiday closing that had the Recovery Center closed.  I have five sessions to go.  By a strange coincidence, my recovery period will be over on the exact same day that my insurance coverage for supervised recover runs out.  I’m shocked.  Shocked and appalled.  But talking about how health insurance works is a whole ‘nother day.

The procedure works as follows: 1) Weigh in.  This is the time that I make it a point to leave my shoes and electronics on the bench.  I home I weigh naked, but I’m guessing the staff and clients at the Recover Center don’t want to see me in my altogether.  2) Once I’m weighed in, I select a three lead heart monitor and hook up, announcing to the trainer at the computer that I’m “On the air.”  She checks my heart rate and then dispatches someone to  check my blood pressure.  Once that’s done, the workout begins.

My current circuit is:

1. 6 -  minute brisk walk on the walking track
2. 7 – minute run on the treadmill, 3.9 mph, 2.5 degree incline
3. 6 – minute arm crank, 30 watts
4. 6 – minute step-up, 6″ tall doing simultaneous two-hand curls with five pound weights
5. 7 – minute run on the treadmill, 3.9 mph, 2.5 degree incline
6. 6 – minute cycle on the air-bike, resistance 3
7. 7 – minute cycle on the reclining Nustep – resistance 7, 160 watts
8. 5 – minute cool down.

They monitor my heart rate the entire time. Mostly I’m left to my own devices, but today we had a little excitement.  Apparently a heart rate of 165 is considered “excessive” by certain authorities, and I got told to dial it back during my second session on the treadmill.  I’m still getting slightly funny looks from my trainers.  I’ll get up on the equipment and light it up (for a fat middle-aged cardiac patient) and they’ll take my blood pressure:  120/80.  Utterly normal.

After ten weeks of this, I’ve made considerable progress.  I’ve lost about six pounds and have gone from walking at three miles an hour for six minutes at zero incline to running at four miles an hour for seven minutes at a 2.5 degree incline. For a heart patient, I’m weird.  I’ve said it before, but it bears repeating.  While I technically have “heart disease,” my issues are with the nerves that drive my heart not tracking the proper signals.  I have no blockage, tears, or muscle damage.  We afib patients are unusual among cardiac patents that way.  Perhaps the most important thing about all of this is that since I’ve started, the monitoring team hasn’t seen a single “off” rhythm.  Straight, normal sinus rhythm, no matter how hard I load myself up.

You find your silver linings where you can, and the fact that I’m in a cardiac recovery unit at 48 is not good.  But at least I’m in the recovery unit.  Moreover, for the first time in a long time, I’m not just “the new guy.”  I’m the young guy.  My fellow patients call me “the kid.”  I’m also the strong one, the flexible one, and the fast one.  And that’s kind of fun.  Until I remember that the reason I’m running with this particular pack is because there was something wrong with me that got a twenty-year head start on me.  And then killed me.

My youngest fellow patient’s easily got 20 years on me. They’re recovering from blocked artieries, multiple by passes, open heart surgery, stents and a host of other procedures that have left them a wreck.  They’ve got chronic obstructive pulmonary disease, peripheral artery disease, and plain ol’ “bad hearts.”  The men around me, and it’s mostly men, women number about 5% of us, were soldiers, sailors, cops, and athletes.  There’s even a couple of Marines I see from time to time.  Most left that kind of work behind and became successful businessmen and teachers at the University.  Many are wealthy.  All are lucky.

And they envy ME.

I’ve got a pretty accurate self-image.  I’m carrying 50 – 70 pounds too much weight.  I have a receding hairline, I’m thinning on top, and I have more chins than the Hong-Kong telephone directory. I’m not only middle-aged, but I’m in the middle of middle age.  Youth and athletic prowess are just a memory.  And, rose-colored glasses aside, I never had that much prowess to begin with.  But I do remember the guy I was when I was twenty.  I also remember the guy I was when I was thirty.  And I envy the guys I used to be.  I’m working hard now to do things that I could have done casually ten or twenty years ago.  Hell, I envy the guy I was when I was 40, and HE thought he was fat and old.

With all of that running against me, they envy me.  I’m not projecting.  I’ve been told that more than once in recent weeks.  All of these alpha-male types around me, decorated veterans and wealthy industrialists, want to be like ME.  Able to run a lousy 7 minutes at 3.8 miles an hour, up a 2.5 degree slope.

Sobering.  Humbling.

There’s a lesson here somewhere.

She will be easy to recognize.  Her hair is platinum blonde; the color of a freshly honed dagger edge.  The color of her eyes have been lost to me in the passing of the years, but they are deep as the blackest night between galaxies and as warm as freshly mixed cocoa in front of  crackling fire.  If I recall correctly, she stands about nine feet tall.  But despite that, her statuesque beauty is rivaled only by her academic genius.  By her will do the tides roll in and out on schedule.  In her name, does the sun rise to warm us and the rain fall to group the crops that feed us. When she speaks, all nature stops to wonder.

With all due regard to my mother, and eternal love and affection for my lady wife,  Miss Childs remains the single most influential person in my life.  She taught first grade at Skyland Park Elementary School.

All the things I know.  All the skills I have.  The philosophies and thoughts the guide my decisions.  The friends I know, online and off.  All these things she gave to me.

You see – she taught me to read.

Yea Gods.  I remember the day and the hour.  I came to her knowing the alphabet, and by custom and by law, she was forced to inflict Phonics on me.  And we plowed through it.  I memorized words and phrases.

Yeah, yeah – I “see Spot run.”  Yes, I will “Look, look,” and “See Jane.”  Big, fat, hairy deal.  This was BORING.

And then, one day, “Today class, we are going to learn a new word.  Remember that you can tell who is speaking because the words are printed next to them?  Well now we’re using a new work, ‘said.’  Now we just look to see who ‘said’ something.”

It was like being hit in the head with a kickball.  You could almost hear the traces snapping as I broke them and read ahead.  Poor Miss Childs NEVER had my full attention again, because there was always a book in my lap.  Text books?  Workbooks?  Read and gone.  The tiny library at the back of the room? Blown through by the end of the school year.  At the end of the year I could read like a fourth-grader, and I never slowed down.

Knowledge is power.  Sheer, raw, unaldulterated power – to make of myself what ever I chose, and to make over my corner of the worlds as I see fit.  And she just gave it to me, without hesitation or reservation.

Thank you Miss Childs, wherever you are.

http://willstuff.wordpress.com/2009/11/11/the-eleventh-hour-of-the-eleventh-day-of-the-eleventh-month/

In fact, I improve so much that my experience is beginning to feel like it was just a nightmare.  I catch myself doing something normal – washing dishes, putting away laundry, reading e-mail, and then think, “How can this be so normal?  Six weeks ago, I was in pieces.  A week after that I could barely move, and I had all manner of medical devices implanted in my person.  Now, I just get out of breath going up stairs and have a little cough.”

I keep coming back to that – how things be so normal?

But there’s one other thing I’ve not yet gotten rid of. I’m fine during the day.  But at night, in between the time that I stop reading and turn off the light and the time I fall asleep, I listen to my heart beat.  I listen to my heart beat, and I wait for it to stop.  Again.

I lie there in the dark, listening to my heart, and realizing that I’m getting older.  I’m slower.  I’m weaker.  My organs are beginning to fail me.  Oh, sure.  I’ve got a goodly amount of time left in the sun.  Even when I run my own calendar down, I’ll be able to hide behind technology for a few years.  But there’s no way around it.  In the dark, alone with my thoughts, in the silence of the night, I try to face it:

I. Am. Going. To. Die.

Oh, not tonight, or this week, or this month.  But someday, and probably not by misadventure. Sorry.  I know it’s self centered of me, but I consider this to be an enormous realization.

You’re probably thinking that, at 48, this should not be news to me.  I mean, after all, we learn about mortality as a small child when our first guppy dies, and it’s rubbed in when we have to bury the family dog at twelve.   We go to our grandparents funerals in our teens, and our parents in our forties or fifties.  But it’s one thing to understand something intellectually.  It’s another entirely to internalize it; to accept it emotionally and make it apart of your identity.  And that’s what I’m trying to do, this time.

My very first experience with mortality as an adult, guppies and kitties not withstanding, was the passing of William Blackfox, a noted caricature artist in the SCA.  I used to pass his booth at Pennsic every year, thinking I’d like to get a portrait.  They weren’t expensive, and didn’t take that long.  But I was always trying to get to the battlefield, or it was dinner time, or a host of other excuses.  But I really did want a portrait.  And then he died.  I thought there would be time.  Then there was the passing of my friend Amy.  Amy was just a few years older than me, and overweight.  But, I thought, in generally good health.  Looking back it was clear that she had been keeping her health issues private.  In any case, she had some surgery, and was convalescing at home.  She posted to a mutual discussion list that she was feeling better and stronger, and would be online more now that she could get downstairs to where the computer was.  The next day a close friend of hers posted that she was dead.  I was gob-smacked.  Amy and I shared interested in Elizabethan England, modern sailing, and the golden age of sail.  There were many movies I had wanted to share with her and many conversations I planned to have.  I though there would be time.  Then it got even more intimate.   Back when I had my motorcycle accident, I ran into this, but I think I managed to cram it into a mental drawer and pretend it wasn’t there.  It got closer when I buried my Dad.  My Mom’s passing, while significant, didn’t hit me as hard as Dad’s.  Probably because I was Dad’s caretaker, and was deeply involved in his daily life.  Mom lived out of state, under my sister’s care.

I. Am. Going. To .Die.

I’d like to say “been there, done that,” and I probably will from time to time, but it’s bravado.  You see, I don’t remember seeing the other side.  I was only gone for eight seconds, but you’d think that would be enough time to at least see the white light and hear at least one deal relative beckon.  But I didn’t get to see the light, nor Jesus and the garden.  What I remember is being told, “we’re staring the anesthetic” and then being asked “how are you feeling?”  And nothing in between.

I’m afraid that my faith has taken a little bit of a hit.  The question of “what comes next” is something I’m not gonna try to answer here.  A whole lot smarter guys than me have tried to answer it.  But I’ve peeked behind the veil, and I saw . . . nothing.

So this post is one I’ve been chewing on since the beginning of summer.

Earlier this week I caught an e-mail on the list of the yacht club where I keep my boat. Recent storms had damaged one of our docks, and the Rear Commodore needed volunteers to replace the damaged boards and re-set the cleats.  Mind you, every time I say the phrase “yacht club,” I feel obligated to explain that you might have the wrong picture in your head.  When they hear someone say “yacht club,” they think of huge motor yachts, oak paneled walls, and Persian rugs.  But, you see . . .  middle class people like boats, too.  So they get together in a big bunch, lease some land, and put together a place to park their boats.  So don’t think of Chauncey and Cyril with their jackets and ascots.  Think lawyers and accountants in flip flops and beachwear.  Anyway, at my club, the term Rear Commodore means “guy in charge of organizing volunteers to keep the buildings from falling down.”  And he’d spent the last week at the club, and wanted to be done early.  So we met at 8:00 in the morning and got to work.  I’d thought, you know, since I was here, I might take the boat out when we were done.

As usual, there wasn’t a breath of air blowing.  The lake looked like a giant sheet of tin, slowly flexing under the rising sun. Beads of sweat immediately broke out between my shoulder blades, and slowly trickled down my back.  Never mind; I’ll get my volunteer hours in and then read a novel

The work was light and interesting.  Recent severe storms had rolled through East Tennessee, causing damage to the West Dock.  Boats bucking at their slips had effectively ripped the cleats clean out of the dock, and in one case, ripped one of the boards off of the dock.  Also – the lake has risen sharply and at least one of the finger docks was submerged, it’s floatation overwhelmed by a dock line that had fouled the rollers and stopped it from rising with the water.

When I got there the Rear Commodore had already left on the Home Depot run to go pick up boards for the repair.  While he was away, the rest of us started mounting or re-mounting the cleats.  One of the interesting things about cleat mounting is that if you have a background in carpentry or home repair, your instincts are wrong, just like the guys who originally mounted these cleats.  It looks like a couple of lag-bolts will do the job, right?  Lag bolts just don’t have the holding power needed to keep a six-thousand pound yacht on leash when the wind hits thirty knots and the lake suddenly leaps to four foot swells.  You have to bolt through the wood and ideally, use a backing plate.  Failing that, a fender washer.  In any case, after about three hours, we managed to clear all of our work items, and it was around 11 o’clock, and the wind had risen to a steady ten knots, blowing in from the west.

As you might imagine.  Wind. Not just wind, but moderate, steady wind.  Here, in the mountains.  I was sorely tempted to sail out from the dock.  But I’m not comfortable enough trying to sail in the tight quarters of the finger docks around OPB’s. (Other People’s Boats)  Sail long enough and you’ll discover that you’re far more solicitous of the state of OPB’s than your own.  It’s something about responsibility.  After all, I can fix anything that goes wrong with my boat.

Once clear of the mooring field I raised sail, and we were off!  Under full sail Charleston Lady leapt into the main channel of the river.  I could feel the vibration of the flow past the rudder in the tiller.  There was  gentle gurgle astern as we moved across the water.  As always, when sailing without  a destination in mind, I headed upwind, in this case, down the Tennessee river toward Lenoir city. I was able to complete the first leg of the river on a broad reach and then started tacking up wind.  The usual “dead spots” weren’t, and I don’t think I dropped below 3.5 knots on the entire voyage.  The skies were sapphire blue, the sun was warm, and the power boats were mostly absent.   I reached my normal turnaround point in just over an hour.  There’s a spot on the river there where south side shoals.  Across the river is an enormous boathouse with a copper clad roof (some people have ALL the money) and some natural caves worn in the limestone.  Normally it takes me about three hours to get there.  Unfortunately, as usual, I was out of time and had to point my bow homeward.  The downwind run was even quicker and I made it back to the mooring field in about forty five minutes.

Turning around that day was one of the hardest things I’ve done.  It was the perfect day, under the perfect weather.  The boat responded perfectly and the air was stiff and steady.  And there was no one to share it with.  If I never sail again, all the money, all the effort have been worth it.  Under those conditions, I could sail forever.

Tip #1:  BATHE BEFORE YOU GO.  I cannot emphasize this enough.  If you are having invasive surgery of any kind, you will be unable to take a real shower for 10 – 15 days at best.  So be sure you shower as close to check in time as possible.  It’s hard to concentrate on healing when you can smell yourself.  Request a sponge bath every 3 days or so if you can stand the discomfort.  Not of the sponge bath, but of the moving around necessary to make a sponge bath happen.  I didn’t, and regretted it.

Tip #2: Of your wallet, bring nothing but photo ID with you.  Leave all jewelry, wallet, and credit cards at home.  This stuff is nothing but distraction while you’re trying to heal.

Tip #3: Bring your own razor, shaving soap, bath soap, and hairbrush from home.  You will feel far more comfortable dealing with your own hygiene when you have your own tools.

Tip#4: Once you begin your recovery in earnest, “real people clothes” or “workout clothes” will boost your mood.  Especially, bring enough underwear for at least half of your stay.  Start wearing normal clothes as soon as it is comfortable and convenient.  Hospital gowns are for sick people, and you will feel better in your own clothes.

Tip #5: The cuisine is going to be weak.  When they ask you want you want for breakfast, ask if a fruit plate is available.  Much tastier than the other options.

Tip #6: If you have heart disease, follow the diet strictly.  If you are like me and are on a “heart healthy diet” because you are “on the heart floor,” smuggle in some of the Forbidden Seasoning:  salt. It goes a long way toward improving hospital cuisine.

Tip #7: Have a family member bribe your nurses.  Boxes of chocolate or fruit baskets are always welcome at the nurse’s station, and you want the people who control your food and pain meds to like you.

Tip #8: Back to hygiene:  I got a haircut before I went it, and it helped, but not enough.  If I have to do it again, I’m getting a buzz cut.  Not having to deal with/worry about hair would have been worth it, and it grows back.  Likewise trim your finger and toenails.  You won’t want to be bending and twisting to deal with this later on.

Tip #9: Pain meds.  One of the things pain meds do is tell ALL of your body’s systems to “relax,” “calm down,” and “don’t be in such a big hurry.”  This includes your digestive system.  The correct response to ANY offer of pain relievers is “can I get a stool softener with that, please?”  Further, take your pain meds as recommended.  I know you’re tough, and you’re worried about either forming a habit or getting plugged up, but take a look at your parents, spouse, or friends, who are watching you try to “deal with” your pain on your own.  If you take your pain meds, your loved ones will feel better.  It’s not always all about you.

Tip #10: Find a pair of slip-on, non-skid shoes.  Sooner or later you will start rehabilitation, which will involve walking around the hospital floor.  You want shoes you don’t have to bend over or tie.

UPDATE:

Sorry, almost forgot Tip #11.  When they ask you your name, do NOT respond with “My name is Inigo Montoya.  You killed my father.  Prepare to die.”  CCICU nurses have NO sense of humor.

Like cancer, though, my condition can recur for no apparent reason, years after the procedure, so while I am currently “out of the woods,” and in three months will be safely “out of the woods,” there is, apparently, a time in your life when health care issues come up and do not go away, and I’ve entered that time.  I will remain “under the care of a cardiologist” and having annual evaluations for the rest of my life.

However – apparently most of the restrictions I have been chafing under, like not being able to work, are apparently from my surgeon, not my Cardiologist.  I’m scheduled to see the surgeon bright and early Monday morning.  I’m feeling quite well (I just walked a mile and a half from downtown to the house) and while I’m certainly ready for a nap, it felt good to break a sweat.

Restriction #1 – I am still not allowed to drive.  The Physician Assistant at the Cardiologist’s office saw no reason why I shouldn’t drive at this point, but since that order came from the Surgeon’s office, she wanted them to clear me.

Restriction #2 – Do not lift anything weighing more than 8.5 pounds.   (This is what a gallon of milk weighs.  This means that I cannot carry groceries, mow lawns, or start the outboard motor on my boat.  In fact, there are challenges to doing laundry under this restriction.  Not to mention, most computers weigh more than 8.5 pounds.  Even if I can get to my office, I’m going to have difficulty doing my job.

Restriction #3 – I have been sentenced to Coumadin.  This is the trade name for wafarin sodium, an honest to God rat poison that humans use as a blood thinner.  And this stuff is the bane of my existence. It reacts with just about everything in the known universe one way or another, and never to the good.  Because of coumadin:  no alcohol.  It’s also a blood thinner, and with the coumadin, it’s possible that my blood might get toothin.  No contact sports (SCA heavy combat).  Anything that might cause bruising is a no-no with my blood this thin.  So no bike riding. Also no green tea.  Nothing with cranberries.  No dark green vegetables.  (Honestly – what kind of drug hates baby spinach, I ask you? And a Southerner giving up collard greens?  Really?)  Now let’s talk side effects: gas, change in the way things taste, tiredness, pale skin, loss of hair, feeling cold or having chills.

That’s just what I need at this time in my life.  Something to make more hair fall out!  Tiredness?  How do I tell if that’s the coumadin, or the fact that I got gutted like a fish three weeks ago and am trying to heal?  Pale skin?  No fear there.  I already have computer geek pallor.  If I take off my shirt, you’ll see more white meat than on Thanksgiving day.

Here’s my favorite, though:
“Warfarin may cause necrosis or gangrene (death of skin or other body tissues). Call your doctor immediately if you notice a purplish or darkened color to your skin, skin changes, ulcers, or an unusual problem in any area of your skin or body, or if you have a severe pain that occurs suddenly, or color or temperature change in any area of your body. Call your doctor immediately if your toes become painful or become purple or dark in color. You may need medical care right away to prevent amputation (removal) of your affected body part.”

Not excited about body parts falling off.  I mean, sure, not having a stroke is my number one priority, but I did not sign onto a no contact sports, no spinach, tee totaling lifestyle when I agreed to this procedure.  My toes falling off is an unanticipated bonus.

Now, let’s talk about amioderone.  When it comes to treating arrhythmia pharmaceutically, amioderone is the Big Hammer.   I had been prescribed a “smaller” drug, but the reaction to that was for my heart to have “pauses.”  So I get the big hammer.  Unfortunately, the big hammer is toxic.  Other organs, such as my lungs, thyroid, liver, peripheral nerves and my eyeballs consider this stuff to be toxic.  Accordingly, I want off it as soon as it is reasonably safe.

Now, a word about “chest tubes.” For those who don’t feel like following the link, it’s a plastic tube that leads from the inside of your body to the outside of your body.  It’s purpose is to drain “stuff” out of your chest and into a high tech bucket on the floor.  They’re sutured to your body, so the don’t slip back and forth, but you can feel them.   They don’t hurt, but you can feel it.  And it feels wrong. They’re not supposed to be there, and your body knows that.  And, of course, they do move, and that hurts.

I’ve spoken well of my nurses, and there’s a lot more to be said about them later.  But they did abandon me one day.  In their place I got a couple of psycho gorgons intent on inflicting pain.  Apparently, after ten days flat on my back there was some serious concern about bedsores, and I “had” to be put on my side.  Mother puss-bucket! I dunno if it was the chest tubes or the rib-spreader, but I did not want to be on my side.  Hell, I didn’t want to move.

But by the weekend the chest tubes had come out and the holes were sewn up.  Oh – my Dad had reported that removing a chest tube really sucked, so I was braced for a lot of pain.  I even had my wife hold my punching hand, ’cause the last thing you want to to is punch the guy removing your chest tube in the nose.  It was really over-sold.  Removing the chest tubes wasn’t any fun, but it wasn’t nearly as entertaining as I had been lead to expect.  By the weekend I was moving better.

But I couldn’t get in a real shower or use the big boy toilet with that pacemaker hanging on my IV rack.  The medical profession has this stuff called “no rinse shampoo.”   You rub it in, and then towel it off.  It falls firmly into the “better than nothing” category.  But without rinsing, there’s nothing but the towel to carry the dirt, sweat, and other “stuff” away.  At this point, I was about ten or twelve days from my last shower, and was feeling really “funky.”  My visitors seems to be standing farther away from the bed, but that might have been my imagination.

The weekend went as quickly as could be hoped for under the circumstances, and midnight Sunday night came quicker than I expected.  I must now stop eating.  Nothing to eat, all day, until my, again, afternoon, cath lab appointment.  For the uninitiated, I had decided, upon the advice of my cardiologist, to have a catheter ablation of the left side of my heart.  After all the blood and thunder of the previous week, there’s very little to tell about my second procedure.  They gave me good drugs, we started on time, ended on time, and I woke up tired and uncomfortable, but in a normal sinus rhythm for the first time in ten days. I remained in a normal sinus rhythm for the next for days, until I was unhooked from the monitors.  My temporary pacemaker had been removed, and a permanent one was not installed.

Oh – and without the pacemaker, I could now take a real shower.  For the first time since my initial surgery, hot water hit those knots in the back of my neck and between my shoulder blades and they began to loosen up.  My lady wife, ever in attendance, helped me bathe and left me with my head leaning against the wall letting that hot water roll over my back and shoulders.

“Sweetie, how much longer are you going to be?”

“Oh, I dunno. Probably just until the hot water runs out.”

“Darling, you’re in a hospital.  The hot water never runs out.”

“That sounds about right.”

Of course, after a little while I had to cave and get dry.  But that hot water felt so good.

Assuming that my recovery continues to go smooth, I will be able to be hit with a hammer to the chest once again.  So there will be at least one more season of SCA heavy combat left in me, unless things go all squirrely again.  But we’ll see about that.  First, I need to be able to walk around the block without getting dizzy and out of breath.  My long term prognosis is up in the air.  Apparently, I have made history.  No one has had a half-maze, half catheter ablation.  The first offered me a 90% cure rate.  The second offered me a 60% cure rate.   Striking out into unknown territory as I have, no one can tell me what my chances are.

Me: “So anyway, I understand that that arrhythmia is all me, right?”

Doc: “Yes, and . . . hmmmm.   You know, I don’t think we’ve tried that.”

Me: “Tried what?”

The doc didn’t answer me.  He took my pacemaker off of the IV stand, popped open the safety panel, and started fiddling with the dials.

I looked like an old Looney Toons character.  My eyes bugged out.  Then they crossed.  I flopped like a fish.  I didn’t hurt per se, but it felt decidedly odd to have my heart rate and rhythm adjusted on the fly like that.  He was, of course, trying to jar my ticker into a normal rhythm.  But my heart was having none of it.  I would remain in afib for another three days.

Eventually there appear a very frustrated Cardiologist.  This is a different doctor than the surgeon.  Dr. H was put out.  This was not normal.  He’d been involved in over a hundred of these procedures, and this had never happened before. Cut here, cook here, close.  Switch sides.  Cut there, cook there, close.  And when something does go wrong, it’s never at the “switch sides” point. Almost losing an entire patient left him feeling quite annoyed.  He kept looking at my afib on the monitor, and saying, “There’s no reason why I can’t ablate that off . . . “  The poor man had to have the conversation with me no fewer than five times, but was eventually able to make me understand that it wasn’t the ablation that my heart had taken exception to, but the breathing apparatus and switching lungs after one side was completed.  Then he confessed: he wasn’t sure what to do. “Normally, when I give advice, I stand on the shoulders of giants.  Doctors who developed this procedure and have done thousands of them, plus my own experience.  But as far as I can tell, this have never happened before in quite this way, and I don’t know what to tell you.  I’m going to take the tapes, the video, and the notes, study up, and recommend something tomorrow (Friday) morning.”

I was not comfortable with my specialist not knowing what to do.  But I knew what my decision was going to be, anyway.

I was going to be offered four choices:

First, we could go back in the way we went in the first time.  They’d already done my right side, so they could start in on the left side without having to shift me over like before.  This approach would offer the same advantages as before: high chance of success, lower chance of stroke.  Unfortunately, I’m now five days in recovery from that surgery, and I know exactly the depth and breadth of pain I’m in for if we do that.  Further, and more importantly, I’m not at all confident that my heart will keep breathing if they deflate that lung, since they can’t tell me what went wrong in the first place.

Second, we could break out the bone saw and crack my chest.  Use the BIG rib spreader to flay me open like a butterfly.   This would allow them to work with nothing in the way and they wouldn’t have to deflate a lung.  There were two problems with this:  first, the scarring.  You wouldn’t think it’s the case, but even when making life and death decisions, vanity weighs in.  I already look like a rough draft of Dr. Victor Von Frankenstein’s undergraduate project.  Adding a huge scar down the center of my chest was not going to help me in the personal attractiveness department, except within a fairly narrow segment of the fair sex who dig scars.  Second, though, is the Big Hurt.  This is going to be even more painful than the work I’ve already had done and from which I am barely recovered.  It would suck the most suck in the history of sucking.  I find that I am not interested in this approach.

Third, we can go with the low-invasive procedure I was initially offered.  Not needing an incision, or to deflate a lung, this approach offers the least pain, the least scarring, and as a bonus – I wouldn’t have to go on the breathing apparatus.

Finally, we can do nothing, install a permanent pace maker, and attempt to get on with my life.  This will be the safest option; my ticker has already illustration, quite graphically, that it is not trustworthy, and could quit at any moment.  A pacemaker would bang away for 10 – 15 years without needing maintenance.  Of course, these things are implanted on the outside of the rib cage in a sort of pocket they make in your chest.  That’s so they can change them out easily when the batteries wear out. (It’s funny – they call it a “battery replacement,” but they really replace the entire pacemaker.)   But that means that getting hit with a hammer is contra-indicated.  No more SCA-heavy combat.  Not even combat archery.  Probably no fencing, although we could consider wearing a chest plate.    But I had been thinking since Friday night. I could easily see myself with more time for woodworking, teaching more classes, and in general finding more non-combat stuff to do.  There are lots of sports I could participate in that are low and non-contact.    So if we have to do this, it’s  not as bad as it might have been ten years ago.

They next day he came back with his recommendation, and it was what I expected. Option 3, the non-invasive ablation.  We scheduled a time Friday afternoon, a week after my full-on cardiac arrest and, conveniently, the next day.  There was, of course, an emergency the next afternoon after I’d been fasting all day, and my procedure was put off until Monday.

*sigh*

Let me tell something about me – I own what I say and do.  So I’m pretty careful.  There’s maybe a half-dozen things I’ve done of which I am ashamed.  Oh, don’t get me wrong – I’ve don’t a boatload of things I don’t sky-write across the city.  But those are things I’m only embarrassed by. It’s shame I’m talking about.  And that number went up by one that Friday night.

It was a long day Friday, watching those numbers change, and watching my afib flatly refuse to show any P-waves.  P-waves represent the normal atrial depolarization as it winds up to beat.  No P-waves.  No atrial contraction. My half-done maze procedure had not done me any good, and, in fact appeared to have made things worse. When my heart rate went into the 50′s, I called the nurse, and asked her to contact my Cardiologist and have an emergency pacemaker installed.  I got a rather firm and professional response from the night nurse that she would page my Doctor, but there was no way that she could promise me that he would order even a temporary pacemaker installed.

It was shortly after that that my heart rate dropped to zero for the first time that night.  If your heart stops beating, you’ve got about five seconds before you lose consciousness from oxygen deprivation.  It’s a really bizarre sensation – your looking at the monitor.  You’re breathing.  Really hard.  But the lights go out anyway.  I woke up a few seconds later when my heart spontaneously re-started.  When my eyes opened, I saw thousands of black dots swimming around my vision.  They clustered at the edges of things.  I tried to picture spending the rest of my life trying to read through all of those ball bearings and make my living.

The dark came again.  This time when I swam up from the black I thought I’d been having a nightmare.  I tried to get out of bed and go home.  But then I got to realize that it wasn’t a nightmare. It was real.

My extremities were numb, I could feel nothing in my face and lips.  After about five or six of those, the appropriate Doctors were, in fact, paged, and my opinion regarding a pacemaker was validated.  And so it came to pass that the lamps were rubbed to summon the catheter lab genies. (Genies not normally working weekends you see.)  And they began to gather from all parts of the city that I might have, at least, a temporary pacemaker installed.

Now comes the humor.  This is the third time that a specialist team has been assembled specifically for me, and someone else has show up with a worse problem than I have.  Just as the cath team was ready to go, an ambulance rolled in with a guy who had a tear in his heart wall.  Apparently, afib with pauses, while scarey as all hell, isn’t dangerous.  The guy with the heart wall problem, he was dying.  But that means that instead of a pacemaker now,  I will get one in three hours.   While all the time I lay in my bed, watching my heart rhythm gyrate and my rate sit around the fifties, periodically dropping to zero, and losing consciousness.  It was not my finest moment.

Sailboats have an issue powerboats do not share – they require water flowing past the rudder to control direction.  Accordingly, they must set courses that are more about enticing the wind than getting to their destination. This gets harder, the narrower passage you try to go through.  If there’s a problem, there’s no place to go to solve it. That’s why it’s important to have the sails set properly and the helm set to sail cleanly through on the first pass.  This is occasionally referred to as going through the narrow passage, or being in dire straights. A sailboat in dire straights has a number of things that need to go right for it to transit the narrow passage safely, but two components are critical.  The first is the keel. It’s the spine of the ship.  It holds everything else together, and keeps the ship traveling in a straight line.  The second is the helm, which steers where she goes.

I was in dire straights Friday night.  There was no one to fight, and nowhere to run.

My training is in the use of words.  I’m pretty good.  I can make them grind.  I can make them cut.  And I can make them burn.  You don’t get exposed to my weapon’s-grade vocabulary here, but I have one.  And Friday night, with no one to fight and no where to run, to my eternal shame I turned on the two women who were trying hardest to keep me alive.  My poor wife would wait for me to wake up, smile at me, and tell me that everything was going to be all right.  I would snarl, and ask her what the fuck she was talking about.  Nothing was “all right,” and it wasn’t going to be.  I read the monitor to her (which she can read better than me).  I explained in detail why things weren’t “all right,” and looked around for a pencil and paper to draw her pictures.  MJ, my duty nurse, got the worst of it, though.  I questioned her training, her competence, her ancestry back unto the seventh generation, and the likelihood that she would beget any descendants.  I challenged her decisions, insulted her parents – I held back nothing. She got both barrels and the extra bucket (to mix a metaphor). Each time I woke up, MJ would explain (again) how I was not going to be allowed to lie on her table with a heart rate of zero.  If necessary they had steps they could take that would force my heart to beat, but if they used them they would get in the way of what the cath lab boys would need to do later.

Do you know that neither one of them ever flinched?  Each time I woke up,  my keel was there, hanging on to my hand and clearly never, ever letting go, and my helm was calling the numbers and keeping my doctors advised.

I suspect that eventually MJ got tired of listening to my crap, because she showed up with a syringe.  “Here Mr. McNutt, this will take care of those pauses you are so concerned about.” They call it dopamine. I call it “charging rhino.”  “WHAM-WHAM-WHAM-WHAM”  That was my pulse, all of a sudden.  I could hear it in both ears as my revved-up into the one-fifties.  I ended up bridging back with my head and butt trying to find a spot where I could here something other than my own pulse.   Then she offered me some anti-anxiety medicine, and I was prepared to wait for the cath lab until such time as they were able to install my pacemaker.

I have been through the narrow passage.  But I did so because two women lifted me up and carried me through it.