Tuesday, November 13, 2012

Ablation Procedure and Obama's Reelection

It has been four days since I lay on what I deemed a very narrow metal operating table at Memorial Hermann's Heart and Vascular Institute in Houston's vast Medical Center. Two cardiologists intended to work their way to my heart through an artery and a vein in my groin. They spent approximately five hours locating and zapping/burning places in my heart where errant electrical impulses cause atrial fib and atrial flutter. My often-irregular heartbeat was not totally controlled with drugs and the alternative solution was this ablation procedure. It has an 85% success rate and we will see in three to six months if I am to be among the lucky 85%.

Just over two years ago, my cardiologist, Dr. Anne Dougherty, diagnosed my increasing episodes of irregular heartbeats as atrial fib. At first, I’d thought that blood pressure medicine was blunting familiar life-long bouts of tachycardia, somehow altering that racing beat. But no, these irregularities were different. When an atrial fib episode struck, it was as if my heart was playing a piano. There was disquieting intermittent syncopation. Some beats were soft. A heavy pedal influenced others. Then there were the alarming pauses between beats.
I learned that there was absolutely nothing I could physically do to stop these uneven notes. I could take Rythmol, a time-release drug that keeps electrical impulses on the straight and narrow, ‘normal’ path.
I swallow a baby aspirin every morning to lessen the possibility of a stroke. And that blood pressure must be kept under control with yet another drug. I have to say I’ve been compliant. Yet atrial fib occasionally breaks through and totally unnerves me.
The alternative to drugs is an ablation procedure. When first diagnosed, I balked at such a procedure. But over time, I’ve surmised that the combination of drugs may be messing with me. I’ve endured two years of hair loss, an itching burning scaly scalp and intense skin rashes. A barrage of skin patch tests showed I am sensitive to foods, fragrances and many of the ingredients in toiletries and household products. I dropped gluten, dairy, eggs and corn from my diet. I eat green. More spinach, kale and cabbage than some eat in a lifetime.
But just maybe, Amlodipine, or now Clonidine, contribute to keeping my skin in turmoil? Periodically my skin is so fiery that I opt for a steroid shot or ten days of Prednisone. Takes the itch and burn away temporarily, but doesn’t cure. Ever. And no doctor can/will posit a cause. An allergist has now suggested a thyroid issue. We’ll explore it.
Two months ago, with thinning hair at my temples and sick to death of scratching, I talked with Anne Dougherty once again and decided to go for the ablation procedure. Most importantly, it could stop atrial fib in its tracks and it might just give my skin and hair follicles a rest. Who knows if the two are connected in any way? Or connected by drugs?
There are two old sayings that run through the generations of our family, "Time will tell," and "It's a long road that doesn't have a turn." With this ablation, I hope we'll see that turn in the road.
+++
November 7 was a very long day. Bea, my designated cab driver, arrived at my door at 4:30 a.m. She'd apparently just awakened because she asked if I knew who won the presidential election. "Obama," I said and then there was absolute stillness in the cab. Moments later, Bea said, "Well, like my Daddy used to say, ‘The one who lies the biggest, wins’.” I gave Bea my Obama elevator speech and we rode on in silence. She circled the round drop-off drive off Fannin and wished me well. 
I, myself, was heartily delighted (pun intended) with Obama’s win. For weeks I'd worried that this ablation procedure was ill scheduled for the morning after the election. With a Romney win, my heart would have filled with such angst, I doubt it could have endured an ablation procedure. Obama’s reelection and my heart procedure will be forever intertwined. 
I went to sleep late on election eve after hearing Obama’s acceptance speech. Hours after my ablation procedure, with iPhone screen on my chest, I read CNN, NYT and Huffington Post post-election articles. Caught a little Rachael Maddow too. Watched replays of Karl Rove in extreme denial on FOX News.
By the way, Sally and Martha, two dear friends, each offered to take me to the hospital and I told them no. “I don’t want you getting up at 4:00 a.m. just to drive me there.” I thanked them and said I’d be calling Bea, resident cab driver. They both offered to bring me home on Thursday. I accepted Martha’s offer, because Sally has already taken me to Memorial Hermann’s emergency room and to the sixth floor of the Hermann Professional building this year. Both trips were atrial fib related occasions.
+++
From the moment I entered the doors of the second floor 'cath lab' until I was discharged the next morning, every Memorial Hermann staff member I encountered was a consummate professional. I was nervous and eager for ‘facts’ about what was to happen next and next and next. To a person that morning, everyone answered each of my many questions and requests. One thing I knew for sure?  I felt in good hands with two experienced cardiologists.
Throughout the 31-hour hospital experience – except for those five plus hours I was under anesthesia – I was acutely alert to fleeting impressions, fragments of conversation, body sensations and the movements of those surrounding me. Taken together, these impressions and sensations formed a narrative that helped me make sense of what was happening in a situation where I had little control or knowledge.
Yes, I took notes late that night as I lay in room 409, my torso and legs absolutely motionless until 1:30 a.m.  Yes, I did wiggle my toes and from time to time, I attempted to reposition my pelvis every so slightly to ease my stiffening back and hips. Those motionless hours were necessary to assure that two groin catheter holes stayed closed. After almost twelve hours of motionlessness, I gained a modicum of empathy for the old and bedridden who cannot move easily, ever.
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Here are my notes, written late at night and expanded upon as I write this post. Note that my use of medical terms and outcomes may not be described with great accuracy. Rather, I write about my experience

“You had a pretty serious procedure.” Who said that to me? A doctor? I heard the words and believe it’s true, because at this moment, I cannot fathom leaving this hospital room mid-day tomorrow and then walking from the car into my house. I’ve not even gotten out of bed yet. People who’ve had the ablation procedure told me it was easy. One friend said the worst part was lying motionless on his back for six hours.

After I checked in at 5:00 a.m. on Wednesday morning, a nurse asked about my medications. I handed him a typed list.
“Oh, this is great. You're so organized.” 
"Do you want the TV on?" he asked.
"CNN" I said. But the talking heads had little new to say. I picked up my NYT and read its election coverage.
The nurse soon put a needle in my left arm and shaved my groin. When the shift changed at 7:00 a.m., another nurse arrived with an electric razor.
“It’s already done,” I said.
“Some folks look like a deer in the headlights when I arrive with this.” He held the razor aloft. I laughed.
A young anesthesiologist stood by my bedside to explain what she’d be doing. Seems there would be a test to check on potential clots behind my heart. The test involved a tube down my throat and esophagus. I am very happy they did this test after I was knocked out.
Dr. Bharat Kantharia, Professor of Medicine, UT Medical School at Houston and my own doctor’s colleague, arrived to stand on the left side of my bedside and outline what I could expect. Dr. Doughtery pushed aside the curtains and stood to the right of my bedside. I was pleased that both were hovering over me, imparting facts and quite frankly, a degree of comfort.
I told Dr. Dougherty I was nervous. I cannot remember her reply, but it was comforting to me to tell her. The big procedure was underway.
Wheeled down a hall and into a cold room, I was transferred to that very narrow metal operating table and asked to sit up so big black electrodes could be placed on my back. An x-ray machine hovered over my chest and it seemed a bit close to my face. The anesthesiologist said she would begin the drip. I was gone.
+++
I remember the space between sedation and wakefulness. I was dreaming. All was a horizontal blur with a story line. Then my eyes opened and the dream story dissolved. Part of me wanted to return to the story, but the horizontal blur had evaporated. Even without glasses or contact lens, I knew that I’d ‘returned.’ I could hear laughing and voices beyond a curtain. The ablation procedure must be over and I am in this moment.
My whole body is shaking. The nurse who greeted me at the beginning of the day shift is by my side. I am cold and more blankets are put over my feet, around my head, across my chest.
“It's the after effects of the anesthesia,” he says. I continue to tremble. My teeth are chattering. And I discover that I am extremely uncomfortable. Not in pain, exactly, but every part of my body is uncomfortable, with one exception. I note that the only spot on/in my body that is not sore and aching is the center of my chest. It is an oasis in my acutely uncomfortable body.
I have never been this completely and totally uncomfortable in my entire life. Uncomfortability is more often localized – a headache, a toothache, a stubbed toe, a sore hip. 
I remember the nurse’s name is Trey. He asks if I want morphine for pain. I tell him that I am not experiencing pain, exactly. My body simply has a ‘run over by a truck’ feeling.
I am wheeled back to the room where I spent the early morning hours before the procedure. Trey says that he and another nurse will remove the two catheters from either side of my groin. He again asks if I want morphine.
“Is morphine anything like Demerol?” I ask. “Because if it makes me as nauseous as Demerol once did, I’m not risking it.”
He cannot tell me.
“Well, then, I’m not taking it.”
“If you change your mind, it’s right here in my pocket.”
The nurse on my left side pulls the catheter from my vein. It feels like a long stinging injection. Not morphine worthy. Trey pulls the second catheter out. More of the same. Acutely uncomfortable, but I am already acutely uncomfortable. Neither catheter removal compares to one late labor contraction.
Both nurses then press their hands/fists? into my groin for, they tell me, fully ten minutes so blood can clot, two holes can begin to close. I am told to lie totally still without moving my torso, my legs, arms, my head. For six hours. Motionless, so those two holes in my groin scab over. 
“Let us know if you feel any warmth. That might mean you are bleeding. And if there is internal bleeding, it will be very painful. Press the buzzer immediately.” These were my instructions. I remain motionless. And acutely and totally uncomfortable.
I think Dr. Dougherty visited me. I know my friend Roanne came to tell me she’d called Earl, my brother John, my daughter Mary, who in turn would call my daughters Caroline and Jeanne and my sister Kate.  And then there was the list of women friends to be called. Roanne sat in that waiting room all day, reading, people watching and writing thank you notes, she said.
“I just could not think of you without someone to send you off to surgery. And you needed to know that someone was in the waiting area when you were through,” she’d written in an email. 
I guess I’d been a bit cavalier about lining up a good friend or my brother or indeed, Earl who was in the midst of teaching the week’s classes at Lone Star College in Tomball. Thank you, Roanne.
   +++
It is near 6:00 p.m. and I remain motionless and sore. I hear conversation and it is about new patients arriving. They need my space and I will be moved up to the fourth floor into a hospital room. It is nowhere close to the six hours in which I am to remain motionless. I am moving through hallways, bumping on and off an elevator and then I hear a call for folks to help with a ‘pul transfer.’ Is that pulmonary? At least five people lift me from gurney to bed. I note the clock on the wall. It is 6:15ish. I request that the TV remain off, lights low. Someone adjusts the blanket that covers my head. It tends to slide over my eyes, even though I am not moving. I am still cold and more blankets are strewn over me.
A very lovely pregnant nurse introduces herself and checks my groin. There has been slight leakage on the right side – that would be the artery side – and the nurse tells an associate that she will make a mark on the bandage so they can tell if more bleeding occurs. Within minutes, she is back for another look. She makes a second mark and tells me to call immediately if I feel warmth or a trickle.
Within minutes, I do feel a warm trickle. I touch the inside of my thigh and my finger is red with blood. The nurse tapes on a pressure bandage, but I know it’s not working and I call again. I believe I am bleeding because I was moved too soon and got jiggled when transferred from gurney to bed. I’ve learned from another staff member that there is a baby shower in the break room for this nurse. I also know that it is ten minutes to seven and the shift change. But this good nurse returns quickly to my bedside.
I tell her, “I can push harder than this bandage is pushing. It’s not working.” She agrees. I ask her when her baby is due.
“Two weeks. I’ve already brought my bag to the hospital. It’s a boy.”
Another nurse named Lauren arrives. The pressure bandage is removed. Lauren begins to press on my groin in earnest with a small absorbent pellet that holds a coagulant. She tells me she’ll press for five minutes.
“They pressed for ten minutes downstairs,” I say. “Press harder. As hard as they did.”
“One of my granddaughters is named Lauren,” I tell her.
At the end of five minutes, the bleeding has stopped. Lauren rests her hands on my thigh and they are trembling from the exertion.
“Thank you,” I say. “You stopped it.”
The bad news is that the clock begins at zero and I have six full motionless hours ahead of me. We count the hours together. It will be 1:30 a.m. before I can shift to my side, lift my knees, turn over.
At 7:30 my brother arrives. “Took me a while to get in here,” he says. I rang and rang the buzzer. Must have been shift change.” Yep. 
As usual, John’s been up since 4:00 a.m. “I could have brought you to the hospital, you know.”
“Yes. But the cab was easy.” I know he takes Trish, my sister-in-law, to MD Anderson with regularity. I’d decided that John didn’t need one more trip or one more day in a waiting room.
John says, "Obama won Florida. And the Democrats took some more seats in the state legislature."
Terrific news. I am so happy. 
I tell John about the ablation procedure and find my head rising from the pillow, my hand gesturing. “I can’t tell you this stuff,” I say. “It makes me laugh. And move.”
Lauren returns to check on her work and my new bandage. It’s holding. No bleeding. She returns a second time while John is there to ask how I might rate the efforts of the nurses and staff. I commend her for stopping the bleeding in my groin. I remember Trey’s name, he of the ‘deer in the headlights’ remark. And then I laugh, which is not a good thing, because laughter could pull my abdominal or pelvic muscles and heaven forbid, start the bleeding again.
“I can’t answer these questions now,” I tell her. “It sounds like an AT&T survey for customer satisfaction.”
I inadvertently laugh again and John chides me.
“I can’t do a survey now.” I like Lauren and hope I haven’t offended her. I am 70 years old, old enough to say I dislike customer satisfaction surveys. Most of them come after I’ve been on hold on the phone, listening to inane music tracks, waiting for a live person. And after we've solved my problem, they always ask "How satisfied are you?" Bless their hearts.
In the case of Memorial Hermann, I do feel a semblance of ‘customer satisfaction.’ I have definitely not been put on hold on either the second or fourth floors. I just don’t like the methods or terminology used to extract information for bean counters in any corporation or institution. John bids me good night and he’s on his way.
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Very early in the morning, after I arrived at the hospital, a nurse took my blood pressure. It was 160, higher than I’ve ever known it to be. Twelve hours later it hovers in the high 90s, which I consider very low.  I think I heard one of my doctors say my blood pressure had been all over the place. Was this during the procedure?
It’s about 8:30 p.m. and I have five hours in which to remain still. 
I’ll write a contining post soon. This story is not over yet.

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