To Save Lives.. You must Love LIFE… And the People in yours …
Heart surgery is a scary thing. As Perfusionists we are at a higher risk, just because of the nature of the beast (profession related stress).
So here is a dialogue of one of our own, who underwent emergent Bypass, survived, and returned to continue on in the profession.
An amazing story- told in a touchingly honest voice.
This is a POV (Point Of View) Interview of a Fellow Colleague who LIVED it.
Can you give me a brief biographical sketch of you and your practice?
At the time of my heart attack/bypass surgery I was 59 that was 5 years ago. I have been in my current practice for 23 years, this is my fourth position since graduating from THI in 1976. Including my current location, I have started two other programs, one in the midwest and the other out west.
I plan to retire next year. I have been working in surgery, in particular heart surgery, since 1973 when I was a surgical assistant for a group of cardiac surgeons in Denver.The first perfusionist who suggested I get into perfusion was Maddie Massengale who pumped in Denver.
Before that, I was a surgical tech in the US Navy, first as a Corpsman at Naval Hospital San Diego and aboard the USS Kitty Hawk, CVA 63.
I had Fleet Marine Training at Camp Pendleton, but fortunately I did not get orders to Vietnam. If It had been any other time in history, I would of probably stayed in the Navy and applied to the newly formed Physician Assistant Program the Navy had established at Naval Hospital Bethesda.
Can you give details of the events prior to and leading up to your MI? Did you have any symptoms or premonitions? At what point did you realize it was serious.
I consider myself very active physically, in fact, I ride bicycles for exercise and usually ride 20 to 30 miles a day in the summer and if the weather is good in the winter, I’ll usually ride 60 to 70 miles a week. I used to ride a lot out in Colorado and in Kansas-the hilly part of Kansas-I also kayak in the summer and ski at least once in the winter.
My only problem is that I am overweight and borderline hypercholesterolemia, but my LDL was always good, my total Cholesterol was always 230. My Triglycerides are up and down, my BP was pretty good and my sugars were always normal. My familial problems are the culprit with my dad dying at age 57 with COPD and heart disease, my grandfather COPD and heart disease, my uncle on my mothers side, same deal, COPD and heart disease.
In fact, my uncle had bypass surgery about five years before he died in 1996, but never quit smoking. My mother died of Cor Pulmonale from smoking since she was 17. My sister is doing OK at 74.
As we always do in September and October I help prepare for our church’s Annual Spaghetti Supper, which we serve in our Parish hall and provide carry outs to the tune of 7300 plates, I tried to work the days where we prepared our own meatballs (17,500) and make slaw (150 gallons) and cook sauce (300 gallons.) We had plans to take a week off to go see our daughter in Colorado. As always I take my bike where ever I go. I road around Cherry Creek reservoir two times, even at high altitude I didn’t notice any chest discomfort, but I did have one episode of SOB when I climbed a short but steep hill.
On the way back from Denver we stopped to see my wife’s family in a little town NE of Manhattan, Kansas. I took off and road an 18 mile up and down, windy course with most of the ride on the return loop uphill and into the wind. I did not have any physical problems. We got back home and immediately had the actual Spaghetti Supper which includes cooking sauce from 6 AM to 4PM for two days and from 6AM to 8PM on serving days. I had no problems with that.
The following week, we had a moderate work schedule and on Thursday, I got home early and decided to go for a ride, it was about 3 PM. The weather was still pretty warm for mid October and about two miles into my ride I developed a dull left sub scapular pain that I have had before but just chalked it up to riders cramps because of the heat. I continued on my ride and decided to cut it short and head back home, I had done 12.5 miles.
I got into the shower and then it hit me, I started to feel “funny,” no chest pain, but an overall numbness. I finished my shower and was stretching on my living room floor and over my ottoman, my dog, uncharacteristically jumped on my back and sat there. Did she have a premonition? I started having noticeable pain down my arm and numbness in my left face. I immediately took four baby aspirin, called my wife and said a prayer. Why I called my wife instead of an ambulance is beyond me, she about killed us all on the way to the hospital.
As soon as they hooked a ECG up to me the physician told me that I was having a anterior heart attack and that I was going to the CVL. It was 6 PM. I don’t remember anything after that until 3 AM on Friday. Once they gave me Versed I had complete memory loss for 9 hours, although everybody said I was talking and joking, I just don’t remember squat.
At 3 AM I woke up and asked what was going on. The nurse told me that I was in CCU and that I was scheduled for surgery in the AM when the surgeon got back into town. He was in New Orleans at a meeting and was driving back. That is a whole other story. She said you have a proximal LAD lesion and two other critical vessels and you have a balloon pump in.
Where you cognizant of the severity of your situation- and having a balloon pump- what was that like?
I said, “holy shit!” Immediately I looked up at the monitor and checked to see if it was timed correctly, as any good perfusionist would do! As soon as I saw that I was still alive, I started to have chest discomfort and I was given a nitro tab. The priest came in and gave me the “last rights,” another “holy shit,” then the gang from surgery all came up and we prayed and then onward christian soldiers to surgery.
The whole time I really didn’t notice the IABP, I guess with getting prepped, getting blessed and getting ready the balloon was in the background.
Aside from the obvious threat of possible mortality, what were your greatest concerns?
When the priest showed up, I had almost forgot about “the end.” I didn’t dwell on mortality, I had faith that the gang would do the best job they could and I know that even if the surgeon wanted to get even with me, he would get even when I was awake.
My perfusionist told me that I told him to make sure that he put some albumin in the pump, I had to laugh at that, another versed moment. I don’t remember anything after getting to surgery, my anesthesiologist did a great job, no pain, no fear, just lots of versed.
Can you share the recovery process? What was the worst, and helped you the most? What are things you think we should know to improve our patient care and awareness?
With all of that versed on board, I was told I woke up at, you guessed it, 3 AM. I vaguely remember being on the ventilator. After a while I was fighting the vent, it would breath in when I wanted to breath out. I hated that thing. I finally got it out, at what time I don’t know, but I did rest for most of the morning and don’t remember my daughter or wife come in to visit.
It really wasn’t until the next day, Sunday, before I really became cognizant of my surroundings and felt somewhat awake. I’m sure I was awake the entire time, but amnesia from the versed was very pronounced in me. I had the same reaction when I had my upper and lower GI scoped, and you guessed it, I didn’t wake up until 3 PM this time.
The nurses were really good to me, the ones that I thought might be a pain in the butt, where actually the best. I told them that too.
In the ICU, I was hot, not just warm but hot. I had a box fan on me the whole time I was up there. Half naked, with tubes hanging out of every orifice, my daughter refused to go back in there since she is really squeamish when she see’s blood.
On Sunday, I remember the surgeons nurse pulling my IAPB catheter, thank God I didn’t bleed from that. He also pulled the pacer wires which felt like your hand being shocked in a electrical outlet.
One by one, the tubes were pulled before I went up to the floor on Monday AM. Internally I was worried about not being able to pee once the catheter was removed, but that wasn’t a problem.
How long was the recovery process? At what point did you feel that you could finally resume your career as a perfusionists. What limitations did you feel you needed to face and overcome? And how did you manage that?
Once I got upstairs I was still hot. I had the room temp all the way down and everyone who walked in said it felt like a meat freezer, I said “it is a meat freezer!” I started to have problems sleeping, I guess with all those high falutin’ drugs I was on finally wore off and now I was on my own.
I got to take my first shower on Monday morning, whoopeedoo. That really felt good. Then I started to think back to when I had my last BM. I said, “God I don’t want a enema.” I asked for a laxative and it wasn’t until Tuesday PM before I finally struck pay dirt. BM’s are a male thing, you women just wouldn’t understand. Luckily, I didn’t have a lot of visitors, but a lot of flowers. I really appreciated that touch.
Coming back from an injury can be scary and certainly takes personal courage. How did you prepare yourself and the team for resuming you duties as a CCP? Did you bring in a backup in case there were issues? Were there cognitive challenges you recognized? If so- how did you deal with that- or was it just a matter of time heals all wounds?
My recovery went pretty well. I went home on Wednesday, 5 days post op, and the only reason was that I got sick to my stomach and I think it was a combination of being on Plavix and the soybean burger I had for lunch one day. From that day on I was on crackers and jello.
Once I got home, I started walking down the street and back home again. Once I got released from the surgeon to drive, my wife and I went out and bought a cruiser bike that I could ride around the neighborhood and the local golf course. The day after I got cleared, I went back to work, to see everybody and to sit in on a case, It was my 2nd week plus 1 day post op. The joke was, “you can do anything you want, drive a car, have sex, or go back to work.” I went back to work.
I wasn’t stupid enough to pump a case, but I did help out. I did have some mental deficit, my decision processes were slow, I was depressed, which I expected. I even started to sell things, things that when I look back, I did not want to part with. I sold a bicycle that I had built myself: bought the frame, the wheels, the “group” brakes, shifters, seat post- all that stuff, basically just gave them away. I sold some bicycle parts and tools; guns and ammo; mechanics tools; I don’t know what was going through my head at the time. I didn’t need the money, I really don’t know why I did it.
On depression. My wife first noticed that I was watching depressing movies on HBO. I remember watching “We Are Marshall.” And thought what a sad but happy movie it was. I watched it three or four times. It is not normal for me to watch any movie more than once, my wife caught me and told me to stop watching it.
I was very fortunate in that my employee had stayed on board to pump my case. He had planned to leave the week after I had surgery for another job. He planned to stay another month, until Thanksgiving. His future employer was gracious to let it happen. Once he left, that would be almost six weeks post op for me. By that time, I was back on my bike and riding 10 to 15 miles a day, although not as fast as before my surgery.
I road all winter long and or walked every chance I got. I had lost about 20 pounds and felt pretty good. I never felt that after my employee left that I would place a patient in jeopardy and I consulted my surgeon to get his opinion and he agreed. I thought very seriously about the liability that I might incur, but other doctors didn’t feel that way, I was unsure whether I should contact my insurance carrier.
What is the most important thing in your recovery? And is the most important thing from this experience you think others should take home as a message?
I have not always been a positive thinker. I think what happened to me provided a opportunity for me to change the way I looked at things. I am thankful each day to God for giving me an extra lease on life. After it was all over I talked at great length to my parish priest about what I felt and continue to feel about life. Life itself is a mystery, and as a Christian we feel that God has a plan for each of us.
In this life many people struggle to find their niche in life and God gave me this living, being a perfusionist, even though I didn’t deserve it. I have always had a temper, even when I worked, and I try to keep that under control in surgery. The one thing I have learned after having surgery is that I needed to control the stress in my life.
Being a perfusionist is very stressful, the larger the program, the worse it is. The combination of stress at work, eating all the wrong foods, not getting exercise, and even a stressful home life is a prescription for certain problems. There isn’t a remedy that is applicable for every situation, I just know what worked for me during this trial, I believed in God, I didn’t stop life, I continued with my workout regimen, I didn’t allow people to expect me to be an invalid, I worked as hard as I did before my surgery.
The reward is that you will feel that you have done God’s will, and that is all that is important.
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