“Reading Loop” is a close reading or discussion by an invited contributor.
Between a Rock and a Heart Place
Ed N. White
Author’s Note: Much of what I have written here is about anxious anticipation; none of what I have written is intended to give medical advice. I’m a fiction writer. Playing with words calms me. Therefore, take whatever I say with a grain of salt, sit back, and feel free to think, “This guy is weird.”
In 1777, Samuel Johnson said, “When a man knows he is to be hanged in a fortnight, it tends to concentrate the mind wonderfully.” When my Cardiologist recently said, “You have about a fifty percent chance to live six more months,” that piqued my interest.
The problem is aortic valve stenosis. I’ve reached the critical stage.
The solution is to get the damn thing replaced. I was referred to a specialist.
The opening in my valve is about the diameter of a pencil. The new doctor showed me the replacement. It seemed about the size of a walnut. I asked The Big One, “And you’re going to push that through a tube into my heart?”
I already knew the answer because I had been with this doctor during a consultation a year ago. My wife had the same problem and anticipated the same procedure. Unfortunately, she died in hospital, two days before the scheduled catheterization.
The method is by TAVR. Transcatheter Aortic Valve Replacement. A non-surgical procedure in which an artificial valve is pushed via catheter through the femoral artery into the existing diseased valve, breaking it apart and taking over. Sounds simple. But, of course, there are risks.
The most common problem is when pieces of the destroyed valve end up in the brain, causing a post-procedural stroke. Wonderful. There are newer improvements in the procedure that now provide a filter to snag any debris, but that’s not a certainty. Although the process has a high success rate, bad shit still happens in about two percent of the cases. Decent odds for most people. But my medical history has always placed me in the select group of “losers” no matter the event. For instance, during my hip replacement surgery a year ago, I had to be resuscitated– twice. The emergency response team was called to do whatever they did, and I finally woke up with something lying on my chest. The nurse held her finger and thumb a skosh apart and said, “We were this close to calling Code Blue. After reading the incident report, my GP said, “It’s amazing they didn’t crush your ribs.” I still have considerable constant pain from the Piriformis Syndrome that started ten days after that surgery, and I’m nearly as disabled as I was before the work.
Again, my medical history is a catalog of bad outcomes.
So, that brings me back to old Sam and concentrating the mind.
At first, I thought I could write a perfect essay with a beginning, a middle, and an end. However, since starting this essay, a snag has developed. I’ll bring you up-to-date with the unexpected and unwelcome developments.
I arrived 15 minutes early for my appointed 8 a.m. preliminary catheterization that would presage the viability of the TAVR procedure. The waiting room was nearly full of anxious faces and blank stares. Everyone was concerned about their next move. Yet, I felt surprisingly calm for a usually very anxious person.
I checked in with the pleasant volunteer, who gave me a clipboard with several forms to complete. I sat. I read. I filled out all the applicable lines and appropriate tick boxes. Then I stared like everyone else. A wall-mounted TV was droning on behind me. After a while, I asked for directions to the restroom, which I would repeatedly do over the next hour-and-a-half. The momentary relief of each restroom break ended when I returned to the waiting room and its many blank stares. I heard someone say, “They are running late today. Must have a lot of patients.” Great–strength in numbers. I felt better. Later, I devised a plan. I thought that I was due, so I left my clipboard and papers on the chair and went down the hall to the restroom again. It worked. When I returned to the waiting room, a nurse in blue scrubs was checking the clipboard. I pointed to myself and nodded at her. She nodded back.
She escorted me down the hall to a pre-op area and a small curtain-enclosed cubicle. She gave me a clear plastic bag for my clothes, a gown, and grey skid-proof socks. Then, since I was using a cane for walking, she exchanged the grey socks for yellow ones. “This is, so people know you need assistance.” She closed the curtain, and I got into the gown, which I could not close in the back with my disabled hands. She said that wouldn’t matter, and, for the first time, I realized the magnitude of my current situation. When I asked for a pillow under my knees and neck to relieve my arthritic stress, she said, “We don’t have any.”
“The supply chain thing. We’re out of pillows.” She rolled up a flannel blanket and placed that under my neck. A few minutes later, she came back with a pillow she had scarfed from another area and set that under my neck, then put the blanket under my knees. She covered me with a warm blanket, and I was reasonably comfortable, but now I had to pee again. This time in the plastic urinal placed between my legs.
A med-tech came in and shaved me in three places with what looked like a cheap disposable electric razor, then rubbed a sticky paper over me to remove any hirsute debris.
“Why three places?” I asked.
“Alternate routes if needed,” he answered.
I thought of all the stitches removed from my cranial Mohs surgery last Friday. They could have used that route and saved some time. I chuckled.
I remained snug in my flannel cocoon, not overly anxious, a little bored, but glad to hear the nurse say, “We’ll be taking you in next.”
Having emptied my bladder, I tried to empty my mind. I breathed deeply and put myself in a better place. I thought to myself, “I should be done in less than an hour.” I anchored to that rock as they trundled my gurney to the operating suite and placed me on the table.
I was swathed in warm blankets and fascinated by the array of lights and equipment I could see from my limited vantage point. Scrub-clad bodies busied themselves about me. Blood was drawn to check my creatinine levels. An IV was attached to my left arm. My right arm was turned palm up and secured to a board. A restraint was placed across my chest. I wasn’t going anywhere. The staff chattered in medical terms about this and that, which meant little to me.
The Cardiologist arrived with happy greetings—“How nice to see you again”—then said he would be going in through my right wrist as his preferred route. I already knew that would get me out of recovery sooner than other avenues. A sedative was presumably dripping into me, although I had no sense that anything had happened. I felt no different than I did before. Maybe they forgot. Heparin was injected into my artery to help clear the way for the catheter.
The next thing I felt was a needle stick in the wrist with Lidocaine at the site. Then pressure in my right palm as though the surgeon was pushing into it. Finally, I felt a sharp pricking in the back of that hand and asked if there was a needle there. The answer was yes, but I don’t think there was. It was merely skin caught against the board by the restraint and aggravated by the doctor’s weight on the hand.
It didn’t take long for me to sense that something was not going well.
The hushed tones between the doctor and the nurses led me to ask, “Any problem?”
“No, not at all,” he answered, and called for more Heparin.
The next thing I noticed was that they were adjusting the blanket to expose my groin. A pinch told me I had a shot of Lidocaine at a new site to access the femoral artery. That seemed like a problem to me. But what do I know? Finally, I felt more Heparin being injected into that artery, and the pushing began there. A pneumatic pressure applicator was on my wrist over the previous opening. It looked like something that Captain Kirk and crew would wear to ward off the Klingons.
Minutes went by with little said. Then, I asked again, “Any problems?”
“No, just a little longer.”
A fluoroscopic monitor facing the doctor was rotated front, back, and sideways close to my face. The back of it repeatedly lying on my nose while the doctor focused on the screen as he pushed the catheter higher. Finally, he began the withdrawal and closed the hole in my artery with Angio-seal and an absorbable stitch.
The doctor started with “Well….” I thought faster than he could speak, jumping ahead in my mind to the rest of the story. “Well, it seems you have much more damage to the heart than we had anticipated. I couldn’t catheter through the wrist because you have gross calcification. The femoral catheter revealed damage in both the front and the back of the heart. Therefore, you are not a candidate for the TAVR procedure.”
That didn’t surprise me since I’d been on the losing end before. Why stop now?
He continued, “We’ll schedule you for open-heart surgery… saw through the breastbone and crack open your chest…take veins from your legs…rebuild the heart…lengthy recovery…blah, blah, blah.”
Because I was prepared for this commentary, I said, “No!”
“No?” He was surprised by my negativity and tried to explain more. “You could live another five or six, or maybe, seven more years.”
When he realized I meant what I said, he told me he would ask a Thoracic Surgeon to discuss this plan further with me, wished me good luck, and left shaking his head. Possibly thinking how close he had come to purchasing that new off-shore Bertram. Oh, well.
The surrounding staff didn’t say anything and got me ready for transport back to recovery. Finally, the Anesthesiologist said, “Good luck and squeezed my arm. Unfortunately, as a nurse took off the heated blanket, she unknowingly caught it on the IV inserted in my left arm and nearly ripped it out. As I’ve said, I’ve been on the losing team before.
Back in recovery, they fed me. The first food and drink I’d had in eighteen hours. A white bread sandwich with a thin slice of turkey and a slice of cheddar with a cookie for dessert. Along with a cup of cranberry juice.
I dug into that, like a dog on a meat-laden bone, only to be interrupted by a young doctor extolling the virtues of open-heart surgery. I said, “I don’t want it.” I felt like Dorothy clicking her heels and going nowhere.
He left. Shortly after, his boss, the Chief Thoracic Surgeon, came to see me. He understood quickly, wished me the best, and said, “If you change your mind….” I was too tired to speak. I just rolled my head from side to side. He placed his card on the table and departed.
I remained in recovery for two more hours. A nurse came several times to reduce the air pressure in my wrist attachment, like gradually deflating a basketball. When that was at zero, they assisted me in standing, and I had to walk a short way with the nurse holding my gown closed behind me. I had to prove I could handle the tough jobs. I stopped along the way to pee again. When I got back to my cubicle, I got dressed and waited for “transport” to take me downstairs in a wheelchair where my ride was waiting.
My brother-in-law asked. I told him everything. He was silent. Then when I said I didn’t expect to buy new tires again, he thought that was the funniest thing he heard in a long time, and we both laughed all the way to Dunkin’, where I got my first “cuppa” of the day.
The phone calls weren’t easy. I thought my sister would cry after we hung up. My oldest son had a somber tone in his voice. My younger son, an open-heart surgery survivor, said I made the right decision, and then I felt better.
I intend to stay as healthy as I can. I exercise daily, I eat right, I’m productive in my own way. I don’t expect to change much even though I have a new “sell by” date. It would be easy to sit at the bar at the Moose and lose myself in a bottle, but that’s not me.
I’ve died three times before– once from Anaphylaxis caused by multiple yellow jacket stings and twice, as mentioned, during my hip surgery. Unfortunately, I have no memory of that. Probably because of the anesthesia. The Anaphylaxis happened fifty years ago, but I remember it as if it were yesterday.
We were in financial peril and in imminent danger of losing our farm. I was working in the tall grass behind the raspberry patch when I stepped onto a ground nest and was swarmed. I ran to the house for some Benadryl. There was none. I staggered out front toward the truck. My wife was mowing behind the barn, and when she saw me raced to me on the tractor and helped me onto the truck seat. While speeding to the ER, steering with her left hand, she repeatedly pounded me in the chest with her right fist as I lay slumped in the seat. We got to the hospital in fifteen minutes, and I was rushed into treatment on a gurney. Several nurses tried, unsuccessfully, to get a needle into my constricted veins. Finally, a former combat medic managed to do so. Then they pumped me with Epinephrine and something else, probably, adrenalin. When I came out of shock, I realized my jeans were soaked. My bladder had emptied. When I got home and changed my clothes, I found no chest bruises. My heart had stopped pumping, and the blood had settled into the lower parts of my body. That’s what happens when a person dies.
Why am I saying all this? As mentioned, we were in financial peril at that time. Soon to lose everything, with nowhere to go. Our stress level was at Defcon 9. But, when I died, I had this overwhelming sense of well-being that I never had before or since. I saw the white tunnel. I didn’t imagine it. I was in it.
So, I don’t fear death. Instead, I remind myself of Bob Dylan’s wonderful lyric in his 1965 album, Bringing it All Back Home, The album that changed my life. I probably can’t quote the line because of copyright, but you can look for it in the song “It’s Alright Ma (I’m Only Bleeding).” It deals with busyness. Look it up.
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About the Author
Ed N. White is a graduate of the University of Iowa and the University of Rhode Island, where he briefly taught many years ago. He is a writer of mysteries and a teller of tales. Many of these writings appear in literary journals in the U.S., U.K., and Canada. He can often be found lurking at fridayflashfiction.com, published in Scotland. A previous self-publisher of the Stephanie Grand/Deena Byrne mysteries (five books) and the TJ Tucker thrillers (five books), he recently unpublished these stories of murder and mayhem, preferring the gentler art of children’s books. He is presently under contract with Histria Books to publish his middle-grade mysteries, Miss Demeanor, by Celia J. (three books) and Taking Care, “A novel exploring relationships.” He posts stories constantly on the subscription reading site Simily.co.