Posted by: wrmcnutt | September 17, 2011

What’s a Half-Maze?


My wife has a talent for  . . .  understatement.  She advised friends and family that there was a “little hiccup” during my maze procedure.  That “hiccup” was a full-on cardiac arrest. But I’m getting ahead of myself.

I have/had a condition called “intermittent atrial fibrillation with rapid ventricular response.” This means that, for no particular reason anyone once can discern, the small chambers of my heart (atria) go into spasms. This confuses the large chambers and they will race (or fall way off). During an episode I get weak and find it difficult to concentrate. I can still read, compute, drive, and even fight in a suit of armor. But I don’t do any of these things very well during and incident, and over the past two years they have been increasing in frequency. By itself, this condition is not immediately dangerous and many people live many years with it. The men in my family have a strong risk of stroke, and afib increase the risk of clots forming in the heart, so my cardiologist and I have decided to have my condition surgically corrected.

I am now well into the third week of recovery from my surgery and I thought I would share some of my thoughts about the experience with you.  Some of it is amusing – some of it is not.

For starters, I had a choice to make.  The treatment for my condition consists of applying tiny cuts to certain portions of the heart and the veins that feed it.  As those cuts scar over, the scars provide insulation that prevents the electrical impulses that drive the afib from jumping across.  But there are two ways to get that scarring.  The first, and most popular is a catheter ablation. The process involves putting a probe up my femoral artery up into my heart, cutting a small hole, and using the probe to generate the necessary scars.  It is non-invasive, has a quick recovery time, and is, as such things are measured, relatively painless.  It also has about  60% success rate for cases like mine.  I am, for this condition, relatively young, and have not spent a lot of time in afib, so I get a “high probability” of success.  The other alternative was a “maze procedure,” wherein they go in through the sides of my chest (both sides), spread my ribs, and work from the outside of my heart.  With more room to work, the ablation is more likely to be successful, and I was offered a 90% chance of success.  The downside?  It’s invasive, has a long recovery time, and, in the words of my surgeon, “hurts a lot.”  I wanted this fixed, so I chose the longer, narrower passage.  I figured, hey, they make morphine, right? They’ll give me morphine.  It’ll be okay.  More about that part later.

So I sorted my professional and personal life out so that I could take four to twelve weeks for recovery, hauled my boat out for long-term storage, and selected the surgical option.  Let me introduce you to my friend, Dilaudid.  No pain, no anxiety.  It’s the Good Stuff.  But take a look at the withdrawal symptoms.  You do not want to develop a habit for this stuff.  But they just started me on it to prep me for the surgery.  I had a number of conversations several times.  “Mr. McNutt, we’ve already told you about this.”  “I’m sorry, you must have been talking to the Dilaudid, because I don’t remember anything.  Could we go over it again.”  The surgical staff, and in particular the nursing team were amazingly tolerant of having to repeat themselves time and again.  Shortly thereafter, the lights went out, and I don’t remember anything else until I tried to extubate myself late that afternoon.  But again, I get ahead of myself.

My routine procedure had begun.  The started in on my right side.  I was placed on the artificial breathing machine, my left lung was isolated, and my right lung deflated.  This gives them more room to work, and the maze procedure was performed on my right side, according to plan.  Then they closed that side up, except for the drainage tubes, they turned me over, re-inflated my right lung and went to deflate my left lung.  That was when it all went squirrelly. Apparently, my heart’s response to this part of the process was to say, “Oh no you did not.  F*&# you and the Beemers you drove to work.  I quit! And it just stopped working.  I don’t do things halfway.  When I start something, I commit.  This commitment, apparently, comes from my heart. Because it refused to respond to drugs. Then it refused to respond to the zappy paddles, even directly applied.

This was the point at which we learn that a) my surgeon had a sharp knife, b) he thinks really fast, and c) he isn’t too particular about what he cut through.  I’ve got a scar on my left side that starts under my arm and makes it almost to my left nipple.  But I’ll take it. By literally taking my heart in his hand and manipulating it like a stress ball, he was able to get my motor to re-start.  By some measurements, I was dead for eight seconds.  (More on that later.)  And now I’m not.  I’ll take “not dead” over a lot of things.  And this was the “hiccup” my wife posted to her facebook status regarding my experience in the OR. She said Dr. H, my cardiologist was just about in tears when he came in to explain the state of things.  This is not supposed to happen with a surgical ablation.

This leaves me with half a maze procedure complete.  A single effort was made to continue, and my heart effectively gave the surgical team “the finger,” and they decided to call it a day, and come up with a “plan B” later.

So now we begin my return to consciousness.  The first thing I notices was that I couldn’t breathe right.  When we can’t breath right, we have strong instincts to clear our airway. When our airway is, in fact, clogged up with the apparatus that is allowing us to breathe at all, our instincts are wrong.  Accordingly, when I tried to lift my hands to my face to clear my airway, I found that I was under mild restraints.  They were soft restraints binding my hands to the side of the bed with surgical tubing. I tried to laugh.  You see, while it had been thirty years since I was a practicing magician, these restraints would have been easy as pie, even in my current condition.  But I realized at the time that this would upset the nice people who were keeping me alive, and you don’t upset the people who know where the “off” switch to your breathing apparatus is.

When next I awoke, I was more alert, the restraints were gone, and I was able to communicate via the manual alphabet.  I’d learned as a kid, entirely self-taught, and it was ideal for this situation. Unfortunately, I was the only one in the cardiac ICU who knew the manual alphabet, so I was reduced to writing on a sheet with my forefinger until someone got me a pen.  This was about the time I found out that the procedure was only half-complete, and that we needed a plan B.  I gave them a  frowny face.

Couple of facts about the breathing machine:   you can’t stick out your tongue in disapproval, nor can you talk.  And I don’t mean you can’t talk because your mouth is blocked or something is in the way.  It bypasses your vocal cords.  You can’t mutter, mumble, hum, or croak. ‘Cause there’s no air going through there.  Your voice is utterly silent. It’s more than a little creepy.  Also, you can fight it.  I wasn’t trying to fight it.  But I knew I was supposed to be trying to breath for myself, and I occasionally missed the timing.  When your artificial lung decides you are going to exhale and your real ones want to inhale, nothing moves, and it’s more than a little scarey.  But at this point, I’ve done all I can with the energy I have, and it’s time to go back to sleep.  My next post will involve a throne, a feeling of godhood, and Valkyries. Or at least handmaidens.

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Responses

  1. I’m glad that your surgeon was smart and fast. it would be a much poorer world without you in it my friend. If you’re up for it, you get a Big Hug come Silver Hammer!


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