The Numbers Game

 Whether you think you can, or you think you can’t, you’re right - Henry Ford

The start of this process could be labelled in a couple of ways.  It could be thought of simply as Day 1, or as I’ve come to know it in time since, and perhaps it could be said to be more accurate, Day -7.

Whichever way one might choose to think about it, one thing becomes clear and unbending:  this whole thing is just that - a process.  In the previous missive however, I described the concept of the times before and the times after, so for the sake of consistency, I choose to stick with that.  As I begin to write this, it is day 70.

Ten weeks since my life was saved.  Seventy bonus days, one might say.  But more accurately, and indeed positively, the end of the tenth week of the process: the beginning of the next.  

As the saying sometimes goes, life is all about choice.  From the outset, I had really only two that came to mind.  I could choose to let my emotions and the cavalcade of overthought get inside my head, become bitter and fall to pieces, or I could instead embrace the opportunity I’ve been given and tackle the challenges that lay ahead in a resilient manner.  I’ve been that guy who chose the former in times past.  Too many times, in fact.  

But this experience is very often described as “the wake-up call”, and now that it’s been so abruptly thrust on me, I believe it.  Focus shifts and priorities change, and in so many ways, this is a positive.  So with relative ease in fact, I have chosen the latter this time.  The path I want to follow is one that not only takes me back to full health, but one that makes me a better version of myself.  In hindsight, it's easy enough to let the negative things get the better of you. As it turns out though, it’s easier to choose to do better.  To be better.  Far aside from just myself, I owe it to the many others I hold close to follow this path.  And to be honest, it's been interesting and even fun so far.  Sometimes the path has well defined goals, but as can often be the case, not everything can be foreseen.  So I focus each day now on the things I can see and that which I can control.  What lies around that corner up ahead, well…I’ll tackle that when I get to it.

The recovery process from open heart surgery begins really from the first moment you regain consciousness in the intensive care ward.  Obviously it's not some kind of overarching thing that can be achieved in a few days, or even a couple of weeks.  It is a long checklist style series of items - milestones really - which vary in intensity and duration, depending on what they are.

Keeping it in the aviation theme for now, the checklists kind of form into a number of sub-categories:

• Pain management 

• Healing

• Endurance

• Fitness

• Mental health

In so many ways it becomes a game of numbers.  To my way of thinking, this is the best way to measure progress. The numbers are really everywhere, even in the few days before the operation.  The monitors above your bed, ever present, showing all the vital data: heart rate, oxygen saturation, respiratory rate, blood pressure and so on.  I became familiar with them all in a pretty short space of time.

And time itself becomes a subset of numbers that play on your mind early on.  The countdown to surgery day is always lurking in the back of your mind, despite the many distractions.  But the time, and the day itself, did come and did pass, and I’m very happily alive to tell the tale.  The numbers that matter really, are those that followed it.  And with nothing much else to focus on since leaving hospital, I have done what I can to improve the numbers gradually each week.

I haven’t worked in 11 weeks.  At least, not in my main occupation.  With my category 1 rail safety medical suspended for a minimum of three months, it dovetails rather conveniently with the projected timeline given for basic recovery.  Specifically, the time it takes for the sternum to fully heal.  So that’s around 12-13 weeks, but within that, there’s a milestone to focus on which comes a little sooner.  The halfway point.

Week six is the first big goal.  Within that time frame, there’s much to achieve.  Week one and two are dedicated to the hospital process, and the array of number based goals that come with that.  Aside from the data streaming across the bedside monitor, nearly all of which came under the category of things I couldn’t control, my focus became one of distance measurement.  Steps and destinations.  How many steps could I walk in those first couple of days?  First the door to the room was the destination, then the nurse’s station just beyond, and then an assisted but triumphant lap of the small foyer outside the door.  It was exhausting, and it was liberating.  By the end of week 1, the nurse in charge and I were able to do a lap of the whole floor of the hospital, and even outside briefly to the ambulance bay to get a few lung-fulls of crisp, fresh air.  It was pretty chilly that night, especially at 2am.  It felt amazing.

The second week was dedicated to cardiac rehab, where the numbers game, along with my ability to control it became more prevalent.  To benchmark things, they begin with a six minute walk.  You’re encouraged to push things as far as you feel comfortable, the pulse-oximeter checks your vital signs each minute and your final distance achieved becomes a good starting point to work from.  248 metres.  More numbers, and I was sweating.  From there came the twice-daily gym sessions where reps and times were gradually increased.  I will admit to trying to push things a little further sometimes than perhaps I should when the physio staff weren’t paying attention, and often paid for that later.  As I may have mentioned previously, I need to learn patience.  I’m working on that;  I promise!

The same six minute test a week later, one day before I headed home, was far easier to do and it produced a figure of 360 metres.  Progress.

Being home again felt a little strange at first, I have to admit.  It’s almost funny to think how quickly I’d become institutionalised in the hospital routine.  In the 22 days since I’d stepped out the front door to head to a quick doctors appointment, a lot had happened.  The car ride home was uncomfortable.  I hadn’t anticipated that, but I could feel every imperfection in the road surface, and it hurt a bit.  But once we got home, I just felt completely drained.  I eased myself onto my own bed for what seemed like the first time in eons and slept like a log for the entire afternoon.

The following few weeks are characterised by the things you can do, but more importantly, the things you cannot.  You’re not allowed to drive.  You’re not allowed to lift really anything.  2kg at the most, but nothing more.  No lifting your arms up too high, no using yours arms to help push yourself up off the couch, no wheeling the bins out on a Thursday night, no shower without supervision, and so on.  You might be out of the hospital but you’re still fragile, and protecting the sternum while it continues to heal is paramount.  And notwithstanding that, your body is still tired.  So there’s that challenge to be patient again.

So with not much to do then, I instead turn my focus to the limited scope of things I can control.  At the top of the list is exercise.  In fact, that really was the list, and therefore also an opportunity.  I know how my head works, most of the time anyway.  And I knew that if I spent too long sitting around, I’d run the risk of getting into that negative mindset again;  and that had to be avoided.  What I could do was walk.  

I’ve been doing a lot of walking.  Walking means I can translate numbers into goals easily, and do what I can to improve them over time.  Distance, of course, is the main set of numbers, but perhaps more crucially, that other data set collected by my smart watch - heart rate.  The one thing I’ve noticed really early on after the initial shock of the surgery subsided was that my lungs just feel amazing.  They’re so clear now.  In fact, more than just about anything else it has been a real indicator of how unwell I’d been before this all started.  I can breathe so much more easily now and I seem to be able to recover from exercise faster than before.  Yes, my heart was clogged with those blockages, but really up until that crucial moment on September 7th, the restrictions they’d been causing were things my mind had rationalised as being something else.  But this feeling of better lung efficiency is something wonderful, and with all this walking, they’ve been getting a decent workout.  

I started with a 1 kilometre goal, and over the past few weeks have managed to crank it up to 5 kilometres.  Combine that with some exercise bike sessions and more recently, twice weekly cardiac rehab at the hospital, well who knows...maybe I’ll be running marathons in no time!  

More realistically perhaps, this exercise forms not only part of getting well, but also keeping a focus on getting back to some of things in life that I want to resume; and not just limited to getting back to work.  Some of them are maybe a matter of months from here, and others perhaps a little further on, but in any event, getting to the other side of the current process should make them achievable in the first instance, and more enjoyable beyond that.   I have also come to accept that some may not return. There will be other things instead, if that is what has to be. Time will tell.

Having all this spare time on my hands has also given me the opportunity to spend more time with family and friends.  In the times before, the schedule was a non-stop blur of work, business, and sporting commitments, all of which made it often difficult to spend time with the people I held close.  Worse still, busy schedules make it far too easy to neglect such relationships.  You can make the mistake sometimes of thinking yourself so important to an organisation that they cannot possibly do without you.  The workaholic mindset perhaps, but I’ve always thrown myself at my work, in whatever form that took at the time.  Too often, especially when I was a little younger, it was to squash down the memories of failure; career ambitions that just seemed so all encompassing in my 20’s, and which never came to fruition.  I was well into my 30’s before I could face a lot of that with any degree of honesty, and it was many more years before I could make any kind of peace with them.  After this experience, my outlook on such things can never be the same again.  The railways were where I found my niche, and I think at this point I’ve ticked off just about every goal I’ve wanted to with that - train driver, on job trainer, instructor, assessor, manager, and locomotive qualified in more recent years.  But now, I’ve been away from work for months and I don’t think the trains have stopped running because of it, have they?  It is such a simple perspective, and perhaps even an obvious one, but there you have it.  The career side of this equation is something that’s been on my mind a lot since this started:  the work/life balance more specifically.  But that’s something to put down in words another time.

This process has been difficult for my family, especially my wife, but on the positive side, it’s allowed us to slow down and enjoy the quiet moments a lot more.  Even something as simple as a shopping trip has been enjoyable to do together, and oddly, not being able to drive, the passenger seat experience has allowed me to relax and take in things I’d often not noticed before.  I’ve spent time with mum as she’s shuttled me around from one medical appointment to the next, time with my brother as we attempted yet again to solve all the problems of the world, and I’ve enjoyed spending time with my uncle as we reminisced over all manner of things.  I’ve caught up with many friends, reconnected with extended family members here & there, and of course, I’ve had the company of my two best little buddies, Jackson & Spencer.  It has been a wonderful thing, and therapeutic beyond measure.

So while it did seem a long stretch to navigate, the first big goal - week six - rolled around and went quite well.  Seeing my surgeon for the first time since being out of hospital was a pretty relaxed experience, and certainly one I didn’t know exactly how I’d handle initially. I mean, what exactly do you say to someone who quite literally has held your life in his hands?  You kind of feel a little inadequate really.  I’m still in awe of his calmness and enormous knowledge & skill.  But this man is just so easy to talk to.  He was happy to answer all of our questions, even the silly ones, and then cleared me to start doing a few more normal life things again, albeit carefully.  And most importantly, he cleared me to drive again.  A big win.

Later that week came the review with my cardiologist, which also went well.  We started talking about the path back to medical clearance for work, and have set up the required series of tests that will need to be done to achieve that.  He cut back some of the rather extensive set of medications I’ve been on since the surgery, and cut out some of them altogether.  More wins, and now the focus shifts to mid-December.

The process, the numbers game, the walking, the quiet time and the extended rest periods will all go on for now.  I won’t pretend that there hasn’t been the odd dark spot along the way.  It happens if you think about things for too long, but sometimes even those moments are an important part of dealing with this.  That’s where support networks are most important, and I’ve leant on them when I’ve needed to, even if those people may not have known exactly what the real purpose of the call may have been at the time.  Or perhaps they did all along.

Patience is the underlying theme.  In the times before I’d not mastered that skill.  In fact, my experience with martial arts, such as it was, was one that should have taught me that; I just failed to learn it.  Funny how life goes sometimes.  I think this experience may just have been the thing to get that one across the line. 

That surely can’t be a bad thing.

In railway parlance, the train has now been out of the shops, stabled briefly in the yard, and is now into the next phase.  Commissioning.  Speed restrictions remain in place for now, but the signal is showing for the mainline and testing continues.  And so far, the telemetry is good.

Onward