Last November I wrote a longish post here about the heart attack and subsequent bypass surgery I had in late October, 2020. Here’s a similar (but shorter!) post about my heart and kidney transplants in May, 2021.
After last year’s procedures, I seemed to have recovered fully. The incisions healed, my energy level returned, I had no pain or lingering side-effects. The only change was to be a little more conscious about eating a heart-healthy diet.
Then in April 2021 I began to have symptoms similar to what preceded the October heart attack. Dizziness going upstairs, or after a short walk; bouts of cold sweat. It didn’t occur to me that these were premonitions of some new heart issue; surely the surgeon in October had fixed everything that needed fixing.
But it happened again, and this time in a more typical manner: I came upstairs after getting the mail, broke into a cold sweat, felt dizzy, sat down, and passed out. This was April 20th, about 4pm.
Fortunately – fortunately! – my partner was working from home that day, and says (from another room, some 30 feet away) he heard me moaning, came to look and found me unresponsive. He called 911.
Yet I came to sufficiently to see two fire engines, and then an ambulance, drive past and then pull up in front of the house. I even walked across the room. Ambulance staff came in the house, and put me in a wheelchair small enough to be lifted, or rolled, down the stairs to street level, to the ambulance at the curb.
And after that point I remember nothing of the next 10 days.
I’m told I was initially taken to Alta Bates Summit Medical Center, in Oakland near the 580/980 intersection, the same place I’d had the bypass surgery. I was put under sedation. Apparently my condition was Quite Serious, and there were concerns about my survival; my heart efficiency dropped to 45%, then to 30%. They installed a balloon pump (https://en.wikipedia.org/wiki/Intra-aortic_balloon_pump) in my inner upper right leg, which connected both to the heart, and via external cables, to a machine next to the bed on a rolling stand. (The machine, about the size of a toaster, made a continuous chugging noise, rather like a running dishwasher.) The options were to do a heart transplant, or an LVAD (https://en.wikipedia.org/wiki/Ventricular_assist_device), in which the heart is kept pumping by an external device (which requires carrying this device around with you everywhere). Since Bates apparently doesn’t do either procedure, they transferred me to one of the two large hospitals in the Bay Area that does: CPMC (for California Pacific Medical Center) Van Ness Campus, part of the same Sutter group as Alta Bates. (The other option, Stanford, was deemed too far away for a safe transfer.) That was April 28th.
At CPMC I was installed in an ICU room with connections to all sorts of monitors, as well as the balloon pump machine. (This ICU room, unlike the one I was in last year, had windows! Albeit with a view only of the side of an adjacent building.)
They took me off sedation, so I gradually became aware of my surroundings, but only in a vague, delirious way. For at least a week, every time a doctor or nurse visited me, they would ask me a set of basic questions: what’s you name? your date of birth? do you know where you are? what’s today’s date? who’s the president?
I got the last two wrong more often than not; I confused the year (I answered 2025, or even 1921) and the president (Bush, a B-name, right?).
Meanwhile I had vivid, hallucinatory dreams, which reinterpreted my surroundings in various fantastical ways. They remained and remain quite memorable, much more so that ordinary nightly dreams, and since some of them had distinctly science-fictional themes, I’ll compile them in a separate post, ICU Delusions.
It took some two weeks before they decided I was up to, and qualified for, a transplant. They ran all sorts of tests. They specifically ran tests to be sure I was clear of conditions I’d had in the past – a particular infectious disease back in the ‘90s; elevated PSA a decade ago suggesting prostate issues. There was even an interview with me and my partner about our relationship, our living conditions, our resources, and so on (though part of this transformed into one of those delusions; it couldn’t have been a conference room full of contentious department heads). And I had the advantage of being blood type AB, able to receive a donation from anyone.
So finally, on Sunday May 16, I was put “on the list,” the list of potential transplant recipients maintained by each hospital that does them. I was rated high, 2 on a scale of 10, meaning I was well-qualified; they were confident they would find a suitable donor very quickly, within days.
(Meanwhile, I lay in bed, unable to fully sit up past 30 degrees due to the balloon pump whose inner tubes could not be stretched. I ate my meals, whatever my limited appetite could stomach, with a couple pillows under my head, looking at the dishware on the tray almost edgewise.)
It actually took 11 days, still far more quickly than typical (some recipients go home with an LVAD and wait months until a suitable donor is found). One reason was because the doctors needed to do both a heart and a kidney transplant (the latter because the failing heart had damaged one of the kidneys) and so needed a single donor for both; the other was that the surgeon, a Dr. Sheridan, was said to be notoriously picky about finding the perfect donor for each recipient. But eventually he showed up at my ICU room door one afternoon, gesturing thumbs-up, and said “We have a donor! Surgery is tonight at 12:30.” (And then presumably he went somewhere to get some sleep.)
So no dinner; prep the rest of the day (including shaving of the entire affected area); waiting for things to happen. People showed up around midnight to take me to the operating room. Big well-lit room with all those light fixtures hanging ominously overhead. I tried to be conscious this time of precisely what happened until they put me under. I heard repeated reassurances that I was in good hands, would be well-taken care of. Eventually a breathing mask was put over my mouth and nose, with oxygen they said, and I was told to take deep breaths. I think I took three.
The surgery took place over two days, May 26th, for the heart, then an overnight break, and then May 27th for the kidney. I woke on Friday the 28th, the intubation tube having been removed but a plastic ventilator still propping my mouth open, and three rubber hoses, called chest tubes, emerging from below my ribs to connect my lungs to several collection tanks sitting on the floor by my bed. They told me they would be removing the ventilator from the mouth that day, but it took them hours before they decided – doing more tests! – it was safe to do so, and this was agony. As they stood there calmly debating this or that, I was literally pounding (unable to talk of course) the rail of the bed—get on with it!
And they removed one of the chest tubes. The others took another five days to be removed. The balloon pump had been removed, during surgery, so finally, by Tuesday June 1, I was disconnected from everything aside from electrical leads to the vitals display. But I was still stuck in bed, flat on my back.
Even before the surgery I had been lying in a hospital bed for over a month, and I had lost muscle mass and could barely stand. Yet Physical Therapy showed up to begin their regimen. They explained that it was to my benefit to recover as much strength as I could before the surgery, to make recovery afterwards all the easier. The initial steps were to transfer me to a tilt table, a flat bed-sized platform hinged across the center so, once I was on it, they could pivot it, and me, into an almost upright position. Then, against the bottom plate where my feet rested, I was instructed to do toe-raises. We did that two or three times. (And then, weak as I was, they used ceiling lift (rather like this one) to return me to my hospital bed.) The next step was to bring in a small, portable treadmill, have me step off the bottom of the tilt-table onto it, and attempt to walk as long as I could—two or three minutes, typically.
At this point the surgery came, and it was a few days after before PT returned. Now they brought in a walker, the familiar kind you’ve seen everywhere, and had me walk (with PT staff attending, of course) out of the room into the corridor, and go up and back, or down and around in a loop, for three or five or more minutes at a time. The first couple tries were difficult. The monitor showing vitals was dragged along (here I could expand again about how much time it took nurses to disconnect and reconnect all the cables between me and various equipment…as I did in the earlier essay), as they kept an eye on my blood pressure, oxygen saturation, and so on. And the collection tanks were carried along, as long as the chest tubes remained in place.
Sleep was poor the first few nights after the surgeries, because fluid in my lungs triggered coughing, often every few minutes throughout the night. It gradually got better. I had pain only for three or four nights after the surgeries, and this was as much in the lungs, due to positioning of those tubes, and the effects of coughing, not from the surgical incisions.
By a week after the first surgery they moved me out of ICU and into a regular room, on the 10th floor, also with windows and with a better view, looking southwest with City Hall and Twin Peaks in view.
I was feeling better, my appetite returning, but it still took two more weeks before I was ready for release. I was taking walks, two or three times a day. Various people – a pharmacist, a transfer team, the physical therapists, an occupational therapist, a nutritionist – began visits briefing me on the regimen once I was released. All the meds I would take and their schedules; the frequency of return visits for blood work and chest x-rays; biopsies of the new heart and other follow-up procedures; and eventually cardiac physical therapy.
My partner Y was extremely supportive through all this. He took time off from work and visited me virtually every day, often bringing me homemade or take-out food for lunch in lieu of the hospital food. (Though I confess as my appetite returned, the hospital food didn’t seem quite so bad.) He brought me books from home, so I actually got some reading done: five books in those last two weeks. (The Asimov and Thomas already posted here.)
Aside from reading I watched a lot of the hospital’s cable TV, of course. There were a couple fascinating multi-part shows on the History Channel, about 20th century industrialists, about the “cars that made America,” and one about fast foods. I watched that “Relaxation” channel of nature videos, that I described in a previous post. BBC, one day of the week, showed ST:TNG episodes all day; I had not watched any of them since initially broadcast in the ’80s, and some seemed familiar, others not. Lots of Food Channel, especially Beat Bobby Flay and Chopped. I watched the Kennedy Center Honors, with Joan Baez. And I streamed the Nebula Awards Ceremony, one afternoon, on my phone.
Each day nurses would come several times to take vitals and blood. The vitals checks were every few hours, including midnight and 4 a.m., and the morning’s first blood work was taken at 5.30 a.m. With only occasional exceptions, there was a new nurse every 12 hours, 7a.m. and 7p.m., and there was not the generational divide among them that I’d noticed in the hospital last year (younger in ICU; older in regular hospital rooms). What I noticed this time was how each nurse had their preferred way of doing things. One, a firebrand middle-aged lady named Olga (or something like that), when I said her instructions conflicted with what other nurses had done, even said to me “Just because everyone else jumps over a cliff doesn’t mean we have to”. Quite a few were Asian men, several of them indistinguishable to me behind their masks. Some were chatty, some perfunctory. And all of them, as if by script, would ask me “Are you in pain?” even when I’d been saying no for a week or two; and asking me about “loose stools” because of something that had occurred back at the first hospital while I was under sedation and didn’t even remember. No, stop asking me. They still asked, as if each nurse had to start from scratch.
There was a rotating team of four cardiologists, one of whom would stop by each day to discuss results of tests, prospects for discharge, and to tell me how good I was looking. (I suspect they told all their patients that.) And there was a respiratory guy who came (once at 9p.m.!) to make sure I was breathing properly into that plastic inhaler device they’d provided me. And a diabetes lady. (I was suffering “post-transplant” diabetes, my blood sugar affected by some of the meds. When my blood sugar was above 150, they’d shoot me some insulin.)
My actual discharge was delayed a week past the initial estimate of the week following surgery. The issue was that one of the immunosuppressant drugs, prograf aka tacrolimus aka “tac,” though administered daily, had to reach a certain resident level in my bloodstream, between 8 and 12 (units? Don’t know), and my level was responding slowly. They wouldn’t release me until it got within that range. A Thursday passed; they don’t discharge on Fridays or weekends; by Monday it still wasn’t quite high enough; I had a biopsy scheduled for Wednesday so it seemed inefficient to release me on Tuesday just to drive back to the hospital the following day; and so on. Finally Wednesday afternoon, after the biopsy in the morning, we got final debriefing and I was let go, at nearly 5 in the afternoon.
Returning home, I was greeted with hesitation, even suspicion, by our three cats. But they recovered. As I already posted about here and on Facebook.
More about the delusional dreams I had in the couple weeks before surgery, in a separate post, later.