I will enjoy my breakfast because after that I am on Nil By Mouth until after my surgery. The ward is quiet except for the humming of the blood pressure monitor on my arm & the distant sound of ECG monitors. I am both excited that something is being done & a little anxious that during the procedure they will see nothing wrong & I will have wasted a bed for 6 days.
Why do I keep doubting that anything has really happened? My brain tells me yes; my emotions really don’t know.
09:10: I have finished my breakfast & have a quick shower whilst the nurses change my bed for theatre. My drugs still make me dizzy & light-headed so after completing my wash I don my sexy hospital gown, return the bed, have new electrode pads applied to my chest & plug my ECG leads back in. A happy nurse arrives with an electric hair trimmer: I am to be shaved at my right wrist & right groin. 5 Minutes later I am smooth & finally ready.11:00: I endure the torment of the tea trolley & my friend across the ward asking me if I would like a drink (knowing full well that I cannot have one). I fight heavy eyes & wake up after a short doze.
13:45: Two figures appear at my bed. “Stuart, we are ready for you.” A couple of checks of my details & surgical wrist band & we are off along the corridors to the Catheter Lab. Just as I am being slotted into place the radiologist apologises: “I’m really sorry, but we have a man with no heart beat so we need to sort him out first.” I am wheeled into the recovery area to wait.
15:00: Take 2. Back into the theatre, onto the bed. Hand placed in a holder. I grasp the bar & local anaesthetic is injected into my wrist whist the Consultant & Medical Team set up the equipment & camera & flush my cannula with saline. We are ready.
“Stuart, you do understand why you are here?” asks one of the doctors.
“Yes, for an angiogram & any repair work that may be necessary,” I reply.
“Good. Then we’ll get started.”
A slight pressure as the sheath is inserted into my radial artery. If feel nothing much. The first line is inserted & the theatre begins to fade. “Heart rate & blood pressure falling rapidly!.” I am given oxygen & then an administration of atropine to increase heart rate, but my blood pressure continues to fall. Everything is very distant. Far away voices ask for a second line inserting into my left arm. Saline is fed under pressure to raise my blood pressure. 500ml. 1000ml. 1500ml. My blood pressure begins to stabilise. Heparin is injected to thin my blood. I eventually stabilise though both heart rate & blood pressure are still quite low. I feel a most unpleasant pain in my bottom & ask whether they are inserting anything, like a bedpost in there. Negative. I am not convinced & ask again. With some amusement they tell me again that there are no lower procedures happening. My fuddled brain recalls past pharmacology lectures (35 years past) & I conclude that it must be the atropine working on my rectal smooth muscle to produce spasm. Not something I want repeated.
Dye is injected through the catheter & various photographs taken. My radial artery begins to constrict around the catheter & equipment in my right arm. “We are removing the catheter in your arm Stuart; this may be a bit painful.” Master of understatement. I let out an involuntary groan & receive an apology from the Consultant, something that will be a theme over the next 3 hours.
Photographs taken, the team consult the screen. “I haven’t seen that before.” The voices are audible but I am now reacting to the physical impact on my body. I feel agitated & trapped. When will this be over? “Stuart, you are allergic to morphine; what does it do to you?” I explain that the last time I received morphine under general anaesthetic during achilles tendon surgery I went into respiratory depression & required naloxone (an opiate antagonist) to reverse the effects. “Okay! We won’t give you that. I am afraid that we cannot give you any pain relief.” I am not too concerned as the pain is only transient during procedures. I feel quite drained.
16:15: A decision has been made. I need stents inserting to dilate 3 narrowed coronary arteries. Various discussions ensue on what sizes & styles are available. They try to insert the stent into my radial artery. It does not want to go in. I involuntarily groan again with the pain in my forearm just below the elbow. My artery is too constricted. They decide to remove everything & try a new entry point: the femoral artery in my right groin. After further local anaesthetic in the appropriate spot, the Consultant starts to insert the new line. I almost jump off the table: no anaesthesia. More is inserted. Pause. Another attempt. The same result. A final extra dose is given. We wait. We try again. Same result. Apology after apology. A second Cardiologist is called & I am allowed to rest. My body is not responding well to the various medical procedures.
The second Consultant arrives, introduces himself, feels around & says, “You may feel a bit of pressure.” If it’s anything like the last few attempts I will feel a lot more! “Okay, let me know when you are putting it in” I respond. “It’s already in.” I didn’t feel anything,
We can now continue.
The catheter is inserted through my groin & guided into my heart. I feel very little. “You may feel some pain as we inflate the balloon.” A dull ache starts & grows to feel a bit like a mini version of may heart attack. The stent is inserted & expanded. “I’m afraid you may feel some more pain as this is expanded.” The pain in my chest increases until it begins to feel like my heart attack, just a bit less intense.
And then it is all over.
“We have two more areas that we need to work on but they will be quite difficult so we need to chat with colleagues on whether we insert more stents or go for open heart surgery. Your body has had enough for now so we will call you back in for the next procedure”
My heart sinks.
The various catheters are removed & the sheath attached to my groin with a stitch & then covered with ab adhesive dressing. This will need removing later when the effects of the heparin have worn off. Bleeding on removal can be spectacular if not controlled & clotting is essential to prevent me painting walls & ceiling. I am lifted to another bed & wheeled to the recovery area.
The staff have all been fantastic & continue to be so. We crack a few jokes & then the ceiling tiles whizz past once more as I am wheeled back to the Cardiac High Dependency Unit. “Welcome back Stuart. We were wondering where you had got to & have been calling the Cath Lab for updates.”
The time is 18:20. The normally one-&-a-quarter-hour procedure has taken 3 hours. I am worn out, hungry, thirsty & glad to be alive. After a week of worrying, I finally begin to accept that I have had a serious event & realise that I am not in the clear yet as I will need to return for further surgery/procedure(s).
19:15: Matt, Becky & Viv (my family) arrive to visit. I am not good company. I want to sleep & am exhausted from my time in theatre. We talk about the day (I try not to give all of the gory details or my son will be on the floor) . It is good to be back in some semblance of normality & familiarity. My family is lovely & keep conversation to a minimum to allow me to rest.
21:00: The pain from my still resident arterial sheath in my groin increases as the local anaesthetic wears off. A nurse takes a blood sample from my highly perforated right arm. My heparin levels are suitably low for sheath removal but there are only a few trained teams for removal in the hospital & none are based on my ward. It is likely to be midnight before they arrive. I have my drink. Probably worth a doze but even the weight of just my gown on my groin is causing me a lot of pain. Paracetamol may help & I have few alternatives, so I take 2.
23:55: Two very lovely & jolly nurses appear to remove my sheath. By this time the anaesthetic has worn off & just looking at my groin hurts! This will not be a trip to Disneyland! They explain the need for a breath in; then out; then deep breath in; then a long forced breath out, during which they will remove the sheath & apply firm pressure to the wound for at least 20 minutes!
They remove the dressing which is liberally attached to hairs that it should not be. With a sound akin to the ripping of velcro I am many hairs less, my mind is diverted from the pain in my groin & the dressing is removed! A final snip & the suture holding the sheath in place is also gone.
Now all we have to do is the final deed & I am free.
I breathe in & then out. A long breath in & on my long breath out they rapidly remove the sheath. I pant like my wife when she was in labour. My head touched the pillow. My heels touch the bed. The rest of my body touches nothing, being bent like a banana. Slowly I relax. 25 minutes later I am a bit dazed but free. The poor nurse who has been applying pressure for this time is in pain, probably as much as I am. We share our condolences.
Saturday 20th August 2017 — 00:30: I try to get comfortable. My chest hurts, a lot. My groin hurts, a lot. My ECG leads ensnare me & I untangle what I can, push my head into the pillow & thank God that I am alive.
When I awake I will have to face the aftermath of today. But for now, I enjoy the warm doziness that envelopes me & drift off into a fitful slumber …