My Heart Surgery

When last we visited our stalwart hero, he was preparing himself for impeding open-heart surgery by writing an earnest if vaguely grim blog post.

To be honest, I’ve wavered for some time on whether I even wanted to write a follow-up. Professionally, my approach to returning from convalescence has been to try as much as possible to make everyone forget I’d been gone for two months. I have been positively aggressive in projecting almost overwhelming health and vigor. And so the idea of revisiting the days of wounds and weakness has been an idea I have grudgingly — but irrevocably — adopted, because, like all major events, I’ve only truly finished synthesizing what’s happened once I’ve written about it.

That it has taken me 3 months to get to this point of conversation on the matter should be a glimpse into the magnitude of the event. The wholly expected result is an experience that, at least for now, informs most of the rest of my life, not just from the perspective of recovery but also in the way I perceive the otherwise mundane trappings of everything around me.

But all that internal, self-analysis mumbo-jumbo: That’s not the interesting part of my story. Let me instead tell you about what happened since last we spoke on the topic.

I don’t really know how to frame how I felt as the seconds leading up to my surgery ticked away like the beginning of an episode of 24. Afraid is obvious, but there was something else, something almost like a kind of emotional anesthesia working in the corners of my mind. It was a kind of detachment, like looking in from the outside as the things that were happening to me happened to someone else instead. Still, every moment slouching toward the zero-hour of surgery was slightly more difficult to deal with than the one before.

There is something about the moment when you start a monumental journey, when you are actually on the road even if it’s only as far as the edge of your driveway. The momentum of a big start changes the context just enough. I remember thinking that I would never be able to voluntarily corral myself into the car to go to the hospital, that wranglers would have to come and tie ropes around my head and body to forcefully drag me into the car like a stubborn mule. But no, instead I just got in the driver’s seat as though I were out to get some burgers from Sonic.

At the hospital, as I filled out forms and processed insurance information at the check-in desk, people around me went conspicuously about their otherwise completely normal days. It felt almost thoughtless or even irreverent. How dare everyone else just traverse the long spaces of an early morning when I was on my way to a questionable fate? I couldn’t help but now feel totally removed not only from myself but the world entirely. Part of that is that 5:00 in the morning feels like a different planet presided over by bleary eyed mad-men anyway, but this oddly bustling waiting room — in a place where I had come to pay men to have me splayed on a table with my heart stopped and insides exposed — was just too much.

I keep thinking about the numbness of that morning. Sitting in a chair as a large, pleasant faced man expertly shaved my chest — as he had been doing for nearly 20 years to countless others — while a tired, twenty-something girl with a Russian accent watched on, a chest-shaver-in-training. That’s an experience that just can’t avoid being surreal, like your life had suddenly become a living interpretation of a Dali painting.

When finally I was carted through long corridors in a wheelchair, despite my entirely functional legs, and led into pre-op where I lay, scared and shorn, in an unfamiliar bed, I was finally out of tools to interpret what was happening to me. Maybe this is what it would feel like to be going about my normal day and suddenly be abducted by a paramilitary team of politically motivated raccoons.

Then things started to get weird.

True fact, your best friend should you have surgery is your anesthesiologist. He stands like Superman between you and a hellborn nightmare of terror and pain. As my anesthesiologist calmly explained why, as a 38 year-old, healthy, non-smoking patient with no complicating factors, I was sort of his dream patient, he administered a wonderful little concoction called Versed, that I initially and incorrectly thought was doing nothing to dull my senses — a belief that I would have happily explained to my caretakers if only I could have cared enough to do so. Also, everyone looked really busy cutting open my wrist so they could put in an arterial line, which by the way was completely fine with me.

It’s not at all like I remember with my tonsillectomy back in the early eighties, when I was taken to an operating room, my face covered with a mask that smelled like tangy, dirty socks and counting back from 10 to just the other side of 9. Going out in the way they took me out was not like a knife blade cutting through consciousness. It was more like fading away, slowly, calmly and with no real sense of a world spiraling out of control. I don’t remember leaving pre-op, but I do remember getting to the operating room, giant blue (maybe not actually blue) lights hanging above me.

The world was exceedingly narrow at this point, and I did not care where I had found myself, because in my state there was no such thing as caring or not caring. In this moment that I should have dreaded on a primal level, I simply existed without judgment or context. The blue lights were pretty. I was quiet. And then the world ended.

In a way, even now three months later, I feel a small bit like I am living a different life, like Sean “Elysium” Sands actually did die or fade out at that precise moment and when I slowly crawled to consciousness later on it was someone very similar in a very similar universe that emerged behind my eyes. I do not have any sense of the seven hours that transpired next, and I don’t have the sense of lost time, but what I do have is a sense of the magnitude of the absolute nothingness that exists in my mind as the break from pre-op to post-op.

For those of you who have never woken from deep anesthesia, there is no real way to convey what it is like. Waking up is the wrong way to describe it. It’s nothing like that. It was not painful. It was not scary, though I understand that’s not always true. It was like reloading your life, a slow ramp up of all the faculties you take for granted as just a part of living. Looking back, I begin to realize the important distinctions between words like consciousness, awareness and lucidity.

The most unusual feeling, and even now I still can reach back and keenly feel it, is the loss of involuntary breathing that happens when scrambling up from the deep. With air being pumped into my lungs when I forgot to do so on my own, which does not seem like the sort of thing I’d be inclined to just forget to do, I kept myself busy just trying to hold on to the thought of breathing in and out every few seconds. It was a thought that frequently eluded me, and somewhere from far across a sleepy universe a buzzer would sound and a stern voice would remind me to breathe.

I would go through a complex set of thoughts at that point as machines cycled air to my lazily confused body. First, I had to remember what breathing was. Once I had a grasp of that notion I had to remember how that was done. Upon getting a firm handle on the instruction I then had to go through the checklist of mechanical items that seemed to inflate my unfamiliar lungs. Finally, chemistry and engineering mixed into a singular, willed thought that took over the breathing from the machine, at least for a while until I forgot how to do it all over again.

If you have never forgotten how to breathe, I do not recommend it.

There were people. Some I remember and others I don’t. My surgeon appeared at my side, delightfully pleased with himself, or so I am told because I’m as likely to remember that occurrence as I am to recall what it was like living through the Battle of Hastings. The world slowly broadened around me, and my attention slowly refocused over time away from basic body functions and on to more sophisticated sensations like the crushing thirst I was experiencing and the general unpleasantness of having a tube down my esophagus. There is no simile, by the way, that I can use to explain what intubation is like — except to say that having a tube down your throat that forces air into your lungs is a lot like having a tube down your throat that forces air into your lungs. It is my new definition of unique.

I had long assumed that when I regained consciousness alive, I would be filled with the spirit of celebration in my punctured heart, joyful at the very fact of life. It would be like landing a plane that had been certain to crash; once on terra firma, on bended knee and making out obscenely with the ground. There’d be tongue and everything.

Instead, it was hours before my thoughts were remotely coherent enough to conceive first of all that something odd had even happened and second of all, oh yeah that odd thing was a whole bunch of heart surgery. It was still even later, as my careful attendants were slowly becoming less interested in my stabilizing situation and dispersing to the winds like dandelion seeds, that it finally clicked into place that I had not died. It was so anticlimactic that I am even now just ever-so-slightly disappointed.

The ICU was nice. That’s something you might not expect to hear, but it’s true. People pay a lot of attention to you in the ICU, and somehow, despite the situation, I recall a sense of safety in that environment. I was still on a lot of pain killers, mind you, but it was sometime around seven or eight that night that I really remember feeling lucid and in my own body, damaged though it was. I recovered rapidly through the night, which would set the long term pattern for my convalescence, and as the hours began to stretch out my need for attention diminished in equal measure.

I can’t say I got much of anything like sleep that night, but I was still fading in and out with such frequency that the night also didn’t feel long or cumbersome. Sometime around 1:00 in the morning I stood up for the first time, which my stomach and other partisan elements of my body objected to strenuously. By the next morning I was sitting in a chair for an hour at a time, which you are just going to have to take my word for as being a major accomplishment.

And then things started to get boring.

Some time during the second week of my recovery I thought about keeping a journal of what it’s like to recover from heart surgery. I whipped out an initial post, which can be found here, that detailed some of these experiences and a few others. I thought that, as I experienced new things, I would continue to describe them. But, frankly there wasn’t all that much to say about my recovery. Even at its worst, it never really hurt all that bad. I’ve told people for months now that even the night I was in ICU, it felt more like having some kind of really bad flu than anything like what I had imagined heart surgery would feel like in the days leading up to the event. Above all else it was just strange how manageable it was.

Each day and week was just a long, slow march toward normal. In a real sort of way, detailing the actual recovery would be like live-blogging paint drying. Dear Diary, today I was a little more hungry than yesterday and ate half a biscuit instead of a quarter. Also I watched four episodes of The Wire.

Now I’m me again. Or mostly me. A sort of best effort approximation of me, perhaps. I can hear my heart click a lot, which is a constant reminder, and it does feel like my insides don’t quite fit sometimes. I am a 10,000 piece jigsaw puzzle with one random piece inverted and jammed back into the empty spot with a mallet. I feel stronger and better now than I did before the surgery, but I’m still not allowed to pick up my kids. Apparently there is an ever-so-slight chance that by doing so my chest could almost literally burst open. Try living in a world where that is a thing you have to keep in mind.

The truth is, I don’t regret for a second the experience. There was a time bomb in my chest where someone had put electrical tape over the countdown. That’s gone now, and there is instead now a thing in that spot that is designed to last for centuries, not that I will likely need it that long. I haven’t gathered some “kumbaya” new appreciation for life from my experience. I don’t have a parable or moral to the story. This was just a survival thing, a gamble against a worse gamble, and it paid off. It’s like going to the casino, winning a bunch of money, but having it wired directly into a long term account that you can’t access until you’re 65. You know you should be happy, but after the weirdness wears off, there’s just a normal life left. It’s nice to be able to stick around for that normal life, though, and just every so often in the most mundane moments of life I have a spark in my head that takes stock of that moment, knows how tenuous it is, and is grateful.

Comments

What a wonderful read, and thank you for sharing your experience with us. I'm so glad that your recovery has been good and that your outlook is positive. This is truly an experience that many would not want to share, but I am grateful that you did as it reminds me of how precious everything in life is, including its mystery.

Tough trade off, the not picking up the kids part.

Will that get better, long term, or is it a forever thing?

Thanks for sharing this whole experience with is, and here's to the glory of the mundane!

As another pracicing anesthesiologist, I'd like to voice similar appreciation for the way you cite our efforts in this piece. We're often called "silent doctors" or "invisible doctors" because so much of our work is focused on making the most traumatic things in life boring and commonplace.

The sweetest thing I can hear from a patient is "So, doc, when can we start the surgery?" two hours after he's wheeled into the RR. It's unfortunate that current anesthetic technique for heart surgery can't make it that comfortable yet, but rest assured, we're working on it!