You Look Like You’re Moving On

It only ends once. Anything that happens before that is just progress - Jacob, LOST

Let’s start this one with the obligatory railway metaphor.

No need to go into the intricacies of the repair work.  As with all such things from the perspective of the driver, the train went into the shops for repairs, the fitters have done their work, and now we sit, waiting for the shunter to clear us back out.  Time for some post-maintenance testing.

The blocks are off, the light is flashing and now the shunter gives the signal.  One hand raised, the other moving side to side: move towards slowly.  Brakes released, crack the throttle, and slowly forward is the order of the day.  In reality, it’ll be the way of things for many months to come.

As part of the process of preparing for open heart surgery, many discussions are had, both from medical professionals and from your wider support network.  In my experience, as soon as family & friends found out what was happening, they were there with me, either in-person or via phone and text.  Among those are a handful of fellow survivors (can I even begin to refer to myself as such?) who have checked in on me every day in one way or another, both before the operation and since.  

The most common piece of advice from all of them:  the first two days post-op are pretty awful.  They weren’t kidding.

Waking up from any encounter with general anaesthesia is always a disorientating affair.  Waking up and finding yourself in the Intensive Care Unit is another step beyond that.  It’s not as though you’re surprised to be there.  You were told that’d be the destination all along, however now trying to clear the fog, focus some vision, and listen to instructions, all while attempting to deal with being intubated, is a serious mental challenge right off the bat.

With the endotracheal tube still in place, it is impossible to talk.  They have to pass it through your larynx when placing it, and so all you can really do is lie there and wave when questions are asked, or instructions are given.  It was a really odd sensation.  You’re in a situation where your body is receiving all the oxygen it needs, is expelling carbon dioxide as normal, all seemingly without any effort, but you don’t have the tactile confirmation of the air passing in and out of your mouth.  If you think about it too much, there can be a natural urge to fight it or panic.  I think I remember just closing my eyes and trying to think about really anything else.  Maybe I drifted off again - I can’t really remember.

It was only after they removed the tube that I was able to better take in the situation.  There’s still a lot of magical chemicals floating around my bloodstream, so recollection is hazy but I know my mum and brother were there.  I know that Cathey had been there prior to that, but I regret having no memory of that time.  The overall sensation is that of pure exhaustion.  The was a small bottle of lemonade on the table next to me, I remember, and a few sips of that were wonderful because my mouth was feeling pretty dry.

There’s a doctor and an ICU nurse floating in and out of picture; I don’t recall exactly what they were saying, except for one common theme.  Cough.  You must cough.  I guess the human body is designed to do a lot of things, but it really doesn’t take well to being disassembled, even partially.  So consider the concept of having the sternum separated down the middle by something akin to a medical grade Makita saw, organs moved around, major blood vessels diverted into a heart/lung machine, and all the rest of it, and it doesn’t apparently take too well to it.  The result - fluid.  Lots of fluid.

I went into that operation at 134kg, and (I found out later) came out the other side at about 142kg.  Eight kilograms of fluid, and all of it had to go.  It finds its way to all parts of your body but the critical organs affected are the lungs.  The longer you retain that fluid in your lungs, the greater the risk that you’ll contract pneumonia.  So, step 1 in that process is to cough it up, and given the current situation, that is far from a simple proposition.

A quick survey revealed a maze of tubes and wires going in all directions.  There’s the now ever present array of ECG wires around my chest and abdomen, an oxygen supply under my nose, pulse oxygen monitor taped to a finger, a couple of drain tubes emanating from my mid chest area, and two wires also poking out of the skin just above them.  There’s also a central line (I discovered this term a few days later) inserted into my neck, running some kind of probe directly into a jugular vein and down to the heart.  Down below, I also have a catheter fitted, so there’s the waste products taken care of - I guess that bit was actually rather convenient.

And then there’s the scar.  That gigantic, 20+ centimetre scar running all the way down my sternum.  If I’d quipped at some point in the past that I’d felt ripped off for a trophy scar out of my knee reconstruction, then this one well and truly has is trumped.  I just seem to find myself staring at it constantly, my hand reaching up to feel it.  I think more than anything, this is the first symbol, even in my still drug induced state, that life has now changed irreversibly. 

It dominated everything.  You can see it, and you can feel it every time you move a muscle.  The pain in this early stage was not too bad, but the advice was not to be a hero when it came to pain management.  You have the magic green button to make it go away at the drop of a hat, and told to use it as required.  It wasn’t long before that became a necessity.

I heard brand names such as Fentanyl and Ketamine being floated around.  Ultimately though, I have no idea what that button was feeding me, but one press would make the entire world go all swimmy, and in those early post-op hours, that was just peachy with me.  The pain when it did poke its ugly head up, was brutal.  So squash that button and make it go away.

As far as I know, it was late afternoon on the day after I went in for surgery when I regained consciousness.  That period is pretty hazy although a lot of it involved using that magic green button.  Watching the ICU staff work was interesting though.  The nurses here work at a different tempo those on the ward.  At the end of your bed sits a large table, angled in such a way that paperwork can be arrayed widely.  Sitting at this almost constantly is an ICU nurse.  Every bed seems to have a nurse of their own.    By necessity they are businesslike in the way they deal with you.  Still compassionate, yes, but there’s a more forceful edge to most of the advice they’re giving you.  As I floated in and out of consciousness that night, I remember them constantly monitoring me, consulting with doctors, and going over checklists.  Separating myself from my situation, it was fascinating to watch.

I guess I wasn’t putting in as much effort as required at some stage, because I remember getting a rather direct talking to by the doctor.  He told me that he could continue with pain medications and make it as easy as I liked, up to and including inducing a coma.  But that of course was not an ideal solution, and so I had to get back into the game, start coughing up some of that fluid and enduring some discomfort for the greater good.  Given I’d been in a semi-conscious state for most of the time, I don’t know what I’d done wrong, but I can only guess at relying too much on the green button.

In preparation for moving me back to the coronary care unit, a couple of things had to happen.  First, the drain tubes had to come out of my chest.  I’m told that process is particularly unpleasant, however I have no recollection of it.  Lucky, I suppose.  Next came the removal of the central line from my neck.  That wasn’t really a painful thing, to be honest.  You can’t see what they’re doing, which is probably a good thing, but it takes a while and the main sensation is that of pressure being applied to the site.  And then there’s the removal of the catheter…enough said about that!

With all that taken care of, by lunch time on the Saturday, I was being wheeled back to CCU.  

You often hear it said that when you come into hospital, you leave your dignity at the door.   I don’t know if that’s always the case in reality, but coming out of surgery of this magnitude, personal dignity can tend to take a bit of a battering.  In the overall scheme of things, it shouldn’t matter, but you have to be able to get your mind around the idea that you’re completely reliant on others for 100% of your needs.

The nurses in the coronary care unit are simply amazing.  While the whole situation was confronting to me, it was business as usual for them.  They’ve seen it all, they’re compassionate beyond measure and they’re completely professional.  I won’t go into every situation, but most difficult for me were the those involving personal hygiene.  In reality, I feel sorry for them.  Picture the famous 23-19 scene out of Monsters Inc, and a now denuded Sully.  That’s how I pictured the scene from their point of view, every time I required help with the most basic of functions.  In time though, you come to a point of acceptance, cover what you can when you can, and let them do their job.  I hope they have good counselling available.                                                   

Probably the one event that still makes me shudder if I think about it too much is the removal of the wires from my chest.  There’s two of them and they’re attached to either side of your heart.  One of the risk factors for the heart itself, given it was intentionally stopped while the procedure was performed, is falling into an irregular rhythm.  If this happens, they can attach these wires to a device that’ll deliver shocks or pulses to restore normal function.  Sounds like no fun at all, and fortunately for me, they weren’t required.  

I’m told the procedure won’t hurt, but after a week or so of being poked and prodded, multiple injections, blood tests, etc, I’m feeling just a little dubious.  There are two student nurses watching on as well, and one of them offers her hand as my jaw starts to chatter a little.  That might’ve been in part at least due to the list of disclaimers the nurse performing this procedure has to talk through before she starts.  Good lord!  Everything from the prospect of a wire becoming stuck through to a risk of an arrest. Yeah, great stuff.  All very tiny risks, of course, but picture how that might’ve felt, laying there trying to mentally prepare.

Taking the wires out required first removing the stitches holding them in place.   Then some slight pressure from one hand while the other pulls each wire, one at a time, until they’re both out of my body.  Did it hurt?  No.  But the feeling itself was seriously uncomfortable.   If you’ve ever been around a metal lathe, and run your fingers over the filings that come off - “swarf”, I’m told they’re called - they have a kind of rough edged feel to them.  That’s how I can best describe this process.  You can feel them first pull away from your heart muscle, then grind their way through your chest cavity until they’re free.  It’s about a 15 second process for each wire.  Seemed like a lot longer when you’re laying there.  I hope I didn’t crush too many bones in that poor student nurse’s hand.

The remainder of the week following surgery became a bit of routine while I was monitored and worked to gain some strength.  Each day begins and ends with an injection of blood thinner to my abdomen; something which had been happening regularly from the moment I was admitted.  The needle is very fine, so it doesn’t really hurt, but the chemical stings for a few minutes while it spreads, and the resultant bruising is epic.  My entire abdomen is a sea of purple and blue.

The week was characterised by battles on two fronts.  Physical and mental.  When you first come out of surgery, breathing too deeply is painful, which makes talking a rather broken up, breathless task.  The cocktail of drugs you’re on, combined with the lingering effects of anaesthetic make it difficult to remember things or concentrate.  The nurses have you up and walking as soon as they can, but your endurance is measured in metres, not minutes.  My first walk, for example, was from my bed to the doorway of the room, rest, then return.  It was exhausting.

There’s breathing exercises that must be done several times a day using simple device with three tubes, each containing a ball within.  Drawing in a breath raises the ball in the first tube, and as time goes on, the aim is to get all three balls to the top.  It’s very handy for measuring progress.  On the first day I could only get the first ball about half way up its tube, but by the third or fourth day, I could get all of them right to the top.

The other two goals were to settle my resting heart rate back from 100 beats per minute to something in the normal range - 80 or below for now - and to get rid of all that excess fluid.  Some well targeted medication took care of the latter, and all 8kg of post-op weight gain were disposed of over a couple of days. 

On the mental side of things, it was often challenging.  They talk a lot about the phenomenon of “cardiac blues” following open heart surgery.  Most say it hits on day three, although for me it was day four.  It hits you out of the blue and is hard to control.  Tears are frequent, but as always, the nurses are there to surround and support you.

Pain wise, as the days went on, the chest wound becomes more of a constant ache than anything acute.  I found I was able to pick up little wins each day, and by the following Thursday, it was time to move on.  The rehab phase awaited, but that wasn’t something accommodated by Mulgrave Private Hospital; my home of two weeks by this stage.

Leaving the CCU was an emotional moment.  The nursing staff in this unit had become my absolute lifeline, and many of them are more like friends now.   They’ve walked this journey with me from diagnosis, through shock, the depression, the sadness.  They’ve sat with me while I tried to reconcile this situation, moved on to acceptance, then helped me deal with the recovery from surgery.  There were hugs, smiles, and more than a few tears.  They are very, very special people.

I’m transferred by ambulance to a new location; South Eastern Private Hospital, just a few kilometres away in Noble Park.  I’ve been here before for other things;  they have a sleep lab, and I’ve done a couple of sessions there in times past, having my sleep apnoea issues analysed. 

The main role of this facility however is rehabilitation from all manner of surgical procedures.  Most of the people I came across here have had various kinds of orthopaedic work; knees, ankles, shoulders.  As far as I can tell, I’m the only one here recovering from cardio thoracic surgery.  It is far quieter here, and I find this actually a little disturbing.  The CCU is a noisy place, and I’d become accustomed to it.  Here though, you’re now left to your own devices, save for the odd check from the nurses.

Physiotherapy sessions are twice a day, and in my case were designed to improve cardiovascular endurance and some muscular strength.  I had sessions with occupational therapists as well, who checked to make sure I could look after myself once I went home.  I even got to show them my Vegemite toast making skills at one point.  I’m sure they were impressed - it’s my specialty dish after all.

With the physio team at South Eastern Private Hospital

These sessions were great, and I looked forward to them each morning and afternoon.  And they produced results.  After a week I could walk further and breathe far better than I had when I arrived, and on the 8th day, 22 days after I walked into my local doctor’s surgery for what was meant to be a 15 minute appointment, it was finally time to go home.

In a previous work life, I had a role in management.  People management really.  The official title, in the overbearing, bureaucratic way of that organisation was Depot Train Driver Manager.  It was a role that was thrust my way, and one I accepted with some trepidation at the time.  Some said at the time the move was foolish - and it has to be said, in some ways, ultimately they would be proved to be correct.  However, contrary to poplar railway opinion, the job did actually come with some good aspects.  The best of those - people.

It was Richard Branson who was credited with saying he doesn’t focus on looking after his customers as a first priority, but instead his staff.  Take care of your staff, and they’ll take care of their customers.  Seems simple, you’d think.

One thing you get to do in this role is to help people navigate some of life’s challenges.  You work to take away the understandable worries around leave entitlements, the mountains of paperwork, and then doing whatever it takes to assist them back into work when the time is right.  Even better than that, you often get to meet their families and similarly reassure them.  The aim was to take away any work related worries so they could focus fully on getting well again.  To my mind, it was a privilege, and I enjoyed being able to help people in their time of need.  I did it with a glad heart, and never expected anything other than a successful outcome in return.

Fast forward a few years though, I now unexpectedly find myself being the one who needs that support.  It feels odd;  as though I’m an imposter in some way.  Seems silly, but I’ve had to adjust my mindset around this;  being the recipient this time.  To that end, I have not been let down.  The organisation I work for now might have changed, but the people remain largely the same.  They have rallied around me and around my family.  Many of those are people I had the privilege of walking similar journeys with in years past.  To all of you, I am so grateful for your support, and I am humbled by it.  Thank you.

So now begins an extended period of recovery at home.  I am going to have to learn the art of being patient - not usually one of my stronger suits.  Lots of walking, exercises and out-patient rehab sessions.  In getting well again, there are a couple of goals I’m focused on.  First, I need to be able to regain my medical clearance for the railways again, so I can resume work hopefully some time in December.  Second is to regain fitness and get back on the basketball court in the new year as a referee.  

The hardest parts of this process are over now.  Getting to, through and beyond the surgery were huge mental battles for me, but I’ll allow myself a small measure of pride in having negotiated those stages.  It wasn’t always pretty, but we got there eventually.  It has been the most profound experience of my entire life.

To the surgical team who saved my life - lead by Mr. Andrew Newcomb, Associate Professor Sandeep Prabhu and Dr. John Lau - I have no adequate words to express my depth of gratitude.  Thank you for your unparalleled skill, your understanding and compassion.  

To the nurses of the coronary care and intensive care units at Mulgrave Private Hospital, you were my lifeline throughout this process.  I will never forget you.  Thank you for everything.  And sincere thanks also to the nursing team on the Cassia Ward at South Eastern Private Hospital, who took such good care of me as I prepared to go back into the real world.

Probably the best way I can thank all of these wonderful people is to aspire to another goal:  I owe it to not only to them, but also to those I love, to take this second chance at a long life and live it smarter than I had before.

I’m not an expert on any of this stuff, but four weeks prior to writing this, I was living what I considered to be a normal life.  I’d become accustomed to being in a routine that was too busy, not entirely healthy, and comfortably ignorant of the warning signs, which with the benefit of hindsight now appear more obvious than I was willing to admit.

The process that led to my heart attack was not a sudden one.  It’d obviously been brewing for many years.  I know now that I’d been sick for a long time.  The hard part was not only not knowing that I was sick, but not knowing how to know I was sick.

So the message perhaps to take away from this experience is to keep better track of your health, speak to your doctor if you’re concerned, and ask for more specific tests.  All my numbers were good; all in the normal range, and yet still this happened to me.  If only I’d known then what I know now, I’d have insisted on more targeted tests.  If you’ve followed my journey this far, well, now you know.