From: "Richard Powers" -- 9 March 2004
Subject: Rumors
Hey y'all:
I just wanted to let you all know that I'm back home now. When some of you said let you know what you might do to help, and I said "just send money!" - - I expected a mailbox fulla checks when I got home, but guess they're hung up in the mail system somewhere. . . . typical. :-)
I realize this might be new news to some, to others who received an abbreviated report, you might get a chuckle. My good friend Dave Berry (humor columnist of the Miami Herald) was here at the time and accompanied me throughout... here's his way of a blow by blow account....... But you need to relax and roll with it.
Last Thursday I had a rapid heartbeat (since have learned the medical term is atrial fibrillation). I mentioned it to Fran, to sorta explain my apparent lethargy. She asked if I was ok, or should we go to ER. I felt ok other than fast heartbeat, and demurred. (Its a "man" thing, I'm told.) I hadn't been doing anything that brought it on, although I had thoroughly cleaned the garage the previous day, took all day. (Maybe a message there, don't clean your garage!?) It came on about 11AM, but not disruptive, so I went on with normal activities, finished "brunch" et al. Fran asked again if we shouldn't go to ER, and again I declined. (Obviously the "man" thing.) But I was pretty wrung out, so I got in one of the big recliners with the dogs to relax, by now it was after 1PM. After again asking if I was ok, and again getting calm assurances, Fran went to get a haircut, and got back about three. I was still in the recliner, apparently had dozed off, but I felt rested. Fran asked how I was, and I said "OK, feel much better." Got up and let the dogs out. She persisted - and I agreed my heart was still racing. I called my Dr's office but Dr not in that day. I had not had any pain of any kind yet.
So I went upstairs and took my own blood pressure (we have one of those BP sleeves with digital readout thingies). BP wasn't significantly off (135/89), but pulse rate was 123! About double my norm. I figured that needed checking (pretty astute, huh?). So Fran drove me to the clinic. (Didn't want to go to ER, because our experience with both Fran and with her Mom, a visit there is typically 6 to 12 hours! And more often than not results in at least a 48 hour admission.) After a bit in the clinic waiting room, went in to the treatment room and they took an EKG etc. They asked me how the pain was, and I replied that I had no pain. The nurse left the room to tell the Dr. and in moments they returned. Said they'd called rescue squad! That my pulse was 143! I said "are you serious?" - Yep, Squad arrived almost before I finished marveling about it. Paramedic and EMT came in with gurney and their own equipment and took their own EKG etc. Strangely, the pulse rate had dropped to 64, pretty near normal.... They asked me how the pain was, and I said I had no pain... and the paramedic wispered to me ("What's the emergency?") - - - But he was probably being half facitious - maybe having had some prior false emergencies from the clinic.
But we went to ER. - -The paramedics briefed them, and left. It was about 5PM now. The staff asked me how the pain was, and I said I had no pain, to which I felt I got a gaze of disbelief. There was a lot of giving history of the event leading to my visit, giving insurance data, and whole medical history. It was fairly busy for awhile there. They had put an IV in, and they had given me a shot of Lovenox (something like that - a blood thinner), and had taken a blood sample. They hooked me up to oxygen (through those little nose tubes), and had me connected to a heart monitor, and oxygen level monitor. After that there was a large block of time spent just laying there. Finally, about 11PM, the Dr said they were going to admit me. My heart muscle enzimes were "elevated." Dr said they'd continue blood testing to track the enzime thing - continued increases would indicate a probable heart attack. He actually pulled a pillow from under my knees and drew a graph on the pillow-case. Also they probably would do some more examination tests the next day (Friday). When asked what kinds of tests, got the "possibly an echocardiogram... things like that." I responded I'd had an echo cardiogram about 3-months prior, and an ekg during a physical only a month earlier. Anyway, once in their domain, no need to debate, just roll over (I was not convinced I'd had a heart attack...) But with this fairly definitive idea of the anticipated schedule of events to follow, I convinced Fran to go home, and I'd call first thing in the morning when I had a room (the hospital was full).
About midnight the Dr. came back in and told me the enzimes were showing continuing elevation, and he would be trying to schedule me for a cardiac catheterization, but wasn't sure if it would be able to get in on Friday, because they were already booked up; it might be Saturday. I then laid there until 2:30AM when I was informed I had a room assignment. They wheeled me to an admissions care unit (a waiting area with stalls similar to ER) - but spent only about a half hour there. I was parked near the entry doors, cube-12 as I recall. It seemed that there might be only one other patient there ... way up toward where the nurses station probably was. I could hear them talking in the distance. Occasionally someone would enter or leave the unit, passing by my cube. Only dim overhead lights were on in the passageway area, the cubes were unlit... but curtains were open. I noticed as these staff folks walked by, they all took notice of my presence, and I would smile or speak back. More than once I toyed with the idea of pulling the white blanket up over my head until the next one passed.... the reaction might have been interesting. But then I had to grin that some dope might just tag my toe! :-) Every time I was moved from place to place, most of the connected equipment was disconnected from that unit's machinery, connected to a mobile device, then re-connected to the next unit's gear. In the admissions unit they did the admissions paperwork, attached a couple of arm bands, asked about medicine alergies, whatever.... they were gentle and kind.
I got wheeled to the room about 3:30AM. We had to make a lot of detours because many of the normal medical access corridors were closed for stripping and waxing! Ended up going down the main "public access" corridor (where you go as visitors) to get to the wing. Somewhere in these processes (probably in ER, I was tired, distracted, and don't remember when) they had started an IV of nitroglycerin..... and by now I had a banging headache. When I got to the room all I wanted to do was go to sleep. And I did, for about a half hour, when they came in to take more blood, take vitals, and give oral meds. They asked again what my level of pain was. By now, it was a TWO because of the headache.
The blood test and vitals visits were about a half hour apart, by different people in the vicinity of 3AM and 3:30AM. Each time, each one would ask me about the level of pain, which was never more than 1 or 2, and that was just the dang headache. So you'd get time enough to just doze off before the other person came in to do their thing. By 6AM Friday (fortunately there was a wall clock on the wall directly accross from the foot of the bed) I felt I'd been there a couple days and nights. Not thinking too clearly, I recalled my promise that I'd call Fran in the morning to tell her my room number, so she wouldn't have to worry. So I did, and even had the audacity to ask her if she was up yet! Of course, she was up just waiting for my call! (DUH!) I had been coherent enough when I got to the room to have the nurse write the room number on the marker board. Obviously more aware than I was three hours later at 6AM! Later she told me that the dogs wouldn't go back to sleep after that, and she did have to shortly get up.
Meantime, back at the hospital, they kept coming in for this or that ; weigh me, check the nitro and oxygen flow rates, make sure I used a bottle rather than the commode when I had to go. Of course, I was so tied down with tubes and wires that it would take a construction crew to guide all the tubes and wires to allow me to leave the vicinity of the bed, so a bottle was about the only recourse anyway! About 7:30 someone (a Dr. I think) told me they were planning to do the cardiac catheterization later Friday afternoon. This planted a seed of dread, I hate invasive procedures! But I had to feign courage, after all, Fran had had the procedure done a couple years before, and she did fine. :-]
Skipping the morning full of stabs and jabs, by 11:30 the nurse came in and said "They're coming for you." I said, stupidly, "For what?" And of course she looked at me strangely, and said "The catheterization." Oh. It seemed like it was the executioner on his way, and I apprehensively kept an eye on the door. I called Fran and told her the schedule. We had expected it to be late in the day, if on Friday at all, and she was scheduling herself to come over in the early afternoon. But she came on over, it's only a 15-minute drive.
I'll skip all the whining and gnashing of teeth, and get right to the good parts. :-))
Needless to say, as with most any medical appointments, they don't do well at keeping to a schedule, not criticizm, just observation. So all my anxious door watching had ceased by the time they finally did suddenly arrivem about 12:15, 45 minutes later. They had this large gurney that they pushed into the room, knocking the thermostat off the wall in the process! They pulled the gurney back out, and tried to hush the hissing thermostat. Then gave it another shot and knocked it off again, again setting off it's hissing objections. They quieted the thermostat but just left the gurney in the doorway. I was allowed to step out of the bed and over to the gurney, lodged in the doorway as it was. As I attempted to do this gracefully with the "ICU" gown on, one of the pushers said, "the underwear will have to go!" Geeze, my last vestige of dignity! They covered me with a blanket and I shed. Fran was there by then, and I handed them to her, secretly hoping they were still pretty clean. We then set out on our trek to the "cath lab" and Fran padded along behind. (Since I was looking at the ceiling, I wouldn't be able to find my way there again.) We went directly into the "lab" and I was transferred to the table, which was too narrow to allow anywhere for elbows, so they shoved some panels under the edges to rest my arms on.
Dr. Kauffman, a cardiologist, had briefed me on the "procedure" (a politically correct term coined to disguise any cutting or bleeding.) He was not certain whether he or his peer Dr (watzisname) would do it. Turned out they split the job. I had been shown a video of the preocedure and later briefed that I'd get a "local" in the groin area, not that I'd particularly notice :-} and valium via the IV to "relax me." I don't recall any relaxing, and felt fully coherent all the time. I had to listen for the Dr to ask or tell me something, which they did do several times. I also didn't notice any deadening, but likewise I felt no pain.
Dr Kauffman did the first part; entered the femeral artery, ran the fiber optic up and surveyed the scene. He said there were a couple of blockages, and turned the job over to Dr (I-still-can't-recall) to do the angioplasty, and stents if needed. Kauffman then went to the cath lab waiting room to brief Fran, who was having a great day herself.... seems there was an extended family there, waiting .... and it was a mob scene.
Well, Dr Seidner (I looked it up) went through pushing baloons and stents up there for about a half hour... swapping stents more than once because they were not the needed size. Finally got one he liked, inflated the baloon to 8, deflated, re-inflated to 16, deflated, came out. I could hear a compressor start up each time he called for an inflation. Got a stent and went back in, inflated the baloon several times to expand the stent, then came out to get another. All along, in the background I could hear the surgical, I mean "procedural" nurse dictating a running log of actions, events, milestones, stent sizes, etc. Sorta reminded me of the narration on a destroyer engaged in sonar tracking of a submarine. About halfway through the "procedure" I began to notice a moderate ache in the groin area, and mentioned it to Dr Seidner. He said, "Yeah, Dr Kauffman is a 20ml guy, but I'm a 30ml person, I'll give you another 10ml." And he did, and I didn't even feel the prick.
At this point, the computer locked up, and he couldn't see the display of what he was doing (xray camera had been running on me all this time). After trying to re-boot, then get an expert from somewhere else in the hospital to come up and give it a try, they decided they'd need to go to plan B. I had to privately grin again at the similarity to the Navy experience, something always seems to crap out at the critical moment. In retrospect I guess the Valium might have been working after all. I didn't really care, but I hoped they wouldn't give up and close, I wanted the whole job since they were already in there.
"Plan B" was to take everything out except the "guide" I guess that's the sheath in the artery.... and move me to another operating room. This entailed taking me out into the corridor again, and into a room about 50 feet away. I was concerned as we passed what appeared to be the waiting room, just imagining what Fran must be thinking as they were spiriting me away! They said not to fear, that wasn't the waiting room, but they'd go brief her anyway. The challenge of "plan B" was they had to move me from the operating table to a gurney, then from the gurney back to another operating table, while my leg was imobilized. I wasn't allowed to "help" as though I could have anyway. At the time, I wished I weighed more like 95lbs rather than double that. I could just imagine the strain of leaning accross a gurney to boost me accross while others had to lean accross the table and extend the carry. Whew!
Anyway, it worked, and I got on the next table, and they re-connected everything (remember, I still had all these IVs in). The second computer came up ok, and Dr #2 continued. There was more of the hunting for the right stent, then baloon inflation and deflation. A somewhat unnerving aspect was that the ceiling had dimmed recessed incandescent lights, and the false ceiling had two-foot square panels with florescents in them (remember, the ceiling was about the only thing I had a clear view of). After they got set up and started, the florescents went off, it was a bit dim if you asked me. But the Dr had been complaining (in the other OR) about the monitor being too dim, so I figured this was just to reduce the ambient light... Then they came back on.... and momentarily went off again, each time with the loud clunk soundling like a major circuit breaker or hi-current relay opening or closing. At the time I envisioned there to be an overload and the circuit breaker kept popping. Then being reset, only to pop again in a couple of minuits. But no one else seemed concerned so I just ignored it.
All along tho, I was a bit disappointed because a video shown to me that morning showed that I would be able to watch the "action" on a monitor. Fran had the "procedure" a few years ago, and she saw it. But I only rarely could get a glimpse of the Dr's monitor when the huge xray camera rotated out of my line of sight - which was not often nor for long. So I had to imagine most of what was going on. I do recall some comments by someone in the "procedure" staff about the mess... to which the Dr. retorted "you should see the mess when Dr. "x" does it!" and chuckled. ("x" is because I didn't clearly hear the name. I sorta wished I could see some of that mess, after all, most of it was probably mine (blood). :-[
Eventually, and seemingly abruptly, they were done. I was manhandled back onto a gurney, and wheeled back to my room. All the while I was fully conscious of everything going on, and didn't seem the least bit "relaxed." The next part was something I had dreaded because the video had cautioned that I MUST keep my right leg fully IMMOBILIZED for FOUR HOURS! Turns out, there have been advances since Fran had hers and since the video, which means you can wiggle your toes, even tilt your foot a bit, just don't bend your knee or hip joint. The point being that you have a large incision in one of the body's main arteries, and you sorta don't want it to hemorrage. :-} The advances are that a plug has been developed, one sorta like those used to repair tubeless tires, which eliminates the need for a sandbag laying on your groin all those hours, which they used to do. But this period passed easily. An advantage was they had removed the nitroglycerin before the "procedure" and didn't resume it after. So my headache dissipated.
I expected to be released Saturday, but that turned out to be overly optimistic. Because they had inserted stents, I needed to take blood thinners and anti-clotting to minimize the body's action to "heal" the damaged area where arteries had been scraped, etc. Such healing would create clots, which raise the risk of strokes. Coumadin was the choice, but it doesn't stabilize the clotting factor right away. So they needed to continue the Lovenox injections until Coumadin stabilizes the clotting factor. There was some discussion about allowing me to go home and give myself the injections... but they wanted to observe another day's worth of vitals, oxygen absorption and clotting factor. So I was slated to stay Sunday, and might as well wait until Monday by then.
So Sunday night, on the possibility that I would be released Monday, but would need to continue lovenox injections for a week, the nurse and I conspired to let me try self injecting. I dreaded it, and wasn't certain I'd be able to overcome the natural abhorrence of stabbing myself. But I did. It's mental, there was no pain nor discomfort either from the injection or the medicine, just the angst of having to stab oneself. The oncoming nurse for the day shift also allowed me to self-inject, and I did. Actually felt a real relief and self confidence that "I CAN do this!" Whew!
Of course the whole weekend had been just like before, vitals and blood every 4 hours it seemed. Weighing and asking about the pain (none yet). Fran had brought over the book I've been reading (Eyewitness to Power by David Gurgen)... I lacked only about 40 or 50 pages, but actually didn't get it finished. (By the way, it's an enlightening read.) Always seemed distracted or interrupted. I got my first exposure to the "diet." No comment.
I survived the "procedure" figuring if it's good enough for Dick Cheney it's good enough for me. They said they'd be mailing me documentation on the stents, that I should carry in my wallet the rest of my life. I figure it's part numbers, etc. in the event of a future "recall." They appeared troubled when I used the "recall" word. :-) I told Fran I was going to send an email telling folks the "Rumors of my demise were premature and significantly exaggerated!" and she responded she didn't like my sense of humor. :-} Thus the subject line. But I just couldn't suppress "the rest of the story."
If you have to undergo this "procedure" I can say only that it is painless, relax and enjoy it.
Keep on!
Dick