On Sunday October 25, 2020, I had a heart attack, though I didn’t realize what it was at the time. I woke up at 6:15 in the morning, and while lying in bed, had mild pain in my chest, such as I’d experienced before, but also mild pain in my lower jaw, and my upper arms. I had broken into a sweat. That the mild pain (not a sharp pain) had spread, suggested to me that the condition I’d had was worsening, and needed attention, despite my dread at the expense of going to the ER.
There had been two stages of foreshadowing to this event. The first stage began at Christmas 2017, when I got a wrist health monitor as a gift, from my partner Y. (It was a Garmin device, which monitored steps and heart rates.) What I noticed after a few weeks was that my resting heart rate would vary widely, without apparent cause. Some days it would be in the 60s, other days in the 90s, even when I was just sitting at home. And out exercising, by which I mean walking through neighborhood streets, or hiking in the nearby woods, it would bump up into the 90s on the former days, and jump up into the 130s on the latter days. Despite which, I didn’t feel symptoms of any kind, no shortness of breath, no feeling of strain. I went to see my doctor, Dr. Faith C, who said any resting rate below 100 is normal, don’t worry about it.
A year later for Christmas I got an even better health monitoring device — an Apple Watch, which not only tracked steps and heart rates, it had an ECG (or EKG) monitor, and could detect atrial fibrillation. I didn’t even know what atrial fibrillation was, but in retrospect that must be what I detected on the first device a year before. Atrial fibrillation is an irregular beating of the heart that shows up as a slight variation in the path the heart signal traces. And sure enough, the Apple Watch indicated symptoms of atrial fibrillation on occasion. And those occasions, I realized soon enough, corresponded with those periods of higher resting heart rates.
So I went back to my doctor, or rather, Primary Care Physician (PCP) as they are called, since in this case it was a nurse practitioner named Douglas F, who referred me to a cardiologist, a Dr. David A. He was tickled by the Apple Watch — he hadn’t had a patient with one before — and was grateful that I brought him paper printouts of the recordings from my watch. He had me do a treadmill test in the office and, once I passed it, prescribed some new medications.
Six months went by before a recheck, and I was the same. Occasional periods of Afib (a couple times a week, for hours or a day at a time) but no outward symptoms. Still, Afib can cause problems even where there are no symptoms, the chief worry being that a blood clot could form in a corner of the heart where the muscles are not workg properly, and that clot could migrate to the brain and cause a stroke.
Dr A suggested I see another cardiologist, a Dr. O, who specializes in electrophysiological procedures. Perhaps he could do a treatment called catheter ablation, where a slender probe is injected from the groin area, then up through the blood vessels to the heart, where the problematic heart cells would be electrically neutralized. Dr O had me wear a Zio monitor, a device that is glued to your chest for two weeks and makes a continuous recording of heart activity, until you mail it back in for processing. By this time it was April 2020, so my appointment with him was by video using an iPhone app. When the Zio data came back, it was sufficiently unalarming that Dr O suggesting checking back in 6 months, and an appointment was made for early December.
(To jump ahead a bit: the Afib condition wasn’t necessarily associated with the heart attack, as was explained to me later. But it seemed to presage some concern about my heart. Despite my several decades of bicycling and jogging…)
By late August I began having other symptoms, while out walking or hiking. The earliest occasion was in late August, when Y and I did a walk around the local neighborhood, past the house that was crushed by the fallen eucalyptus tree some four years ago and now rebuilt but still unoccupied, and on the return leg, uphill, felt more stress than I’d ever had on a walk or hike. At the time I attributed it to the bad smoke in the Bay Area. This was just a week or so before the infamous orange sky condition over the Bay Area, that I posted a couple times on Fb, on Sept 9th. (Does this link work? Apparently so.)
Over the next month, I had sharper symptoms while walking or hiking. I would break into a sweat, feel a tightness in my chest and temples. But I would pause, stand still for a minute or two, and the symptoms passed. I walked on, if perhaps a bit slower. Perhaps I was just getting old, I thought; I had turned 65 on August 30th.
Later conversations with a cardiologist, and my partner’s ex-wife, a pharmacist, suggested that I was suffering from “stable angina”, and then unstable angina.
By early October I made phone calls to my PCP (primary care physician) and then to the cardiologist Dr O, and each time spoke to a physician’s assistant. The PCP assistant said that if it happens again, consider going to the ER. The cardiologist assistant said they would arrange to have another Zio monitor sent to me. In retrospect, they were both remarkably unalarmed, and neither mentioned the term angina. (The Zio device, ironically, arrived at home while I was in the hospital following the heart attack.)
Now, my notion of what a heart attack was, was that it entailed someone having severe chest pain, clutching their chest, and falling onto the floor, or sidewalk; and if there was someone to apply CPR, or in a gym situation to grab those paddles mounted on the wall, to keep your heart going until the ambulance arrived, could save you. If no one was there to save you, you would flop around on the gym floor, or perhaps at home, like a fish out of water, and die.
It wasn’t like that at all.
On that Sunday morning, October 25th, I sat up in bed, at 6:15am, feeling light-headed, and in a sweat. These symptoms had passed before, after a minute or two on my walks. But now there was mild pain my lower jaw, and upper arms. I sat up, and after 45 minutes, the symptoms didn’t go away. Y asked, should we go the ER? I sat there and considered, and said, yes, let’s go. He drove me to the ER.
To the ER
Not knowing any better, we drove to the nearest ER from our home, via Google Maps, which was at Highland Hospital, on 14th St. just south of the 580. It was not busy at all. The ER entrance was marked “ambulances only” so we found the regular parking garage, almost empty on this early Sunday morning. We found the entry into the building from the parking garage. A man at a desk. Which way to the emergency room? He asked, you’re having…? Some chest pain, I said. He pointed down the hall. We had to walk down a hall, through some double doors, down another hall, then *outside*, then along the front of the building to where the ambulance ER was. Not very efficient, especially if I had been in excruciating pain. As it was, I could walk OK; I just felt rather woozy.
Inside we were met by a nurse with a thermometer to check us for Covid symptoms. Then we sat in plastic chairs for a couple minutes. Then were summoned to a triage station, again, *outside* (which seemed odd; Covid precautions?), where I was hooked up to an EKG. The nurse immediately saw something alarming, and summoned a wheelchair. I was taken back inside, while Y had to leave; he couldn’t go with me, and there wasn’t really anyplace he could wait.
Now I got into a proper ER room, and moved from the wheelchair onto a bed, or a gurney. More EKG. They took off my shoes and most of my clothes and put them into plastic bags. Also my iPhone, and my wallet. The nurse opened up my wallet to verify with me that there was $32 cash in my wallet. (In fact, weeks later as I write, I still have $32 in my wallet; I virtually never use cash anymore.) And I got my first Covid test, the kind with the very long swab that goes up your nose, which left me gasping and drooling. (The news came back later, the test was negative.)
Things start becoming a blur about here. There were more tests (blood pressure etc.), and then a move on the wheeled gurney into an examination room, which was a couple floors lower in the hospital. It was large but dim, with fixtures hanging above me from the low ceiling. And then… I waited. Apparently a cardiac team was being summoned (not being already at the hospital before 9am on Sunday morning), and nothing more could happen until they arrived. That took about an hour.
Once he got there, the cardiologist, Dr. Y, explained what he was going to do: insert a catheter from my groin area up into my heart (much as the catheter ablation procedure would go). This would have a tiny camera on it, I gather, so they could inspect for damage, and possibly even repair the damage right then. There would also be a tiny pump to keep the heart going should anything go seriously wrong. And by this point things definitely started to blur, because they were giving me sedative. I remember someone came in to shave my body hair around my groin and upper legs.
Some time went by before I woke up, vaguely, with various medical staff hovering above me. Dr. Yang was there, and told me that my condition was more serious than he’d thought, and I would have to be transferred to another hospital for major surgery, that could not be done at Highland. And he said, “The good news is, you’re still alive. You’re not at home dying of a heart attack. You did the right thing coming in this morning.”
More time passed, in a daze. An ambulance was being summoned, but it had to travel all the way from Cupertino (south, near San Jose), and that took another hour. Meanwhile, since my hospital stay would likely be for a few days, a young technician came in to install a catheter, so I could pee without getting out of bed, or moving at all. This was another first for me (Covid test; catheter). It was one of those procedures where you’re told, Now take a deep breath…! And as you do, they do what they do. It wasn’t painful exactly, but it wasn’t pleasant; it was a sensation where you don’t expect to ever have a sensation.
The ambulance team finally arrived. The driver and two assistants all politely introduced themselves to me, as if we were going to have a personal relationship of more than half an hour. (Everyone beginning in ER introduced themselves to me, but of course everyone was wearing masks. I’m not great and remembering names and associating them with faces at the best of times, so even with nurses I later saw day after day, there were only one or two whose names I remembered.) The ambulance technicians connected various monitors to mobile drip stands so they could be rolled alongside the gurney. Actually, they moved me from one bed or gurney to another (to the ambulance’s), by several people lifting me bodily and moving me horizontally, a procedure I would experience over and over in the next week.
(There’s a Nobel Prize for anyone who can efficiently solve the problem of managing all the cables and drips when moves like this take place; they seem to invariably get tangled up. The same principle would apply to computer cables behind your desk. In the hospital it always took a couple three nurses a couple three minutes to get situated for any kind of move.)
So, then, on the gurney out to the ambulance. Another first (Covid test; catheter; ambulance ride). I was on my back staring at the ceiling of the ambulance, of course. There were a driver and assistant in front; and three or four technicians wedged into niches on either side of me. I was on oxygen by this point, and a portable oxygen canister that rolled with me along the gurney was switched out for an oxygen feed in the ambulance.
The ambulance set off, running its siren though not driving very fast. We went to Alta Bates Summit Medical Center, just a couple miles northwest from Highland, mostly on surface streets but perhaps partly on the freeway, the 580. We pull in to the ambulance area of Summit. They pull out my gurney, and wheel me across a considerable expanse of very bumpy pavement (like a sidewalk made of stream pebbles; who plans these things?) and into Summit.
(The ambulance company later sent us a bill for something like $5000. For a 10 minute ride. We got lots of other bills too, from both hospitals, and from individual doctors. We’re working them, with the insurance company.)
The Operation and Aftermath
Then what? Was there a stop before they put me in my own ICU room? Don’t recall. They gave me another Covid test (with a shorter swab; again, negative). Nurses and other staff came by. The heart surgeon who would be taking care of me, Dr. Kahn, came by and advised me they were evaluating options and doing more tests, but would likely be doing coronary artery bypass surgery, perhaps as early as this afternoon. (It was by now past noon.) So I lay there all afternoon as various technicians came and went, doing tests. Taking X-rays and whatnot. They wanted to see if I was healthy enough for surgery, apparently. The afternoon passed without any indication of surgery (which would take 3 or 4 hours) that day. Tomorrow morning, then.
The staff at Highland, and then Summit, phoned Y (who had gone home) to advise him of the hospital move and the planned procedure. Summit had only recently, a week before, relaxed its visitation policy, to allow one visitor to a patient at a time, though only from 11am to 6pm. Y showed up every day to my ICU room to visit. Sunday evening I’d had no surgery done yet, so the staff brought me a regular dinner, around 6pm. It was a Thanksgiving-like dinner, with turkey and gravy, mashed potatoes, yams. Alas, I wasn’t really hungry, and I suppose I was on enough meds, or stressed by all the tests, that I ate only three or four bites and then couldn’t keep it down.
I may have watched some TV that evening.
One thing I learned during this experience is the routine of emergency hospital visits. I had not been a patient in a hospital since I was a teenager (and only rarely had occasions to visit anyone in a hospital, and then only in a regular hospital room). The progression is: ER, ICU, hospital room. (I suppose for elective surgeries one would go straight to a hospital room.)
Another thing I learned the following week was that, in ICU especially, you don’t get much sleep. At best, a couple hours at a time. They wake you up every couple hours for one thing or another: to give you meds; to draw blood; to check your oxygen; to take a chest x-ray. And there’s a blood pressure cuff attached continuously, which goes off every 15 minutes. I thought it curious that sleep was so undervalued as a restorative from major surgery. But I suppose they know what they’re doing; those tests every two hours are intended to help you survive, and sleep deprivations can be recovered from.
I remember nothing of Monday morning, of course, except perhaps the vague impression of being wheeled out of ICU to a formal operating room, with those big light fixtures glaring down on you from various directions.
(And, of course, another first: Covid test; catheter; ambulance ride; open-heart surgery.)
The surgery, to be clear, entailed cutting the sternum, the bone in the middle of the chest that holds the ribs together, to gain direct access to the heart. The coronary arteries along the outside of the heart, three of which were clogged in my case, were bypassed by attaching pieces of an artery from my lower right leg between spots on the heart around the clogged coronary arteries. When the surgery was done, I had this big evil-looking incision, nearly a foot long, down the middle of my chest, covered not by zipper-like stitches (as in the old days apparently) but by purple glue (which gradually came off over a month of showers) and also a sewn-up incision in the upper thigh of my right leg. There were two sets of plastic tubes coming out my chest, at the lower end of the incision (right at the point where the alien burst out of John Hurt’s chest), which led to plastic tanks on the floor alongside my hospital bed, to drain fluid from the chest area. And also the catheter, to a plastic tank for urine.
If I understood the surgeon later, they actually *stopped* my heart for about an hour, and kept me alive with some kind of external pump until the surgery was done, then restarted my heart.
I remember none of the procedure, which took all morning, of course. The first thing I remember was one of the worst experiences of the entire stay — when they un-intubated me (the correct terminology is extubation), pulling out that plastic tube they stick into your mouth and down your throat to keep you breathing during surgery. Having it pulled out caused much coughing and spitting up for a good 30 seconds.
Coming out of surgery like this, you’re flat on your back, of course, and you can hardly move even if you wanted to, because you’re connected to IVs and draining tubes and monitor cables on all sides, including the blood pressure cuff on one arm. To the side of the bed is a monitoring screen that shows heart rate, blood pressure, EKG, and so on, a screen at eye-level on a wheeled stand. Even days later, when most of these tubes were disconnected, it wasn’t easy to turn on my side to sleep, as I usually do, because of the strain it put on my chest. I had to learn to sleep on my back.
Another curious device in ICU: they strap something onto your lower legs that are, in effect, calf massaging devices. (The correct terminology “sequential compression device.”) They’re inflatable sleeves that go over your ankles and calves, connected to a pump that’s mounted at the end of the bed. The pump keeps them alternately inflating and deflating, for the purpose of keeping blood flowing in the lower legs, to avoid blood clots. They were weird, but weird in a curious way. I mentioned them to one of the nurses, who said some patients hate them. I liked them well enough to check how much they cost. Hundreds of dollars!
Monday afternoon, I likely slept. Y was there. For months he’d been working from home most days (due to the pandemic), but he told his work about me and took the entire week off, to be with me in the hospital as much as he could. On Monday evening I was allocated only broth for dinner, which was OK. Otherwise, I’d eaten virtually nothing for a second day in a row.
I remained in ICU on Tuesday and Wednesday, tended to every couple hours, as I’ve said, drinking more broth, finally take some solid food on Wednesday. The doctors were concerned about fluid build-up, especially in my lungs.
Tuesday night was the worst part of the entire stay. Someone — the surgeon? Or one of the other attending doctors, like the cardiologist and nephrologist who were resident in the hospital? — was concerned about my ability to breath, or about fluid in the lungs, or something. Tuesday evening about 9pm (just about the time I was trying to fall asleep, given the 5am wake-up times) a nurse arrived to tell me they needed to do a CT scan of my lungs. They moved me from my regular hospital bed onto a gurney (again, with that complicated process of disconnecting and reconnecting tubes and wires), wheeled me down the hall, into an elevator, down a couple floors, and eventually into a room with the scanner. (At the time I’d confused this with an MRI; the CT scanner is much smaller and the scan doesn’t take nearly as long.) I was back in my ICU room in under an hour, by 10pm.
–But then, right about midnight, they brought in some infernal device I guess called a breath machine, a device with a big mouthpiece that pushes air into your lungs, forcing you to take deep breaths, over and over. The problem with this is, you can’t sleep! They left it on from midnight until 4am. I suppose I went partially into a semi-sleep daze from time to time, but it wasn’t comfortable; it was agonizing, like sleep-deprivation torture.
They wake you up at 5am routinely. In my case the reason was to take a chest X-ray, and to be awake for the perfunctory visit from the surgeon, Dr. Kahn. (I gathered he has some kind of schedule routine: patient visits in early morning; surgery in later morning; office visits in his clinic across the street in afternoons.) Dr. Kahn would get all the reports from my nurses and from my tests, so there was little he didn’t already know, except to hear my own reassurance that, all things considered, I was feeling fine, no particular pain, and so on. And so every morning at 5:30am or so, he would show up cheerfully at my room, tell me I was recovering fine, and I’d be going home in a couple days. Thirty seconds max.
There were other routine procedures, every couple hours or before every meal: a prick on a finger to measure blood sugar (as I gather diabetics routinely do), and a plastic cuff over a finger, a pulse oximeter, to measure oxygen absorption.
And I was given two devices to practice improving my breathing, one to blow into, the other, an “incentive spirometer,” to inhale through. In the latter device as you inhale a little marker rises up a scale, and you’re given a target to reach on the scale, and instructions about how often to use it. (When I eventually checked out, I was given both of these to take home, as well as the heart pillow that I’ll mention later.)
By Wednesday, still in ICU, the surgeon and other doctors had settled on a regimen of new medications, replacing a couple of the prescriptions I’d been taking for two, three, or more years from my PCP (primary care provider) and earlier cardiologist. These new prescriptions were targeted at dealing with my blood pressure and atrial fibrillation, with optional drugs for pain and for stool softening.
The latter item is worth a point. The stress of a major operation like this causes, I gather, the body’s GI system to lock-down, so to speak. You can’t stop peeing, but your system can go several days without evacuating solids. In my case, I’d eaten virtually nothing on Sunday and Monday, and not much on Tuesday. But by Wednesday, the nurses would routinely ask, have you had a bowel movement today? Um, no not yet. By the time I was moved to a regular hospital room (on the 8th floor, with a great view of the San Francisco skyline), a nurse explained that conditions for release included several things, one of which was the resumption of regular bowel movements. And every day they offered a stool softener pill to make the process easy, without straining. But it took me until Saturday before my system resumed normal functioning (even without the pill).
Thursday, three days after the surgery, the doctors thought I was well enough to leave ICU and be moved to a regular hospital room, which was on the 8th floor as I’ve just said. I ate lunch there, with Y already visiting, and then felt light-headed. Nurses came in, I was laid back into bed, and they saw my blood pressure was 80/50; doctors were summoned, and suddenly there were all these people hovering over me, while I was in a bit of a daze.
They moved me back to ICU, for one more night. The only conclusion I gathered was that the various new prescriptions were not quite right, and needed to be adjusted. Y, to his credit, was very alarmed and upset, pleading with me to survive. He had been very attentive throughout the week, often questioning the nurses, asking why the same equipment in the ICU rooms wasn’t available in the regular hospital rooms, checking my drips, and so on. No one could ask for a more caring and attentive partner.
That evening back in ICU, I was visited by the hospital’s dietician (a quite young Asian man), who was concerned about why I hadn’t been eating my meals. I explained that I had no issue with the hospital food (bland, but sustaining), it was only the stress after my surgery that left me with little appetite. Here I can add that while the hospital brought standard meals routinely, they offered the option of ordering off a menu, by phoning the kitchen. I tried that once or twice, but when I was told that I could not have a cheese quesadilla, or a couple other things, because I was on a cardio diet, I gave up and just took the standard meals.
On Friday, the medications crisis passed, they returned me to a regular room on the 8th floor. The pace and routine is much different in a regular room than in the ICU. You’re not constantly hooked up to a monitor that displays your heart rate, with a blood pressure cuff that goes off every 15 minutes. Instead, a nurse comes in every couple hours to take blood pressure manually, or to give you meds. You get a little more sleep than in the ICU. Another curious difference: the nurses and technicians downstairs in ICU are all relatively young (not to mention multi-racial); the nurses upstairs are, shall we say, further along in their careers, and thus somewhat slower, without the emergency attention ICU patients often need. More deliberate.
Once in a normal hospital room, the staff encourages you to get out of bed, at least to sit in a chair for meals, and to walk around. But for patients with my kind of surgery, there are strict guidelines about getting in and out of bed. You can’t use your arms. The nurses are always there to help. They give you a heart-shaped pillow to hold across your chest, to prevent you from using your arms, and then they help lift you to a sitting position, pivot 90 degrees, and to lean forward far enough to get you on your feet. And a reverse process for sitting in a chair, and later getting back into bed.
A particular problem is that most of the time your hospital bed is raised so that you’re slightly sitting up. But you have a tendency to slide down into the bed. To get you back up to a semi-sitting position — remember, you can’t use your arms! — at least two nurses come in, flatten the bed so your head is slightly down, then lift you bodily, usually via the sheets underneath, and slide your up headwards. Then raise the upper end of the bed again.
One of the exit conditions, in my case, was that the fluids draining from my body needed to diminish. Because of the fluid in my lungs, I was on some medication to make me give off fluids, both through the tubes coming out of my chest, and from the catheter. At some point they removed the catheter and gave me plastic bottles to pee in so I wouldn’t have to get out of bed to use the restroom. After a couple days the volume of liquids into the plastic tanks on the floor, from those tubes, and the volume of urine peed into those plastic bottles, subsided.
In parallel, another exit condition, of course, is that you no longer need any of the various IV needles in your arms. I needed one drip or another often enough that they just left an IV in each arm (or hand), clamped off, for whenever needed. (They would occasionally need to “irrigate” these to keep them clean.) Your arms also have various bandages where blood draws were done. There were at least a couple such draws a day.
And it turns out my arteries (veins?) are smaller than normal — they used some commonplace word to describe how they were problematic, like “inconvenient” though it wasn’t that — and so on more than one occasion they had to poke me several times, in various places, until they got a fit. And they would use not just the crook of the elbow, but also the back of the hand, and various spots along the inside of the lower arm. At one point they brought in a nurse with a supposed special prowess for finding difficult veins… And even he had to try three times!
Eventually all of these have to come out, of course, with varying ease. I have fairly hairy forearms. (Ironically, for the surgery, they had shaved my upper legs near the crotch, and my entire stomach and chest — but not my arms!) And so every time they pulled the tape away from from one poke site or another, there would be this ripping of my arm hair. The worst, one of the last ones, was on my lower left arm, the bandage across the top. It would be painful, so I offered to pull it off myself — and in doing so removed a swath of arm hair. Which has not grown back.
(And once I got home, and for a week, my forearms and hands were covered in small bruises.)
By the end of that week, once I could get out of and back in bed well enough, an occupational therapist would come by and talk about my recovery. It would begin by my getting out of bed and walking down the hospital corridor, for at least a few minutes. Initially I used a walker, but by the second or third walk I was just pushing the walker in front of me. (They gave me a walker to take home with me, which I haven’t used.) They explained how once I got home it was important for me to keep walking, a few minutes a day, gradually working up to an hour a day. And how to climb stairs, initially. (I’d told them I live in a three-story house.) One of the therapists (I think I saw three different ones over four days) took me into an emergency escape stairwell to show me. You put your left foot up on the next step, and then the right foot to that step beside it. One step, in two steps, at a time.
These therapists also gave me instructions about body movement even once back home. No lifting of both arms above the head. No lifting any object more than 5 or 6 pounds. No driving for 6 weeks — the concern there is that in an accident, an airbag explosion would damage the chest. (If I had to go anywhere, I would have to be driven, and sit in the back seat away from airbags.)
The Week Goes On
Meanwhile, my stepson Michael and his wife Honey, from SoCal, came up for the weekend following my surgery to visit, in part to calm Y. (Yes there’s a lockdown because of the pandemic, but Honey is an ICU nurse herself, and she had been calling my hospital to speak with my nurses directly, so I can’t imagine anyone I would trust to make a personal visit than her and Michael.) Honey visited me for three hours on Saturday afternoon, discussing my experiences as recounted in this essay, and took walks around the floor perimeter with me.
Also, I started getting “get well” bouquets once I’d been moved to a regular hospital room and had a room number for delivery. One from the crew at Locus, others from family members, plus a phone call from my sister, whom typically I see only at Christmas (as I wouldn’t be this year), and a couple little videos from young family members in Tennessee via the iPhone.
Y and I did a Facetime with my other stepson, Jimmy, and his wife Hailey (who just had a child, three days before my heart attack), and did several more walks.
The fluid situation had involved a team of technicians, during that week, to sit me up, stick a drainage needle through my back and into the lung, and drain pale red fluid. This happened twice in ICU. The total from both times was well over a liter. It stung when they stuck in the needle in, but I felt nothing as the fluid drained out. I got a reputation among the staff as having a high pain-threshold, though it didn’t strike me that way at the time.
Sunday came the final criterion for release from the hospital: my fluids had drained sufficiently that the final tube coming out of my chest could be removed. Take a deep breath, they told me, as they pulled it out…unghk. Again, the doctor remarked that most patients feel more pain when that happens; I only slightly flinched.
Monday morning various doctors came around to do a final check. And a final stage of being released is taking a shower. (There are no private bathrooms in ICU, but each hospital room upstairs has a full bathroom with shower.) So my nurse led me in to the bathroom, told me how to the shower, and once I’d finished, helped me towel off, discretely.
Another concluding step was a visit by the hospital pharmacist with a bagful of prescription bottles, basically take-home supplies of the medications I’d been receiving in the hospital. There were about 10. She stood near the end of the bed and described each one (rather awkwardly holding them all in one hand or another, rather than setting them down anywhere).
And one of the nurses brought an “After Visit Summary,” a check-out package so to speak, summarizing all my prescriptions, when to take each one (and which of my previous prescriptions to stop taking), as well as guidelines I had to follow once at home, in terms of diet and exercise. It also, almost belatedly, included descriptions of the procedures done at the hospital–spelling out plainly that I had a heart attack, 3 vessel bypass surgery to treat it, as well as “right pleural effusion” (fluid in the lung), pericarditis, atrial fibrillation, and acute kidney injury.
(I’d actually asked a nurse a couple days before if there would be some kind of documented summary of my stay, including description of the surgery I’d undergone — a project summary, in the parlance of my engineering career. Indeed there was.)
I wasn’t released by lunch, and so we ate lunch in the hospital. But finally they brought the traditional wheelchair to my room, to take me downstairs and out the front door, to where Y had brought his car, to drive me home.
Once back home I started by sleeping on a stack of pillows, to keep my upper body elevated, that was gradually reduced over the following month. I walked up stairs as instructed, though it only took a week or so before I could walk upstairs normally.
Our three cats seemed glad to see me (perhaps only since I’m typically the one who feeds them), though we had to take pains to keep them from climbing up onto my chest. The heart pillow was useful for that. I would hold it on my chest with both arms, just as I was still doing when getting in and out of bed, to keep one cat or another from climbing on me any higher than my tummy.
I was given instructions about physical movement, described above, which I generally followed. The best restorative from a heart attack, everyone told me, is to keep moving. Walk, more and more up to an hour a day. Once home Y and I started with very short walks, up and down the block for 10 minutes, and gradually extended them over the next few weeks. And it took a good three weeks or so of Y helping me sit up to get out of bed, he literally pulling or pushing me as I held my arms over that pillow onto my chest.
And instructions about diet, similar to instructions for anyone with high blood pressure or cholesterol. While in the hospital I was on a ‘cardio’ diet, which meant no fatty foods like cheese, but also non-caffeine and low-fat. So decaf coffee, one egg dish a week, and so on, on the hospital’s weekly standard meal plan. Initially every meal would come with a small carton of (low-fat) milk, which normally I never drink, so I got them to substitute a small can of diet Ginger Ale instead. (I grew quite fond of Ginger Ale, and chamomile tea, and also those little cups of pineapple they would bring with meal desserts, during that week.)
Once home there was a challenge of settling in to a new regimen of medications. I had eight or ten of them, I think, and some were once a day in the morning, some once a day in the evening, one was every other day until they ran out, another was twice a day, and a couple (including a pain medication) were optional and went untaken. Y took charge of sorting them out and dispensing them at the proper times.
For several weeks after returning home, still recovering from the trauma of the operation, I was tired and sleepy most of the time. I took two or three naps a day. I’d get up in the morning and sit in a leather chair as Y brought me my morning prescriptions and a mug of (decaf) coffee and something bland for breakfast, like yogurt. After an hour I’d sit at my laptop a while, to check my daily sites and do my scheduled Locus Online posts a couple times a week, then take a nap before lunch. And another after. And so on. It was a good month before I was back to my usual schedule, which entails taking a nap after lunch on most days, though not every day.
Once back home we’ve made some significant dietary changes. For a decade now, we’d focused on a eating a healthy, protein-based, diet, limiting unhealthy carbs (white bread etc), and eating two eggs a day, each, whether fried or scrambled or mixed into an omelette. Now I’d been instructed to cut back to two eggs a week, or so. Less meat. Less fatty food. Without eggs for breakfast every day, we had to find other things to eat. Oatmeal, cereal, yogurt with a bit of granola sprinkled on top. Or a fried egg or two of which I ate mostly just the whites.
I’ve become less obsessed with the heart monitor on my Apple Watch (which has never shown Afib since the operation) than with the Pedometer on my iPhone, which I now carry obsessively around me wherever I go. An hour a day, they told me; well, I’d established my pace at 1000 steps every 10 minutes, and now I’m pacing 5000 or 6000 steps a day, two months out. Some days we go for walks outside; other days I walk back and forth around the house, e.g. while listening to the evening news on TV, or watching “Jeopardy,” to get my step total for the day above 5000.
Meanwhile, I was instructed to make follow-up appointments with 1) my PCP, 2) my cardiologist, and 3) the surgeon, within two weeks. The first was conducted as a phone call, and consisted mainly of my reading the list of my new prescriptions to Douglas F. (You’d think different medical facilities could communicate this kind of information through some kind of master database? Apparently not.) For the cardiologist I was seen in person by that physician’s assistant, and also had to go down the list of prescriptions. Also in person was a trip to the surgeon’s office adjacent to the hospital, and to have a final chest x-ray done. Yet again, I was seen by an assistant for most of the visit, with Dr. Kahn himself ducking in for the final minute or two.
There were nurse visits to the house over the following couple weeks as well. He or she would check my vital signs, visually inspect the incisions (chest and leg), and ask about my general health. I was well enough by the third or fourth of these, that we agreed to discontinue them.
And there was my first in-person visit with my cardiologist, Dr O, at his office in Walnut Creek. I’d begun seeing cardiologists because of my atrial fibrillation, of course, which had become a non-issue with the drugs prescribed after my surgery. As Dr. O explained, though, one of those drugs is not meant to be taken indefinitely, but only for two or three months, and that was the drug now controlling the Afib. So once I suspend that drug in February, I will wear that Zio monitor after all for a couple weeks, so he can evaluate my Afib status.
Also, to be clear — Dr. O said there’s no necessary correlation between the Afib, that I’d detected for the past two or three years, and the heart attack. The heart surgery would not magically solve the Afib — though in fact, since I’d discussed it with the surgeon, he did actually include a couple steps during his surgery to assuage the Afib, including cutting the bit off the outer heart that typically causes strokes. So my Afib is still an open issue.
So now here we are in January 2021, nearly 10 weeks after the heart attack, and I’m feeling mostly fine. I’m nearly as active as I ever was, this past year, though I’m less inclined to do the ambitious hikes, up and down hills in our nearby woods, that I was doing three or four years ago. I do notice the occasional twinge in my chest, or slight aches or itches at my incision… but not so serious that I’ve been inclined to phone my cardiologist. I have a follow up with him in a couple months.
Life Goes On?
I know (or know of) other people who’ve had heart attacks, and survived them and lived for years and years. I hope I will emulate their experience. Yet I’ve already started re-planning and re-prioritizing the things I want to finish in life, and get the most important ones done first. As I’ve already (as of Jan 2021) started to do.
(Draft 24nov20; updated and revised 2Jan21 and a bit more on 3Jan21, and a bit more on 4jan21; and somewhat more on 5jan21; …and on 6jan21; …and on 7jan21.)